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apocatastasis 8,150 Views

Joined Feb 13, '08 - from 'Austin, TX'. apocatastasis is a APRN/ARNP, PMHNP. He has '4' year(s) of experience and specializes in 'Psychiatry, ICU, ER'. Posts: 213 (59% Liked) Likes: 542

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  • Oct 15

    OB rotation *is* hell, and it certainly hasn't been my experience that there's no modesty in labor. When I did L+D two weeks ago, I was prevented from seeing ANY births at all because neither of the two moms giving birth that evening would tolerate a male nursing student. It was really humiliating and boring.

    I don't think there should be OB rotations in the first place, nor do I think maternity should be tested on the NCLEX. Not unless they start making students do a semester or half-semester of oncology, cardiology, critical care, etc. etc., which in the long run would probably be far more worthwhile.

  • Sep 13

    Hi all.

    I got my RN license at about this time last year, right after I started working as a GN at a downtown San Antonio ICU. It's a SICU but we see a wide variety of medical/surgical/cardiothoracic patients. We generally have very high patient acuity. Lots of drug abuse, non-compliance in the face of multiple comorbidities, repeat offenders leaving AMA and coming back a day or two later, etc.

    In some ways and on some days, I love working as an ICU nurse. I'm finally able to more or less independently care for the sickest patients that we get. Vented patients, balloon pumps, septic shock pts, CABGs, managing multiple drips, CRRT, RRTs and code blues, I do it all and the rush keeps me going.

    But although I do my best when it comes to particular patients, I feel like I generally just don't care anymore. Without even going into the issue of how hospital administration and doctors' attitudes get me WAY down... patient-wise, I see the same things day after day after day. People who don't want to learn, don't care about their health, don't care that our team snatched them from the jaws of death. And then I read about the pertussis outbreak way over there in California. And then I think about my dad, who has years of untreated HTN and refuses to see a doctor and is probably gonna end up as a STEMI on a balloon pump.

    And then I think, why do I bother? Why am I busting my ass and breaking my back for you, mister 34 year old, 800 pound, 6 cigarette pack a day CABGx5, when you're gonna go to the nearest McDonald's immediately upon discharge and eat 8 big macs? Or you, the violent, intubated 22 year old heroin overdose with seizures and anoxic brain damage, with a history of being intubated following heroin overdose and hemodialysis since the age of 15, whose insane mom is sneaking in opiates behind my back and screaming that the benzos we're giving him for sedation are killing him.

    I feel like I used to care about my patients. Sometimes I still feel like I do. No matter my attitude on any given day, the job always gets done. Some days I go home and I'm proud of my work. I said goodbye to my alert/oriented patients in the morning and wished them well, and I really meant it.

    But then there are the bad days where I go home, have a beer, put my head in my hands. And I feel like an empty human being because I don't care about people anymore, entirely dread having to go back to work tomorrow, and wonder what the point of all this crap is.

    Sorry, I just had to vent. Thanks for reading.

  • Mar 22

    I'm a new NP, received my Master's 3 months ago. I have no complaints about the clinical portion of my MSN program. But we would have been well-served with MORE than 700 clinical hours. I would love, and willingly pay for, a doctoral program that would provide me with additional didactic and clinical training in psychotherapy, neuroscience, and psychopharmacology. You know, USEFUL stuff that we're supposed to know.

    Would the DNP provide those experiences? Absolutely not, because this clinical/practice doctorate is neither clinical nor practical.

    I've looked at curricula from schools all across the U.S. I can't help but see the DNP, quite frankly, as an inferiority complex-driven grab for money and power that embodies everything that is WRONG with nursing education.

    Forgive me if I'm overly cynical, but these wounds are too fresh. I've already yawned my way through more hours of health policy, systems, and research than I care to count. I've already witnessed the most egregious and childish stereotyping of minorities in the name of a semester of "cultural competency." I've already written far too many forty page papers on the history of dryer lint and the ethical concerns surrounding Florence Nightingale's lighting farts on fire with a match, formatted in APA format and referenced.

    And they're telling me I have to do it AGAIN? NO. THANKS.

    When AACN gets its act together, it can find me over here... actually taking care of patients. (Now there's a concept they've never heard of.)

  • Feb 13

    I'm an NP student, with slightly over 2 years of experience, and I resent the OP's post.

    I say this as a ICU nurse who, with a measly YEAR of experience, had multiple opportunities to save the asses of SEVERAL "experienced" nurses both in ICU and in rapid responses on the floor.

    I can also say this as an ER nurse who has had to take on facets of care of critically ill patients for allegedly "experienced" ER nurses who, for instance, couldn't use the IN-LINE SUCTION on a VENT. Don't even get me started on how these "experienced" nurses don't know how to properly start or to titrate nitro drips, pressors, or propofol.

    I get the gist of your vent. A person is a fool if they say or think they know everything. This is independent of how much experience they have. Do not paint us all with such broad strokes.

  • Dec 24 '15

    As an ICU/ER nurse (and atheist), I don't think I should have to pick up the slack because of your religious beliefs. Sure, I'll check the blood with you, but YOU are responsible for YOUR patient: you spike the bag, you prime the line, you set the pump, and you monitor the patient.

    I've had patients that needed 5-10 blood products in one shift... you're going to interrupt me every time your patient needs FFP, PRBCs, albumin? Honey, I got patients too, and I don't always agree with patient/family attitudes or plan of care but I still do my job. Maybe this kind of nursing isn't for you.

  • Dec 15 '15

    For what it's worth as a psych NP student with 2 semesters to go (!)... we are regularly inundated with postings for psych NPs. They are all over the internet and all over the place. The last one I got was in Chicago, starting salary of six figures with 2.5 months per year of PTO (2-3 weeks sick and CME and the rest vacation). Full medical insurance paid. I know that at least a couple of psych NPs in private practice here in Texas make more than 200k a year, and 90k-130k starting seems to be the norm across the country, though inpatient/hospital type settings seem to pay less across the board.

    A common theme I'm seeing about NP salaries is you have to know how much money you are bringing in to a practice and argue your case for an appropriate salary. Healthcare is NOT any different from any other business, if you own a practice, build up a clientele and charge the going rate in your area. If you are employed by a practice, you HAVE to play hardball sometimes to get what you want, or, yeah, you will be paid $65k a year and you have nothing to blame but yourself. Why would an employer pay you 120k a year when you are ignorantly chugging along, thanking him for the 1,000 dollar raise to your 65k salary?

    Nurses in general seem not to be very astute at business so they slide along making crap wages. Sorry, but here in Austin, RN wages are TERRIBLE given the work conditions, who wants to do this for the rest of their lives?! If you look, you will find opportunities to make a decent wage, earn a good return on your money, and, most importantly, do what you love to do.

  • Dec 2 '15

    One of my co-workers ate the leftovers from the dirty, nasty patient meal trays from our dirty inner city hospital ICU crawling with MRSA and VRE and E. Coli ESBL and all kinds of other goodies. Day after day. SO gross.