apocatastasis 9,736 Views
Joined: Feb 13, '08;
Posts: 213 (59% Liked)
; Likes: 547
APRN/ARNP, PMHNP; from
4 year(s) of experience
Psychiatry, ICU, ER
And to think that some of you have been labeled “ guides”. I know that many school advertise on this site and whoever is behind this site is making money. Do not make fun of someone else because they took a step forward and obtained higher education. And do not place your self -worth as a nurse or person on where you received your degree.
I am an FNP and I work for a large regional oncology group as the hospital-based NP. Nothing could have prepared me for the types or severity of pain my patients experience.
I recently cared for a 43 year old just diagnosed with metastatic pancreatic adenocarcinoma. She had been diagnosed in a small, rural hospital. Discharged home to be brought to her parents home in a larger, metropolitan city. The first hospital had stopped her iv pain meds and sent her out for a three hour drive with some po meds. Only problem was her esophageal obstruction. I started her with dilaudid 2 mg IV and left that night with a PCA pump using a 4 mg basal and 2 mg q10. I sent her for celiac plexus block that failed because her tumor was growing in and thru the plexus. I tried sending her home with hospice at 50 mg basal and 10 mg q10 but her pain continued to accelerate. After three days she was back in the hospital and we started mixing liter bags of dilaudid and using iv pumps because we were burning thru the pca vials in less than an hour. She was exceeding 150 mg hourly and beginning to have spasms so I added an ativan drip of 4 mg an hour. I moved the dilaudid back and added to the dilaudid and ativan a methadone drip.
I had never imagined prescribing these types and volumes of narcotics but neither had I ever anticipated such a horrific disease process. She was the second patient in as many months to require these massive doses of drugs - the other girl was only 27. Neither of these young women exceeded 60 kg and neither had any history of drug or alcohol addiction or abuse.
I share these two instances because had there not been someone there with these patients, throughout the day, who was able to prescribe and adjust doses on these drugs these women would likely have suffered even more than they did. The ED doctors had given each of them dilaudid 0.5 mg IV q3-4 hours. Like spitting into the wind.
So, yes, I firmly believe nurse practitioners should be entrusted with prescriptive authority including narcotics of any flavor. If you are careless with prescribing you might injure someone just as mortally giving them digoxin.
I have heard the arguments that NPs are not qualified and I wonder if the skepticism is rooted in our training and qualifications or something else.
How is this even a suitable question for debate in a NP program? It's offensive.
Better schools do provide preceptors. As others have said, it all comes down to money. Distance based programs are a cash cow for schools because they get to collect full tuition without offering any of the amenities of an on campus program. Schools saw huge money in NP programs (lots of eager students, the ability to charge insanely high tuition, etc) but having to provide a clinical preceptor ate into the profit of the programs and very few schools did it. Suddenly, someone realized the NP accreditation boards didn't CARE if you provided preceptors - apparently they were more concerned with NP quantity over quality. What was originally meant to ensure rural areas had providers was being abused to provided low cost, high return graduate studies to students all over the country. Every for-profit (and the vast majority of not for profits) in existence has jumped into the "game" because the largest barrier to a quality healthcare program, the clinical component, has been completely removed and dumped onto the students.
Any program that requires students to find their own preceptors without any vetting process at all clearly cares more about collecting tuition money than about education high quality NP students. It's sad, and I wish current NPs and NP students would begin writing letters to the accreditation boards to halt this practice. This is NOT helping the profession: it is creating a GLUT of NPs because more can be educated at once, while also lowering the skill of newly graduated NPs. If this continues to grow like this, within 10 years the NP market will be worse than the current RN market and those lucky enough to get jobs will be working for $25/hour.
Agree with the previous posters. The schools like to make the money on the online courses ... while the preceptors provide a lot of the education for free (but you pay the school for the academic credit for the preceptorship). The preceptors get totally ripped off.
I think nursing schools who do this should be ashamed of themselves. Can you imagine a medical school doing that?
Another point to add to what others said before. If you have a hankering for more knowledge, nothing is stopping you from picking up medical-school level textbooks and educating yourself. I find that my master's has prepared me enough that I can teach myself minimum what a typical medical student learns. And when it comes to CME we read the same journals and attend the same conferences as medical doctors do. I don't get involved with ******* contests about who's smarter and who knows more, and I'll always defer to the person with greater knowledge and experience, no matter what their title is.
Do you want to do family practice/internal med or specialize? Your post said "keep going to be a family practice clinician." Is that because as a nurse that would be the natural course, or is that really what you want to do? Because if you went to medical school you would be essentially starting all over and could choose any specialty you wanted and wouldn't be "stuck" with family practice. There is a reason it is the last choice of MD/DOs, lol.
How old are you? Male/female? Are you single/married, are there children? Do you want to have children? Do you want to travel extensively? Write, research, volunteer/medical missions, play a competitive sport 20 hours a week, etc?
You don't have to answer those questions on the board, but consider to yourself what it is you really want from your life and decide accordingly. You really can not have it all. If you, for instance, are a female who has or wants to have, a large family, I wouldn't recommend med school. Ditto (IMO) if you are a male, although theoretically, if you are a male you could leave the parenting to your wife (and her 2nd husband/your childrens' stepfather, lol). Figure out what it is that you want, prioritize and go from there.
Do you have debt/savings? Who is paying for your education? Who would support you while you attended medical school? Depending upon your age upon entering medical school, debt incurred and lost wages, you may or may not end up better off at retirement. Much would depend upon the specialty you choose and factors we cannot predict. You should talk to your financial adviser and do some actuarial number crunching together examining the real cost of attending medical school versus anticipated salary in your desired specialty. The 375,000 quoted above is very unlikely to be a family practice MD. I would think that would be a specialty (gastro, cards) internal med physician at the top of the pay scale. I don't know anyone in family practice making that much money, no matter what their credentials. I think we are pretty much topping out at about $200k.
I will be the first to tell you that NPs being "more holistic" than MDs is complete hogwash. I am on a personal mission to correct that ridiculous fallacy, lol. You can be as holistic as you like, or not at all, in either role. FYI.
Autonomy depends entirely on where you practice. I am completely autonomous. NPs in some states have zero autonomy. Chose wisely.
No doubt that MD education offers greater depth and breadth. If you have the time, money and intellectual curiosity to invest, why not? My only caution would be that one should pursue it for learning sake alone at this point, because there is no longer any promise of the financial return on the investment that there once way, or a least not to the degree that people think. Not once you factor in the opportunity cost and actual cost of attendance.
So for me, if my circumstances were exactly the same and I had it to do all over again, I would do it exactly the same other than I would return to NP school sooner than I did. I would not go to medical school in my circumstances. My family would have had to sacrifice too much and the trade off would not have been nearly worth it. We don't need more income and time is the most valuable commodity in our lives. Having more money would not buy us more of that, so there wouldn't me any practical advantage in it for us.
Had I been single and childless, had no hobbies or interests that required as much of my time as mine do, yes I would have applied to medical school. I can't imagine that life though, and I don't think I'd like it! YMMV.
Good luck to you.
Try filling out an incident report every time you find this unsafe condition as a 'near miss'. That usually gets people's attention- it does for me!
Trust me when the JC is there they will be dumped/changed......I have worked for small hospitals before....you are trying to change a culture...tread lightly. Ask if you can have some spare containers in the department to change yourselves....I would page housekeeping until they are changed.
You have asked several questions about the JC survey at your facility have you never been through a survey? Take a deep breath.....the surveyors don't bite....much....LOL I'm kidding...try not to be so anxious...((HUGS))
Unless I missed something, no one in this thread spoke to the impact of tats from the patients perspective. I know where I work, the vast majority of my patients are of the 70+ age group. Those folks have their own set of values based upon their own life experience and culture. Tats are few and far between on them, and like it or not, they associate tats with bikers, sailors, and little else. I believe that is why our facility has a 'no visible tats' policy. Makes no difference to me what someone does with their body, but I think it does to most of our customers. And in my opinion no, a caring attitude and skillful care will not make up for that negative stigma.
ANP/FNP are not educationally prepared to work in acute care. Period. Historically they have, but some states are now cracking down and requiring post-MSN certificates.
I was hired as a new grad to an urgent care with a base of $95k and production bonus. Most of the midlevels at this practice easily clear $130k+ a year. The topper is we only work 12 days a month. If you want it, you can get it.
The southwest is good for PsychNP's. I moved to Az solely for that reason. Well that and I was tired of snow and gray skies.
PA's will soon follow the NP's whom are also going to require the doctorate to practice at an advance level and for RN's, the entry level degree will now be the BSN.
May your interview be smooth, may your hairspray hold, may you blind your interviewers with your brilliance. It's great that you have such a passion for this area of nursing--your excitement is literally palpable and contagious. Absolute best of luck to you!
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