mammac5 8,364 Views
Joined Nov 10, '09.
Posts: 735 (30% Liked)
I've only been an NP for a few months, but I must say that it is probably the best decision I ever made. I feel extremely lucky to have had the opportunity to go to school with my husband's support and blessing. I can't imagine ever regretting making this career choice. Even if I was in a position that I hated, I could take a different position. There are opportunities to change and grow all the time. No regrets here.
GOOD diabetes education affects a patient's glucose control.
All the education in the world cannot change a patient's glucose control habits if they don't want to change.
That's definitely true and it's frustrating working with people who are stubborn or have victim mentalities.
But the reality is that our nursing and medical schools still do a pretty terrible job of diabetes education. Because of that there are healthcare providers who don't have a basic knowledge of diabetes management. Sometimes health professionals have decent patients and give them bad advice about diabetes, then label the patients noncompliant when they fail.
You know, this irritates me beyond words- providers who don't follow the guidelines. Not you OP, the person before you who did the unnecessary pap along with the diagnosis of HSV. I know, I know, it was "just to be on the safe side."
Arrrrgghh!When we come behind them and tell pt/parents that repeat pap is not indicated, they think we are slack. They insist, "just in case." We either make them angry or end up running up health care costs with inappropriate testing. As I am a male and cannot afford any appearance of impropriety with regard to unnecessary vaginal exams (!), I opt for looking slack in Mom's eyes, lol, but it is ridiculous.
FOLLOW THE MOTHER BLESSED GUIDELINES PEOPLE!!! YOU DO NOT KNOW BETTER THAN ACOG.
that is all, thanks for letting me get that off my chest.
ACOG recommends against screening until age 21, unless the patient has HIV or is otherwise immunocompromised:
ACOG - Cervical Cancer in Adolescents - Screening Evaluation and Management
ACOG - Exceptions to Pap Screening in Adolescents
So...my patient came back to see me today and it was great....her daughter came with her and I spent about 30 minutes or so going through more detailed info on the diet, we came up w/a workout plan....she said after she left the office last time it kind of hit her later that her a1c was up and her diabetes was getting out of control...So she said she brought her daughter to help her take notes, and the two of them were going to start working out together, etc....it was great!
After discussing more w/my supervising physician, I ended up decreasing her glyburide, stopping the Januvia, and starting Victoza....I do see the benefits of just putting her on Lantus, but my doc was pretty set on Victoza, and it could help her lose some weight, so I figured it was worth a try.....I'll keep you all updated...
I reallly appreciate all of the advice and info....you all are great....
I don't know anything about the VA, but in general, I strongly disagree about asking about salary. In professional negotiations, pay/benefits is never discussed in early interviews. Ever. Unless, and only, if the potential employer were to bring it up. Under no circumstances is it acceptable for you to ask at the screening interview. If they ask you, you should be very vague. "Negotiable." If they mention a scale "from 5 to 10 rupies a year, " you say "I look forward to hearing more about that." It is not time for formal negotiations.
There are lot's of skills, including the ones you mentioned, that an APN can do that an RN cannot. However, those in my field (psych) are so highly skilled that we do not even have to touch a patient.
I don't think anyone is saying that RN experience doesn't count or isn't useful, just that people from other backgrounds have a lot to offer as well.
Doubt it. Isn't the first line of the application to test: have you completed an ANP program?
*pushing a chocolate bar slowly toward the OP*
You did the right thing. I see this kind of non-compliance all the time in ICU. With us, it's "well, it's getting to be the end of the month, and John's going to have run out of his check by now..." and sure enough, toward the end of the 3rd week of the month, we get our DTs. You talk to them, you tell them what they are doing to themselves, if they don't stop they are going to die and they come back in another month, same thing. Rinse, wash, and repeat. Thousands and thousands of dollars spent on rehabs that they check themselves out of, not to mention that they take the bed of someone who actually has decided they want help, want to stop. My cousin was like that, was in 16 different rehabs over the course of his life. Died from acute ETOH intoxication and aspiration. He always said he'd rather die than stop drinking. Well, he got his wish.
We get the folks wth GI bleeds all the freakin' time. Why? They have diverticulosis (not new onset by any means), and they decide to eat the "fruit and nut" diet they saw on TV/news/from a friend. The seeds get into the diverticuli, and kaboom. Or we have idiot docs who prescribe coumadin for alcoholics who are actively abusing ETOH. Nothing like the smell of a GI bleed mixed with beer.
Then we get the CHF/renal failure/dialysis folks, who absolutely refuse their diets and treatment regime. We had one guy that would go to dialysis, walk out to his car, and pull out a 2 liter soda and drink it before he left the parking lot, in full sight of the other patients/nurses. And then he'd end up with us, emergency dialysis because he'd go into pulmonary edema from fluid overload, and the same dialysis nurse he'd told "you can't make me do anything, B" is staying up until 0400 after working all day trying to get the idiot dried out enough to breathe. There goes more of the social security/medicare money I'll never get to use...
You can't fix stupid, and unfortunately, it seems to be a growth business. *hugs* to you and your little passenger.
Adults are just that; adults. I work with an indigent, at-risk, medically complex group of pts. Its all in how you approach people. You have to get them to buy in to the idea of health. Sometimes you can, sometimes you can't.
I've been an APN for over 5 years now and many, many of my pts are noncompliant. You fix the ones you can.
There is no reason to get upset - the pts are the ones that are sick. The providers must be able to separate themselves from the pts. Documentation!
I'm a Direct Entry grad (2009). I had no problems finding an NP job, and I've done just fine, thank you very much. Also, Direct Entry programs do not take anyone who can pay the tuition. These programs are highly competitive and only admit a very small percent of applicants. They are not degree mills. My program was very intense and we were held to very high standards. Everyone in my program worked their butts off to ensure that we were prepared to enter the workforce as novice NPs.
I work in the outpatient setting, so very little of what I learned in the RN portion of my program is applicable to my job. I am not trained to work as a hospitalist. I think you do need bedside RN experience to work in the acute care setting.
Deciding to go the direct entry vs. the RN/BSN route is up to the individual. Some people prefer and perhaps need time as an RN before moving ahead with the MSN. Others prefer to go the direct route and are very successful. Two different paths, but neither is wrong.
"I suppose one could refund their money if they do not Rx an ABX. This would satisfy the customer monetarily and increase trust in the clinic, but then the NP is not making the clinic money, and less business income means over time equals closed doors and unemployment lines."
I realize that the above quote is highly unlikely but just want to warn that this type of thing would just be reinforcing the public's belief that they are paying for a script. They are paying for an educated, knowledgeable, experienced assessment and diagnosis NOT a script. If the assessment of nasal discharge and congestion revealed a tumor that had to be referred to a surgeon would you refund money because they did not need abx? No, you are being paid for your assessment and diagnostic skills, not a script.
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