mammac5 8,428 Views
Joined Nov 10, '09.
Posts: 735 (30% Liked)
We use an Insulin Pump Self-Management agreement. A provider has to deem the pt is fully capable of self-management...we determine this with various questions and we expect the pt to show us his/her basal settings, tell us how many units:grams of CHO they bolus, what is their correction factor, etc.
They sign the form that states Nursing will check CBGs on our machine, the pt will inform the RN how many units will be bolused based on the CBG and anticipated PO intake. That is scanned into the chart.
There is a section in our EMR (under therapeutic monitoring) where the bolused are charted by RN.
The basal pump settings are documented under home meds, then that is carried over to curren meds so this is in the EMR. We change this if we adjust the rates while in hospital so the correct doses/rates carry over at discharge.
We have a Diabetes Mgmt Team (NPs/PAs) who see most of the pts with pumps which means not everyone has to be familiar with them. We are available to RNs (even overnight call) when they have problems, don't know where to document, etc., so they can contact us.
I have social anxiety and am naturally quite introverted - nothing recharges me like having a full day where I don't have to talk to anyone. I am an Adult NP x 4 years now and very good at my job. Whether in clinic or at the hospital, when I see patients I am in control of the situation. I steer the conversation and I basically determine how long the encounter will last. I have found that when I am in my element, I have little to no anxiety. And I am a great listener, although doing so for hours on end drains me and then I come home to peace and quiet. I have a great husband who understands that I want to be in the same room with him in the evenings, but I may not want to talk much all night.
Now a work-related social event (cocktail party, holiday dinner, etc.) or a meeting will definitely make me anxious and I do all I can to avoid these situations. Hate small talk! When they cannot be avoided, I rely on pharmaceuticals to keep it together.
Violence - whether domestic, on the job, or from a stranger in a parking lot warrants a call to the police.
Bullying or poor treatment warrants a one-on-one conversation between you and the person you perceive as being the problem. If that's been tried and failed, knock it up to the next level which is you + the other party + the person's direct supervisor.
If that does not fix the situation, I would advise going to HR and make someone aware that this person is a liability.
I've been practicing over 3 years now. Graduated in August, passed ANP exam in September, started work in October. I'm in North Carolina. My job offer was a surprise and was entirely thanks to contacts I made during my clinicals.
I work inpatient (ANP) and schedule 7 shifts per pay period. Of course, that means holidays and weekends...
It is beautiful here. There is so much to enjoy in the mountains OR the coast. Great food! High medical needs with very high rates of diabetes and hypertension. Large immigrant population. Rural needs as well as Native American healthcare needs.
We we live close enough to SC that it's a quick trip to the coast there for a weekend. But the taxes are high, practice is restricted, and hospital systems are all scared right now.
In many regards, NC is a great place to live. It's not a great place to practice as an NP. I am an ANP living on Western NC (worse area of the state to work from a pay perspective) but moving is not an option for a few more years. So here I am, pushing for higher pay, knowing that when the system I work for increases pay for NPs, pay will necessarily increase across WNC. I like to think I am making a difference in my little corner of the state. My husband's job prohibits our moving at this time.
The NCBON is notoriously difficult - restricting practice, restricting educational opportunities for anyone who wants an out-of-state education, etc. I hope they will catch on...with so many states passing regulations that allow NPs independent practice, it seems all states will eventually follow suit as they see patients are not suffering I'll effects of our "free range" practice!
I work in both inpatient and outpatient DM mgmt. There is theoretically no limit to the doses of basal insulin...no upper safe dose to prescribe the way we think of meds like METFORMIN. Having said that, I normally will have pts split a large dose into 2 injection sites for better absorption...say, if they are injecting 80 units total I would have them inject that into two sites, but they can do so at the same time.
Patients who require 200 or more total daily units of insulin may do much better with U-500 insulin since the volume injected is much smaller and seems to be better absorbed/assimilated. I live/practice in an area of the country with high insulin resistance and actually use quite a bit of U-500. We still use NPH for some patients, as well. Especially since it is dirt cheap at Walmart pharmacies...not as great a basal insulin as LANTUS or LEVEMIR (which usually should be dosed BID) but cheap = the only way to go for many patients.
So, back to the original question...
My experience as an NP without RN experience has been fantastic. I was hired one month after graduation as part of an in-patient research project funded by the DoD. Did I have a steep learning curve with my lack of RN experience? Yes, I did. Would I have had a steep learning curve even with RN experience? I believe so.
The research study led to a permanent full-time position in the same hospital. The contacts I made there led to a part-time job in an outpatient practice...I work both jobs now and really enjoy both.
My path to a great career where I get to help people every day was different than what a lot of others had, but I hardly ever take the same path as anyone else.
I have nothing against anyone who attempts to further their education. However, I don't understand why anyone would go through all the headache of becoming a NP without EVER being a RN. A Physician Assistant can go from nothing to a PA with no problem. Someone who goes from nothing to NP raises flags in my mind. The FIRST question that ALWAYS pops in my head was why didn't you go to a PA program instead? The SECOND question that pops in my head is were you TOO GOOD to work as a nurse?
With that said, this past Friday at our practice, we had a "roundtable" interview for a potential candidate (NP) to join our practice. I can honestly tell you if that person had ZERO experience as a RN they would NEVER have received an invitation for an interview.
Just to be 100% clear, this is NOT my intent to start a FLAME war. This is NOT a personal attack. Its just MY honest 2 cents. I graduated from a bridge program myself and went from nothing to NP. However, I was ADAMANT about being able to put on my resume that i had 4 years of FULL TIME ICU experience on my resume. I paid my "dues" as a RN and in my opinion, my resume shows this.
If you spend any time perusing the discussion boards on Allnurses.com you will see numerous posts of NP's experiencing difficulty obtaining employment. In the city where I live the University is churning out class after class of BOTH Physician Assistants and Nurse Practitioners PLUS there are 4 other NP/PA programs within a 3 hour drive churning them out also. UNLESS you networked your way into a job. UNLESS you know a physician who is ready to hire you already. You would not be able to find a top-tier employer willing to hire you in my area. (Even if you have a 4.0 GPA)
$3 an hour for overnight call
I never worked as an RN.
I had many years of experience as a medical assistant in outpatient practices, had done some teaching in medical assisting programs in a local college, etc.
I completed a bridge program and had no trouble getting my first NP job, mostly due to contacts I made on my clinical rotations.
Check your state BON site to get the answers you need.
I appreciate everyone's input here. Normally what I hear is how everyone's salary is much higher than mine, how they have better benefits, etc. Even though I'm sorry others are suffering from financial cuts, I guess I'm satisfied to know it's not just me. I've been feeling very disrespected by my current situation but do not want to jump out of the frying pan and into the fire.
Ride it out? I'd like to open my own practice but it definitely does not seem like the timing is right.
Pts should not NEED a snack. If snacks are routinely needed, the insulin dose is too high.
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