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Content That ThePrincessBride Likes

ThePrincessBride, BSN, RN 36,228 Views

Joined Jun 13, '10 - from 'Somewhere'. She has '1 RN, 3 tech' year(s) of experience and specializes in 'Med-Surg, NICU'. Posts: 1,965 (60% Liked) Likes: 5,182

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  • Aug 29

    Quote from meanmaryjean
    My MSN and DNP research is about this very topic. (I've long lobbied for a separate discussion board about night shift issues- but alas...)

    Anyway, there is a genetic difference in strongly morning types (larks) and strongly evening types (owls). This difference appears on the CLOCK gene. There is actually a screening tool to measure morningness and eveningness. I almost think that this tool would be useful before extending job offers.

    That said, sometimes the lack of adjustment to night is because the person is trying to keep up a daytime existence and not allowing enough time for sleep. For example, mothers of young children who will not place their children in the care of others and instead try to maintain wakefulness for 36 hours to avoid this and still work their shifts. SOMEthing has to give.

    If anyone's attending Nursing Management Congress in Vegas this November, I'll be presenting on the topic of nurse fatigue. Fun fact: the presenter right before me (who I am now referring to as my 'opening act') is none other that ZDoggMD!

    What a beneficial study this might be. I've long thought that "sharing nights," as a previous poster mentioned might be a solution.

    7-7:30 shifts are absurd. Night shift isn't in bed until 9 AM, and day shift isn't in bed until 11PM.

    After over 20 years in this gig, working days, nights, and on-call, I've come to the conclusion that a standardized 5-5:30 shift schedule would hit the "sweet spot."

    P.S. and Zdawwwwg in da house! That guy is a damn wind-up toy. He just keeps going and going and going....Love him.

  • Aug 29

    To be quite honest I would not have an ex-husband pull strings for me to interview/work in a place where they also work.

    Nursing at the bedside is incredibly taxing and stress inducing, you do not need an added level of stress in your life having to work alongside your ex-husband.

    With all that being said, you know yourself and what you are capable of handling. Best of luck in your career.

  • Aug 28

    And since this is a political thread... I doubt Donald Trump of today who is a sexist bigot born with a silver spoon in his mouth, has any respect for nurses. Especially since many of us are female, work for a living, people of color, and/or were not born to the upper echelons of this society.

  • Aug 27

    There are undoubtedly many, many unemployed new and experienced nurses who would be grateful to have a job taking care of feeder/grower babies. They also have the humility that makes them welcome on a unit when they get their chance. Give these little babies your best and you will find yourself progressing, your efforts will be noticed.

  • Aug 26

    Wow, what a thread. Just out of curiosity, where was it located before it was placed in the NICU forum?

    I can speak to your questions as one of the few NNP posters on allnurses who has read a lot about getting into NNP school and the shortage of schools, now working as a NNP for almost two years now. There was a lot of good information laid out for you so far.

    From your initial post:

    1. It's not actually that difficult to get into NNP school as compared to other specialties (FNP might be easier since there are so many, CRNA is definitely harder). What is it that is making it so difficult in your mind? Just the required experience? I'll discuss that in this post.

    2. Why do you have to work in a NICU prior to NNP school as compared to ACPNP or even ACNP?

    Nursing school prepares you to work for adults right out of school. Every rotation is focused around adults (med-surg, elderly, psych, community, etc etc). You may get a smattering of experience with newborns in your OB rotation (although it's largely focused on the mother) and you generally just get one clinical rotation through pediatrics, of which you might get an introduction to the NICU. You certainly don't get a a semester's worth of knowledge in the NICU like other specialties (including peds), but if you're lucky, you might get to do a cap stone/senior practicum/etc rotation in the NICU during your last year in nursing school.

    So while I personally still think it's somewhat questionable for a RN with no clinical experience to become an adult NP, at least if it's with the adult world, the nurse was specifically trained on common adult pathophysiology & treatments. It's a bit more circumspect for a nurse with no experience to become a PNP (particularly acute care PNP), but at least everyone has had a semester of didactic and clinical knowledge regarding pediatrics while in nursing school. I will tell you that it's probably virtually impossible to work in the PICU as a PNP with absolutely no experience as a nurse or a NP.

    Then we come to NICU. The NICU is its own little world with a completely different way of doing things. You have to essentially unlearn nearly everything you learned in nursing school, down to the most basic of things like what a normal vital sign is. For example, adults breathe 12-20 times a minute. Babies breathe anywhere from 30-60 times a minute. Let me assure you that if an adult was breathing 60 times a minute as a regular rate, unless I'm mistaken, a rapid response would be called pretty quickly. An oxygen saturation of 85% may be of no cause for concern in the NICU whereas it can be a panic number on an adult unit. This small bit of representation doesn't take into account any of the "biggies" of just learning that a baby's organ systems are different than that of an adults (even things like basic blood circulation) and there is no way you can learn how it all works in graduate school with no nursing experience (unless we significantly extended the school education). They simply do not have the time to teach you basic pathophys- you are being taught on a much higher level on what to do with treatment and diagnosis differentials and it's expected that you already have a basic knowledge of this. This basic knowledge is not taught in nursing school.

    I will also tell you that in my own experience, new grad nurses flourished much more easily in the NICU as compared to experienced nurses with non-NICU experience. It was very hard for the latter group to transition into this completely different way of thinking and we had very little success in training many of them as compared to our new grad groups.

    Why isn't the NICU taught more in nursing schools? They are trying to prepare you to be a generalist nurse with the expectation that you can specialize later after you pass boards. There is simply not enough time in a nursing program to focus on niche specialties, of which NICU is one of them. NICU also has very little cross-over with other specialties, so there is little incentive for a school to give it any air time. Even a specialty like newborn nursery may be difficult for a NICU nurse to handle at first. For example, my unit sometimes gets newborns who are otherwise completely healthy and normal besides that they have a defect (in this case, an in-utero repaired spinal defect). Newborns do not eat hardly anything for a few days and certainly not much in the first 24 hours. Yet, I had many phone calls from multiple nurses who were concerned that the infant in question wasn't eating "enough" and wanted more interventions, such as placing a nasogastric tube for artificial enteral nutrition or an IV for fluid administration. I educated them and refused the interventions, but they were uncomfortable enough that I kept getting the same phone call for the first two days that this baby was in the unit. They were so far caught up in what they "knew" as a NICU nurse that it was hard for them to break out of that mentality.

    3. Why is there a shortage of NNP programs?

    There are about 20 or so, probably less at this point. I did a whole spreadsheet back in 2010 of all the schools I could find (posted somewhere in the bowels of this forum, but sadly outdated at this point) and read a lot about them. It's a national concern that there are so few and many of them closing. My own MSN program nearly shut down its NNP program. It was avoided by the board of directors who found out about this continual shuttering of programs and they didn't want to be another contributing program, as they are a top-ranked program for graduate nursing school in general and felt a responsibility to continue the torch (for now).

    I am by no means an expert on this topic nor do I claim to know all the factors. I can tell you what I've read, heard, and experienced in my 8 years of working in the NICU. It largely boils down to finding instructors willing to get paid peanuts (when they easily make six figures in clinical practice) and finding clinical sites for students. Some schools flat out tell their students that they are responsible for finding their own clinical site (one of the most ethically wrong things in nursing graduate school, IMO). Hospitals are generally less willing to provide this type of education to students unless they are an academic center because it is completely altruistic on their part. When you put in the fact that many students are trying to get into just a few sites, the competition means that hospitals can be choosy about which schools they will accept students from. I made sure to choose a school who would set up the clinical for me, not the other way around. Another factor is that you are completing nearly all of your clinical time in a NICU (although I did have probably about 50 hours split among newborn nursery, NICU follow up clinic, and shadowing a midwife for L&D). Other specialties do not have this restriction. Adult clinicals can go to any number of floors or settings as well as PNPs, but there is only one NICU in the hospital. The amount of resources this requires of the NICU is large.

    My own hospital is currently orienting 4 new NNP graduates who are FTEs on a 4 month orientation (standard at this hospital and not too far off the mark for other similar hospitals that are Level IV). I was recently asked to precept a NNP student even though it's not an ideal situation since I have <2 years experience as a NNP; showing you our lack of resources.

    I hope to teach one day in a NNP program to give back to my profession, but I am under no illusions that I will put in more than I get out monetarily.

    4. In regards to your question about requiring experience before starting school, that may be the case at that particular school, but it is not the case at all schools. Look further into this because many schools will let you take didactic non-NICU courses (like research or pathophysiology) before you start clinical. You generally have to have the clinical experience before you go into NICU didactic/clinical time though.

    It actually used to be a requirement to become licensed by the NCC (where one takes the board exam to become a NNP), but this dropped a few years ago. It's more driven at this point by schools. It's still a good thing IMO for the reasons I said above. You would simply drown without the experience.

    5. In response to GeneralistRN comparing to the medical field, as llg said, you go to medical school (which prepares you as a generalist in the adult world) and then you are required to have further training in residency and/or fellowship. As she pointed out, to become a neonatologist, it requires 3 years training in pediatrics and 3 years training as a neonatologist. Keep in mind that during these 3 years each, the doctors are working 80 hour weeks, largely clinically based (except in the last years of each). If nurses worked 80 hour work weeks they could probably get away with 1 year of nursing experience for appropriate entry into graduate school to become a NNP.

    6. In response to GeneralistRN's comment about PAs working the NICU, they are very rare for a good reason. PA school is 2 years long and (like nursing and medical school) are equipping them to work in the adult world. A PA without experience working the NICU would require an extensively long orientation and many of those folks do not make it out because they have to (again) unlearn nearly everything they did while in school. They may know the basics of making a diagnosis or knowing basic drugs, but not as it applies to the NICU. Most employers are not willing to train someone for 6 months (paid) with a high risk of them not being able to transition successfully into the job. If they are hired, it's generally at large academic institutions where they can support them more fully. I know that my hospital refuses to hire them (even experienced ones) in my NICU.

    There is a PA residency that has cropped up over the last few years, but only in a few sites as someone else pointed out. As I understand it, it is like a true residency where one is not working the general 40 hour week, but more on par with a medical residency type hours. I want to make it clear that this is not being created out of the desire for PAs to be in the NICU. They are not trained in neonates unlike NICU nurses who go to graduate school and solely focus on NICU. This is being propped up as a response to the national shortage of providers in the NICU and hospitals are becoming desperate just to hire people.

    The average age of a NNP is older than other NPs and with programs shutting down, the shortage will only get worse. Couple that with the fact that pediatric residencies no longer require a full 3 months in the NICU during their training- so many programs have dropped the extra month. Someone has to fill that role for those months that there is no resident. PA residencies are a response to this national shortage.

    *****

    I hope this answers some of your questions. I can sense your frustration about the required clinical time, but trust me, it's needed. I had 4 years going into grad school and had 6 by the time I graduated. I didn't necessarily need all of that time (I lacked self-confidence about my own knowledge), but 2 years is definitely a solid number that I think people need. If not, then the clinical time and didactic time in grad school needs to be upped, which will not happen due to shortages as I listed above.

    It's hard to get into the NICU as a new graduate but there are ways. Be the best candidate you can be, read the threads on this forum (for the love of everything, please don't ask on a new thread because there is so much information on this topic littered throughout dozens of threads).

    Best of luck in your journey through nursing school and your transition in the RN role. Keep us posted on how it's going. Let me know if you have any other questions.

  • Aug 26

    Could you please cite a source for this increased liability you keep referencing? I feel that if there were a significant increase in the number of nurses litigated against in ICU settings, the insurance for these areas would be more expensive. (As it is for the specialist physicians you reference in your first post) However I have only seen increased insurance rates for AP nurses and obstetrics.

  • Aug 26

    ICU nurse here. I agree that nursing isn't all about "working hard," and yes we are highly trained.

    That said, I also agree with the PPs that other specialties do have their own areas. Labor and delivery? I'd be clueless. Their skill sets are a huge part of why most women/babies today survive childbirth. Public health? Their skill sets are vital to keeping the public well, and they are highly trained to practice nursing at a systems level. LTC/Geriatrics? The elderly are a vulnerable and an extremely important population, and their nurses are top-notch at assessing patients without the help of monitoring. Med-surg? They are so much better at patient teaching than I am, especially when it comes to discharge planning and readmit prevention than I am. Psych? Their skill sets keep their patients safe from themselves, and help prepare them for a healthy and productive return to the community

    There is no way in hades I could float to one of those units and be competent. Why not -- I'm a highly trained ICU RN. It's because RNs in other specialties have different​ skill sets. Not less, just different.

  • Aug 26

    Quote from Sour Lemon
    You get "paid" more in ICU by having 1-2 patients instead of 7-8.
    I do think nurses with experience in everything (or complicated things) can often negotiate a better pay rate, but it doesn't make sense to me to break it down by specialty. And even "hard" specialties have "easy" days. Would anyone be OK with being paid less on the days when they have a lighter assignment? I wouldn't.
    Quote from CardiacDork
    If you believe that two patients "only" is a lighter assignment then you are far removed from the reality of critical care. These two patients require extra time and attention. I cannot articulate in words how extremely time consuming two ICU patients can be.
    I'm not saying it's easier to have two ICU patients, I'm saying it's roughly equal to having three to four times more med surg patients. In other words, your trade-off for having more complex patients is to have fewer of them- as opposed to being paid more to take care of them. Hope that clarifies things.

    I've never met an ICU nurse who likes to float to med/surg despite the fact that they don't get paid more for working in the ICU.

  • Aug 26

    Quote from CardiacDork
    I want to remind everyone that an unpopular opinion is not a vicious or nasty one. I am not personally attacking ANYONE.
    Telling every nurse who is not an ICU nurse that their specialization is not comparable to your specialization (implying that the only GOOD nurse is an ICU nurse - and yes that is what you are implying) isn't a personal attack? You have chosen your ICU pedestal, why are you so upset that someone pointed it out? Again, why are you pretending you are neutral in this discussion when you obviously are not? If your bio is accurate, you have 2 years of ICU experience - do you really believe you have that much more specialization than a 20-year veteran of L&D or psych or surgical nursing?

  • Aug 26

    I don't think nurses should be paid more according to what area they work in. However, I do feel they should be compensated if they decide to continue their knowledge base beyond what is required to meet minimum practice requirements (specialty certifications, ACLS, PALS, etc.). For example, I worked in inpatient oncology. When I received my certification (hospital based) to administer chemo I received a raise. When I became certified for PICC lines, I recieved another raise. When I became nationally certified in oncology (OCN) I received another raise.

  • Aug 26

    Quote from CardiacDork
    I am stimulating a healthy debate. How am I being nasty or argumentative? I've been told I'm on holding myself up on pedestal, that seems catty to me. I'm simply expressing my opinions.
    This is not a healthy debate, you've already stated you could float and perform on the job responsibilities in another nursing field and implying no extra training is needed. That premise in of itself is asinine.

  • Aug 26

    Quote from CardiacDork

    I am not siding with one side or the other.
    Then why are you being argumentative and nasty with every person in this thread? You obviously think you deserve to be paid more than other nurses. Your ICU training does no good on a labor & delivery unit; they are specialized and take on responsibilities just like you. The same can be said about nearly every aspect of nursing. If you want to be paid more for your choices you should CHOOSE a different profession.

  • Aug 26

    Step down off the pedestal. ICU nurses should not be paid more.
    Medical floors can be just as stressful with less support than the ICU caters to.
    Physicians pay scales are structured differently than RN's. Look into how physicians are reimbursed; HR often dominates RN wages with little wiggle room.

  • Aug 26

    We have a $2.50/HR critical care differential for our ICU nurses and a $2/hr differential for our step down unit nurses. I think it's ridiculous. Our ICU nurses are highly trained and experts at what they do, but every unit in my hospital is specialized in some way and has highly trained nurses who are experts in what they do. Our ICU nurses work hard taking care of 1 or 2 patients, but other nurses are working hard taking care of 4 or 5 times as many patients.

  • Aug 26

    You get "paid" more in ICU by having 1-2 patients instead of 7-8.
    I do think nurses with experience in everything (or complicated things) can often negotiate a better pay rate, but it doesn't make sense to me to break it down by specialty. And even "hard" specialties have "easy" days. Would anyone be OK with being paid less on the days when they have a lighter assignment? I wouldn't.


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