Latest Comments by ThePrincessBride

ThePrincessBride, BSN, RN 37,849 Views

Joined Jun 13, '10 - from 'Somewhere'. She has '1 RN, 3 tech' year(s) of experience and specializes in 'Med-Surg, NICU'. Posts: 1,982 (60% Liked) Likes: 5,235

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    Mid-twenty-something RN with 17 months of experience in adult med-surg and neonatal ICU.

    Back in nursing school, I was so sure I wanted to become a neonatal nurse practitioner. Babies were and still are my passion and I enjoy my job very much.

    In my area there is a shortage of NNPs. I know getting into an NNP program would be easy as not many neonatal nurses are wanting the extra responsibility and the in-patient schedules that NNPs have.

    I want to pursue a higher degree but I am not sure which direction. Some days I think I would be better off attempting family nurse practitioner or something else. NICU is so specialized and I am not sure I would want to work on holidays and nights every single year for the rest of my career. But it is something I am passionate about and find fulfilling.

    I am intimidated and don't feel smart enough to get through a program. I also worry about the experience I am getting. I currently have nine months of experience in a level 3 with more than half being off orientation. I have yet to take care of vented baby by myself, give vasopressors or successfully get an IV in (though I have a few attempts).

    I look at the people going directly into np school without experience and am baffled. Maybe they are smarter than me, but I am terrified. NNPs practically run the unit and if the most senior nurse can't do something, it falls back on the NNP. I want to do right by these babies and be proficient.

    At the same time, I want babies of my own. I am 25. The program is almost three years. If I start next year, I will finish at 28/29. If I wait another year, it will be 29/30. I want two kids with the option of a third and feel the clock ticking.

    But I am conflicted. I feel one more year would help. It would also give me more time to travel to some places I want to go to as well as solidify my resume and skills. The school requires two years of clinical experience and if I wait an extra year, I will have double. is one more year. I am afraid that if I wait I will end up regretting or just not go to school at all and become comfortable with the money.

    Any insight? Personal stories? I want to get all my formal education out the way before having children.

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    In terms of bed side nursing, I think I've found what I like. Advance practice? 17 months and counting. Still not sure which direction to take my career in.

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    PICU is even harder to get into and not something you just do for a few months and then leave. It is incredibly challenging and highly seeked. There are very few openings in my city and I live in a decent size city. Because of a nearby children's hospital, many of the doctors in my area won't touch a pediatric patient and will send them off to this hospital that has a pediatric ICU while there are NICUs in most of the major hospitals in my area (and there are many).

    You are setting yourself up for failure with your myopic vision and poor attitude.

  • 6

    What happens if you don't get a NICU job, OP? Will you just refuse to work? Be miserable? You may never end up in NICU as it is highly specialized and coveted. You need to be okay with that.

    I say this as someone who was gung ho about getting into a NICU and was devastated about not getting in. But I kept an open mind and took a job in adult med-surg and spent 8 months before landing a job in the NICU (and have been there for almost nine months). I learned a lot in med-surg and while I don't think it is necessary to start off in med-surg, I have found myself to be a lot tougher and more versatile than nurses who have never worked with adults. I still have my med-surg job as a PRN staff member.

    While NICU is amazing and fulfilling, it gets to be repetitive and it is very hard to leave after spending time in there. Adult med-surg experience gives one incredible experience, hence why I kept my job among other reasons. Also, many people don't know this, but some NICUs have extremely high turnover and burn out. My unit has a billion people on orientation at any given moment.

    And NICU quiet? Ha! You are clueless. Alarms ringing constantly, crying inconsolable babies, NAS babies, demanding parents, bubble cpap and oscillators...I could go on. Even the feeder-growers are not all that quiet and peaceful.

  • 1
    psu_213 likes this.

    I already have heard of coworkers saying they will call off because for almost three years they have been screwed over with the scheduling. Some have been forced to work every major holiday or work in such a schedule that didn't allow for any family time.

    I would say that unless it is grossly unfair (like being forced to work every holiday or having a ****** schedule year after year), you need to show up. Sorry.

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    I have never worked adult ICU, but I do work in "baby" ICU and I understand getting tired of alarms and the stress. Have you taken a vacation recently? You may be due for one!

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    I have it heard that it takes one year to become competent, two/three to become confident and five to be considered an expert.

    Sounds about right.

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    Thanks for the replies, everyone!

    I wish I had more space in the article to explain more ways to save. Yes, absolutely save in your HSA and FSA folks! HSAs (Health savings accounts) are great as the money is never taxed IF it is used for healthcare-related expenses and they roll over from year to year. FSAs (flexible spending accounts) are similar in that they are free of taxes but they have lower contribution maximums and don't roll use it or lose it.

    Also, I agree that even if your employer doesn't offer a match, it is still important to contribute as much as possible to a pre-tax retirement account as it lowers one's tax liability and allows the money to continue to grow in a tax-sheltered "bucket." The ONLY time I would be hesitant to contribute to a 401k/403b is if the funds offered have outrageous loading fees and expense ratios that will end up costing you more money than a taxable account.

    OCNRN63, some employers have an automated annual increase program in which you can have your paychecks automatically increase the percent that goes to a retirement fund (ex. 1% per year starting on January 1st). A nice set-in-and-forget-it way to continue to ramp up retirement savings without any effort.

    LadyFree28: Absolutely! One should invest in (government) bonds for some stability, but in order for a portfolio to grow and prevent its owner from outliving his/her funds, investing in stocks is imperative. Bond interest rates are extremely low and may not keep up with the rate of inflation, whereas certain stock index funds have on average, after adjusting for inflation, returned about 7-8%. I understand a lot of people are afraid of stocks, and I was too, but investing in the market should be seen as a long term gain. People close to retirement who lost so much were invested too heavily in the market when they should have been much more conservative with their funds (including a couple of years' worth of expenses in savings).

    Some conservative financially gurus say have your age in bonds. A 25-year old should have 25% in bonds, 75% in stocks. Others are more aggressive and say have your age-10 years in bonds. So a more aggressive portfolio for a 25-year old will have 15% in bonds. I, on the other hand, am well over 90% in stocks, but I will gradually become more conservative.

    For those of you who may think this is overwhelming, there are some great funds called "Target funds" where you can pick the fund closest to your desired retirement year and the fund will automatically start more aggressive and then become more conservative as you get closer to exiting the workforce.

  • 6

    Quote from BeentheredonethatRN
    My suggestion is to stay under the radar , keep a smile (but not too happy ) , hang in there , but look for another job. Go figure , who knows what politics are at work there. Check this out , right here at my hospital's ER the mangers will use the power of the shifts to get people out. Imagine , staggered shifts from Hell- examples: 1pm-1am , 3pm-3am , 12am-12pm , 1:30am-2pm or whatever sadistic shifts they can think of. Also, if you can , find another job inside your system because we all know this healthcare thing is almost two stops from a monopoly.
    3p to 3a is my dream schedule with 1p to 1a a close second. At my facility, you would get all of the night shift differential without completely messing up your sleep cycle.

  • 4

    Bedside nursing is extremely blue-collared. I say this as a daughter of an actuary and an accountant. I went to private school, took horseback riding lessons and learned how to play the flute. The other kids (upper class, unlike myself) in my school had parents who were doctors, lawyers, sports team coaches, etc. There was a push for higher education (particularly grad school).

    Nurses don't make **** in comparison to many white-collared professionals. Educational standards are minimal and so many nurses are against making a four-year degree the entry requirement. Nurses are not treated with the same amount of respect as professionals with advanced degrees.


    In certain circumstances, nursing can put one firmly in the middle class to upper middle class. A single nurse with several years of experience with no debt, minimal expenses and zero kids could easily be UMC. A single nurse with five kids and consumer debt could be riding the poverty line.

    I have come across nurses driving 70k cars and living in large homes and while others live frugally. Guess who is truly middle class?

    I find nursing is very good as a supplemental income for a dual income household. I know plenty of nurses who work part-time or contingent because their spouses make great money and their salary is for savings and extras.

    Nursing is a great and flexible field to get into and if one plays his or her cards right, it is possible to become financially independent many years before traditional retirement age.

  • 10

    I guess this is more of a public service announcement/reminder...

    I was talking to a bunch of coworkers and became deeply disturbed by a certain trend: many Americans are completely ignorant in regards to retirement planning and investing and too many are not saving enough for their golden years. Some fear the stock market and refuse to participate in it, others feel that social security will take care of them (ha ha), while a decent amount stick their heads in the sand.

    This post isn't directed to those who are living in destitute and can't afford to save anything. Obviously, not everyone will be able to put forth anything in an IRA or 403b. This is more towards those who are living above their means and/or aren't adequately saving for retirement: don't forget to invest for your future!

    Unfortunately, many hospitals and other facilities are cutting back on retirement benefits. Defined benefit pensions are disappearing, and some employers do not contribute anything to their workers' retirement plans at all; my employer has reduced its 403b matching savings for new hires while keeping wages stagnant.

    While I realize that some people are scared of the market (and that is completely justified) and find investing confusing, understand that historically, the stock market has always rebounded, with the S&P making average returns of 11%. And with feds keeping the interest rates low, it is even more crucial to involve oneself in the market, less one keeps real estate, wins the lottery or has a rich dead uncle somewhere.

    What does this have to do with nursing, you may ask? Everything. Nurses have such a high rate of burnout and on-the-job, career-ending injuries that it is imperative that we save now so that we aren't suffering in our older age.

    But how to get started in retirement planning? First, look to make sure that your employer has a retirement benefit. Most healthcare facilities should have a tax-deferred account, also known as a 401k or 403b (for the non-profit sector), available. In this year, anyone under the age of 50 can contribute 18k of pre-tax dollars, with people over the age of 50 being able to contribute an additional 6k per year. A 403b gives an advantage to workers by allowing them to save taxes upfront, letting their money grow, and then withdrawing the money presumably at a time when their tax liability is lower. Also, depending on certain circumstances, contributing to your 403b may not change you take-home pay. Awesome? I think so! When choosing investments, however, make sure you diversify (never put your eggs in one basket!) and check your 401k/403b expense ratios, as fees can erode your returns.

    Don't have access to a 403b? NO EXCUSE. Low-fee brokerage companies offer individual retirement accounts, also known as IRAs. The max is lower (5500 for those under and 6500 for those over 50), but both the Roth and Traditional offer tax perks to those looking to invest in their future. Taxable accounts, though not as advantageous as Roth or Traditional accounts, also provide avenues for those looking to participate in the market.

    And don't feel as though investing is an all-or-nothing. Most people who participate in their company program cannot afford to or don't max out their accounts and still manage to save enough to meet their post-work needs. The key is to start early, save often and be consistent. Start by getting enough to capture your employer's match (if they offer one)...NEVER leave "free" money on the table! Once you have an emergency of six or so months of living expenses and have all high-interest debt paid off, work up to at least saving 15% of your income, the percent that many financial experts agree will help you exit the workforce at the traditional retirement age...more if you started later and maybe less if you started saving early.

    Above all else, just save. The sooner you start, the more your money can compound and work for you!

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    I have a full time job and a PRN job, and I find it a challenge to coordinate staff meetings, continuing educational requirements, etc for both of them. I couldn't imagine the amount of work required for a FT and a PT job.

    Nah. Just stick with the FT job.

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    I left my first RN job before one year (I am now there PRN) for a very competitive specialty. While many of my coworkers are stuck in their current jobs, in the time I have left, I have been hired, trained and off orientation for several months (have been in my specialty for over eight months now). I am gaining the valuable experience needed to advance my career (NNP) while my med-surg counterparts who want to become CRNAs are being held back. No regrets here. However...

    The OR is a completely different beast as orientation and costs of onboarding are ridiculously long and high. OR orientations are usually six months long (minimum) and expect a LOT more ROI then a med-surg unit that rushes new nurses off onto their own. You could be burning a massive bridge by leaving so soon. Also, OR is oftentimes considered a holy grail in nursing as a highly coveted specialty. On top of that, you are switching from dayshift hours, shorter commute to the night life with a longer drive. Can you handle bedside night shiftwork, especially after coming from an OR, day-shift background?

    These are some things to consider. If CNM is your goal, then by all means, apply. But know you are giving up a great opportunity that many nurses never get by leaving the CVOR, so you better be sure that this is what you want. If you weren't coming from such a specialty, I'd give an enthusiastic "yes!"

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    Quote from mta1976

    Finally, since you are a FT employee and probably earning PTO... once you get your bank built up... having an extra day off with PTO pay isn't so bad.
    I'd much rather keep my PTO for a real vacation instead of a free day here and there. I get very little as is.

    I would get a PRN job, OP. I have a full time job at 0.9FTE at one place and my PRN job (where I used to work full-time) to supplement. The PRN pays at a much higher rate than my FT gig, AND I have access to a defined benefit pension all the while diversifying my skill set.

    Also establish a hills-and-valleys fund. Save the "excess" (hills) so that you have enough to cover the famines ("valleys").

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    The only time I become annoyed is when the transfer is held until toward the end of shift after waiting several hours for the admission. Really?