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Joined Apr 4, '11 - from 'Northshore, MA'. BostonFNP is a Primary Care. Posts: 4,466 (60% Liked) Likes: 10,522

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  • Dec 3
  • Nov 27

    The schools should contract with about 20 NPs as preceptors and then have the students fight in cage matches for the right to a qualified preceptor. You lose your match then you are out of the program - but they keep your check.

  • Nov 7

    Over on the NP forum, we’ve been discussing lawsuits - this is something very real and worrisome for providers. While nurses can get sued; most often they are dragged into a suit along with others; while APRNs by virtue of being providers can “stand alone” and take the brunt of the lawsuit themselves.

    Unfortunately I can speak to this firsthand. I’ve been an APRN for over ten years now and I still shudder when I remember the incident that completely changed my practice. For privacy sake, I will keep it general. I made a prescribing error.

    So...began the odyssey of lawyer visits, depositions, court appearances, meetings with my boss, with the practice president, and many many years of endless waiting wondering: would I have a job, would I have a license, would my house be taken, my wages from whatever job I could ever get be garnished, would I have to declare bankruptcy and on and on my imagination wandered?

    It was very stressful on me, my family, my co-workers. And oh yeah...did I say you can’t talk about it to anyone??? Me...who talks all day long! To worry in silence for many years was another stressor.

    In the end...an out of court settlement was reached for what I considered to be a lot of money but for what the attorneys patted themselves on the back for negotiating. I came out with my job intact.

    On the day I signed the settlement, I received the final blow - oh yeah didn’t we tell you that this has to be reported to the board of nursing and the National Practitioners Data Bank? Uh...what???

    More worries, more time...in the end after I hired an administrative law attorney to appear with me for the BON hearing, my license was cleared. My name does appear in the NPDB and will always show a payout for a malpractice suit. However, it is possible to get a job with this and it is possible to get credentialed with this on your record.

    Some things I’ve learned along this bumpy road:


    1. Always be scrupulously honest with everything. If you are in the NPDB - everyone will find out anyway.
    2. Keep your own malpractice insurance. Although your practice will cover your lawsuit expenses, it will usually not cover your licensure protection and you will need that if you are found at fault.
    3. If you find yourself being sued, realize this is a long haul adventure. Get yourself some support which can be difficult as you will be told “don’t talk to anyone.” You can talk to clergy, or a counselor or your spouse with the expectation of privacy as long as you don’t discuss the case itself but rather your feelings and emotions.
    4. Be kind to yourself - this is stressful. It can happen to anyone at anytime. It does NOT mean you are a bad person, a bad provider or that you made a poor career choice.
    5. We always want to do the best for our patients but we are human - we do make mistakes - sometimes our mistakes don’t cause harm, but unfortunately sometimes they do.


    And to those of you reading this saying, “that would never happen to me, I’m too cautious, I’m too smart, I would never harm a patient,” until ten year ago I was thinking the same thing….

    It happens….be prepared…

    And...if it happens to a colleague...please be very supportive. Realize they can’t discuss the details but let them know you care, invite them for lunch, remind them of all the positives they bring to their job. And...remember to keep supporting them thru the long haul - realize when they are gone for a court date, deposition, meeting and touch base with them and let them know you care.

    This is a caring profession but sometimes we are least kind to each other...

  • Oct 27

    OP-

    Starting practice can seem a bit overwhelming. I would be much more concerned if you were starting out overconfident-that makes for a dangerous provider. As others have pointed out, you will see the same conditions over and over, and will become very familiar with common diagnostic and treatment regimens. I utilize resources such as Uptodate and Epocrates, and my favorite derm site, Dermnetnz.org. And if you don't know something, then ask. There's nothing wrong with asking questions.

    One year from now you will feel very differently. Best of luck to you.

  • Oct 27

    Quote from EmergencyRN22
    There are good NP'S and bad ones. Just like there are good Dr's and bad ones.


    Gotta think, they "all" weren't top of their class. Your doc could have been an average or "barely passed" too.

    Just like every other profession ...you have great, mediocre, and bad. True with Drs, RNs, mechanics, teachers and every other freakin job.
    You are absolutely correct and I sometimes need to remind myself that I know as many incompetent psychiatrists as I do psych-NPs. Since it is personal and the NPs are representing my profession I do take special offense to those who do not have the experience or skill set to do our job competently. Fortunately I have worked in this specialty for awhile and have a decent reputation but it still stings when I admit a patient on an egregious medication regimen that was prescribed by a psych-NP.

    Personally I'm not so sure it totally about the formal education they received as much as their experience and innate abilities but the masses of schools cranking out "advanced practice" nurses sure aren't helping with overall quality, imo.

  • Oct 26

    nursing departments, i am sure at least many, would love to be over everybody.

    some of them are like huge macrophages extending out their processes trying to engulf any and all into their clutches to make themselves feel better about themselves.

    I am glad those days are over for me

  • Oct 24

    Quote from Susie2310
    I don't know your scope of practice, but I assume you assess patients, develop a plan of care, and can order some medications and treatments/interventions, monitor their effect, and revise the plan of care as needed within your scope of practice. But you don't have the same level of responsibility or accountability as a psychiatrist as you are not trained as a psychiatrist. A psychiatrist is still ultimately responsible for the care of the patient.
    Actually if I kill my patient, it's my butt not a psychiatrist 300 miles away.

    And no I don't have a plan of care. We don't do that. We examine and treat in a problem focused manner.

    You sound like a nurse disgruntled by NPs.

  • Oct 20

    . . . am pleased to announce that I passed my ANCC FNP test today. I was so relieved when the proctor handed me my paper touting my success that I was in tears, and shock. Hours later, though, it's sinking in and I can't stop grinning.

    I am pleased to have the support and advice from folks here.

    Now to apply for state licensure, jobs, and all the other accouterments that comes with.

  • Oct 20

    Hi there - I live in IL also and nope no problem with you doing that. Is this a nephrologist that you are working with? The reason I ask is that I work for a large nephrology practice and we have 8 APPs (advanced practice providers) rounding on our pts.

    Getting credentialed at the big two chronic dialysis units is not much fun either.

    I'll be glad to answer your questions about nephrology - its a pretty specialized field which is why I was asking if you were working with a nephrologist.

    I also wanted to add that the IL APN Practice Act "sunsets" in 2017 and here are the proposed changes:

    We are gearing up for another big push for full practice authority in 2017. We have a lot of work to do and need all APNs in the state to support our efforts.



    • Change APN to APRN throughout the act and other laws


    RATIONALE - consistency across states and to align with the APRN consensus model

    FOR THOSE PRACTICING AS A CRNA

    • Remove language that references the requirement of physical presence by physicians during the delivery of anesthesia services. Specifically, remove where this language below appears in the Nurse Practice Act or related Acts:


    "and remain physically present and available on the premises during the delivery of anesthesia services."


    FOR THOSE PRACTICING AS CNP, CNM, CNS PROPOSALS INCLUDE:

    • A transition to practice for newly licensed APRNs.
      • After 3000 hours (of practice in Illinois) the APRN may practice without the WCA. They will need to notify the department of that intent.
      • The transition period shall include a written collaborative agreement with a physician licensed to practice medicine in all its branches OR an Advanced Practice Registered Nurse who has five years of practice in the same certification.
      • All currently licensed advanced practice registered nurses may or if desired will be grandfathered as long as they meet the following criteria:
        • Un-encumbered license with appropriate national certification for at least 5 years
        • Notify IDFPR of their intent to practice without a written collaborative agreement


    RATIONALE - National trends show that a transition to practice model leads to successful passage.

    • Increase pharmacology continuing education requirements
      • Total hours will not change 50 hours CE per renewal cycle
      • 20 hours must be pharmacology with 10 of those hours specific to Schedule II


    RATIONALE - National trends show that a transition to practice model leads to successful passage. CE recommendation - To circumvent issues that may occur due to continued conversations in Springfield related to the use of schedule II gateway drugs that may lead to substance abuse (heroin overdose)



    This is important for all IL APNs.

  • Oct 18

    Quote from AAC.271
    Frankly, if we are talking about outcomes, NP education is indeed superior to MD education as the data indicates our outcomes are equal or superior to physician outcomes. This is the facts and really goes to show that NP education produces better providers than MD education.
    Your ignorance is absolutely astounding.

  • Oct 18

    It may help you to realize that, based on my reading so many comments here, if you were to make a major life decision based on those questions and opinions, when you're done a whole new group will show up to ask you when you're going to get a BSN, work in this or that specialty, become an NP...etc..etc

    Since you can't escape it you may as well do what makes you happy and feels right. Best wishes to you!

  • Oct 15

    Quote from rnfrombama
    Hey all!!! I'm still trying to get this commenting and replying thing right. I usually just read these articles and print them out take them to work. Thank you all for your responses and your input. Many people have told me and you all have suggested trying a change of scenery. I've talked to some of my coworkers whom have traveled or worked at other facilities and they've said "It's this hospital." The facility in which I work is surely the huge problem. I've even had a physician tell me "This [hospital] isn't a good place." This place has frustrated me to the point that I'm done with nursing. I will try to find employment elsewhere. It will be difficult because of the area that I live and the monopoly this facility has on healthcare throughout. That's where a lot of my frustration cones from. To Mikey, who asked about the reason for nurses leaving. I'm sure pay has something to do with it. But it's the lack of respect that we professionals receive on a daily basis. This facility's culture is making money and making the docs happy....that's it. There is no question about it. And BTW, this facility is a "non-profit" organization.
    After reading your article, and all of this thread. It seems many of the main complaints are purely personal.

    I was a nurse for 20 years. I always found peace in 3 things.

    I bounced around and tried to stay out of politics. In almost all of my jobs, I worked float in large hospitals. So I was never in one place for more than a day or two in a row.

    I focused on my patients and let everything else roll by. Unit politics rarely affected me, and I didn't have trouble relating to physicians.

    Every day I tried to make a significant difference in someone's life, and then I left work and counted on the team to take over. That's the way the modern hospital system is designed.

    I couldn't be responsible for what happened after I left.

    I do take offense at your attack of physicians (I include myself since I am a provider now). I really didn't have serious issues with providers (MD, DO, PA, NP), anywhere I worked. On occasion, one would go off or vent (kind of like you). Usually, I would say, "Ok, now that you are done, you can buy us lunch". Or hand them a bill for $50 for counseling.

    Sometimes, they have reasons for their rants that you don't know about.

    But I am going to say that from the providers point of view, sometimes your nursing colleagues make it challenging to be a nurse. When I walk down the hall and see nurses with their heads buried in their phones (texting or surfing the net), or listen to them stand at the desk and complain, I lose a little empathy. I will see somewhere between 15 and 20 patients in a day. I will receive calls from nurses, pharmacist, case manager, social worker, family, etc. And I have to field every one of these because being a provider is the business I chose.

    I didn't realize how much work I could get done when I had to.

    When I was a nurse, I used to say "I used to be a roofer, but this is indoors and year-round". I don't know anything about your past, or how much you think people on the outside make. I don't know what you think non-nursing jobs are like. But I can tell you, if you truly feel the way you do, get out now. Anyone who copies articles from the internet to take to work, anyone who calls in on their day off to check on patients, anyone who lets menial clerical tasks affect their professionalism, is way to close to the problem.

    Take care of yourself. You owe me $50.

  • Oct 12

    I rarely deal with physicians on a daily basis in school nursing. Just sayin', find another specialty before quitting nursing all together.

    I get attached to my kiddos, but it's kind of a good thing in my setting, sometimes I'm the only "love" they get.

    You seem very compassionate and we need compassionate nurses, don't quit, just make a change.

  • Oct 7

    I went to graduate school in the early part of the previous decade when one can find on-campus programs in state universities with approximately $300+ per credit tuition so in a Master's program with 45 or so credits my total cost was something around $20,000. On top of that relatively low cost, I received a HRSA grant which covered half of my tuition so I finished my ACNP program with no debt and didn't have to default on my mortgage (lol) by keeping a full time job as an RN.

    Nowadays, even state universities charge anything from $700-1,000 per credit so the cost has more than doubled. With inflation, I would say that if I were to attend school now, I'd be willing to pay no more than $50,000 for a program but that's just me. I would also want to have some peace of mind that the degree I'm trying to obtain will pay-off in terms of job placement and advancement.

    One thing I notice on your post is that you are set on WHNP. Is there enough opportunities in that field where you live? I am certainly not the expert on job markets but WHNP is a narrow field for NP's compared to the other more popular tracks which leads me to think that if I were in your situation, I would want to make sure I could easily find employment before I invest my money on it.

  • Oct 3

    Actually, wait, here is the proof!

    Imgur: The most awesome images on the Internet

    I don't know how to properly cite this. Could someone write it up in APA format?


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