BostonFNP Guide 41,346 Views
Joined Apr 4, '11 - from 'Northshore, MA'.
BostonFNP is a Primary Care NP.
Posts: 4,653 (61% Liked)
I am a Direct Entry grad who has been practicing as a FNP since 2009. I had a lengthy career in another health profession, but really wanted to be involved in direct patient care. I have no regrets about obtaining my NP through a direct entry program. I worked harder in this program than I ever had in my life. I was only able to work a limited number of hours per week, as school took precedence and the volume of work was high. My program's standards were high, as they should be. It was stressful, but I never felt that I couldn't handle it or that I had made a mistake. Maybe that's a benefit of going back to school as an older adult. I worked in a community health center for a few years, which was very stressful due to lack of support and resources. I'm now in a private specialty practice, and I don't find it to be very stressful. I'm paid well, I'm good at what I do, I have a great work-life balance. Oh yeah...I also really help my patients.
If you choose to go the DE route, make sure you choose a reputable program with stringent admission standards. Do not settle for a for-profit school that will admit anyone willing to pay. I personally chose a 100% brick and mortar, no online component school. I felt that being in a classroom and working with other students was a better way for me to learn. I also liked meeting with faculty face to face and being able to ask questions in real time. I think it's also important to find a program that will help you find preceptors for your clinicals.
Best of luck to you.
I think a doctorate can come in handy for a future role in teaching so I'm considering it but I'm in a state that doesn't offer a great selection of DNP programs that I can attend in person. I'm also considering the cost factor and don't want to spend a lot of money on a degree. I never had loans for my Master's and want to be able to do the same for DNP.
I think you should consider a few things while making your decision: where do you want to be in 5 or 10 years? What are your other goals- professional @ personal? Also, for me, at least, age is a factor.
I am 53 years old & have been a nurse for 32 years; nurse practitioner for 16. I really like what I do & hope to remain in my current position for at least 5 more years, but I'm tired! If the opportunity arose, I would probably go part time. Obtaining a DNP at this point is just not something I want to put time, effort & money into. It would not help me in my current position & I would not make any more money.
You, however, may be much younger & plan to work a lot longer than I will. You may just want to bite the bullet & get it over with. Just another hoop through which you will have to jump...good luck!
Actually that is what I said. I do not care if they want to get high. Was not my drug of choice but could've been I suppose...I feel a bit sorry for anyone who is strung out on Rx meds given the hoops they jump through. Really I do not see what the big fuss is over anyone altering their mood, that is the whole idea behind alcohol...
I make about $300 per hour or $200k+ working 4 days, 8 hours per week, just billing insurance. If some physician is paying you less, you're getting ripped off. I'm a PMHNP.
A lot of time, thought and teaching went into this article, and it shows. Yes, we've all met Jake I would guess.
I wonder how many of us have met Harry too?
The year was 2002, and I worked in a VA facility at the time. Harry was 71 years old, and among other things he was Dx'd with chronic pain. Harry had only recently started on MS Contin 30 mg PO BID in the past 6 months, and it worked fairly well for pain he had suffered for a long, long time. Harry had also been on coumadin for many years.
Harry was approximately 8 hours post-op. His post-op pain med orders were generic: percocet 1-2 PO Q 4-6 hours PRN, and demerol 50 mg IM Q 4-6 hrs PRN severe pain.
Because Harry was Rx'd coumadin the night nurse opted to D/C the IM demerol for safety reasons to prevent hemotoma, but didn't think about calling to get IV pain med orders. Harry was NPO over night, so not only did he not get his evening dose of MS Contin, he never received any PRN percocet either after being transferred from PACU.
I arrived at 0630 for report, and walked into Harry's room at 0700. Harry sat huddled in his bed sweating and shivering, gown and sheets soaked, goose flesh visible on exposed skin, miserable. Harry spent a sleepless night in pain, and unbeknownst to him, narcotic withdrawal too.
Harry smiles wanely, "Well hello there young lady. I think I may have the flu! I'm not feeling so good …".
"Hmmm, I'm not so sure", I say.
The residents are making AM rounds as I check the med sheets. I find a tired looking pair at the unit clerk's desk sitting in front of computers, eye bags large enough to be hammocks for small rodents (an unwillng, irritable audience, but an audience nonetheless).
I explain the situation unfolding in ICU room 12. The female of the pair turns to look at the male resident, "An addict" she says. He nods frowning, never taking his eyes off the computer monitor.
Internally I'm steaming - Mt. Vesuvius - while externally my face is wiped clean of all emotion. My eyes are on the prize, which is relief for my elderly post-op patient who never should be experincing narcotic withdrawal in the first place.
"I believe this would be symptoms from the abrupt discontinuation of a legitimate Rx medication doctor … physical dependence".
Both residents stare blankly at me.
I get a verbal one time IVP order to make my patient comfortable until rounds get to him, advance his dietary orders, and allow his PO meds to resume.
Harry gets medicated, his symptoms subside and he feels much better. Later we have a talk about physical dependence and education ensues regarding his MS Contin for future need (Harry had another elective surgery pending in the near future).
Harry was surprised to learn he should not abruptly stop his MS Contin, and was dismayed to discover the commitment he had made to be free from the worst of his chronic pain. He worried he was an addict - it took much convincing on my part to reassure him that he was not.
Why was it I understood what was occurring when some of the staff interacting with Harry did not spot it for what it was?
I myself am an addict, now 25 years clean and in remission. Even though Harry was not an addict per se, narcotic withdrawal looks the same regardless of the reason for it - and I know personally what it looks like like whilst others may not.
When all was said and done, and Harry was transferred to the step-down unit later that morning I should have felt relief rather than uneasy. But sadly this was not the first or last time I encountered a scenario like this in my nursing career.
I, as many of my colleagues understand that not all patients who take narcotics routinely are created equal, even if the residents that day did not.
How many people do you know personally who have died because of an epidemic that we play a role in?
Like I said before, I'd love to work in your hospital where "seekers" do not exist.
I'm shocked one of you finally acknowledged the existence of drug seekers.
...because they know eventually the docs will give in as opposed to telling them they will not prescribe them controlled substances th do not have a need for.
Now, will you be courageous to say that physicians should not order them narcotics for the sole reason of feeding their addiction?
Again, I am trying to distinguish between people with medical issues versus those who do not.
Here's the thing: Jake may have the "same right" to pain meds and your time as other patients, but management of his behavior will take time away from other patients care. Not exactly equal or fair, is it?
Self-reflective practice is a vital component to providing good care, at any level.
If nothing else, hopefully this thread has engaged everyone reflecting on how we individually approach patients that have been labelled "seekers".
We need all NPs to have doctorates from 2015 out.
There is a rationale for pain meds. Coke & Meth don't do anything for pain.
I have never quite grasped the thought process behind holding/rationing pain meds for an addict when they are in hospital for some acute process which results in pain. We have a lot of addicts (heroin is a HUGE issue in our area, one of the highest rates per capita in our state) that come to us for whatever reason. Cutting someone open will result in pain whether you're an addict or not. Acute bouts of pancreatitis result in pain whether you're an addict or not. The only difference is that an addict may require higher doses of pain meds to control/cut through the pain.
These are my issues: The patient who shows up religiously every three days in ED for pain. Said patient is with pain management. Patient knows darn good and well we will not go outside the parameters of the pain management contract. Same patient knows that #1, "chest pain" gets them to the front of the line in ED, and #2, no matter who they demand to see (all the way up to hospital president) they will not get any pain meds outside of their pain management contract. But they try every. single. time. and waste the time of RNs, supervisors, etc.
My other issue is the patient who decides to bring their illicit drugs to the hospital and shoot up in their room when no one is in there. Or you remove a patient's socks and needles and baggies fall out. Or flip a pillow and have a syringe with God knows what go flying across the bed. I'll admit it pisses me off to no end to walk into a room to find a patient gray and not breathing because they took something.
I guess you're right. I will take this as a lesson learned but will not be seeking anything else at this time.
Wile E Coyote Could you please sight your source for this statistic?
The above is a quote, I can never use the quote function correctly!
Sorry, no I can't. I am pretty certain that most violence is committed by someone the victim knows personally as in a close personal acquaintance or relative.
I am sure you can find cases of psychiatric patients stalking, even killing, their care provider after they have been discharged.
I am sure you can find cases of medically ill (no psychiatric diagnosis) patients stalking even killing their care provider after they have been discharged.
I have no statistics but I believe these cases are extremely rare.
Fearing mentally ill patients is perpetuating a stigma that professional medical health care workers should be striving to end.
It is exactly the same as fearing all Muslims or any "group" you want to label as dangerous.
Violence toward mental health staff has been receiving national attention in the face of diminishing resources to treat what appears to be an increasingly violent patient population. Assaults by psychiatric patients against mental health care providers are both a reality and a concern, as the effects of violence can be devastating to the victim. Some staff rationalize that violence is an occupational hazard and believe that they are equipped to cope with it. Despite these beliefs, these victims suffer from many of the same physical and psychological sequelae as victims of a natural disaster or street crime
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