BostonFNP Guide 40,296 Views
Joined Apr 4, '11 - from 'Northshore, MA'.
BostonFNP is a Primary Care NP.
Posts: 4,565 (61% Liked)
I had a few days orientation, mostly to learn the EMR and organizational policies. I was started with 1 patient every 30 minutes, but was expected to ramp up to a full patient load within a few months. There were always providers around to consult with, but I was expected to handle the routine cases independently. OP-I am a little concerned that you're taking so long to handle a simple case. Did you not work up cases from start to finish in your clinicals? Is this a knowledge issue or is this a confidence issue?
A new grad should not be an expert by any means, but should know how to handle common issues like basic prescribing for HTN, 1st line treatments for diabetes, diagnosing and treating a simple URI. Review these and other common issues. I would go home from work when I was a newbie and study every single night. I still study on my own to stay abreast of current and new practices in my area.
I think your physician is giving you a decent orientation. The basic training should have happened in your clinicals.
RockyMay seems to strongly dislike NPs and I have to wonder if she joined this site just to argue that NPs are incompetent. I can't find a way to quote her past posts and put them here with the quote function, but here are some of the things she has said (I copy/pasted):
She frequently makes very strong statements against NPs/nurses...
- "Sounds like you want to throw every test in the book at the PT. That's both unnecessary and also inappropriate, but it's common in NPs." (March 11, 2016)
- "NPs utilize more resources than PAs or MDs as a result of their inferior training and lack of preparation for the autonomous practice of medicine" (March 11, 2016)
- "Welcome to nursing, Michelle. You will never meet a nastier group of people" (June 8, 2016)
- "Most clinical training sites loath taking NP students due to their extreme lack of preparation and knowledge." (June 8, 2016)
- "MD/DO>PA>>>>>>>>>>>>>NP" (August 3, 2016)
... and then of course, everything she has said on this thread
It is also very unclear what type of clinical degree/license she has.
- "I am about to graduate from PA school." (March 9, 2016)
- "I am *NOT* a PA. I am more nursing experience then most people here!" (June 22, 2016)
- "Nope, I am *definitely not* a PA. You misread my post." (June 22, 2016)
I don't disagree with everything she says and if people have strong opinions regarding the relative competency of PAs and NPs it's perfectly fine to express that in a respectful way. However, RockyMay's statements are very inflammatory and inconsistent and I believe she is trying to get us riled up (and speaking for myself, I hate to say it's working). I honestly forgot what the initial question in this thread was because I've gotten so distracted/off topic by RockyMays statements. I guess I "took the bait", so to speak
RockyMay: I am sorry for whatever experience you went through that made you hate NPs so much. I would really like to know where this hate stems from, because it seems quite personal to me. I understand if you don't want to share, and you probably don't, but is there any chance you could clarify the following:
- Under what license are you practicing? Did you go to/complete NP school? Nursing school?
- What do you hope to achieve by expressing such hostility towards NPs on this website?
I give all my students my "worst" patients. It's good for them. And me
I feel the same way. I was a nurse for 15 years, and worked closely with physicians to gain trust and write "verbal" orders for things that made sense. As time went on, I think autonomy and involvement dwindled. Making the jump to nurse practitioner was, for me, a necessity.
When I walk into hospitals today, never see the same nurse twice, and see them all sitting at the desk doodling on their i-things, I get a little annoyed. Ask a question of a nurse, the common answer is, "I don't know if he went to surgery yesterday, I've only had him for 4 hours".
But any nurse who is planning to move up to NP should already be at a point in their career where they are thinking "I know what I would order/do for this patient. Man I wish I could just write the orders". That is someone who has enough experience to make the transition and be successful.
I am sorry it makes you feel like a criminal David40836, but when I was doing primary care, I had pain med contracts with ALL my chronic pain patients. I explained to them at the start that this is the way it has to be, and if they want/need the meds, they need to comply with the contract. The ones NOT selling their meds had no issue with it, the others (and I heard all the stories, "my child dumped my pills in the toilet," "I had company and someone stole all my pills," "I had them in the glove box of my car and my car was stolen," etc.) left. I was already nearly 100% certain who would be okay with the contract and who wouldn't. I always tried to work with the patients as to need, but I often required physical therapy as part of the contract. I understand chronic and acute pain (I worked in oncology for 23 years) but I also am not a fool and have no desire to have my compassion taken advantage of. And I totally agree we need non-addictive pain meds.
As a novice (in any field) it is acceptable and advisable to seek answers from those more experienced. I came into a specialty with which I had little experience as a novice APRN. I rec'd five full months of didactic plus clinical preceptorship = 800 hours. I was also expected to put in additional time studying which I did. At the end of the five months, I was seeing pts on my own but still had backup for issues with which I was unfamiliar.
Even now, 10+ years later, the MD and I talk about issues occasionally though the occasions are now more a teaching point then me asking for advice regarding a certain pt/care situation. I am now the lead APN and the others come to me for advice. However, I still do not have all the answers. I still look things up.
As nephrology moves into the primary care arena once again, I will look up more because for the past 10 years I have not taken care of all primary care issues where I will now.
Providers that think they know it all, be they APRNs, PAs or physicians are the ones that we need to be afraid of...
I think it's a bit of an exaggeration and somewhat dramatic to say all NP programs suck. Many do, but some do have stringent admission criteria and give adequate preparation for a novice. I would like to see more science based education and less "fluff". I also think clinical hours should be increased and schools should have relationships with preceptors that have been vetted carefully. I was fortunate in that I had a few very reputable brick and mortar programs to choose from in my area. I researched them, visited the schools, and felt informed to make the best decision for me. The program I chose accepted less than 10% of applicants. I did not even consider applying to any for profit schools. I knew that a lot of my learning would be up to me, and would not take place in the classroom, and i was prepared to work hard so I wouldn't suck.
It's also my opinion that many NP students (and probably many professionals in other fields) expect to graduate knowing more than they do. Maybe some of that is due to inadequate training, but much of it is due to the fact that we are all beginners or novices when we graduate, regardless of how smart we are or how much experience we've had in nursing or other fields. I'd love to see paid residencies for all NP graduates. It would be so beneficial to have a year with a mentor and would go a long way in increasing the competence and confidence of a new grad.
So NPman, I'm glad you are asking how not to suck. It's encouraging that you have a realistic view of your training and that you know you still have a lot to learn once you graduate.
Gee thanks because there aren't already enough new grads with no nursing experience let alone any psych experience just dying to diagnose someone's poor child with Bipolar disorder and start Lithium.
I disagree that there are a shortage of programs or they are difficult to get into. In fact I know of two online programs with rolling admissions and virtually no admissions criteria. Rumor is one even said if you can't meet the gpa requirement they will admit on a a provisionary basis. It appears there are approximately 100 programs listed here and if each only accepts 25 students a year that is 2,500 new providers a year so not so rare and in a few years the market will likely be saturated with wages tanking.
Psychiatric-Mental Health Nursing Graduate Programs by State - American Psychiatric Nurses Association
I've actually considered adding another post-MSN cert as a PMHNP to my credentials as more and more of my "medical" pts need psych help and the wait list is one YEAR!!!
I think that sort of situation calls for direct frank discussion with the patient with two clinicians present, preferably with everyone seated so no one looks extra intimidating. Of course be sure the test is correct. If it was just a "dipstick" test, get a real one using gas chromatography, then start the conversation with virtually certain confidence the test results are correct.
Talk with her with a strong bias toward discovering a mental health problem that she is treating with the benzodiazepines. She might be using the benzodiazepines to relieve anxiety, and she might have been using the hydrocodone for the same reason. Maybe the benzodiazepines are just to fill in after she runs out of hydrocodone each month.
Have a referral ready for a mental health evaluation from either a psychiatrist or psychiatric NP, and offer to continue pain treatment while that referral is being planned, but insist on bi-weekly urinalysis and pill counts - she shows up, or she gets no Rx.
Drug abusers have a horrible problem, and I think we have a moral and clear ethical duty to help without just throwing them out. If this is her first time "caught" abusing two drugs (using benzo's and NOT using hydrocodone is TWO abuses in my opinion), then be frank but supportive. Include early in the discussion that you intend to keep treating her, and if she has a pain condition, even assure her you intend to keep using the hydrocodone with special arrangements to make sure she uses it correctly.
Unless you also are a lawyer, do not give her legal advice per se, but DO remind her that selling or sharing hydrocodone is a serious crime, and so is acquiring benzodiazepines without a Rx. Make it clear you intend to help her, and actually plan to do so. In all that you do and say to her, be genuinely biased toward helping her and not just getting rid of her.
Consider exotic scenarios, but those usually are not what's happening. Of course, be open to the possibility that she is being abused and forced to hand over the hydrocodone to someone. Benzodiazepines sure would make a person more cooperative with an abuser, so maybe the benzo's are being forced on her. That sort of thing certainly does happen. You might even want to start the next assessment with a focus on whether she is safe or being abused by anyone. If she is, that will sure affect how the interview continues.
So...you’ve decided to advance your education and obtain a masters degree in nursing (MSN) or a terminal doctoral degree. Which route will you travel? What is your ultimate goal? Where do you see your nursing career in 5 years, 10 years, 20 years? AN has a robust Advanced Practice Forum.
In this article we will explore the four options for advanced practice careers.
According the American Association of Nurse Practitioners, NPs are:
“...clinicians that blend clinical expertise in diagnosing and treating health conditions with an added emphasis on disease prevention and health management, NPs bring a comprehensive perspective to health care.”
NPs fulfill many roles both in the hospital, in private practices, nursing homes, correctional institutions, home care and in management positions. NPs are sought after for their clinical expertise and ability to provide cost-effective medical care in our ever-changing world of nursing. They perform their duties professionally and compassionately. Outcomes from NP care are economical and have been proven to be on par with professional medical standards. Today, many NPs function as the primary gate keeper to US medical care. Many patients have an NP as a primary care provider.
I did say it has a long half life. Small does for a few days isn't going to hook the person and for those who need 24/7 pain management it's a God send. I think the government (who are the ones making all these ridiculous laws governing people with chronic pain) would look at it a little differently when approached with the methadone idea.
Weaning off of methadone is like weaning off of any narcotic; easy does it...with methadone it takes a little bit longer.
I would rather the short term tooth pulls, sprains, etc... be treated short term with small doses of methadone then be given Vicodin/Percocet that would put them in the sky if they are opioid naïve. That's where a majority of addiction with young people starts IMO. If there was no high, I believe not only would it save the person from knowing the so called ecstasy of escape (I've heard comments like, makes my tummy all warm, I love that feeling it gives me; from young and old), but the healing process could be more focused on.
Also, couldn't agree more with increasing doses of methadone to find the right dose. Most careful...in long term, chronic pain patients.
Either way, if you get hooked/dependent (from your own fault or having to stay on the meds for a long time) you have to give something to pay the piper. I believe the average half life of methadone is 26 to 32 hours depending on the person. Can also be shorter or longer for same reason. All weaning off of any controlled substance II should be monitored and controlled with other meds for comfort measures and safety.
As with anything, education is key.
Actually, if this goes on unchecked, this could come back to bite the OP regardless of whether he/she utilizes quizlet or not. If the classes ahead of the OP are using quizlet and a large portion of those classes are failing their NCLEX, that could call the school's accreditation into question. And if the school losing their accreditation before the OP graduates, that could create significant problems for him/her when trying to obtain licensure and a job.
How does abuse happen? 15-year-old went to ER for a sore throat (not strep, brought me the ER papers.) Came to me as a provider for a refill of his Vicodin the ER gave him a Rx for to manage a SORE THROAT!! What happened to warm salt water gargles and acetaminophen? Needless to say he did NOT get more Vicodin from me!
The benzo positive is concerning but not my "problem"; sure it is something to talk about.
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