Latest Comments by BostonFNP

BostonFNP Guide 41,338 Views

Joined Apr 4, '11 - from 'Northshore, MA'. BostonFNP is a Primary Care NP. Posts: 4,653 (61% Liked) Likes: 11,256

Sorted By Last Comment (Max 500)
  • 0

    Quote from gettingbsn2msn
    I would love to have a DNP , however, I own my own practice and see no value in doing free clinicals at someone else's practice.

    Plus I am 56 years old. Age wise, I love to learn new knowledge but not spend the $$ for the terminal degree.
    You shouldn't have to do clinical for MSN-DNP just FYI.

  • 1
    heron likes this.

    Quote from jdub6
    And this is why we should be cautious about prescribing narcotics in the first place.
    The key part of this, which differentiates from the original post/article, is are you personally prescribing the narcotic. If you aren't, then the rest is a moot point.

    Quote from jdub6
    ...because with people dependent on high doses (legal or not) it is often (though not always) literally impossible to safely provide a dose that will relieve their pain to the same degree that 4mg morphine will work for someone totally naive.
    Do you have some evidence that it is "impossible to safely provide a dose that will relieve pain"?

  • 1
    mw73 likes this.

    Quote from pappa22v
    It sounds like you made a wise decision. However, OP's statements for why they want the Direct route and motivations for FNP, sound off. nothing they have said instills the assurance tha they are doing this for the right reasons.
    What are the "right" reasons/motivations for wanting to by an APN?

  • 2

    Quote from mw73
    It seems that the majority of the comments indicate that nursing is a highly stressful career. Are any of the posters that have commented about this NPs in private practice?
    I believe some of the prior posters are NPs and others are student NPs or RNs.

    I am a private practice NP. Nursing is a stressful career. Nursing at the APN level is perhaps less physically stressful and more mentally stressful. You are responsible for the life of 1500-3000+ people in a job where one miss or one mistake could significantly impact the quality or quantity of life in any one of those people. Additionally, there is a significant amount of administrative red tape which is also stressful. As is just dealing with people at times

  • 2

    Quote from Sue Demonas
    The best foundation for a successful nurse practitioner career is to have strong bedside nursing experiences. Entry level nursing (ie bedside care) provides the foundational experiences and skills that are needed to build on for advanced nursing practice.
    Do you have a source on this that you can share with us?

  • 2
    ICUman and SopranoKris like this.

    Quote from SopranoKris
    Have you had students with acute care/critical care backgrounds who feel "bored" by family practice or clinical work? Would an urgent care setting be better than family practice? I'm an ICU nurse and I just love the ICU. However, I see how the night shift NPs get treated and it doesn't seem appealing to me to fill their shoes. (7 days on/7 days off, nights only, on-call during day, etc.) I'm just worried that transitioning to family practice might not seem as interesting as ICU. Do you feel it gets routine to see the same patients all the time?
    In the past several years I have had three seasoned nurses from high-acuity care MICU/SICU/Trauma and well as dozen+ more from telemetry/medical/surgical tertiary care.

    All of them had a new-found respect for primary care; granted I work with a complex adult medical patient panel. One of the three, a MICU nurse at a major tertiary academic hospital for more than 15 years, really struggled in the primary care and the provider role; her difficulty was that she could not step back and see the larger picture of the patient instead she was focused on trying to micro-manage each individual problem and she was not familiar with many primary care meds. The other two students did well, were able to take control of a patient and direct their care. One ended up in cardiology and does a mix of inpatient and outpatient. The other stayed in primary care and has done quite well.

    There is very little that is "routine" about my days in clinic. Having longevity with patients is something that I really love about my job. I don't find it boring at all; keep an open mind because you may find it is a lot of "fun and excitement" trying to manage complex patients outside of the hospital! The primary setting is no less challenging that the acute setting, it is just a different set of challenges.

  • 0

    Quote from wanna_be
    My question is, what are the job prospects for a DNP/FNP upon graduation? Would my previous experience appeal to employers in primary care, or would being a relatively new nurse prior to starting my APRN degree negate that? Since many of the clinics where I've worked have employed APRNs I assumed the job market was good, but in doing more research I see that there are few openings for mid-level providers and many requires 3-5 years experience.
    It sounds like you will have an excellent background for the transition into primary care. The experience you bring from having been both an MA and an RN in a primary setting will make things easier for you when it comes to your job search.

    Nationwide, NPs are still in demand, especially in the primary care setting. That being said it varies a tremendous amount locally, with your personal and professional network, and with your school/alum network. Job postings will often "require" 3-5 years of experience: it is more of a wish list and a potential bargaining chip than it is a true requirement. From your perspective, you have a significant amount of primary care experience, and while not in a provider role, you know the workflow and the pitfalls of clinic work.

    The best jobs are often never posted: they come from your networking and from your clinical rotations. You likely have a lot of contacts through your work history, make sure everyone knows that you are in a program. Often times clinic will know about an opening months or even a year in advance and they may be more than willing to hold a job for you if they think you are the right candidate. Additionally, many positions in small independent clinics are filled via provider networks (I have offices call me a few times a year asking if any of my good students are looking for work or if any colleagues are).

    Hope that helps, if you have follow-ups fire away. Best of luck.

  • 1
    VonnieC likes this.

    (At the suggestion of one of my clinic students based on this type of thread being popular on other forums.)

    I am a (relatively) experienced NP in adult internal medicine/primary care with a primarily older and complex medical panel. I also have worked for many years with NP and medical students both in the lecture hall and in clinical practice.

    Have questions about what primary care is like? What to expect as a clinical student? Ask away.

  • 7

    1. Are you glad you got your DNP? Why?

    I am glad I got it out of the way, it makes me more comfortable for whatever future lies ahead. The way I see it, it is never going to hurt me and may help me in some form or another down the road, either in practice or in academia.

    I also "just like" having a terminal degree. There is a feeling of completion there in a job where otherwise you can never stop learning.

    2. Are you glad you didn't get your DNP? Why?

    I wouldn't have done it if I had to pay for it.

    3. Does it really matter?! Why?

    It matters but not in many significant ways. It opens doors to academia. It prepares for the future. It engages practicing NPs in a number of different ways. I think it is good for the profession moving into independent practice from a purely superficial standpoint.

  • 0

    I know RNs that make more than 150k/year, but none of them do it without significant differentials and a significant amount of overtime.

    That being said, I will go back to the advice I always give: go to NP school because you want the role not because you want the money. There are much easier ways to make more money.

  • 2
    LibraSunCNM and Rocknurse like this.

    Quote from russianbear
    I have defended my position admirably. I'm shocked one of you finally acknowledged the existence of drug seekers. Now, will you be courageous enough to say that physicians should not order them narcotics for the sole reason of feeding their addiction?
    Again, your position seems to keep changing to more and more extreme examples in an attempt to justify a prejudice. I doing so you have missed the entire point of the thread, which is providing addicts with appropriate care, and most importantly, reflecting on how we as HCPs approach these patients.

    There is no point in this thread where anyone has said that addicts and seekers don't exist. There is no point in this thread where anyone, other than you, have suggested that HCPs blindly feed anyone's addiction.

  • 6

    Quote from russianbear
    I love the air of superiority in your posts. Like I said before, I'd love to work in your hospital where "seekers" do not exist.
    Save your ad hominems and discuss the topic, if you can't defend your position without personal attacks perhaps you are on the wrong side of the issue.

    Seekers exist. They get appropriate care (as thy are humans after all, sick humans) regardless of their addiction, at least when I am the one admitting them. Or I do my best at least/hope.

  • 5

    Quote from russianbear
    So if a person comes in with the sole purpose of satisfying a craving for opium, and we give them that, if it's not enabling, what is it? I think if you examine the concept of enabling, and codependency, you'll see that it is. If a cocaine addict comes in sans medical problem, should we give them a dose of pure Colombian?
    Self-reflective practice is a vital component to providing good care, at any level. Posts like this indicate a need for some serious self-reflection for all of us. Struggling to create a barely fathomable scenario to try and justify a reason for why it is "ok" to have a prejudiced approach should itself indicate there is a problem.

    If nothing else, hopefully this thread has engaged everyone reflecting on how we individually approach patients that have been labelled "seekers". As said before, I don't think anyone likes feeling manipulated, and drug addicts by the nature of the disease attempt to manipulate members of the health care team.

  • 3

    Quote from russianbear
    Again, I am trying to distinguish between people with medical issues versus those who do not.
    If you have the education, experience, facility privileges, and scope to determine that it's a different argument than not giving a post-op patient pain medication as the attending nurse because you personally feel the patient should get it (for whatever reason).

  • 7

    Quote from russianbear
    I'll give you an example. I can think of several patients who, the moment the attending sees their name puts in various orders for controlled substances before even knowing why the patient is there. So I ask you, just because it's John Doe, we automatically order Dilaudid and Percocet. What is the medical justification for that? Is that prudent?
    That's a really complex issue, why is John Doe being admitted and/or what is John Doe's history? To be honest, I don't know many providers that just order inappropriate narcotics, especially for those that are labeled as frequent flyers or seekers. I have a few patients that have addiction issues that I admit on a monthly basis or so and those are the ones I am the most stringent with, as I know their history. I would be very surprised if narcs were being ordered without some sort of medical justification. That is malpractice and unethical.

    Quote from russianbear
    That's how littl of a f*ck some people give about the problem we've caused.
    I see the ravages of the opioid-abuse crisis every day in clinic: it is one of the most difficult parts of my job. That being said, I still believe that all patients deserve to have access to a standard of care following major surgery. I also believe that the acute care setting is not the place to "cure" addiction.