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Barnstormin' PMHNP 9,212 Views

Joined Mar 8, '12. Posts: 355 (65% Liked) Likes: 975

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  • Dec 4

    Quote from chare
    And who exactly is it that is "shaming" you?
    Nursing schools (and some on this forum) are full of the following silly attitude: you couldn't possibly know what you want until after you are experienced, and you can't be experienced without a year of med-surg, so shut up about your desires and go work med-surg for a year minimum. (As if med surg wasn't its own specialty, it is)

    And I think that attitude is bludgeoned into some NS. A better message students is: "keep an open mind and be willing to switch tracks."

    One can learn a little about a poster in a single thread, but OP is clear and I like OP's determination. I'd want that determination in a NNP.

  • Dec 4

    No one on this internet site (or any other) is "real" enough to me to cause me any distress. I'm human and can get irritated just like anyone else, but I don't ever feel bullied in situations where I can simply log off.

  • Nov 29

    Be sure to check the hiring situation for NPs with no experience. In my neck of the woods, it's not very good. Experience as a counselor is not relevant to the medical skill set needed to safely and effectively manage medications.

  • Nov 29

    I have no legal background so this is just my opinion but I'm not sure why you feel they are still your patients or the practice has a legal obligation to send them your way. What would you like the BON to do? My understanding is that they are not your patients they are your former practice's patients and although its amazing that you have moved on and are running your own practice don't expect them to fill your docket. Your patients who are interested in continuing care with you will will find you and better to let them come to their own conclusion about the helpfulness or not of the previous practice in that process. Sounds like you should also make sure you are listed on google.

  • Nov 26

    I think 5 years of quality nursing experience is more than enough. I can't speak for other specialties, but nursing experience for the NICU is a must and (thankfully) virtually all schools recognize this and require a few years experience. I had 6 prior to becoming a NNP working at a tertiary center on a unit that promoted strong nurses. It made me a much better clinician coming out of the gate and the role transition wasn't as difficult as I thought it would be (ironically my anecdotal experience has been that NICU nurses who have 15+ years experience have a harder time transitioning to a provider way of thinking).

  • Nov 26

    @jules - surprised you said this. Saddened too. Many of my family members have NPs/PAs as their PCP. I provide (now thanks to CMS) primary care to dialysis pts. Many preferred me over the doc as they say I "talk their language." I have to say that the physicians in my practice are excellent and provide great care. However, as we all get pushed to do more and more in less time, I foresee a time when NPs will be just as stressed as MDs. I worked 15 hours yesterday and 12 hours today and unfortunately this is becoming the norm..

  • Nov 26

    Jules - I've been an APRN for over 10 1/2 years. I had 14 years total nursing experience before that; 12 as an RN and 2 as an LPN. (Nursing is a second career, military was the first and not in nursing)

    Our practice does have 8 APRNs now where we had 4 when I got hired. Our APRNs (who I have a hand in employing) are first rate. We range in age from 26 to 62, get along very well, work as a team and generally get the job done very well. We are valued in our practice and frequently thanked. (I got two Thanksgiving texts from the two docs I work with most often thanking me for all I do to care for our patients and for working so hard).

    Our younger APRNs do have other goals: starting a family, several have kids at home, two are childless, two of us have adult kids. Yet, we all get along well.

    All of us have similar work ethics and as we all work independently of each other, we are only in contact via phone/text.

    Maybe its the environment you are working in?

  • Nov 21

    I couldn't do the questions on my phone and drink my cocoa.

    I'm of a mindset that some elements of life suck and there's just no fixing that. I don't think "support" is necessarily warranted. I

  • Nov 21

    Although its too long to hold my attention, the questions aren't bad. I was anticipating a female driven, whiney expectation that our workplaces be nurturing. The short version is I find being a NP far more stressful than I ever could have imagined but I absolutely love it and don't really expect support. What I have found most valuable is the work relationships, many I consider friends who I get together with regularly, that I have fostered over my nursing career with all disciplines. My best jobs have been the result of inside contacts.

  • Nov 21

    You'll have to be more specific with what the role entails. As a PMHNP, are you going to be doing neuropsychological evaluations and recommending psychotropic medications? Then, that's within your scope regardless of whether this is in an ICU or not.

    You mentioned that the fellows in your Neurotrauma ICU have Neurology and Psychiatry backgrounds. You'll have to be more specific about what fellowships these guys are under. I've never come across a Neurocritical Care fellowship that admits fellows from a Psychiatry residency. Most programs do admit applicants from broad medicine backgrounds (IM, Neurology, Anesthesiology) but never Psychiatry. The neurointensivist role requires broad knowledge of critical care concepts of sedation, mechanical ventilation, hemodynamics, line placements, etc that a Psychiatry residency graduate would not transition well into.

    BON's are typically not specific about what roles various kinds of NP's can do. There are some that are starting to delineate the differences, however, so you'll have to check with your state. In the absence of BON regulation, the default is national standards. I've sat in an ACNP national task force to define the ACNP role and the push is for NP's who train in acute care perform acute care roles. Experience as an RN in acute or critical care is not a substitute for the appropriate NP training. That's at least what the national certifying body is pushing for.

    There are legal repercussions of practicing outside the scope based on state and national standards.

  • Nov 6

    Run, run, run, run!! Why do nurses and NP's feel they have to put up with this? You are not receiving the respect that is due you. Don't tolerate it. I am lucky because I am in a position where the physicians who I work with respect me and often protect me from others who do not. Yes, it is not good practice to leave before 6 months have gone by. So you need to do some reflection and decide if you can stick it out. Don't sacrifice your mental health for this. There are other jobs out there! Do some research and find a place where you will be valued and treated well. You don't have to put up with anything less. By the way it starts with the orientation, if you get an unorganized mess of an orientation, that is a big red flag that you are in the wrong place. Don't sell yourself short, there is a good job out there waiting for you!

  • Oct 25

    There is a turf war. No doubt about it. Look what happened in Ohio when NP's lobbied for independent practice last year. The AMA threw up their heads and howled. Here's the fact: I am not a doctor. I am an NP. Are there things that are beyond me. Of course. We are not asking to be doctors. We are asking for independent practice as Nurse Practitioners. We are not trying to take over medicine or push them out of the picture. We will always need doctors and their expertise. Many of them resent NPs. Many of them do not.

    As NP's we practice medicine. I do not practice nursing. I medically manage patients and treat them medically. The more 'holistic' part is in the way I approach the patient. As a nurse, I was taught to make a partnership with the patient and for mutually acceptable goals. I bring that over with me in practicing as an NP. I have noticed that physicians approach patients from a more paternalistic view. They want to dictate the patients treatment and expect them to just follow it. I will explore how the patient feels about the treatment and look into any barriers like: lack of money, social issues, family issues. Do you see the difference in my practice? It is a strange hybrid of a nurses demeanor and love of caring and a physicians practice of medicine. Frankly, it makes for better care and is much more patient-centered.

    Having said all of this, you want to keep one thing in mind. Be very careful where you accept a job as an NP. In the ER where I work, NP's are loved and esteemed. The physicians I work with are an incredible group. They treat me as their colleague and afford me the respect of a provider. God help you if you come down to this unit and yell at me or treat me in a less than respectful manner. They will be all over you so fast, you won't know what hit you. They even ask my opinion about treatments and EKG's all of the time. I am very, very lucky. In this same hospital there are NP's who are treated like nothing more than scribes. I asked around, sniffed around and did a lot of research before taking this job. Make sure you are going to work with doctors who will respect you and let you practice at the top of your license.

  • Oct 24

    It is entirely inappropriate to be managed by "nurse managers". Just because the same board licenses us in many states does not mean that an RN is qualified to supervise or manage us. The argument of being accountable to the BON does not make management by an RN appropriate. If I was called to the BON and asked why I rx'd a particular med would an answer of "my manager, she's an RN and she told me to" me acceptable? It would be 10x worse if the same answer was given to a jury or malpractice attorney. Now if I looked at my note and see that I consulted with Dr X who is my manager, and said that I rx'd something, how does it sound? See the difference?

    Many states have a law prohibiting the "corporate practice of medicine". Essentially it requires a physician to own a clinic. As an RN you couldn't go out and open a clinic and just hire a Dr to work there. This is because you do not have the privileges to diagnose and treat, nor would the entity you created to open your clinic and thus you do not have the knowledge base to supervise a provider.

    Period. End of story.

    This argument is similar to what I have with my toddlers. I have the knowledge and do not need to argue the fact. Accept it and deal with it. An RN is not qualified to manage or supervise NP's, PA's, MD's or DO's. State laws in half of states have established this and it is punishable by incarceration in some cases.

  • Oct 24

    Quote from Susie2310
    No hostility; I am concerned about the standard of care. We have two classes of health care. Some patients receive their care from physicians with many years of education and training, and some receive their care from NP's, with a small fraction of the education and training of a physician.
    Because the outcomes are definitely better for physicians! Am I right? Awesome!

    Clearly, whether you want to admit it here or not, you have some tremendous bias. I have yet to see you post any data though, why is that?

  • Oct 24

    Quote from Susie2310
    A NP is still a nurse, correct? Where is your scope of practice specified, and where are the rules and regulations regarding your practice? Are they not on your state board of nursing web site? You sound very defensive. Remember that different states have different laws regarding NP practice.
    I'm indeed defensive of our position as NPs. You as a RN do not understand our scope. You're not qualified to supervise me. No RN is. The board of nursing and word "nurse" are irrelevant here. We have an added credential that we work with, and that's why we are NPs and you or any other RN without that credential cannot dictate our practice. Say you worked for me, which is possible, I could supervise you because my scope involves directing your actions and ordering your practice. If I hired a LPN to supervise you, you'd have a tantrum.


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