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sirI, MSN, APRN, NP Admin 74,358 Views

Joined Jun 24, '05. Posts: 100,626 (17% Liked) Likes: 26,261

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  • Jul 20

    Whichonespink: Thank you for taking my post in a positive way. Reading it again, it sounds a little harsh -- and I didn't mean to be harsh.

    I've met lots of people who view advanced education as an escape from a job they don't like -- and who jump into a big grad school commitment without doing enough research and reflection first. As you seem to now recognize, you need to do some good career planning first, before you will be ready to invest in a graduate education.

    I made similar mistakes -- twice in fact. When I first entered grad school to get my MSN, I chose the wrong major. I majored in Nursing Administration and minored in my clinical specialty because I thought that was the best way "up the ladder." Once in graduate school, I realized that Administration was not for me (had never done it before) and I started seeing all of the other roles that were possible with an MSN with a clinical focus. So I flip-flopped my major and minor and opened up a broader range of possibilities.

    Later, with my PhD degree, my dissertation topic wasn't well-chosen. It fit me at the time, but it didn't lead me to jobs. So after graduation, I had to take a step back and figure out another career path for myself. My dissertation related to Informatics (a hot, new field at the time) and as I saw many problems with what was happening in the field at the time, my dissertation was not "politically correct" with the Nursing Informatics faculty at my school. So it went nowhere ... and I went back to the drawing board to reconsider my career options. I ended up in Nursing Professional Development -- with a good 9-5 day job that is fairly low stress and pays OK -- and am reasonably satisfied.

    People say it all the time - and only some people believe it -- but it is true: there are lots of different options in nursing. Don't just look at the "standard" options that seem readily apparent. Get to know people, network, find out what different people do for a living. Identify you high priority needs and be open-minded about what types of jobs might meet those needs.

    Good luck to you.

  • Jul 19
  • Jul 13

    Although I thoroughly enjoyed my years working as a floor nurse I have zero regrets since becoming a NP. My experience has been excellent with regard to my treatment, compensation and being welcomed into the fold by my physician colleagues. The politics as a RN were far more precarious than anything now as a NP because I'm sheltered by being a member of the medical staff. It is harder than I could have ever imagined but I'm making over twice what I made as a RN and I love the autonomy.

  • Jul 12

    There are a lot more politics when it comes to being a provider than I would've thought. As a RN, you know your duties and do what you are assigned for 12 hours then go home. I had a bad experience with primary care for my first job. I was left alone in a practice as a new grad and was sold a dream which was not fulfilled. The office had been sold by my supervising MD to a "pain" clinic doc who only was out for the bottom line. Needless to say when the owning doc realized the practice wasn't a cash cow, he closed shop. My friend just lost her job this year in the same situation. She basically ran the practice for 2 years with little training as the doc said her preceptorship was enough and didn't give her any training time. She flourished but unfortunately the practice was a rural town with mostly Medicaid/medicare patients. She went to work one day and was told with the rest of the staff at the staff meeting that the office was closing!!! My current position is with the state. I treat HIV infected inmates and after about 6 months, the challenge was gone. Specializing in just a specific disease is very non-challenging after you learn the medication guidelines. My biggest challenge some days is just arguing with non-compliant inmates who refuse to take medications for various reason (usually manipulation to get what they want). I have posted in here about my issues with the job now that they want me to take over a new Hepatitis C clinic for no reimbursement. Unfortunately some people (administrators included) cannot get over the "nurse" in NP and think they can delegate new duties as if they are not making money off your care. At this point, I am not necessarily over NP...but I would love to return to the hospital settings. I am looking at jobs in the ER or even working as a hospitalist. I like working at an hourly wage and having the opportunity to make more money by picking up extra shifts. I really wish I had jumped aboard the new group which took over my hospital's ER. They paid $85/hr and only required 10 shifts per month to be full time. If Monday-Friday jobs interest you then go for it, but really negotiate your salary. Overtime is not paid to "exempt" employees and I know several NPs putting in 50+ hours per week. One NP who works in an outpatient practice said he was immediately reprimanded for leaving early one day after his clinic was over. He says he definitely puts in more than 40 hours per week but was told he needed to put in PTO time if he leaves early.

  • Jul 12

    I'm definitely in the minority here on AN but yes, I regret it every single day. I was in ER RN in a level one trauma center and loved loved loved the chaos, never knowing what would come thru the door, having to be on top of my game at all times.

    I've been an APN for 10 years now and although the money is good, the hours are pretty good, I'm not as challenged as I was and really have to work to stay up on knowledge....

  • Jul 12

    Quote from traumaRUs
    and really have to work to stay up on knowledge....
    A bit of a hijack but what a great point and exactly why I intend to retire in my early 60s. Its difficult to stay current and so sad to see older prescribers of all disciplines who aren't able to remain on top of things.

  • Jul 12

    You need to be very conscious about burnout especially in your first few years of practice. The role is stressful and involves a lot of hours and responsibility but it's also very rewarding.

  • Jul 12

    Quote from anchorRN
    Thanks everyone for the feedback. I know I'll probably miss the fast pace of the ICU but I think this is the right direction for me
    Primary care has a different type of fast pace and a different set of challenges. You'll stay plenty busy

  • Jul 12

    I work in-patient ICU (NICU) and don't regret leaving bedside for one second.

    The best part of the job was talking to parents & feeding babies- both of which I still get to do, although the former is something I do on a daily basis and latter whenever I have extra time on my hands.

  • Jul 12

    I don't miss the physical side of bedside nursing (ie lifting, foleys, obtaining stool samples etc) but being a RN has different burden of responsibility which personally is easier to bear with experience.

    also like a previous post said, the level of office politics as a provider is different.

  • Jul 4

    Multiple posts deleted due to language (quoted deleted post). Thanks to the OP for sharing this inspirational piece.

  • Jul 4

    Please don't contact me, I am not in the consultant biz. I'm happy to answer questions here on this forum.

  • Jun 28

    Hopefully the admins will move this to the nursing school forum (rather than school nurse) for more replies. I will say that HESI is all about practice, practice, practice. That's how I survived when I had to do HESI.. I actually did much better on my HESIs than I did regular exams. .

  • Jun 26

    Read about Amber's day and see if you agree with what she did.

    ED Holding

    ED Holding was created as a holding area for patients who have admission orders and are waiting for a bed to open up. They are moved out of ED Main to help with patient throughput. While in ED Holding, which is a kind of limbo, patients receive all their meds, admission assessments, etc. It’s like being a patient on the floor but in a temporary location.

    The problem is that while it does help alleviate the congestion in ED Main, it also delays the bottleneck. Just as ED Main patients are waiting for a bed in ED Holding, ED Holding patients are waiting for a bed upstairs.

    ED Holding has 14 beds with curtains in between the tiny spaces, and one bathroom down the hall. Everything is in close proximity, and feels crowded and miniature, like in a small airplane.

    Some days in ED Holding are manageable, even routine. Some days are chaotic and crazy.

    A Crazy Day

    This particular day, all 14 beds were full. The secretary had called off sick, and there were 3 nurses to run the unit- Amber, Sarah, and Tiffany. Amber was charge, Sarah was experienced, and Tiffany was a new grad just off orientation.

    It was 1100 but 0900 meds were not yet passed because Pharmacy missed stocking the Pyxis every time Steve was off. The other pharmacists had not yet hard wired the fact that ED Holding should be on their radar, because it wasn’t open every day.

    An elderly woman in Bed 2, kept screaming “Someone help me! HELP ME!! I’m being tortured!” The intermittent screaming punctuated by periods of silence set everyone’s teeth on edge. Staff alternated between trying to placate her and trying to ignore her.

    A feverish, fretful baby wailed and sniffled loudly but wasn’t allowed to nurse because he was NPO. His mother looked on the verge of crying herself.

    Next to the baby on the other side of the curtain was a man with a moist, gurgling cough the sound of which brought visions of copious, thick sputum being expectorated into a cup.

    Amber’s phone in her pocket rang.

    “This is Tara in ED Main, we have a patient for you.”

    We’re full, I have 14 patients already. I have 2 nurses and no secretary today.”

    “Well, we can’t close our doors, you know. You’ll have to put them in the hall. We do it all the time.”

    <sigh> “OK, give me report”

    “It’s a COPD, I don’t know much, I’m covering for Don who’s taking a patient to Cath Lab.”

    “Who’s the doctor?”

    “Uh...not sure. You can look it up, alrite. We’re slammed.”

    Within two minutes the patient was being pushed on a guerney to a spot by the nurses station in the hall. He was accompanied by three weary looking family members clutching his belongings. The group took up the narrow hallway and kept dancing around and bumping into each other to try and stay out of everyone’s way.

    Amber’s phone rang again. This time it was the Supervisor.

    “Amber, we have a bed on 3W for your patient in Bed 4 so I OKed you getting another patient from ED Main, it’s a pleural effusion and you’ll need to get ready to put in a chest tube. Tara will call you in a minute, thanks, bye”

    Amber flagged Sarah.

    You need to call report on Bed 4 and get the bed clean stat even if you have to do it yourself- I think Housekeeping’s at lunch. I’ll help you.”

    “Ok, but the blood just got sent over for the patient in Bed 6 and I have to get it up. I haven’t seen the patient in the hall yet.”

    Well, maybe Tiffany can help you ….” Amber looked over at Tiffany. With complete tunnel vision, Tiffany was slowly and deliberately doing an assessment on her patient. She had started 15 minutes ago. “Never mind.”

    Amber’s phone rang again. It was Tara.

    “I have report on the pleural effusion”

    Amber drew a breath and put her hand to her forehead.

    “No. Wait. Stop. I am calling a 10 minute Time-Out. No patients, no report, nothing. We need to re-group.”

    Stunned, Tara did not reply but heard Amber discontinue the call.

    Amber stuck to her guns and used the next 10 minutes to literally count patient heads and review which nurse had which patients. Together, they figured out where the next 2 patients would go, and who would care for them. After 10 minutes, they resumed and got through the shift.

    Amber texted her manager to let him know what she had done as it was not just unorthodox, it was unheard of. She knew she could be in trouble. Her manager responded in a long text which included “all parties have to work together to resolve patient flow issues using approved forms of communication”.

    Word got around fast and before the day was over, Amber heard through the grapevine that some of the ED Main nurses thought she “couldn’t handle the pressure like the other shift leaders”. Other nurses applauded her for what she did.

    What do you think of Amber’s actions? If you had been on duty that day, would you stand with her or criticize her? Or do you think it's surprising that this is even an issue?

  • Jun 16