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lhflanurseNP, MSN, NP 11,072 Views

Joined Jan 6, '13. Posts: 637 (41% Liked) Likes: 508

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  • Jan 23

    newbie blues....I have struggled with those....the good thing with those federally funded places is that they can schedule 30 and usually a good chunk of those are no shows which thins out the day a bit.

    You have a friend who works there so that seems like your best option to talk things out with and vent.

    I did a good chunk of clinicals in a federally funded clinic and was reminded not to cure all their problems, but to focus on why they are there for the visit. You do not have time to solve everything in a 15 minute visit. We would reschedule and cover something else. If you did not you fall behind.....

  • Jan 17

    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.

  • Jan 17

    One of my (dearly beloved) instructors as a student made the comment, when someone expressed concern over feeling like she wouldn't know everything she needed to be a staff nurse, "You definitely won't. You will know enough to be educable when you begin, and you will learn the rest in your specialty."

    I actually took some comfort in this, and over the years I've realized how true it is, and how it's not only true of new grads- few if any nurses, even those with years of experience, know enough to thrive in every specialty without additional training and education, even if it's informal and on the job. Nursing school and licensure is there to ensure you have a base of universal knowledge- anatomy, physiology, pharmacology, pathophysiology, and nursing theory, along with a few basic tasks- things that will mean you aren't totally at loose ends when you're handed to a preceptor- you will understand their rationales as they teach you, you will be able to comprehend the whys behind the whats and hows of policies and procedures. Everything else will be- almost must be- picked up as you go.

    Pay attention, look things up, ask questions, don't be afraid to admit when something is new or confusing to you, and you'll be fine.

  • Jan 17

    The best advice I can give is despite how you are treated or feel you are being treated by your preceptor, ask for help. No question is a dumb question when you don't fully know what you are doing.

  • Jan 17

    Thank you Ihflanurse!!!!

  • Jan 16

    Get it as soon as you can.

  • Jan 16

    OP- please, please, please change your username if it is your real/full name!! These boards are public and searchable. There is a reason they are anonymous. You don't want future employers doing a Google search and coming across this thread

  • Jan 16

    Quote from looking for work
    Hello Johnathan. I have been an RN for many years and have experienced many negatives, such as you have. First, since being a nurse, I worked in hospitals, nursing homes, a jail, rehabs, surgical facilities, a doctors office and homecare. Do not fall for the story they gave you about why you were let go. The real reason is for money, and the desire to constantly have a turnover in staff so no one ever accumulates benefits and time off. The nursing field is over saturated, and there is always someone who will work for less money. Doctors are some of the greediest creatures alive. Its all about their pockets and their bank accounts. They are constantly downsizing and looking to cut corners and save $$$$ without any regard for the employee at all. I have seen this time and again.What really bothers me the most is that instead of just telling the truth and admitting that they are greedy, they tell you a tall tale, ruin your confidence and create drama for no reason at all. At one job, I was working full time, and they were bleeding me of every ounce of energy that I had in my body. Naturally, I was worn down, caught a virus that had me running to the bathroom every 10 minutes, so I had no choice but to use my sick days. When I returned, I was told that I already used up my sick day allottment, and that was considered excessive, because it was only the beginning of the year. While they were crapping all over me and making me feel lazy and worthless, they were simulatanleously hiring two part time LPNs to replace me at a cheaper rate without benefits. Then they let me go. I tried to use my health benefits before they got cancelled, but found out at the doctors office that I was never even enrolled in the healthplan. I had an insurance card because they signed me up, and cancelled the policy the same day, so I would think that I had benefits. As I said before, you will soon learn what greedy bastards exist in the medical field. Never let them shatter your confidence, no matter how hard they try to. It is all based on sheer greed and beefing up their own pockets.
    Ummmmm, OP, I think it is in your best interests to kind of just move on past that post.

    I think it's awesome that you're showing some introspection and understanding of why you were let go. Don't let anyone tell you that a Dr's office is "easy" work or that you won't learn anything in that setting. You now know that's definitely not the case in some offices. My own personal opinion is that MD offices are not hiring appropriately-educated individuals any more and then are expecting too much of them. For instance, most surgeon offices I know refuse to hire nurses and expect their Medical Assistants to perform adequate intake information and health histories. Then the MA takes the blame when the patient's surgery is cancelled due to lack of pre-op preparation.

    At any rate, since you plan to continue your education, now would be a good time to do that if you can. Your RN resume would reflect leaving the allergy position when you started RN school.

  • Jan 4

    Writing "SEPARATE NOTES ON EVERY HEADING OF THE CARE PLAN, in ADDITION to the admission notes" the preceptor's style.
    You are an experienced nurse, but you ARE under the direction of your preceptor.
    Let it go. This is not the time to complain about the little stuff.
    Just ..get..

  • Jan 2

    Quote from casias12
    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.
    Then why go to NP school? Just sit for the exam and be done with it if you already know what to do? I'm being facetious of course, but that just seems a bit over the top. Anyone who thinks they already know what to do before going into a NP school is setting themselves up to be a dangerous provider.

  • Dec 30 '16

    Before you consider anything, shadow some local NPs and ask them about the local hiring practices. There are a few established and well-respected brick and mortar NP programs in NC and you may have a difficult time securing a good job if you don't have the right program and network.

    There are very few quality online NP programs and they all require site visits. Look into Georgetown and Simmons programs.

  • Dec 30 '16

    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...

  • Dec 30 '16

    Quote from NPman
    Thank you all for your comments. I am especially proud to have Jules comment. Let me clarify, I am in no way saying that I am capable or able to practice. I see so many threads of people saying how unprepared and incapable many NP's they come across are. My school is decent but I do find it lacking in the necessary skills needed. I am looking for good habits now so that someday I can be a better practitioner. I want to do primary care in the future. Please, nobody take this as prideful.....I am more concerned for my future patients.
    At the end of your program and following your board certification you should be prepared to competently and safely practice as a novice provider. It is vitally important that every provider understand their own limitations, can identify what is within them and what is not, and direct patients to an appropriate source of care should that be required. This is true of physicians, nurses, PAs, podiatrists, dentists, etc.

    I hope you have found a mentor or two; mentorship is underutilized in nursing and it can be the difference between your ultimate success or failure in the quality of your work or the quality of your life as a provider.

    Remember, skills can be taught to anyone at any time: it takes little medical knowedge to run an interrupted suture or perform an I&D, they are simply technical skills. It is the knowledge behind them that is important: what to suture and when to do it, what to open up in the clinic and what to refer, how to manage a complication, etc.

  • Dec 29 '16

    The sharpest and most competent NP I know just turned 80. She obtained 2 PhDs in her 40s, teaches full time, and moonlights a few weekends/evenings a month. She has more energy and smarts than pretty much anyone I know. Age is just a number....

  • Dec 29 '16

    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.