Considering career as NP

Advanced Practice Columnist / Guide · May 3, 2011

There is one available for consults.
I am referring to the place where I used to work as a RN. I do not work there now, and never did in the capacity of NP.

See that's not unusual at all. There is an intensivist available as a consultant. What you are telling me is basically a difference in ICU models of care where some ICU's are open (primary team still managing their pateints with intensivist on consult) vs some that are closed (intensivist becomes primary team when patient is admitted to the ICU). I've worked in both models and though studies show that there are no difference in outcomes between open and closed ICU's, there are definitely advantages and disadvantages in both models but these are basically dependent on the point of view of which provider you ask (intensivist vs primary care physician). There is an intensivist shortage in the US but in my opinion, the jack of all trades ER to ICU self-management by a provider is mainly seen in small rural hospitals.

linearthinker, DNP, RN · May 3, 2011

I'm sorry Juan, I'm confused. I wasn't trying to tell you anything about ICU models. ??? I was replying to someone else that not every HCP hands off their patients to someone else by virture of ICU admission, that's all.

Where I worked (certainly qualifies as small, probably rural too depending on your definition), the hospital would not credential NPs or PAs for inpatient stuff at all, just their policy. However, what commonly happened is that they saw their own patient(s) and then their collaborating doc would just co-sign stuff. Not the letter of the law by any means, but that is what happened.

There was an intensivist that worked for the system at the "mothership" location across town and we occasionally faxed stuff to him for the PCPs. They would talk and the PCP either accepted or declined his advice, but I'd have no way of knowing since my interaction with the intensivist service was limited to the fax machine, lol. He didn't come see the patients or write orders. We kept very very sick people that I think might have been better off in a University hospital setting, but our medical staff was pretty stubborn and loathe to admit they needed help. Especially the surgeons -shocker.

I didn't mean to tell you something about your own practice, lol. I apologize if it sounded that way.

Advanced Practice Columnist / Guide · May 4, 2011

I'm sorry Juan, I'm confused. I wasn't trying to tell you anything about ICU models. ??? I was replying to someone else that not every HCP hands off their patients to someone else by virture of ICU admission, that's all.

Sorry to confuse you. My post wasn't meant to start an argument. It was a general statement not meant for a single person in particular but to start a discussion on the issue. I did go on a tangent and inadvertently made it look as if I was responding to a claim you made but my intention was purely meant to state my point that specialization is the trend in the realm of physician practice and should be the case with other providers who are involved in the same kind of patient management physicians do. While I can appreciate the fact that the general practitioner who does practically everything is still the name of the game in remote areas of the country, I feel that physicians have largely shifted away from this practice and so should we NP's. I just wish that we would use what available structure we already have in our current NP models of training and go from there.

linearthinker, DNP, RN · May 5, 2011

Oh, I see. The limitations of internet communication rear their ugly head, lol. No worries.

LovePurple · May 12, 2011

Hey all! I'm an RN currently working in specialized cardiac hospital on tele/step down unit. I've been an RN for almost 2 years now. I'm considering making a career move as an NP in the next couple of years before it changes over to a doctoral degree. I'm just having difficulty deciding what specialty to go with. I know for a fact I don't want family practice unless I deal with adults only, I have no interest in dealing with children at all and don't have any experience with it anyway. I have no experience working in ER or ICU, but these areas definitely appeal to me. I'm thinking of maybe going with the acute care program just because it seems like there would be several options. I don't know that I'd want to be a full blown ER NP, that just seems stressful, but an Urgent Care Center seems like it would be a good place to work. Basically I'm just wondering what your job options are for the different specialties, particularly the Adult NP vs Acute Care NP. I have no interest in women's care or peds.
I love working in an acute setting as an RN, but am not sure if I want to be the one calling the shots necessarily, so that's the only thing about working in the hospital setting as an NP that doesn't appeal to me. Maybe I just need to not be afraid and limit my abilities so much. So NP's just explain your different roles that you do and the specialty that you went with.

I'm in a similar position with work.. working on tele/stepdown unit for 3 years. Really seeing how burnt out you can get with the whole bedside nursing thing. I have my ADN and have a bachelors not in nursing. Thinking about competing my BSN next year (it'll take 3 semesters) and then possibly going straight through to FNP school. I'm definitely going to browse through the threads to see how everyone likes/dislikes being a NP vs a floor RN. Good luck to you all and keep me posted on how things are going for you all.

missvictoriat · Jun 3, 2011

OFF TOPIC......

I was beginning to think about my class schedule. Now, of course, I'm going part-time, so I will be only taking about 6 or 7 hours at MOST each semester. I've heard HORROR STORIES of taking Adv.Patho & Adv.Pharm at the same time or either of these with Adv. Assessment.

Would anyone RECOMMEND, which classes work best with each other and which to ABSOLUTELY AVOID taking together?

I was thinking of taking theory & adv.assessment (1st semester), then research & adv. patho (2nd semester), and Adv.Pharm & Adv.Nursing Role (3rd semester). What do you think?

carachel2 · Jun 4, 2011

For my core classes (this was at UTA though) I tried to take a theory or research class along with a core class. First semester was Advanced Patho and then Theory; second semester Research and Adv. Pharm and then Assessment with Research and Theory (UGH...over kill on the research and theory classes !).