ED NP Fellowship Blog - Albany Medical Center

Guest1144461 · Oct 5, 2021

I did a fellowship, was worth more than my program x10

mochi1190, DNP, APRN · Oct 14, 2021

Excited to hear about your journey. Recently accepted a fellowship position also and in the middle of credentialing/waiting for license. Congrats!

BenjaminV, ADN, BSN, DNP, RN, EMT-I, APRN, NP · Nov 7, 2021

***Crossposted from AAENP Sig "Student" Forums.

10/11/2021:

Okay everyone! First week! My time as a fellow actually started two weeks ago with a last minute invitation to an ED MD resident Webex regarding 'diversity, equity, and inclusion in healthcare', 'disability rights' w/ a staff attorney, 'sickle cell disease', and case scenarios. It was super interesting, and definitely fun to listen/observe the group dynamic of the ED residents. Last week the APP fellows were invited to the ED Resident journal club, the articles all involved pharmaceutical treatment of agitation in the ED and covered haldol, droperidol, olanzipine, ziprasidone midazolam, and lorazepam. The APP fellows (including me) sort of just listened in on the Webex, as a lot of the practice changing (or not changing) knowledge was regarding the specific psych populations encountered in the AMC ED. Being that we haven't physically started yet, we had little to offer. However it was extremely interesting listening to the attendings discuss their experience with droperidol, as I "came up" as providers were looking to other medications to manage patients due both (at different times) a black box warning and national shortage. Most of my knowledge of droperidol came second hand through stories from my medic friends. Hospital virtual orientation today and tomorrow (benefits, disaster preparedness, hand hygiene, etc). ATLS course in two weeks, (they provided the book about 1 month ago).

We received our schedule and will be on the floor this week, potentially beginning to see patients on Friday! An APP fellow at AMC needs to join SEMPA as a member so that AMC can enroll the fellows into the ROSH EM review, so I did that as well. We have our first SEMPA grand rounds this week on Wednesday. Benefits seem like they are OK, nothing to write home about but not horrible. Cheers!

11/6/2021

Well, as you can tell it's almost a month since my last post and things are super busy. The first two weeks I was paired with an outgoing fellow (Senior Fellow) that was transitioning to employment within the department. First day was a general orientation to the hospital in person - at the time I felt the hospital was a huge maze. I've since become more comfortable, thankfully! There is an underlying level of stress (at least I have), if I can't position myself within a building, easily find the bathroom/locker room/cafeteria/exit etc. I have been riding my bicycle to work, there is a dedicated bike cage that is badge access only which is nice. We started seeing patients during our first week, bouncing between the "E-zone", which is sort of like a fast track when it is open, pediatrics, and the adult A and B zones. Getting used to the EMR here and all the extras that you need to use it well has been a challenge. They use Soarian, which in itself is a mediocre EHR, but all other hospitals in the area are on EPIC so that data doesn't merge with Soarian. The outpatient clinics that are within the AMC network use an allscripts derivative which also doesn't populate into Soarian - so you really need to use two different applications to gather patient records. It is really tedious. On the bright side of this - you have to go on what the patient tells you ( or nothing if they can't) with very little background. Not the best way to do medicine this day and age with all the information available, but definitely leaves plenty open for differentials and such. I have been on my own (away from preceptor) for a week now and have been seeing patients, running them by the attending, and implementing my plan. The patients here are really sick, I am admitting most of them actually. I was initially surprised, but when I look at who actually makes it back to a room here, they are mostly ESI 2's with a few 3's and the occasional 1. In that respect, I suppose it's not that surprising they are getting admitted. Lots of transfers from outside hospitals. The admission process here isn't too bad, there are actually two different processes depending on what time of day but I have gotten pretty good at getting patients admitted with orders to get them by until the hospitalist can see them. Staff is really friendly here, and because I spent so much time as an ER RN I'll go ahead and put in a line and get labs when I can if I'm not too busy and the staff is slammed. There is a big staffing issue in Albany in general, with a limited pool of nursing talent moving between hospitals (Whoever is paying the highest contracts). Additionally, the AMC RN staff just joined NYSNA (which I support, as I have historically been a member of some strong and active nursing unions) - and predictably the new union contract has quite a bit of breadth between what is in writing and what is in reality.

I passed my ATLS course the week before last, I also just attended a full day toxicology conference hosted by SUNY Upstate which was awesome. It was so inspiring at the end of the day I jumped online and ordered a used current edition of Golfranks. My EM book collection is growing nicely! I start my weeklong optho rotation on Monday. I spend the morning in the clinics, and the afternoon seeing consults with the optho resident in the hospital. On my final day, I take the optho consults in the ED (with resident backup). I'm pretty excited about that, and even found the slit lamp and another willing fellow to practice with last week because I feel rusty since graduating! End of November is the two week U/S rotation. They want us to have ~300 documented U/S upon completing the fellowship, and if I do a certain amount of ultrasounds in several different categories throughout my year here I can obtain some type of certification or credential though it may be limited to just this hospital system. Oh! We also had our first simulation lab experience this past week - we went through 3 iterations of a fun megacode type scenario with SIM-man and a live actor family member. There are three fellows, so we all swapped out being team lead and refining our approach after a quick debrief following each session.

Details wise for the fellowship, we are required to wear maroon scrubs and are dressed exactly the same as the residents. The nursing staff pretty much assume we are all residents. The attendings and resident staff are generally very respectful and all very intelligent. Some are more helpful than others, and overall I don't know how well versed the residents are with the fellowship but I imagine the 2nd and especially the 3rd years are pretty familiar with the role and scope (which is essentially wide open) of the APP fellows within the department. One thing I noticed though, and sort of knew before going in, this is traditionally a PA fellow program. Now there are plenty of NP's that work in the department and APP's have the same role regardless of NP or PA. However, when people see I am an NP (my badge), or I introduce myself as an NP fellow sometimes I get a comment from the other person along the lines of thinking I might be the first one or the first one in a long time. Hopefully I make a decent enough impression on the hospital here that it becomes more commonplace, as a seasoned ED trauma nurse/now NP in an ED APP fellowship should be a high performer, and that is what I am striving for. The PA component is reinforced by my mandatory membership in SEMPA (reimbursed by the department). Also, we are supposed be doing at least 10 ROSH EM questions per week. We will occasionally be assigned materials that sync up with our rotations on the ROSH dashboard as well. There is supposed to be an initial assessment, mid-term, and final assessment during the fellowship and it is arranged through SEMPA somehow. Just as an FYI, an NP can join SEMPA and they are of course welcome - but are non-voting members. Semantics for me, but just in case you were curious.

I think our cohort will benefit from the decreased number of fellows (3 vs 5) in terms of having more exposure within the department. In part due to staffing, and also due to a return in pre-covid numbers, the flow is SLOW. Some days I cannot pick up more than 2 or 3 patients because there are so many boarders and not much movement. APP fellows do not currently take sign out from residents on boarders, which is good (we will later on in the program, though, or at least sign these patients out to eachother). We do sign them out to residents though. I'd say on any given day 50% of the department is boarders, and that doesn't count our ED OBS beds or the psych area.

Anyhow, that's all for now. I hope someone is reading this!

Epidural, BSN, RN · Jul 2, 2022

Thanks for the info. Sounds interesting.

sm2013_SN · Oct 15, 2022

Hi, I graduate in April and am also looking to do an ER fellowship or residency. I am also an ER nurse. I looked at Albany’s website and I see it only lets PAs apply to the program. Just wondering how you got past that. Congratulations, it looks like you are learning a lot!

Shoshanna · May 2, 2023

Hello Benjamin,

Thank you for posting about your experience. It's difficult to find anyone documenting their experience as an APP Fellow regardless of specialty. I will start as a psychiatric APP Fellow in Fort Worth, TX in the Fall of 2023. Our cohort has six fellows (NPs & PAs) and we have a rotation in the psychiatric emergency department. Your post helped me compile a list of drugs I will have to know in more detail before my ED rotation. Thank you for sharing and I wish you the best in the ED as a provider.

LaurieCRNP2002, MSN, RN, APRN · Aug 7

Hi Benjamin

It looks like you are probably done your fellowship by now. It would be great if you are willing to provide an update as to what you are doing now and how valuable you felt your experience as a fellow was. I read what you did post and found it interesting.

Best wishes to you as you continue on in your career!!

Laurie