Hello everyone. I hope someone can give me some advice and suggestions. I am a new RN (graduated in Decemeber) that started on a general surgery (and medical) floor in January of this year. It has been about 9 months into working on this floor and I realized that it is NOT for me. I will be honest and say that I absolutely hate working on this floor. I hate working on weekends, odd hours (evenings), and working overtime. I can't stand the stress and pressure of a med/surg floor. I give a lot of props and credit for those that can handle it.
I recently got accepted to a Master's program in Boston to become an FNP. My intentions from the beginning was not to become a floor nurse but an NP. But because I have to move to Boston and make money for living expenses, I would have to be a part-time student and work full-time. Now I am trying to search for a nursing position that is not on a med/surg or floor nursing at a hospital setting, and have reasonable (normal) working hours. I would probably have about one year experience (or may be a little less...but more than 6 months).
I would like some advice on where I should apply with my qualifications and needs. I realized the pay would not be as much as a floor nurse but its to the point where I don't care about the money because I feel utterly miserable. I feel like the money's not worth it. Some have suggested a nurse in private practice or a clinic setting (which would be ideal since that is where I want to end up after I become an FNP). If anyone can help me with this job search in the Boston area, that would be great! Any suggestion or advice will be greatly appreciated. My goal is to find a job up in Boston as soon as possible, quit my med/surg position, and move. Please help a fellow nurse! Thank you for reading and I look forward to your replies!
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
Please don't get me wrong. I understand a master's degree is a difficult endeavor and much respect should be given to this effort.
I truly believe that spending time in a clinical setting would only BENEFIT the NP as well as the patient.
I guess I would venture to ask the following...
Have you ever seen maggot therapy? Leech therapy? Necrotizing fasciitis in an oxygen chamber? Severe ARDS in a 24 year old that is on 16 drips that you're trying to keep from going fibrotic? Ever seen a 6.1 ph and know that patient is going to die and he actually doesn't?
Bivads, Lvads? Transplants? Traumas?
23 weekers less than 400 grams that live with no developmental issues?
Worms in the lungs from a patient in ARDS coming from South America?
Elongating QT interval that you ACTUALLY catch on the monitor while everyone else misses it? Using and overriding with a transvenous pacer because the doctor wigged out and so did his PA when he couldn't figure out which is the right button to push so the patient can come out of VT or an SVT? Figure out that a patient is NOT sleeping (NP actually told me this) when patient was truly narcotized from a C02 of 75. Couldn't wake her up so decided to leave her be...too many things.
Yes, that comes from TRUE CLINICAL.
So...yes, it is very difficult convincing me that a DE NP can be as good as one who has a true clinical background. Adequate yes.
To a certain degree I've got to agree with JoPACURN. A Nurse Practitioner is an advanced practice nurse. To me that implies that one should have the basic practice of the science down pat, and then expand upon that to become an advanced practitioner. I realize that that one can learn from a book what the symptoms of a disease process are, but without practical experience, how well will one be able to identify what the onset of those symptoms looks like in the real world? I haven't attended NP school, but I get the impression that there isn't a HUGE amount of clinical time involved. So it's safe to say that one should already have that knowledge. To me it just makes more sense. I'm not saying that all direct entry NP's are automatically bad at what they do, I'm just saying that it makes more sense that they would have a good, broad base of basic nursing knowledge to expand upon in an NP capacity.
What Jo says makes a lot of sense for an NP working in a hospital/critical care setting. I would not begin to presume that a DE grad with no RN experience, or even an experienced RN/NP without that specific experience would be suitable for that kind of position. As a DE grad I would never apply for that kind of position right out of school. I am simply not qualified. However, there are many other settings that are perfect for new NPs (DE or traditional) who have not had that very specialized exposure. And as far as basic nursing skills go, I learned them in the first part of my program and make sure I stay competent in the ones that are applicable to my current job setting, such as dressing wounds, taking vitals, starting IVs, and giving injections. I don't work in an in-patient setting, so there are procedures/skills I don't get to use. But I would hazard a guess that most nurses don't use every basic skill learned in nursing school. As I have said before in other posts/forums, don't be too quick to judge DE grads. For the most part, we know the pre-judgement and bias we're up against and work twice as hard to make sure we live up to our patients' and employers' expectations. Like the old Avis car rental commercials, we're number 2 so we try harder.
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
What Jo says makes a lot of sense for an NP working in a hospital/critical care setting. I would not begin to presume that a DE grad with no RN experience, or even an experienced RN/NP without that specific experience would be suitable for that kind of position. As a DE grad I would never apply for that kind of position right out of school. I am simply not qualified. However, there are many other settings that are perfect for new NPs (DE or traditional) who have not had that very specialized exposure. And as far as basic nursing skills go, I learned them in the first part of my program and make sure I stay competent in the ones that are applicable to my current job setting, such as dressing wounds, taking vitals, starting IVs, and giving injections. I don't work in an in-patient setting, so there are procedures/skills I don't get to use. But I would hazard a guess that most nurses don't use every basic skill learned in nursing school. As I have said before in other posts/forums, don't be too quick to judge DE grads. For the most part, we know the pre-judgement and bias we're up against and work twice as hard to make sure we live up to our patients' and employers' expectations. Like the old Avis car rental commercials, we're number 2 so we try harder.
You have a great attitude; and that's good that you know where your limits are. My concerns are the ones try to get into the hospital setting (like that poor NP who, thank goodness, is perseverant) and expect to just "run."
I have a clinician now who is going for her NP. She is a pretty new pre-op nurse who is gearing to teach some very, very experienced PACU RNs. When she tried to "teach," she was so overwhelmed with the questions she didn't know were coming at her that she was in tears at the end of the session. Poor thing; it wasn't a "let's lambast this clinician". She was just out of her league; thank goodness, she has our support--we love her dearly and she knows that this was just part of the process.
My concerns are the ones try to get into the hospital setting (like that poor NP who, thank goodness, is perseverant) and expect to just "run."
I have 2.5 years of hospital nursing experience and I would not be prepared to work as an NP in an acute care setting. Others might feel differently with just as much experience. It's as you say: know your limits.
That being said, I can't wait to work as an NP in a community setting, which is what I've trained for and what my goal has always been. To bring this back around to the OPs initial concerns, this is the point--know your limits and have a goal. The great thing with nursing is you can always change your mind and go a different route--you just have to be prepared to work for it. Maybe I'll do peds someday (not likely). Maybe I'll want to get back into acute care--if so, I would need more acute care clinical training.
This is also not to say that going into community practice is easy--but it's harder as an RN to really see those clinically amazing patient cases when you're working with a generally well or stable/fragile population.
Jo, I mean no disrespect to you and your experience at all. I know my 2.5 years will help me as an NP, even in an outpatient setting. I'm guessing that if we sat down and talked we'd probably be more on the same page than it sometimes sounds. :)
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
I have 2.5 years of hospital nursing experience and I would not be prepared to work as an NP in an acute care setting. Others might feel differently with just as much experience. It's as you say: know your limits.
That being said, I can't wait to work as an NP in a community setting, which is what I've trained for and what my goal has always been. To bring this back around to the OPs initial concerns, this is the point--know your limits and have a goal. The great thing with nursing is you can always change your mind and go a different route--you just have to be prepared to work for it. Maybe I'll do peds someday (not likely). Maybe I'll want to get back into acute care--if so, I would need more acute care clinical training.
This is also not to say that going into community practice is easy--but it's harder as an RN to really see those clinically amazing patient cases when you're working with a generally well or stable/fragile population.
Jo, I mean no disrespect to you and your experience at all. I know my 2.5 years will help me as an NP, even in an outpatient setting. I'm guessing that if we sat down and talked we'd probably be more on the same page than it sometimes sounds. :)
And good luck in school!
-Kan
Considering you are going to be a community NP, I think your 2.5 years would probably be the best thing you would ever do for your future patients. Good luck to you!
Those stable and fragile population often hide illnesses you will need to catch; you have considerably seen some sick people, so I am sure that they will fare well under you.
As for me, I can't think of doing anything other than a very acute area--transplants, open hearts, with some very, very technologically dependent people etc.,--it is my forte and I totally love the constant investigation and speed of everything, the rapid interventions. I LOVE THAT.
PostOpPrincess, BSN, RN
2,211 Posts
Please don't get me wrong. I understand a master's degree is a difficult endeavor and much respect should be given to this effort.
I truly believe that spending time in a clinical setting would only BENEFIT the NP as well as the patient.
I guess I would venture to ask the following...
Have you ever seen maggot therapy? Leech therapy? Necrotizing fasciitis in an oxygen chamber? Severe ARDS in a 24 year old that is on 16 drips that you're trying to keep from going fibrotic? Ever seen a 6.1 ph and know that patient is going to die and he actually doesn't?
Bivads, Lvads? Transplants? Traumas?
23 weekers less than 400 grams that live with no developmental issues?
Worms in the lungs from a patient in ARDS coming from South America?
Elongating QT interval that you ACTUALLY catch on the monitor while everyone else misses it? Using and overriding with a transvenous pacer because the doctor wigged out and so did his PA when he couldn't figure out which is the right button to push so the patient can come out of VT or an SVT? Figure out that a patient is NOT sleeping (NP actually told me this) when patient was truly narcotized from a C02 of 75. Couldn't wake her up so decided to leave her be...too many things.
Yes, that comes from TRUE CLINICAL.
So...yes, it is very difficult convincing me that a DE NP can be as good as one who has a true clinical background. Adequate yes.
Good? With time I suppose.