jensfbay 5,217 Views
Joined: Oct 19, '06;
Posts: 85 (4% Liked)
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The pay in Seattle is less than any place I have lived when you include the cost of living.
I also always introduce myself as a nurse practitioner and emphasize that because at times, I will get introduced even by bedside nurses as "he is part of the team of ICU doctors taking care of you". I agree that if the response you got was "so you're like a doctor?" then that patient gets the idea and it's their own way of analyzing the situation and looking at you as their provider.
You can always follow-up with "if you meant doctor as in physician, then yes, I am able to provide care to you like a physician does as I am a nurse with advanced license and training". To avoid confusion as I'm part of a collaborative ICU team, I also say "I work with Dr. ___ who is a trained ICU physician and we will be taking care of you (or your family member) while you are here in the ICU".
This is how I introduce myself. I say this quickly to avoid questions so I can get into the meat of their visit and get them on out the door.
"Hi. I'm Psych Guy. I'm a nurse practitioner, and I do psychiatry. So how are things going?"
When someone catches it and does ask questions, my general answer is "we do the same things." (Imagine all of the physicians getting ticked off over that, lol). For the many kids I have taking psychostimulants, my answer is, "Well, the only difference for you is that I cannot sign a stimulant prescription, but I have a guy that mails me stacks of signed prescriptions for stimulants so you're covered. And that's my only limitation."
I don't get into education or anything. If asked specifically, I just say something like "my school was three years, physicians go for four." (Again, imagine all of the seething physicians.)
It's really an irrelevant discussion with patients. Only the brightest seem to grasp a full explanation of our roles perhaps because many of my SMI have no substantial education. No matter how many times I tell them I'm not a doctor I get called "Dr. Guy," etc. Our staff still refers to me as "the doctor." Whatever.
When the random public asks what I do for a living, such as the case when shopping for some new furniture this past weekend, I say "psychiatry" because that's what I do. Most people, educated or not, have no clue that psychiatrists are physicians. I don't really care what the public thinks so I don't feel like I'm impersonating anyone I'm not. "Psychiatry" keeps the conversation short. If it's a new friend that I wish to engage in dialogue with I'll actually say somehthing aking to "I'm a nurse practitioner specializing in psychiatry." Most of the public seems to think counselor, psychologist, therapist, psychiatrist, "head doctor," etc. are all synonymous. I don't care. The patient's paperwork and billing lists my credentials or NPI (which lists my credentials) so I'm fine with whatever their perception is as long as their attentive during their visit and adherent to their treatment. Fortunately, I'm able to convey adherence pretty well.
I do telephone triage for the same health system where I did acute care. I make more than an office nurse but less than I did as a bedside nurse. The reason I was given for the lower pay was the lack of direct patient contact, which made sense to me. My base start was higher than base start for a new nurse at the hospital though, likely because they require at least 3 years experience.
I looked on INDEED and could not find telephonic nurse - I did fine medical call center representative but the base pay was less than $15/hr so I don't think they are nurses. Still I would see what a non-bedside nurse with lot's of clinical experience makes in the Seattle are in general and go from there. Non bedside jobs always pay significantly less that bedside.
I've been an FNP in Primary Care for 2 years and was hoping to move into a specialty ( hematology) in the next few years. However, I've found I really like working with the elderly and I'm also interested in palliative care and derm. So I guess I don't know what I want yet!!! However, I think Primary Care is giving me a good background and valuable experience while I figure out what I want to be when I grow up. That all being said, I'm glad I went for my FNP cause it made me more marketable. I only see adults right now, but I could see kids (like if I wanted to moonlight in a retail clinic). I'm not sure I would want to go back for a post-Masters cert. I hope training would be sufficient should I decide to leave primary care.
Best of luck to you!
Psych NP and Clinical Psychologist are very contrasting career paths, so it is important to know what you want to do with the training....as both would not really make sense for the amount of schooling required, etc. Clinical Psychologists are primarily trained in research, assessment, and therapy. They are often professors, researchers, private practitioners, supervisors, administrators, consultants, etc.
The goals of each profession are very different, and they both have their drawbacks. The amount of education needed vs. pay isn't as good...but few people go into psychology for the money. The autonomy/lifestyle that comes with clinical psychology training is often a draw for people. It is true that MA/MS level people are being hired for primary therapy, but the supervisor and administrator roles are going to the doctorally trained clinicians who often have private practices on the side. Private practitioners who run cash practices and/or do consulting can make significant amounts of money, but on the whole it isn't a profession that is going to make a person rich (unless you own a practice and/or are a specialist who can get high $/hr rates.)
If a person is looking to primarily do meds management, go the route of NP/PA/MD/DO as prescribing psychologists are a small minority of clinicians in practice. If a person wants to teach, supervise, publish,
run a private practice, handle psych assessments/reports, etc....clinical psychology can be a rewarded career.
Community health nursing. You get a very broad base of experience and also work closely with midlevel providers as part of a team. There are also a lot of FNP programs that require community health nursing experience, or favor it. Programs also look favorably upon applicants who have worked with vulnerable populations.
I work night shift in CCU. Before I began NP school (I go full time), I dropped to per diem, but I average 24 hours a week. I'm on my husband's insurance, so that helps. I also have two boys (11 and 16) who demand a great deal of my time as well. It helps to be per diem because I can make my schedule depending upon what I have to do. So far it has worked out beautifully. I don't think I could work full time with my personal level of demands. Good luck to you!
I completely disagree with taking an office job. The work you would do there will not prepare you for an FNP job. There are things like immunizations that you would learn better, but that's easy to learn while in school. The things that are hard to learn like picking up on subtle assessment changes you will learn in the ICU and not in an office. I have never seen a nurse in primary care responsible for doing a complete head-to-toe assessment. You would be responsible for this in the ICU. You also aren't going to learn medications or labs in an office. As an ICU nurse you are expected to know all of the medications you are giving and why, in addition to being able to interpret the labs of your patient and know when to call the MD or NP. Although you will learn a lot of stuff that you won't use as an FNP, that background will still help you a lot more than working in a primary care office. If you work in an ICU for a couple of years and then want to transition to an office while you're in FNP school, that would be fine, but you will lose your basic nursing skills if you only work in an office.
I am taking full time grad school classes (ranges from 9-12 credits), and couldn't possibly afford my house payments if I didn't work. As it is, I take all the loans I can get, the (minor) tuition reimbursment from my work, and though I'm hired at .6, I usually work 6-8 shifts per payperiod.
It's all very well and good to not work if you can afford it that way, or not take loans if you can swing it some other way, but those options woudn't work for me
My advice before you give up would be to not give up. Some people just aren't good at them and that is ok. But You will learn that you will have good runs and bad runs. Maybe you'll sink 2 or 3 in a row, and then miss 2 or 3. It's just how it goes, sometimes. My advice. Warm packs, if the patient is mobile enough, have them hang the arm off the edge of the bed, low, for a few minutes, this allows blood to pool to the extremity thus "puffing" up the veins. Tourniquette a couple fist squeezes, if they can. Look and feel, don't feel with a glove because you wont feel anything. A big one, I tell all my students, don't stick them if you don't feel or see anything, that would just be silly. Constantly mess with your own hands and arms, not actually sticking, but feel where your veins are, see what makes them puff out and what makes them hide, chances are your patients will be similar if not the same. Also, chances are where you have a big vein, your patient will have one in that GENERAL area too. Lastly, if you don't see or feel anything, there is no shame in calling the vascular access specialists, if you have them, and having them use the ultrasound machine to find a nice deep big vein.
As far as the poke, find your spot, try not to go anywhere it is bifurcating or if you are so blessed to be able to feel valves, obviously avoid those. Stabilize the vein, hold a finger or a mental spot of exactly where that sucker is if it isn't visible. Another good trick keep the corner of your skin cleansing pad right at the point you want to insert, this way you won't lose your spot. Have everything prepared, stabilize the site with one hand, and insert the needle at a moderate angle, the angle depends on how superficial the vein is, and this I can't really describe in words, you kind of just get a feel for it. If there is no flash back right away feel free to maybe advance a very little bit, or pull back a very little bit and slightly reposition and re-advance, be patient, do this until you get blood. Don't give up after the first 30 seconds. Sometimes it takes some finesse and a whole lot of praying . Don't give up, keep practicing. The only way to get good at them is to do them, and try.
I am a PNP who went to work right out of school in a Developmental Peds clinic. About 4-5 yrs in, I came to the conclusion that using DSM dx and psychotropic med prescribing (particularly off label in children) was not training I was provided in my PNP program. In the unfortunate event of an irreversible reaction to an atypical for example, I would have difficulty in attesting to a formal educational program that prepared me to Rx these meds. Therefore I continued to work and it took me a solid 3 yrs to finish the Post Masters. This was due to the large number of clinical hs
required in the Preceptorship portion.
Although it took me a while to get through, it was the best thing I ever did and would
do again in a heartbeat. Also your potential job opportunities double being dually
certified. I've been in the same job for 14 yrs and can see no compelling reason where a doctorate degree would be useful to me.
I hope the information I provided was helpful. By the way, I have no prior psychiatric nursing background. I hated Psych in RN school (maturity).Luckily i was able to get mostly ALL my Preceptorship hrs (365) in an adult psch ER so that I could really experience it.i've found that one can plan all you wish, but there is NO substitute for maturity in getting a feel for where you should put your energies educationally.
Good Luck! Chris
Ultimately you need to decide what area you are most passionate about. I am in a PMHNP program. Marketability is, in part, due to your location. Are you able to relocate after graduation? Do you feel drawn to FNP vs PMHNP? Have you considered getting your MSN as FNP then adding a post grad cert in pysch? Or, vice-versa? You mentioned enjoying the clinical side of nursing...ask yourself which aspect do you enjoy? I think you can create exactly what you want. This is a great place to brainstorm.
I graduated WGU in Dec 2015 1 week before having a baby. I took a year off to be with him, and today received an acceptance letter from UTA for FNP starting in February. It is absolutely possible.
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