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Neuro Guy NP, DNP, RN, APRN, NP 6,137 Views

Joined: Mar 6, '11; Posts: 168 (61% Liked) ; Likes: 355
Neurosurgery NP; from US

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  • Oct 21 '17

    Congratulations on your new role, that's awesome for the medical profession as a whole and NPs of course.☺

  • Sep 27 '17

    Quote from CardiacDork
    Simply put I believe that many of the people I have personally encountered lack the scientific inquiry that I believe is necessary to become a successful provider. I've seen firsthand the material provided by the numerous online programs and it's laughable at best. Relying on pure memorization and regurgitation with no reliance on the why. I think THAT is far worse than people with little to no nursing experience entering the field. (Granted, I DO believe there should be an experience minimum requirement).

    The fact remains that people that could care less about diagnosing or treating are only switching to advance practice to get away from the bedside, in search of the "grass is really greener" and THAT is not okay in my opinion. Unfortunately it happens and WILL continue to happen so as long as these fluffy NP programs continue to pump out graduates, and the NP title will continue to be the laughing stock of the healthcare/medical community.
    Can I rant back a bit? Some of this is playing devil's advocate, but I have seen lots of posts lately hitting on some of these things.

    First off, getting frustrated about the motivations of others is really an exercise in futility. It is no surprise that with increasing salary for NPs and PAs that talented people are starting to pursue those roles more directly, just as they have with medicine and law for decades. This isn't a "bad thing" for the profession necessarily.

    Second, while everyone has opinions, not everyone has expertise. Four or five years ago now there was a study that showed that strength of opinion was inversely correlated with knowledge of the topic. There are some strong beliefs/opinions being expressed on these topics here and it oft seems that posters scarcely consider if they have the relevant experience/expertise to properly affirm those statements. The bias that exists here makes it difficult for many novice NPs; one of the biggest challenges a novice NP will face comes from other nurses, which really is a shame.

    Third, if we are following the scientific method as an essential prerequisite, then we should consider the data rather than anecdotes.

  • May 21 '17

    Quote from traumaRUs
    Yes to all those questions.

    For me, I've been an apron 11 years and I make six figures, have 8 weeks vacation per year and take vacations too
    As a frequent typo culprit I had a chuckle from this.

  • Apr 29 '17

    I'm not sure whether it's permissible to endorse a book on this site, but here goes.

    Take a look at Carolyn Buppert's "Nurse Practitioner's Business Practice and Legal Guide".

  • Apr 26 '17

    I'm curious to know how the hospital board representation is structured. Is it exclusively represented by MDs and DOs? Is there mid-level representation? And what was the instigating set of circumstances that led to this decision?

    As others have stated, this action sends a strong negative message to any mid-level provider that they are not part of the "team." This is a cultural problem that supercedes being just a lounge access issue. This would be rather disheartening and while you might be looking at just the lounge access across other facilities and health systems, you might also tap into research showing the strong correlation between employee satisfaction and health outcomes of patients.

    Good luck.

    Darth Practicus, FNP

  • Apr 26 '17

    Like you I will no doubt catch grief for supporting you in this post, oh well, c est la vie. People think a lot of things and verbalize a lot of things, for a lot of personal reasons and/or life's experience good and bad or prejudice. My hat is off to you, in that you have done your family thing. You took a not so wanted career and provided for your family the best way you could, this is now your time to satisfy you passion. Take the step forward as far as the learning curve yes it's a steep one at that. Don't worry about not having the clinical nursing background. If you have the fortune to have Physician mentors that are willing to take the time to teach and not just show you but really have a passion for catching you when you start to fail and then explain why then teach you the difference, how to avoid those pitfalls, and improve the outcome, you will do just fine.

    I have spent over 40 years in medicine military and civilian and have the pleasure to have known nurses that have taken the path of Advanced Practice and non medical types that take the role of a Physicians Assistant that go on to be a learned and respected part of the medical community. Likewise I have known those that, well they have moved on to different camping ground. The long and short of this is take the challenge and go with it don't worry what you don't know. There are a great many things in medicine you will never know, just take those things and skills you have they will be the tools to change the don't knows into "so that is what that is or does" now I know and understand. Keep feeding the passion the rest will follow.

    to quote some of Dr. Seuss
    "Oh the places you go"
    "Congratulations!
    Today is your day
    Your off to grate places
    your off and away

    You have brains in your head
    You have feet in your shoes
    You can steer yourself
    In any direction you choose.

    You're on your own and you know what you know
    And you are the guy who will decide where to go"

    Good luck.

  • Apr 25 '17

    Quote from ksisemo
    Serious question, because I think you are right - do you know if there have been any studies done on the safety and/or efficacy of NPs both with RN experience and without?

    I am certain these types of things are studied or tracked when compared with MDs/DOs. Of course, insurance companies watch "evidence-based medicine" practice like a hawk and will reimburse based upon those practices, which are supposed to be founded in safety and efficacy. But I am wondering if there are any real, controlled, peer-reviewed studies published on the track records of NPs based upon level of experience.

    I wonder, though, if this might be hard to nail down, because NPs with RN experience might have obtained that experience in an area entirely different to their NP specialty.

    ??
    Excellent question and there are a couple of articles out there indicating there isn't an issue, "nursing research" of course, however I believe it is too early in this new initiative to have enough data. Unfortunately the trend is now to admit anyone who can fog up a mirror held under their nose and pay the tuition so my guess is the next 5-10 years is where we will see the problems although I consider negative outcomes, short of death or extreme disability, difficult to quantify. And patients LOVE their NPs because they hold their hands, and mop their brows with little concern of their actual skill set.

    I've posted about this in the past but how would one discern if a patient saw NP with c/o ear pain, received antibiotics and actually didn't have an ear infection? Or a patient who comes in with a rash that gets treated for eczema without effect, then tinea corpus, then finally scabies which they had from the onset. The patient didn't die or likely suffer disabling harm so would this even be documented or monitored? Would the insurance companies pick up on this eventually? In psych I frequently see egregious regimens for people with substance use disorder and bipolar disorder. Bipolar is a common train wreck that inexperienced clinicians seem to favor for people with SUD, personality disorders and most concerning children who have trauma hx and horrible home lives NOT bipolar disorder. Do your first intake on a NP's patient who is 9yo with a bipolar disorder diagnosis on a stimulant, alpha blocker and lithium, which has blown out their thyroid, minimal therapy and living in an unsafe home and get back to me on how dangerous inexperienced prescribers can be.

    My opinion and one that clearly isn't shared by the universities who are interested in retaining students and therefore tuition is overall the odds of being a better clinician would be more favorable if the person actually had nursing experience which if anyone cares to remember is why our short nurse practitioner education was originally approved. PAs and of course physicians have significantly more clinical hours.

    Overall I think its too early in the new trend of everyone and their poodle becoming a NP for us to tell exactly how things will go but one thing is certain, our wages are going to continue to tank as the supply exceeds the demand and those with zero business sense accept lame offers. Like you and others have said there are certainly outliers however I would disagree that NP clinical requirements of 500-1000 hours is sufficient to take a person from zero medication knowledge to competently diagnosing and prescribing regardless of how well regarded the university is so imvho you will need to be the exception rather than the rule.

  • Apr 25 '17

    OP, I was a career changer, too. I originally wanted to be a PA and decided to go to a community college to get my RN so I could quickly get hands-on patient care experience. The ADN only takes 2 years (3 if you don't have any pre-reqs, like Anatomy, Physiology, Micro, etc.) and it was affordable, so I was able to pay using my own savings. Once I became an RN, I started learning more about NPs and their scope of practice. I am now an ICU nurse. I can honestly say, in my area, the ICUs & ERs only want to hire ACNPs who already have an ICU/ER background as an RN. You've never been a nurse on the unit. There is so much you learn in the ICU that is beneficial to your education as an NP later. Just being around the patients and knowing that raspy sound is a cuff leak in an endo trach. When to start titrating pressors. How to effectively manage multiple drips along with CRRT. How to interpret ABGs and see how changing vent settings affects the patient. Getting ACLS certified and actually participating in codes. Being able to assist when your patient is having an art line inserted, central line, intubation, managing chest tubes, etc. These are all things that are difficult to learn from simply reading in a book. Nurses are at the bed side a full 12 hour shift. Even in your NP clinicals, you aren't going to get the deep, hands-on, in-depth experience you would get as a nurse with your patients. I personally feel having some experience as an RN first will make you a better provider. Just my personal opinion and what I see in the real world.

    Now, that is not to say that you can't or won't be successful. As previous posters have stated, there have been good direct-entry NPs with no prior RN experience. I just know that it's difficult to land that first job without any ICU/ER experience if you're trying to break in to the ACNP field. I would put out some feelers with the hospitals in your area to see if they hire direct-entry ACNPs. You don't want to go through all that time & money and not be able to land the job you want.

    As far as salary, new NP grads don't earn as much as experienced NPs. The NPs in our area average any where from $98K to $120K, depending on the type of acute care practice. Cardiology seems to pay a higher salary than the other specialties in our area (midwest). The hospital when I work takes in to consideration your prior RN experience if you're a new grad NP seeking your first job. Something to keep in mind.

    I definitely don't want you to feel discouraged. It's great that you're getting a chance to pursue what you really want to do. I'm glad I made the career change decision. I just want you to realize what you might be facing in real world when you're ready to start looking for your first ACNP job. Research your job market, call some local hospital HRs and see what they have to say about direct-entry NP grads.

  • Apr 25 '17

    I went to a Masters Entry NP program at a very well respected B&M school. I've been practicing as a NP for just under 8 years now. I did not work as a RN during or after my program. It just wasn't feasible. I worked in another area of health care for 20+ years so did not enter nursing completely wet behind the ears.

    I am a successful and well respected NP in my area. I precept NP students, and have found that previous RN experience is not necessarily relevant to success as an NP. I've had seasoned RNs who struggled, and students with no NP experience who have been rock stars. I've also seen the opposite. It's very individual. I would much rather have a student with no RN experience who can think critically,take initiative, and seek excellence than an RN with 20 years experience who cannot switch their mindset to the provider role. I think RN experience is always valuable, but is not imperative to be a good NP. It's a very different role. I use very little of what I learned in the RN program in my day to day practice. I believe those who want to be an Acute Care NP should have some hospital experience.

    You should not be discouraged by those who feel you cannot succeed as a NP without RN experience. There can be more than one path to the same destination. Work hard and do as many clinical hours as you possibly can. I wish you the best of luck.

  • Apr 7 '17

    ...There are several additional points that I would like to make at this time. The concept of students finding and arranging their own preceptorships in advance nursing is an unsustainable and unethical one. For one thing, there is an unequal playing field in the process. Students that have greater access to medical professionals due to their previous experience or background will have a tremendous advantage in securing preceptorships. For instance, the son of an ICU physician would undoubtedly have almost no problems finding all his preceptors due to his father's connections. However, a first generation, aspiring nurse from a disadvantaged inner city that is pursuing an advanced degree will face significant difficulty securing preceptors.

    Furthermore, students, in general, have almost no leverage when trying to secure a preceptor. An advance practice student, being one of the lowest in the medical hierarchy, is in essence trying to get a highly paid medical professional (Physician, PA, NP) to teach him/her a skill or profession without any type of compensation whatsoever. The natural question is of course "Why would anybody want to do that?" And the answer to that question is that "hardly anybody" and understandably so. In addition, medicine is practiced in a highly regulated and litigious environment. Even if a student secures a preceptor (most likely due to personal connections), there are nowadays a myriad of institutional regulations by hospitals and clinics that provide significant hurdles. What kind of incentive does a hospital or medical clinic have to allow just anybody to walk through its door and provide that person with the opportunity of becoming a highly skilled professional? In the case of advance practice nursing, they have none. With the increased concentration and buyouts in medicine, many more practice environments are now regulated by big corporations. Mostly gone are the days, when a nurse could walk into the office of the local town doctor and ask him to train her. Now even the local office might be owned by XYZ Inc. which has regulations, and a lot of them.

    Certainly, the leaders of physician and PA programs understand this and that is why they arrange clinical experiences for their students. As nurses, we expect the same of our leaders. Unfortunately, our nursing leaders and schools have shortchanged us as students in the past, but this got to change. Most physicians and physician assistants express general satisfaction with their education. I haven't met many nurse practitioners yet that came to the same conclusion.

    As NP students we pay the university to provide a service to us - education. One of the most important parts of this education is the clinical experience. It is not sufficient for the university to charge tuition, write a plethora of rules about the clinical experience and to abandon students to find their own preceptors, knowing well that many will not succeed.

    Key Element III E of the CCNE Standards for Accreditation of Baccalaureate and Graduate Nursing Programs (2013) states, "To prepare students for a practice profession, each track in each degree program and post-graduate APRN certificate program affords students the opportunity to develop professional competencies in practice settings aligned to the educational preparation. Clinical practice experiences are provided for students in all programs, including those with distance education offerings."

    It states, "clinical practice experiences are provided for students in all programs..." It does not say that students shall provide their own clinical practice experience.

    I believe that the CCNE should start enforcing this rule. Schools that are not willing or able to provide this most important aspect of NP education should not be accredited by CCNE. Obviously, this accreditation agency has lacked in enforcing its own standard in past times. However, I believe as an officially recognized national accreditation agency by the U.S. secretary of Education, it needs to step up to the plate and do its job. It is unfair towards the schools that follow the rules and provide clinical experiences when other schools skirt their responsibility, getting by with it. Our physician and PA colleagues have shown us that providing clinical experiences for their students is not that difficult and results in a superior educational experience.

    I thank you for your time and appreciate any constructive feedback.

  • Feb 24 '17

    Interesting. The data supports them in terms of their competence and outcomes.

    Some roadblocks I see are PA's don't go into primary care anywhere near the rate NP's do, and that's one of the bigger arguments NP's make when it comes to autonomy. Essentially the demand for primary care is there, we do it competently, and the majority of us are working in primary care. If I remember right, less the 15% of new PA's go into primary care. Where I am, PA's are typically seen in surgery. I know one that works in primary care pediatrics, and another that works for an endocrinologist. The rest work in surgery.

    Another hurdle is they are directly titled "Physician's Assistant", are trained in a reduced time medical model, and aren't independently licensed. We as Nurse Practitioner's, even in collaborative states, work and operate on our own independent licenses and use a different educational model. The PA really just a PhysicianLite, where at least NP's can make the argument the training and model are completely different (even though I know it's ridiculous and we all end up doing the same thing).

    I honestly wish them luck, but the very nature of their title, licensing, and educational model will make it difficult.

  • Jan 28 '17

    Quote from Neuro Guy NP
    Example: It'll be a five point in depth question about stroke and they have to answer with rationale and describe treatment algorithms, blah blah blah.
    Sigh, this sounds amazing. You are probably putting out decent clinicians, imagine that?

  • Jan 24 '17

    Quote from traumaRUs
    We banter around about liability insurance, but when it comes right down to it, no matter who you work for, they are out for them, not you. So...you need to protect yourself.
    The facility's insurer will not prioritize the nurse's interests over the facility's interests if the interests of both parties do not happen to coincide. Also, if the legal fees incurred are more than the facility's insurer provides, it looks to me as though the nurse would likely be responsible for the amount not covered. I would never practice as a nurse without my own liability insurance, and I was taught to always carry my own insurance right from the first day of classes in nursing school.

  • Jan 24 '17

    Please include specialty!

    City/State: Outside Washington DC

    Years in current position: 5-psych

    Salary: $185,000 base but I work weekends, holidays and part-time elsewhere for a higher rate and gross >$200,000 year

    Benefits: health, PTO, CEUs

    Bonus: premium for weekends/call and at 2 positions I bill per encounter

    1. Know your areas rates. Seriously find those few rock star NPs and become their new BFF. If you don't have NPs in the area that you worked with, were precepted by or know through your state's NP organization get on it before you graduate and find some! I can't emphasize this enough. The support both salary, knowledge and opportunities you can gain from having friends in the biz is non negotiable.

    2. Use your professional contacts to find work especially places you did clinicals and physicians who liked you as a nurse because they are usually able to push for a hire and good wages.

    3. Do an honest assessment of your abilities. If you are a new NP who was a killer RN with major professional contacts and experience in the specialty demand a top tier rate especially if you know they will not offer an orientation. If they do offer an orientation price it out before accepting a date with the devil that will haunt your ability to increase in wages once you get up to speed and start making money for the practice. Do not let some dolt in HR or a ED make you feel as if you aren't work a decent wage especially based on your lack of experience. I informed one who was attempting to low ball me at my first job that I'd imagine they wouldn't be billing less for me as a new grad-got the job btw but the medical director there wanted me so probably not an across the board best practice, lol. If you will be weak initially, sorry no more holistic way to put it, look for the places that are willing to coddle you-NP run practices or with a MD who is a control freak and wants to train you their way, provided they are a decent doc or you will learn to be a crap NP in their image.

    4. Be aware of and prepared to assimilate into the culture before accepting a job. If the physicians are total workhorses who do call, evenings, weekends etc. without whining please don't go in expecting Mommy friendly hours and a day off every week because little Susie has an earache. Seriously if you want that kind of environment, they are out there, find it but don't go in and make NPs look lame in a culture that is not well suited to your needs.

  • Dec 4 '16

    I am 36 (for reference)

    I know I have told my students how I didn't even touch a computer until I was in 6th grade. There is no way to show younger generations what it was like to not have the technology we do. Just as it is impossible for me to imagine life without a telephone or television.

    The best I've come to explaining it to my student is discussing it in terms of time travel. Take a person out of the year 1600 and put them in 1700, life is pretty much the same. Take someone from the year 1350 and put them in the year 1450, not much different. If you transplant someone from 1916 and plop them into today, the world is a completely different place. Travel wise, tech wise, social issue wise.

    I don't think that this generation is any less respectful than any other group of children to pass through our world. Every generation has the exact same complaints about the following generations. The argument is as old as recorded history.


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