Challenging specialities

Jules A, MSN · Oct 12, 2016

I think doing psych well is challenging because so much of what we do isn't based on labs or concrete data. Unfortunately I also think doing it poorly is easy and it disgusts me that the admission requirements to psych NP are so lax as this is a very vulnerable population. Although I have zero first hand experience I personally admire NICU and Acute Care NPs the most and think there jobs must be extremely difficult.

Trauma Columnist · Oct 12, 2016

I find nephrology still challenging after 10 years. Most of my issues are not with pt care but rather other providers that don't take into consideration renal function.

Baclofen for instance - if used at all, MUST be dose reduced otherwise it causes neuro-toxicity.

And antibiotics....ugh

allnurses Guide · Oct 12, 2016

I would find psych to be the most challenging specialty. As JulesA said, there's not a lot of concrete labs or data you can use. I also find emotional pain to be incredibly heartbreaking, and I don't think I could deal with that well or objectively.

I work in asthma and allergy. Most of the challenges for me arise around the issue of non-compliance. Parents who smoke around their asthmatic children and wonder why they're frequent fliers in the ER. Patients who don't take their meds. Patients who don't take food allergies seriously. Parents who won't keep their children on controller inhalers cause they're afraid of steroids, but are quick to ask for oral steroids when their kid has an exacerbation. We educate as best as we can, but there is no magic.

WKShadowNP, DNP, APRN · Oct 26, 2016

Oh the ER visitors expect us to wave magic wands. Especially with rashes or vague pains that defy all diagnostic reasoning.

Trauma Columnist · Oct 26, 2016

Oooohhhhh I hate rashes. If it ain't shingles or calciphylaxis, I'm gonna have to look it up......

wayemika · Oct 26, 2016

Oh the ER visitors expect us to wave magic wands. Especially with rashes or vague pains that defy all diagnostic reasoning.

this is a good point. I know so many patients make complaints or will bash the ED online if they don't get those mysterious things fixed right away in the ER or by discharge from the hospital.

jwester · Nov 3, 2016

It's a definite challenge when an NP cannot spell or write with proper grammar .

nursetim, NP · Nov 12, 2016

I've been working in a homeless clinic in PHX. Very challenging due to comorbid mental illness, the heat that spoils the insulin we prescribe, the drugs and alcohol issues.

Aromatic · Nov 12, 2016

psych patients. psych is hard enough, and psych always has other physical comorbis that goes with it. Not saying psych isnt a physical problem since we learn day by day it is, but you know what I mean.

If you want a challenge hop on the non-compliance bus

wayemika · Nov 12, 2016

So would all of you say being a Psych NP is more stressful and harder to do long term because of the patients, to much stress and not likely the chronic ones will ever improve?í ¾í´”

Jules A, MSN · Nov 12, 2016

psych patients. psych is hard enough, and psych always has other physical comorbis that goes with it. Not saying psych isnt a physical problem since we learn day by day it is, but you know what I mean.
If you want a challenge hop on the non-compliance bus

Whaaaat??? I took care of lots of crazy people in ICU!! You mean you can't just take a few classes as a post masters and automatically recognize and treat EPS? or distinguish between psychosis, delirium, trauma or malingering? I'll be fine, my borderline patient with substance abuse issues is really only suffering from ADHD so I'm going to add a stimulant to the benzodiazepines she's getting for the most severest anxiety on the planet and oh yeah btw that 10 year old threatening Mom with a knife is definitely Bipolar and needs Lithium for sure. Said tongue in cheek however I have seen every single one of the above scenarios at the hands of an under prepared NP.