buttercup9

Hello all, I am in need of some advice. I an AGACNP graduate (6/19), I did not take my exam until Nov 19 and the job search started after the Holidays were over. Little did I know that there was a pandemic brewing... Fast forward 7 months I am still looking for an NP job (still working as an RN). As I am acute care, I really want to be on the inpatient side, however almost all the jobs that have been available have been ICU level. As an RN I have ED and solid organ transplant experience but not ICU and this is severely impacting my job search. I have at least made it to the inpatient interviews for two inpatient positions but they went with an experienced NP in both cases. I am now applying to specialty clinics in the hopes that I will be able to transition to the inpatient roles. I have at least gotten some interviews in these positions and I am waiting to hear back. My question currently is this. I applied at an urgent care clinic with multiple locations in the area, they at first said they do not take new graduates however they were looking for people to run their "covid ready clinics". From the description that I got of this position, I would be covid screening employees that are coming back to the work places. It sounds like it is exactly what I am doing as an RN when I triage in the ED. Everything about the position appears to be in the RN scope of practice and not NP. I have been upfront with them regarding this concern and that my goal is to work in the clinic. I initially told the recruiter no to the covid position but she contacted me a few days later stating that there was a clinic postion open that I may be appropriate for given my ED experience. I had a phone interview with the medical director under the guise that maybe they would hire me into the clinic as I have ED experience and had ED clinical rotations. She then backtracked, stating that they really needed people for their covid clinics. She sold the position saying that it may be a way to get into the clinics as I would then be familiar with the company and the EHR (I have had enough jobs to understand that learning logistics is a big part of the learning curve at a new place of employment). I asked what the training would be like if I did eventually get into the clinics, and her response was "what would you like it to look like"? That felt ominous, so I responded with "at least two months" (every other hospital I've interviewed with states that they would have at least 2-3 months, along with some other training benefits). The look on her face clearly indicated that amount of time was not going to happen. She indicated maybe two weeks and then I am on my own (the only provider in the clinic with an MA and maybe an RN) but able to reach another provider by phone. Again, my initial concern, which I shared with both the recruiter and medical director was that the covid ready clinics did not sound like NP experience and that if after the covid clinics were over, and there was no clinic position available,other employers may assume that I have solid NP experience when I really would not be making clinical judgments at the NP level. I was offered the position yesterday. It appears to me that they are in dire need of NP's to run these covid clinics and I have the impression they will take any APP that walks in the door. I am also skeptical that I would be hired into a clinic and my instinct is to say no, but as I am having such difficulty finding an NP position that perhaps I should accept it? Thoughts?

I worked multiple types of units prior to going to the ED, including med/surg tele, solid organ transplant & thoracic (I am in a non trauma ED). My co workers in the ED look at me like I am crazy when I tell them that the ED is easier. Its a different kind of stress but it is not the same stress as constantly feeling like you aren't moving fast enough and leaving every shift feeling like your patients needed so much more that you could give. The animosity b/w ER an floor nurses is sadly very real. I have tried for years to get my coworkers to back off their complaints about floor nurses, but to little avail.Having never worked on the floor, they just don't get it. Another poster commented about the annoying habit of floor nurses needing ever single detail. That drove me crazy when I worked on the floor! I do not need to report to you that the patient had a shoulder replacement 12 years ago and today they are being admitted for a bowel obstruction. You can find those details in the chart. We would all get out faster (and perhaps even on time) if RN's stuck to what is pertinent and didn't give extraneous details. I think that this is one of those situations where people hear other nurses asking for those details ( Reporting off RN: "Mr X got PRBC during his surgery 12 days ago, no bleeding issues post op"- receiving RN interrupts "how many?" Reporting RN " I'm not sure". Receiving RN- looks at you like you are an idiot and rolls their eyes) and then nurses think they HAVE to give ridiculously detailed reports. We need to be better communicators (and back off the shaming), have a better understanding of what is the most important and remember that a lot of information can be looked up. We don't need to continue to highly detailed report just because thats what we've always done. ..... Sorry, report is a huge pet peeve of mine. Anyhow, I congratulate you on wanting to try something new! While its a shame that is isn't a true stepdown unit you have now at least experienced the other side! Another poster mentioned some of the upsides on the floor. You get to have a much better and deeper relationship with the patient. Especially if it is a specialty floor. You develop and use your teaching skills ( like discharge & med teaching) much more on the floor than in the ED. If you go back to the ED, don't forget to incorporate what ever skills you learned!

Seriously, you need to find a new job. Ashagreyjoy You have clearly put a lot of thought into this issue. Very well said!!

I have heard good things about Vanderbilt from a co worker whose spouse just finished.

I read this article with great annoyance. One of the things I love about nursing is the flexibility. The best staffing options that I ever had was a floor with a mix of 8's and 12's. While it may have been a headache for staffing (no sympathy, your job is staffing) it allowed for less disruption on the floors during change of shift and it allowed those who wanted 8's and/or 12's to have them. I can say I am just as tired after 8's as I am after 12's (and I almost never work past 12- unless its a code or something). I did 4 8's for a few years. My work life balance is significantly better with 12's than 8's My hospital did not offer 5 8's, so you only worked 32hrs weekly. Also, I have don't 5 8's in a week and by the end I am more tired and my frustration tolerance is much lower. Obviously an n of 1 is not statistically significant, but it is significant to me I wont get into the sources cited, but on first reading it seems like your articles are fairly cherry picked to fit your conclusion. If you don't want to work 12's, then don't. Advocate for mixed shifts instead and staffing solutions that work for your facility. Broad based solutions usually lead to everyone being unhappy.

While this may be true, very few post certifications NP residency's exist. Good luck finding one. For what its worth, I graduate in a few weeks from a well known AGACNP program. I have 11 years of RN experience from bedside to ED and I am terrified. I cannot imagine trying to be an NP without this experience. As for the medical students, I have had rotations with some (and just finished an ICU rotation today). They were in the unit 5-6 days a week 8-10 hours a day. At minimum this was 160 hours in just the month they were there. They have a ton of hours just as students and then they go on to their residencies. Yes, I didn't need to do rotations in ped's, OB/GYN, mental health or family practice as I don't plan on working in those environments but over all, NP's just don't get as much clinical training. I currently have more than the required amount and really wish that we were required more than 500. As to the comment No one is denying the intelligence or capability of DE students. I have been in classes with some of these students and they are extremely dedicated and intelligent people. I know many bedside RN's who are second career nurses (myself included) and each brings a different perspective to the table. Of course prior experience has value! I obviously have a bias as I do have RN experience and I have learned so much from this. I suspect that when you hear NP's who were RN's first say that RN experience matters is because we have been there. I am not sure if this will come across clearly, but until you do something, you don't know what you don't know. Or as Rumsfeld puts it "the unknown unknown". No one is denigrating the intelligence of DE students. It is the required hours that is a problem. Again, as an RN with 11 years of experience (and over the past 2 years as a student), I've definitely used my ED job to practice assessment skills (above and beyond RN), think of my own differential diagnosis, interpret labs etc... I have 600 "clinical" hours and again, I really wish more hours were required.

I am really sorry this happened to you. As far as this company goes, it is lousy that they own such a large part of your market, but as they lack integrity and ethics, they are not a company worth working or in the first place. By your description, they are clearly unethical and I would fear not only for patients in such a place but for my license as well.

My ASN program required an 82% for the semester to pass. It was not per exam, but by semester. At the time, it really stressed me out, in hind sight, I am really glad they had such high standards.

As a per diem RN with 10 years experience, in SF I can get somewhat close to 200K IF I work 36 hours a week. I would have to do a lot of OT and pick up shifts to cover that difference. However I work days, but I don't think the differentials would quite get me there either. You also need to consider what Federal tax bracket you will fall into (are you single/ married) and how will that affect your overall income.

Have you spoken with admissions counselors regarding what you need to do to get in?

I don't think this is true. While those grades will be on a transcript forever, it does not necessarily reflect your current ability. I would ask some admission counselors about retaking some of the courses (ones especially relevant to nursing) to prove your ability to handle the coursework. Some schools take into account growth and maturity. They may see it as good sign of work ethic and dedication that you were willing to retake classes, do well in them and prove your worth. My original non nursing BS was not great, not terrible but certainly not exceptional. About 6 years after my original BS I went through an ASN program and my grades were substantially better at 28 years old than at 20. I then finished an online RN- BSN program with a 3.9. I was terrified that my original GPA of 2.9 overall (chemistry really did me in) and 3.3 for my major, would keep me out of grad school. It did not.

Ahhh, but she is a slayer, so mere mortal rules don't apply. What bothered me more about Faith being in a coma, was that she was in a coma in the 1st place... with all the slayer healing superpowers an all.

You don't need to apologize!!! I had (and sometimes still do) have a difficult time with boundaries. Maybe it is because both sides of my family avoid conflict at all costs (and often to their cost) and it is difficult conditioning to shake. However, I learned about personal space in healthcare before I was an RN. After college, I worked per diem as a counselor in a locked psych facility with kids and adults. I learned very quickly to adopt a very firm and inflexible no hug policy. This made it much easier when I became an RN (not psych!) to extend that policy. Its usually patients that want to hug me, but I simply say some variation of "I don't do hugs". You don't have to explain your boundaries to anyone. Ever.

Absolutely true

Not a school nurse, but if you are required to have clothing available, can you: 1. Get the same model shirt/ pants/ gloves in whatever sizes needed 2. Make sure it is the ugliest thing you can find. 3. As for undies... maybe get pullups instead--- that may be a motivator not to need new underwear. I work in the ED so I clearly have no soul.