Darth Practicus

The same could be said of obtaining a BSN over an ADN. A lot of people will not go that extra distance because of the cost ratio. I think the vast number of people seeking a BSN do so because of it being required for entry into advanced nursing practice. That's my experience in talking with a number of people at least. It's a profession-wide problem. And it's not about compensation, although we all consider it at one point or another. It's about just being able to get into the academic setting for me, which is the point of the opening question. Darth Practicus, NP

Jen - I appreciate the response. You have hit the nail on the head. It's kind of ridiculous. I will check out WGU. Definitely looking to get started with teaching this fall. I agree that if you're a full time educator, it might not seem like the investment is worth it. Will you even see much of a return on that investment? This is a barrier to a lot of people, I think. Darth Practicus, NP

I've given it thought as I have a strong ED background... I just kind of hate shiftwork, but perhaps worth looking around. Trouble is, Urgent Care in my area is limited to one that is owed by a competing practice and this might cause issues for my primary job. Hmm...

That's pretty solid. How many hours would you say you attribute to this? I might see about doing this as its something I hadn't considered before.

I did hospice for a year and I had a patient I lost that really had become close. I shed quite a few tears when she passed. Sweetest lady ever. I think its great that you opened up in that way. Darth Practicus, NP

I think you made a strong choice there. Creepy.

Well, thankie! Darth Practicus, NP

This is legit. Dealt with a double pediatric murder situation in the ER this past fall. 4 and 6 year old brothers shot in head by father and we received them via ambulance and they were pretty much already gone. Literally bothered me for a couple weeks with sleep difficulties, trouble concentrating, etc. We deal with things that are sometimes otherworldly. Thanks for sharing! Darth Practicus, NP

That's too funny because I remember in my first week of being a nurse that the same thing happened to me in a round about way. Accepted a new patient from the ED and as per the usual we would change the patient into a telemetry-compatible gown. This 80-ish year old patient just stripped before my eyes and she said "no need to look away, these puppies are what you're wife will have some day" (alluding to her sagging bosom). My jaw dropped, lol.

Ollie, I work in a collaborative practice state as well and I share in the experience you describe. I am certainly not made to feel inferior. If anything, my MD is a great resource to have because he may provide some perspective I did not get and vice versa. An example that comes to mind is a patient I saw in the office a couple weeks ago as a new patient. The patient reported that he was experiencing rectal spasms that seemed to only occur when he was not focused on a specific task or concentrating on something. When his mind went idle, he felt some feelings of anxiety and the rectal spasms. In the interview, he denied any back problems, injury, etc. I did learn that he was a victim of sexual abuse as an adolescent. My experience led me to think outside of the box to include both a medical disorder AND a psychological disorder of PTSD. My collaborator had only thought of the medical issue and thought I should refer to GI. So, it goes both ways in my collaboration. And honestly, I'm blessed and thankful. I know that my personal experience does not constitute the entirety of what my colleagues may experience in their own practices. I have heard of some pretty terrible stories out there of some vicious collaborative agreements and relationships. I will say that a doctoral degree for nurses does not improve clinical proficiency at all. The Core Essentials of the DNP is well off the reservation when it comes to that. Darth Practicus, NP

Congratulations on your first gig!! UpToDate is a must! I'm fortunate that my practice has a practice account with it. What kind of EHR do you use? I found I probably over-charted on my initial visits, but that is something that you will learn to balance as time passes. Darth Practicus, NP

Having read some of the threads on here over the past year or so, I have seen where some NPs can earn quite a bit of additional income beyond their FT job with a secondary job, etc. I'm wanting to learn about some of these opportunities that boost income potential but do not become a time suck. I have considered teaching online part-time (running into road blocks there due to saturation). Just wanting to make an extra $20-30k a year (is this too hopeful?) without turning into a workaholic. Note: I do work in a state that requires a collaborative practice arrangement in order to practice... so there's that. Would love to hear ideas! Darth Practicus, NP

I can't say this is a bad thing for our profession, right? Darth Practicus, NP

I'm presently in a DNP program and have done quite well without spending an inordinate amount of time in the class. My program has 8-week accelerated classes and usually just a couple of the weeks require an intensive amount of time to complete the project. I, admittedly, am one of the world's most prolific procrastinators when it comes to classwork and I always manage. So, anyone with a semblance of ability to balance work over a span of weeks would breeze through from a time-investment perspective. The cost and wanting a break from school are legit things, though, and something to consider before going back. :) Darth Practicus, NP

You sure can! Go comment a few more times and we can connect easier. I was shy on posts as well. DP

Haven't seen a new post in this subforum in months, so I thought I would kick off a new wave of discussion to help spur ideas for a presentation I have planned next month geared towards men in healthcare. What's something you never expected to run into as a male nurse? Can be something positive, negative, but preferably surprising. Cheers, Darth Practicus, FNP

This really sounds like something I would run away from. Holy Moses. What a nightmare. I also agree with Pro-Student. Sounds like a pill mill to me. Darth Practicus, FNP

I kind of like what Riburn has alluded to here. I agree 100%. There will be a ramp up and this will effectively help you establish a panel of patients rather than come in and take over someone else. Coming in at this time may afford you some flexibility in shaping policy at the practice itself as needs arise that need to be addressed. I also agree with negotiation in your contract. It's certainly okay to haggle with the terms of employment. If they offered you the job, then you obviously have what they are looking for, so now make sure they know you have conditions that need to be met. They are doctors, so they know all about this, and shouldn't object to it. Things to consider asking for in your contract include: 1. Negotiate a half-day off during the week. 2. Add a week time off for continuing education 3. 2 weeks vacation time + 5 days sick time, you get an additional day off per year for each (it's been proven that you will get sick more in your first year of practice) 4. If no orientation built in, then ask for a ramp up such as 2 weeks of 8 patient per day, 2 weeks of 12 patients per day, 4 weeks of 16 patients per day, then 20-24 thereafter (not sure what expected volume will be). 5. Bonus compensation??! And if not, then definitely negotiate for $110k and see where they meet you. $100k a year in Massachusetts is rather meager. Lots of possibilities if you ask. Good luck!! Darth Practicus, FNP

I'm curious what state you work in. I live in Missouri and here we do not have full prescriptive authority and can only write for controlled substances in limited amounts and only after completing nearly a year of practice. When we have DEA authorization, my collaborative physician has to provide supervision on 20% of my charts (compared with the 10% for NPs without DEA). To me, I actually enjoy the fact that I can't write for controlled substances because it's such a Pandora's box for folks. We have a very large opioid addiction issue in southeastern Missouri and so it's nice to not have to dip into the pool. Of course, it helps that our practice position is that we write only for acute pain management, anything over 6 weeks is sent over to a pain management clinic for further evaluation and management. If you're seeing nothing but narc patients, it seems like the providers are being a little too loose in writing for them. (Just a thought.). Darth Practicus, FNP

Hey there - Sorry I missed your post, mcleanstrong. I am presently doing the Health Systems Leadership DNP through Chamberlain, so you have a keen eye. If I were be perfectly honest, I'm just not all that impressed with the core curriculum of the DNP. I don't fault Chamberlain for this. My professors, all save one that is, have been exceptional and helpful in building knowledge. The material just isn't all that interesting. The first couple classes are like Nursing Theory on steroids and I felt my rate of male-pattern baldness accelerating in each of the first two classes. The leadership class, usually third in the program, was fairly relevant and had some crunchier topics for conversation. I'm just starting Population Health, and this class seems to have more to it than just a couple papers and weeks of discussion topics to endure, so that's promising. It's terribly expensive, but Chamberlain has some nice perks such as being online, flexible in hours, strong technical support team, and a great team of educators. I really like the 8-week class versus the 16-weekers I had to choke down in my MSN. If you think in terms of analogies, I would say that the DNP is to the MSN what the BSN is the ADN. It builds contexts, broader understandings, and a better global view of healthcare and how it affects patients. It does not really teach you to be a better clinician. There's nothing truly technical that a DNP-prepared FNP might do that a MSN-prepared FNP would not aside from having a better understanding of things at the systems level. Hope this helps. I welcome any other questions you might have via PM if you have any. Darth Practicus, FNP

This sounds intense. I've been in practice for 2 months now and so I can relate to some of the jitters. I certainly have my "sea legs" now, but I had some anxiety at first as well. I can't speak to your practice environment because my practice environment sounds vastly different than what you describe, but it sounds like there are some issues that are complicating your immersion: 1. Being introduced as a Dr. if you do not have that title is strange. Surely, your collaborator knows your right title, so he should be using it as a professional thing to do. 2. Coming in and "fixing" all of your charting is not a supportive method of onboarding. First of all, that action basically devalues what you are trying to do and instead of using it as a teaching moment, he is simply "taking the wheel and driving." This is hugely problematic and would likely increase anxiety in any individual trying to acclimate to the practice. He needs to recognize that you are not his drone and you may make some different choices with regards to documentation. You both might want to sit down and discuss some key points with regards to documentation (and frankly, it should be reflective of the requirements of billing for the type of visit you're doing rather than adopting whatever parlance he uses with his own charting), and thereafter, your documentation should be measured on that rather than any particular style or level of detail. So long as you're meeting the needs of accurate documentation then move on and allow you to come into your own in this regard. In summary: he needs to get off your lawn. 3. It seems, from reading your post, that there are some cloudy expectations between you and the provider you're collaborating with. Maybe sit down with him and say that you have some concerns about understanding what is expected and that could be remedied by setting some goals and mutual expectations about workflow, etc. Ask the questions: "If I have a question about a particular problem I see with a patient, what's the best way to work with you to collaborate?" Perhaps he will have an answer. Perhaps he will defer to you on it. Either way, come to an understanding. It will make the both of you feel better about the situation. You will build up trust with him that he will be supportive and he will enjoy that you are comfortable enough to come to him when you have a concern. That's how mutual respect is born. 4. You won't know everything there is to know. Not ever. Coming from being a highly-proficient and experienced RN to being a newcomer NP is a shock. But you don't have to be alone. I strongly recommend you subscribe to a medical reference that won't gather dust on a bookshelf and will constantly be revised to reflect the strongest evidence possible in terms of medical decision-making and treatment options. I use Up To Date and so do my colleagues. There is a monthly cost for using it that isn't the cheapest, but it's the best collaborator I could wish for. You can use it at the clinic, office, on your mobile device, tablet. You can download it onto a device when you're in situations where you don't have internet access. If you don't use it, I would highly recommend you give it some consideration. As a bonus, you accrue some nice CEUs for every article you read. Best of luck. Feel free to msg me privately if you need a colleague to decompress with. It's not easy being "green," as Kermit would say. Darth Practicus, NP

Seems a lot of people want to use loan reimbursement as a factor in the overall compensation package, but do note that not everyone that applies receives reimbursement and that reimbursement comes from the government and not the employer. Don't let them piggyback off of a third-party program.

HAHA!!! That has to be the funniest assumption ever. However, after several years of working in ERs of various types and sizes, it's not surprising such assumptions are made of ER nurses. ER nurses literally save lives. Patients do not enter the hospital proper in emergent situations without first having had the touch of an ER team. An ER nurse often gets 5 minutes or less notice of a trauma arrival that will upend a large portion of one's shift. At any given moment, you might be hanging life-saving medication while dealing with a repugnant drunk who thinks it's okay to cuss you out over the hospital's choice of plain turkey sandwich as their main ER entrée. One minute you should be silently swearing to yourself over the self-serving complaints about the wait time over their mild cough and sniffle while you're trying not to lose your sh@t because you know part of that wait was due to a police officer getting shot and the whole team trying to rally to save him. ER nurses do their best to walk into a patient's room to offer a refill of ice to a patient who's been hammering the call light while you've been busy performing CPR on a young boy and his brother who were shot in the head by a deranged parent. And despite your best efforts, you now have to somehow gather what remaining willpower and strength you have left for the family who now has two empty seats at the table. It's not all doom and gloom, but I don't know of a single other environment that has such various elements (highs and lows) in a shift. You could be at the end of your rope of patience in dealing with people who aren't really sick or who just want a place to crash because they got drunk again... and in the next moment have to refill your compassion bucket to deal with someone who is on death's door. Just as inpatient nurses may feel they get endless admissions, ER nurses do not get to tell ambulances to go somewhere else. We just take them because that's what we do. Even when we are at capacity. That's usually when we really need nurses on the inpatient side to understand that delaying that report, or pushing admissions off on the next nurse may seem like its helping you, but in the end it's compromising patient care. It takes a team. Assuming all ER nurses do is "set IVs" and such is just about as insulting as someone assuming that non-ER nurses just sit at a nurse's station. We can do much better. Thanks, Darth Practicus, NP and all-around good guy Former ER Nurse, ICU Nurse,

Hence, my dilemma.

Hi Tony - First of all, thank you for your service to our country. It's an honor to live in a country that is free and secure thanks to those who have served in our armed services. Next, I was in a similar situation (wife was open to moving anywhere in the country when I graduated) and so I looked around. A lot. I found several areas in the country that offered some great opportunities as someone starting out. When I looked, I considered things like cost of living vs. salary (to this end, $90k a year in Seattle is a joke and barely above poverty line due to the very high cost of living), location, and state stance on advanced nursing practice. Three areas really stood out as promising: 1) Eastern Washington State - Washington State is one of the leading states when it comes to being an NP with regards to practice authority. No collaborative practice agreements, full prescriptive authority, can work outpatient and inpatient settings for the most part. East of the Cascades in Washington affords all of the great things about the state minus the awful rain and ridiculous cost of living you will find in the Seattle region. 2) Colorado Springs, CO - housing is very affordable for the size of house you get. Colorado has some pretty nice practice authority as well. Salaries aren't bad considering cost of living, and the area is fantastic for outdoors, being a military-centric area (which might be a perk for you). 3) Reno, NV - the town speaks for itself. Practice authority is great. Might be a stellar area for someone who is single and might enjoy the finer aspects of what the town has to offer. Salaries will offer you some comfort. Good luck in your search! If this doesn't work, there are loads of travel assignments you might do. My recommendation, though, is to fine a place that offers great collaboration for 1-2 years to give you your bearings and then look around. Darth Practicus, FNP