Sha-Sha RN

I agree that this is a question best posed to the employers who are requesting it. My thought about it is maybe there will be some inpatient rotation/hours required with the job and a lot of hospitals are now requiring ACNP cert to work anywhere in the hospital.

H to the E to the double hockey stick no! No way I would apply for that. That must be a typo especially given the population and expectations. I would stay working as a bedside RN and wasting for something else to come along or do some per diem work as a np. Medicare home visits is a good way to get your foot in the door with some experience.

But someone who is lazy may get hired based on his/her RN experience on paper- you can't see laziness on paper; this usually gets discovered later. When I was searching for my first NP job, I got a lot of interviews based on my RN experience and many of the questions asked during the interviews focused on my role as a RN. No one asked my about my experience during my NP clinical rotations, other than the job I ultimately accepted and they really didn't ask either. I mentioned to them about my experience and exposure at a outpatient Diabetes clinic during my last clinical rotation.

My hospital still documents on paper and there is a special flowsheet to document the FS, bolus amounts and basal rates for pumps. There is an order in the EHR for the pump settings but monitoring is done on paper. I'm sure that flowsheet will have to be made into an electronic version once the Nurses start to document directly into our EHR.

As others have said uptodate, epocrates. I also find medscape and physicians reference helpful.

Sounds like insulin resistance without knowing his insulin doses. If he's type 2 then he makes insulin but it's not working with the glucose like it should. If he does snack what is he snacking on and what time of the day. How much sliding scale coverage does he get? He may need a set premeal/nutritional insulin dose along with a correction scale and a little more Lantus. Why is the lantus split bid, does he get a large total amount for the day? Is he only on insulin, no oral regimen. What type of setting is this, inpatient or long term care?

With the new consensus model and the specialization become more specific between acute care NP and family/ adult np specialization based in primary care it will be important to find out will you be hired as a FNP to work in an ER. I know some hospital still hire FNPs to work in an acute setting based on their nursing experience, but I'm not sure how long this will happen. As far as preceptor yes I have heard there are programs (mainly online, but some brick and mortar schools) that require you to have preceptors lined up when you get accepted. The reality is that you have to start looking for preceptors at least 1 year before you start clinical rotations. The problem is that there are more NP students in need of preceptors than there are available preceptors and some preceptors have students lined up to train maybe a year in advance either arranged by the school or the student doing the arrangement themselves. My program (blended online/onsite) required us to find our own preceptors and they wanted us to submit a preceptors name a semester in advance so they could vet them and make sure that they were an appropriate preceptor for a primary care experience.

No my change heart about women's health did not set me back at all. My program required us to do at least 40 hrs in women's health during a semester we had to complete a total of 180 adult primary care clinical hours (Gyn only). So I did 50 and moved on. If I had more interest in women's health I probably would have done more hours during my last semester which my school allowed you to do specialty hours as long as you 500 primary care hours were done.

I'm a new AGNP. I graduated last May, but I started at my current and first NP position 5 months ago. I work inpatient at a hospital on the Endocrinology Service. We only see adults for everything metabolic/ gland-related from out of control diabetes to high calcium levels to adrenal insufficiency. Very interesting field and I am learning a lot. I don't regret doing AGNP vs FNP because I really had no interest in doing peds. At one time ( before I went to NP school) I thought I wanted to work in women's health, but after my women's health clinical rotation during my NP program, I realized I did not want to look at lady partss all day everyday. So the AGNP program gave me that luxury, that I would only have to do that role sometimes if I work in primary care.

Have you tried your state NP association? They usually have preceptor lists. Can you have MDs precept you? If so do you have any MDs that you know or are friendly with? How much help do your school give you? I know my program was little to no help unless you were close to the professors.

As a NP I don't do blood draws or IV starts but I know FNPs who worked in the ICU who may have to draw blood sometimes or do arterial sticks if no one can find a vein for blood. I know one of my preceptors did draw blood if his RN was out for the day. However it is not a job requirement and you need blood from someone or iv access there is usually someone around who can do it.

I'm not sure the boards are that easy given the multiple number of post on allnurses alone of people fail the exams multiple times. Granted I can't speak to someone's knowledge base, if they are currently a practicing as a RN, just not great test takers, if they intelligent or just book smart. I know very smart people who did very well in their NP programs and impressed their preceptors very much with their clinical knowledge who have not past this test on the first try.

Some people do it because it has been a struggle to get their foot in the door as a NP somewhere and are willing to go for broke with the first ( and maybe only) offer that comes along. Not the right thing to do but true for many.

The adult- Gero exam is new. The one being retired is the adult np exam ( the one without the Gero).

Some employers prefer ANCC certification mainly because it's been around longer. You have to find out what job prefers. AANP exam is strictly clinical multiple choice questions. ANCC is a mix between clinical, delegation, research and leadership questions - at least 60% of the questions are clinical. There are also different types of question - multiple choice, pictures, multiple-multiple answers, ranking question by priority. The reason why ANCC has more chances to retest than AANP is because ANCC has 3 versions of the test vs AANP has 2 versions.

That's what I'm expecting. I'm here to make myself as well as the profession look great.

I have to agree with Jules A on the patient compliance issues. Now as a prescribing provider with my NP job for the last 3 months, I find it difficult that we as providers, Especially NPs put a lot of work and individualized pt care into our plans with some pts verbalizing they will do it, but you know deep down it's not going to happen. However, I have seen many success stories. I know a major problem for new grads is finding that first job. I have classmates still looking for that first job and we graduated a year ago. Many NPs are trained in primary care, but I have found that most primary care jobs want NPs with at least 2 yrs experience. The people I know who are NPs who got jobs less than a year out of school , including myself, got our start in specialty areas or in doing home assessments/home visits. Finally, I think we still have a long way to go in getting respect from our physician colleagues. In my 3 months in my current position I had never felt less than equal until today as I'm in my first 3 days with rounding with a different service attending of the month and he questions most of my suggestions, has no regard for my time (we round after 5pm until 7pm and I've been onsite since 8 or 9 am ( of course no OT pay). I've also noticed more scrutinization of my notes vs the notes of the 2nd year residents who are doing an elective rotation with us ( never questions their input or read what they write just writes his addendum and signs - their plans don't usually match - or as the newest resident said to me, he writes something very vague so it wouldn't even matter, somehow some way it will match the attending's plan). I even asked him about his being comfortable with the residents filling out the plans before we do rounds and discuss with him and he said they are 2nd year residents, more than capable to do that. The good news is not every attending feels that way. The kicker today was we were being told a story by the attending about how in the old days before insulin drips how pts received iv pushes of insulin q 1 hr which was probably more effective and really did not see any improved outcomes with the institution of insulin drips. But the iv push days was when pts were being watched, but now no one is watching the pts only watching the computers, then he said the nurses that is. He then remembered I am a nurse and said sorry but he and the resident were looking to me for confirmation that nurses just sit back and watch the computer instead of patients. I said nurses's watch their pts especially speaking for myself. So as a NP you have to continually prove yourself, that you are a capable and competent practitioner considering you're just a nurse and nurses are lazy. This is a good topic. I hope to see more thoughts.

Socializing? Very interesting take on a RN participating in rounds. All I can say is good luck in your new role as a AGNP. Now back to the main topic of this post.

I don't think you were not getting supported; I think the question was valid, getting an assessment of your background. I have been an inpatient nurse for 10 years and even when I was caring for my patients, sometimes 5-7 at a time, I would find a spare moment to join that circle of influence as you call it because as a RN I considered myself the center of that circle (along with the pt). I was the only one with the patients all day and have something to contribute the the information being shared. Plus I was able to find out what the teams or consults were planning.

Did you take a review course? Did you Check out past posts on this forum? There are plenty of posts on this topic. I know for me the Maria Leik book helped along with my Fitzgerald review course. Also there a book by kellerman, a FNP review book 1000 questions with rationales. Brush up on your research hierarchy, know your derm, ekg strips.

I know for me I knew wanted to be a NP after working as a RN for a number of years and working along side many types of providers (MDs NPs PAs) and I wanted the ability to do more for my patients. I wanted to be the one part of the team that was making decisions about their care instead of just carrying out the orders.I have watched many different NP and admired the ones I worked with that truly has a major role in the treatment plans for pts in the hospital and especially NP who are output keeping their pts well and out of the hospital. from what you are saying it sounds like ACNP or CRNA would be best suiting for you because those roles have more excitement attached to them. I'm a ANP in Endocrinology input and I can say I have my fair share of excitement and many opportunities for learning. I know many FNPs in specialty areas who really enjoy what they do. I would suggest if you have an opportunity to shadow some NPs or CRNA do so so you can get the feel for the roles. For the NP try to shadow with the different types FNP, ANP and ACNP so again you can feel thru the differences. Try to do this before enrolling in a program because their is nothing like starting a graduate program and once you get to the clinical portion you become bored and hate what you signed up for. These programs are it walks in the park, so be sure you know what you are getting into. Good luck.

Honestly, I don't think a lot of programs are forthcoming on the process of finding preceptors in the materials potential applicants see. As I mentioned in another post I did not find out my program didn't help until my first day of orientation. The other side of this issue is in certain states you are limited to where you can matriculate into an NP program. I know for instance in NY there are only a couple of out of state distance programs that the State BON recognizes. Others may be limited by finances, so there is not the option of applying to a program that finds preceptors for you where you are going to pay 100k for that benefit. So I say all that to say that we all may do our research, but there are reasons many of us go into programs that require us to find our own preceptors, because if you can't financially go to a program that finds preceptors for you, your limited by state constraints or you don't get accepted to one of these programs you are limited in choices and you really want to be an NP.

In NYC RNs in hospital make at least 70k annually without OT.

I don't remember seeing that tidbit of info anywhere when I applied. Even now, on the website it has a statement that says they can't guarantee availability of preceptor, but does not say they don't help you secure them. The wording is very misleading.

I went to Stony Brook for the Adult-Gero NP program, but back to your basic question, I have met a lot of NPs who said to me their programs made them find their own preceptors and many were in onsite programs. I know schools like Hunter, NYU, Pace and Columbia will place your with preceptors but you have the option of finding your own.