HarleyvQuinn

I know this is an older post, but being just after the holidays and all. . . I just have never understood the need of some folks to not only screw over their coworkers like this, but also blatantly announce their crime for all to hear ahead of time, too. It just makes no sense to me.

Tread carefully. The BON in any state, let alone states like TX, are not known for their friendliness towards the nurses they oversee on even the most generic of issues. It tends to go downhill on issues such as mental health, substance use, and fitness to practice. They are not there to help you. They see themselves as there solely to protect the public. Do not provide these administrators with ample rope with which to destroy your career.

I imagine they'll take it as a question of mental stability in that, if you're a danger to yourself, you may not be clear-headed enough to reliably or safely practice until cleared to do so by psychiatry. It doesn't necessarily mean you're at risk of directly harming patients, but rather that you're not in the right frame of mind/stable mind to currently safely practice until you're doing better. How they go about it leaves much to be desired.

You disclosed suicidal ideation to the BON, worse so the TX BON. Even if it's not Bipolar Disorder, they have you for some form of mental illness due to suicidal ideation. That alone will keep you on the mental health track. Seek diagnosis clarification for your health and well-being, not purely in trying to get out from under the BON's watch. I'm not convinced a diagnosis change would alter much for your contract. I'm glad it sounds like you're doing better now.

It's that OIG exclusion list we all should rightly fear. That's the one that'll get you blackballed from Medicare/Medicaid-funded places. Which is like everywhere. ?

You can get an initial endorsement to NC, which will have the vast majority of the paperwork done and is what takes most of the time if you submit all their requirements ahead of time. Employers often look for at least this much to be done. Once you are employed, they will supply you with the supervising physician's information that you would then submit to the BON for the final full approval for NP practice. That's how I went about it, anyway. The DEA licensing also requires your supervising physician's information, I believe, and took longer to obtain initial certification. Credentialing is just a giant pain across the board.

The same way I would advise strongly against a CDL Truck Driver against doing so, even if it is technically legal in their state, I would advise any license-holding medical professional against this. The BONs go by federal law, which currently holds THC as illegal and class 1 controlled substance. We don't have any real studies showing how long one is impaired after use, especially given how long you test positive for (longer with regular use). For reference, the DOT when certifying those with CDLs states that current THC use is the only substance that is an automatic disqualification. I imagine the BONs have a similar attitude and, given how ugly the alternative to discipline programs can be (expensive), I wouldn't test them.

Currently licensed in and working in NC. I don't have to pay for the collaborative agreement as it's through my workplace. Honestly, I wouldn't consider it micromanaging, either. We have both a primary collaborating physician and a secondary and they're both available any time there is a question and we have several scenarios they want us to always run past one of them. Both physicians are easy to talk to and love to teach. I've actually enjoyed the practice environment that I'm working in greatly and continue to expand my knowledge and skill base by working with these two physicians, the other NPs, and the PAs I work with. This is an urgent care setting. I think it all really depends on where you work and the culture of that workplace.

I disagree about getting rid of FNP - it's not too broad necessarily, it's how you use it. It works great with family medicine clinics in primary care where patients want to use one clinic for their whole family, but it requires the support of the physicians and PAs who also work in the clinic. I also think having specialists such as Pediatricians involved is key. Primary care used to be a very generalist role in and of itself - we've just hyper-specialized medical care over the years. There are also other outpatient scenarios that aren't primary care where FNP works great - Urgent Care clinics. You need to be able to see all ages, it's not emergency care, but more a mesh of basic acute care visits you'd see in a primary care office and procedures that they used to do in primary care (suturing, I&D, basic fracture stabilization/care) but have gotten away from due to reimbursement issues. Occasionally get the ER patient who needs a quick call to EMS for transport because the community confuses urgent care and ER all the time. As for fixing the schooling? For one, while I don't mind online learning, there needs to be actual teaching done. I know no one wants to sit through lectures these days, but there should be an interaction between the students and professors regarding the material being taught and there is much to be gained in hearing the professor's own experiences in practice. There are also a multitude of skills that -need- to be learned before starting practice. This should involve direct interaction between the professors and the students - ensuring that the skills are being performed correctly, and on more than just one occasion throughout the program. Being able to perform procedures shouldn't be overlooked, either, as they're an expected part of advanced practice. We should stop sending NPs out into practice with "just pick it up at a conference" when it comes to suturing, I&Ds, splinting, casting, reading x-rays/ct/other imaging. Time spent with the professional models learning to perform the pelvic exam and testicular and digital rectal exam should be required, not a selling point, for a program. Model the programs after our CRNA counterparts. Stop partnering our programs with the Nurse Administrator programs. They are not our peers. They are not providers. CRNAs and CNMs ARE. I had no problem with going to school year-round for approximately 2.5 years for my program, nor working hard in it. I was lucky to have skills evaluations, testing on model patients (real people, scripted situations, actual performing of HPI/exam/diagnosis), working with professional models, suture class, microscopy training, x-ray training, cadaver time, etc. The University that merged with the one I started at? They were looking at cutting some of these necessary components because of cost. All of my graduating cohort passed our boards on the first attempt. I would also keep in mind they only admitted small cohorts each year.

Reglan can also cause side effects, especially if pushed or infused too quickly. Akasthesia especially, or that feeling of "coming out of your skin" or "crawling in your skin" type of sensation. I've seen it happen in pregnant patients receiving the medication by IVPB or IVP. As for Compazine, it's actually a fairly well-known side effect. I've experienced it personally, as well, and it's quite painful. Benadryl or Cogentin can help treat the EPS until it's out of your system. Torticollis/EPS is one of the reasons Compazine fell out of favor in a lot of ERs. Outside of prolonged QT syndrome, I haven't seen many issues with Zofran. Promethazine being a vesicant is a major issue, but I've also seen a paradoxical type of effect with it similar to what you can see in Benadryl. Instead of sedation, it hypes some people up or even causes hallucinations in some people. Not something I've seen frequently, mind you. It's always important to be aware of the potential side effects of medications we prescribe/administer. ? You never know who is going to be that 0.1% that experiences a less common one.

Compazine works great until you've seen someone with extrapyramidal side effects like severe torticollis from it. It caught me completely off guard when it happened to me. No thanks, I'll take Promethazine IM if need be. I usually order it IM, as well, rather than worry about ensuring someone is getting a good line. If it's needed, a little extra discomfort from an IM shot won't be minded. Zofran is great for the milder cases where it's tolerated and there is no pre-existing long QT issues. When it comes to GI viruses, though, I've found it often lacking to help control the vomiting.

HCA as a corporation are soul suckers. Do not underestimate them. There is a reason they need these contracts and need sign-on bonuses to lure in staff. Have an actual consult with an attorney to discuss your options and settle up. Always be prepared to pay back any offered sign-on bonus if you leave a contract early.

Haha. Never. That poor girl has been with me for almost 13 years now and is one of the best dogs I've ever raised. She was sick and needed my help and was trying to alert me. She couldn't help it hit her again right as she was waking me up. Poor girl. It's rare that she gets sick. Besides, it still didn't smell anywhere near as bad as opening up a pilonidal abscess.

I felt very blessed when my manager was graceful enough to let me be 4 hours late as a provider to the clinic when my dog woke me up by throwing up unceremoniously on me in the bed. Gave me time to get her to the vet and toss the linen in the wash. . . and stop dry heaving myself. Pets can be just as bad as kids sometimes. ?

We took the APEA version. It's not something you're necessarily supposed to ace, but they want you to be close to the national average. APEA does sell their study bank of questions for the 3P exam and I found them to be really helpful when studying for it, as they ask their questions in a particular way. I also found their study bank and review course helpful prior to taking the FNP board exam, as well as utilizing other study tools.