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Adult Internal Medicine
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BostonFNP has 10 years experience as a APRN and specializes in Adult Internal Medicine.

BostonFNP's Latest Activity

  1. “Vaccine hesitancy” in regards to the Covid vaccines really is a misnomer: it is not “hesitancy” in a traditional sense. There was an interesting survey recently that showed that majority of the unvaccinated say they will “never” get vaccinated. Of the remaining, the majority give that they “don’t trust covid vaccines” as their main reason. However, if the survey asks to select “all reasons that apply” instead of just one, the majority pick all of the reasons. This equates to playing a game of whack-a-mole with reasons why these folks are “hesitant”. The only thing that may convince them is seeing more of their friends get sick and die, unfortunately.
  2. IMHO, in the setting of a ongoing pandemic, every person has a responsibility to those around them to be honest about their vaccination status. I'd wager 99.9% of people that are uncomfortable being nagged about their vaccination status are unvaccinated folks. The fact they are uncomfortable about it, ironically, demonstrates that somewhere deep down they know they should be and feel embarrassed/guilty they aren't. For that other 0.1% that feel uncomfortable telling someone they are vaccinated, I'd offer this: you got vaccinated for a reason, feel comfortable sharing that reason to anyone, maybe a skeptical acquaintance would listen to you and make a better informed decision for themselves. Antivaxxers are emotional and irrational and debating them is often fruitless, however, if we don't push back on these people their pseudoscience gets a opportunity to take root in the minds of those they may not be totally decided yet.
  3. BostonFNP

    Reality Check.

    I wanted to chime in on a few things here because I think it’s important for you abs your socialization into a new role. 1. I think it is important to acknowledge from the beginning that you are moving from a place where you have developed competency and expertise through years of work experience into a role where you will be starting fresh. Being an expert nurse only qualifies you to be a novice NP. There is no skipping steps, you need to rebuild that competency and expertise with experience in practice. I often see NP students that are experienced RNs putting far too much pressure on themselves to know everything from the start. It’s OK to be a student again and simply learn. There is a mantra of fake-it until-you-make-it in NP school; I make students dump that at the door because it creates stress and it ruins your learning experience in the clinical setting for sure. 2. We all make mistakes. We all misdiagnose. Some doctors enjoy pointing out when NPs do this but the truth is, if they are in practice, they’ve made the same errors. If they don’t think they have, they not only aren’t good providers they are dangerous ones. Self-reflecting practice is the hallmark of a good provider; it can be anxiety producing for students/novice providers because it means we actively look for our mistakes, but overtime the anxiety goes away and we are left with being able to accept our mistakes and grow from them. Remember there are lots of illnesses that you will come across as a PCP that have an average time-to-diagnosis of 5-10-15 years! 3. Primary care is far too broad to know everything; there isn’t a provider on the planet that knows it all in-depth. I tell patients frequently “ I don’t know”; the art of medicine is being able to create a plan from that! The MOST important thing a PCP can do, and it’s simple, is identify normal from abnormal. If you can do this simple thing (and the longer you practice the less simple it gets) you will have a solid foundation to grow on. 4. I may take some flack here but I am a firm believer that you are making an investment in yourself in a new career; working FT and doing NP student part time is not the ideal way to build a strong foundation. Would you rather see a PCP that did their education and training as their second priority? On the flip side, would you want an RN taking care of you that was focused on trying to learn something different? It’s a big investment of your money and time, make the most of it.
  4. BostonFNP

    Seeking Advice! Failed 2-Year Program. Now What?

    I am simply stating the facts (and correcting a rather common misconception): accredited nursing programs can not admit students, take their money, then fail them in the last semester to manipulate their NCLEX pass rates. Accredited nursings program can (and do) fail students who are unable to meet their academic or clinical expectations provided that more than 70% of their cohort is able to meet those expectations. These are usually clearly defined in the student handbook. On your original topic, do you have a chance at an accelerated program? Sure you have a chance. Will you be the most attractive applicant, probably not, but that doesn't mean you won't get admitted. I have sat on an admission panel for a very competitive accelerated program for many years, and what I can tell you, is that if you are lucky enough to get an interview, you should be prepared to answer questions about your past performance in a nursing curriculum. The panel is not goign to be interested in external excuses, they are gong to want to hear that you have evaluated your performance and have reflected on how to improve in a new opportunity.
  5. BostonFNP

    Seeking Advice! Failed 2-Year Program. Now What?

    You stated your program "weeds out" students to "manipulate pass rates"; that doesn't sound like the case if your cohort graduated more than 80% of the enrolled students. Any quality program is going to have exams that are more difficult then the NCLEX; the NCLEX is a minimum competency examination. No quality program wants to graduate individuals who are not prepared to enter practice. Failing an exam does not mean the school is "weening" you out, especially if more than 80% of your peers passed it; it means you were not prepared. Most quality programs also either require or strongly suggest students take an NCLEX prep/review course and do NCLEX test bank questions to prepare. It is not indicative of a bad program, in fact, good programs are more focused on preparing you for practice than teaching you to take an exam.
  6. BostonFNP

    Seeking Advice! Failed 2-Year Program. Now What?

    FWIW, if your program did this it would lose accreditation (assuming it has it) very quickly. To remain accredited, the programs needs to have a graduation/completion and retention rates that meet the minimum standard (for example, for CCNE it's 70%). They also must maintain a NCLEX pass rate set by the state BON. This is always a rumor in nursing programs, but its not something that can really happen.
  7. BostonFNP

    dont understan DNP

    DNP is an academic degree not a certification.
  8. BostonFNP

    Need to interview a Nurse Practitioner!

    Have you reached out to your local network? These assignments are given to most (if not all) NP students at some point early in their graduate education, and the purpose of them is to get perspective NPs engaged with local NPs to build mentorship.
  9. That is both disgusting and not accurate. You are, again, giving bad/dangerous medical advice that has zero basis in evidence. You are actively endangering others.
  10. 18 states should be returning to phase 1. https://publicintegrity.org/health/coronavirus-and-inequality/exclusive-white-house-document-shows-18-states-in-coronavirus-red-zone-covid-19/
  11. https://www.businessinsider.com/states-reopened-without-meeting-safety-criteria-coronavirus-case-surge-2020-6 How is Texas doing this week? Getting nervous yet? A significant percentage of hospitalized and severe illness COVID patients are over 65 and on Medicare, I don’t know if you’ve ever looked at your paystub, but you can go ahead and do that and let us know what you see. Lets play a little game: current there are 10,500 hospitalized cases in TX, more than 50% of those are over 65 and the avg cost per day is $38,000. That’s 20million a day in Medicare cost.
  12. BostonFNP

    How Does This End?

    If you want to maker that leap, then then you have to make it on the other side too, that they were fighting radical Fascism, which has be responsible for quite a few deaths as well.
  13. BostonFNP

    How Does This End?

    Incorrect. There are 3,565,476 cases total but only 1,740,955 have had an outcome so far. There are 1,601,508 that have recovered and 139,447 that have died. That is 8% case fatality rate. WOW! Texans are pretty fragile huh?
  14. BostonFNP

    How Does This End?

    My two cents based on where we currently stand now: I think that basic infection control precautions (washing hands, reasonable social distancing, wearing facial coverings when unable to distance, avoiding unnecessary high density enclosed spaces) are here to stay for awhile. They are reasonable and effective and they help reduce more than just COVID. I think we need to get kids back to school and some degree of normalcy (youth sports, social interactions, etc), taking care when we can to practice basic infection control. Worship services (church, temple, mosque, etc) are very important to some peoples' lives. They are a calculated risk but that also can be mitigated with some basic infection control precautions, and I think we need to get people back to services as quickly as possible. As healthcare providers, the most important thing we can do is translate the best evidence based practices to the lay public, and to speak out against pseudoscience and partisian lies with our patients, our families, or friends, and social media/internet.
  15. BostonFNP

    How Does This End?

    The case fatality rate is 8% in the US right now, just to be clear.
  16. The same poster on multiple occasions has advocated for the use of Decadron on mildly symptomatic and early stage COVID patients; it demonstrates that the poster is either ignorant of the actual data or maliciously giving dangerous advice. And, I am qualified to offer the above opinion.