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Adult Internal Medicine
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BostonFNP is a APRN and specializes in Adult Internal Medicine.

BostonFNP's Latest Activity

  1. BostonFNP

    Quality of Online NP Programs and Providers

    Any type of national formalized residency is going to be expensive, even if it was 25% the cost of a medical resident year, given the huge numbers of NPs being churned out it would be a big chunk of change. Smaller independent programs have had some success with residency/fellowship programs. These tend to share the cost between the resident/fellow (in the form of a stipend that is below market rate for an NP) and the healthcare system (with some work commitment post-residency). NPs need to be careful here because adding a residency to counteract poor preparation and poor quality programs is not the best solution. All NPs traditionally had a sort of residency in that all of NP practice was supervised/collaborative with physicians; the push towards independent practice (and perhaps the shrinking of oversight even in supervised practice) is starting to fore the hand on this.
  2. BostonFNP

    Quality of Online NP Programs and Providers

    1. If they are intelligent, clinically skilled, and hardworking then why do you think it is they can't find desirable jobs? 2. Honestly, have you ever worked in primary care as an RN or an NP? 3. Experience is valuable. All sorts of experience: education, RN, non-RN life experience, NP clinical, NP practice, etc
  3. BostonFNP

    Quality of Online NP Programs and Providers

    To be clear, better schools and education is also a barrier to entry for some/many. I would suspect its because of some of the threads we see right here on AN. I just read one last week about a new-grad FNP with no RN experience that took a job on an Intensivist consult service. That should be scary to everyone. The consensus model has tried to address this but there are still a fair amount of new-grad FNPs going to work either in-patient or on specialist services. I think the more time you spend in your NP career (as the naivety starts to fade) you start to think about what happens when there is no longer primary care provider shortage?
  4. BostonFNP

    CMA playing "Nurse Manager?" CMA boundaries? NPD?

    To be clear though, in this situation, the only "qualification" the CNA needs to function in an administrative role is to be hired/placed in that role by her boss.
  5. BostonFNP

    FNP in Hospital Setting

    ((To be clear the OP is not me...for those of you that messaged to ask. )) I recognize this is an old post, I'm curious i there is an update on how the job went? Did you have acute care/critical care clinical rotations are part of your NP preparation? I am sure you can understand how concerning posts like this are, at least on the surface, to bedside RNs, out-patient FNPs, experienced acute care FNPs, and ACNPs (along with basically anyone that might ever be a patient with a serious illness)! 1. Unless you had significant APRN clinical experience(s) in acute and critical care, you are practicing so far outside your scope that it puts you in legal jeopardy, let alone the risks to the patients under your care. 2. Anything can be learned with time: we all start somewhere and our didactic and clinical experience makes us into safe effective clinicians. The danger here is being in an environment where you lack both the education and experience while functioning in a role with unclear level of collaboration/supervision. For example, a first year medical resident (who has the education not the experience) in the ICU is dependent on the expertise of the RNs and the senior residents/attending physician while they gain experience. Unfortunately, a novice NP in this same scenario doesn't have the education, likely doesn't have the direct supervision, and has probably alienated most of the RNs. 3. All of us, OP included, as APRNs need to protect our profession/career/future, which is entirely dependent on maintaining safe, effective, quality, and cost-efficient care. Other people reading this post considering the same path as the OP, I hope will consider the danger in this route. FWIW: I graduated as an FNP with a relative lack of acute care RN experience (about 16 months) but I did two acute care rotations in my program. I took a job in a internal medicine practice that covered our patients in the hospital. I worked for a year as an NP before I started rounding in the hospital. I spent six months rounding with a very experienced physician before I started rounding myself. If our patients were admitted to the ICU, neither of us would continue to attend them, either transferred to a intensivist or transferred to a OSH.
  6. BostonFNP

    Recently terminated- being reported to state BON

    Call your malpractice carrier ASAP!
  7. BostonFNP

    novel coronavirus

    Our facility just emailed enacting the the CDC guidelines.
  8. BostonFNP

    Dismissed from a Nursing Program (Need Advice)

    Have you been able to examine not only what you did wrong but also how to fix it? If you don't have a strategy to fix the problem, history will repeat itself.
  9. Have you considered sitting down with your professor in office hours and getting some extra help with this? I am glad you got some help here, but this is a basic skill that you will need to be able to use both frequently and confidently all through your career. Understanding the basics of dimensional analysis will allow you to answer this question or any other of the thousands/millions of variants of this type of question you will see through school and your career. Getting help now will make your like much easier and your career much safer.
  10. BostonFNP

    Typical clinical days as a NP student

    Here what a student's first day with me might look like (adult internal medicine practice): 1. Meet and greet if we haven't already met and discussed the semester. I'll outline what I expect from the student and try to nail down what the student expects of me. I like to hear what they feel like their strengths and weaknesses are (keeping in my if this is their first clinical rotation they are expected to be completely green). I go over my "rules". And I give them a tour of the clinic. 2. First half of the day I just have the student be my shadow: come into each visit with me, listen to the history, follow along on the physical, and have a dialogue with me about the assessment and plan. In the beginning students won't know the "right" answers but I want them to get used to applying what they know to new experiences and also get comfortable not always knowing the answer. During this time I am assessing the student and figuring out what their strengths and weaknesses are and if they need more shadow time. 3. Second half of the day I will either have the student continue to shadow or I will let them start to conduct some of the history while I am in the room with them and can help guide them. We'll still do the exam together. I'll start having the students give me a 2-4 line report before we discussed the A&P. During this time, depending on the student, when we are discussing the A&P if the student doesn't know the answer I will start having them look it up and then come back and tell me (using POC tools or texts). Every preceptor is different, but I am willing to bet that most will follow a similar pattern.
  11. BostonFNP

    NP schools without an RN license

    Direct-entry NP programs are simply accelerated RN programs (for those with non-nursing bachelors degrees) paired with a graduate NP program. After the accelerated RN, students can normally choose to continue directly into the graduate program full time or transition to a part-time graduate portion while working as an RN. For better or worse, most direct-entry NP programs also have a RN work hours requirement to complete the graduate portion. All direct-entry programs are like this. All NP students must have their RN licence before continuing on to their APRN education and training.
  12. BostonFNP

    CMA playing "Nurse Manager?" CMA boundaries? NPD?

    Do you have a problem with a practice manager disciplining a nurse they employ? Why does it matter what their degree is? The facility hired them into that role. I own a private practice with a partner. We employ an amazing practice manager with years of experience who has an associate degree in healthcare administration. She makes our hiring and firing decisions for our medical assistants, admin/office staff, and even our clinicians (NPs and MDs).
  13. BostonFNP

    NP schools without an RN license

    I am curious what you are basing this on? Just your personal opinion? I have taught DENP students for many years for a high quality and well respected brick and mortar program. The program has a 6-mo postgrad employment percentage of near 100% for the past two decades. I know at least one other local program has similar numbers. In the event that an NP is having trouble finding a job, they could also get employment as an RN to gain further clinical experience where-as the PA is unable to.
  14. BostonFNP

    Anti-Vaxxers Shut Down Immunization Events

    A few important things to correct here because it is important. 1. While vaccination is available for TB, citizens of the US are not regularly vaccinated against it while many countries across the globe do vaccinate for it, so not a great argument for or against vaccines 2. The vast majority of TB wordwide is diagnosed in one of the 30 designated high burden countries (HBC). Only one of those 30 countries is in the Americas. Further, MDR TB is not endemic to any country in the Americas. 3. Your first link is related to immigrant refugees. Immigrant refugees are not “undocumented workers coming over the border” and that is an important thing to be clear about, least of all from a healthcare perspective . 4. Your second link is about the TB burden in the Hispanic population within the US. Hispanics living in the United States are not “undocumented workers coming over the border”. That CDC brief is very clear that the burden of TB in that population is related to the associated poor access and barriers to care and socioeconomic status, something all healthcare providers should be working to fix rather than using it as evidence of immigrants bringing diseases into the US. 5. To use as an example, so we can be clear about vaccines, the childhood vaccination rate for measles in Mexico is 97% while the US is 92%. There are now pockets in some states in the US where that rate has dipped to as low as 19% due to exemptions. The critical threshold for measles is 93-95%. 6. The fear-mongering of “diseased immigrants” is not routed in fact; far more people travel in and out of the country then immigration. Moreover, there are far more dangerous countries from a communicable disease-burden perspective that people travel to for vacation on a regular basis.
  15. BostonFNP

    Anti-Vaxxers Shut Down Immunization Events

    Which countries exactly are you concerned about? Most of the South American countries have better vaccination rates then the United States. The statement above has existed since the pre-1900s as a lightning rod for anti-immigrant ideals. Regardless, the way to combat epidemic spread of vaccine-preventable illness is to increase the vaccination rate over the critical threshold.
  16. BostonFNP

    What nursing jobs provide the best foundation for a NP?

    Your experience is what you make of it. If you are invested in patients, you take time to listen to them, do full assessments, pay attention, and you follow their plans of care you will build yourself a good groundwork for advanced practice no matter what your setting is. If you do incomplete assessments, go through the motions, etc then no matter what setting you work in you won't gain much. That being said, for working with primary care NP students from all sorts of different backgrounds, I've found that those with experience in ED, med-surg, primary care practices, case management, home health tend to have the most relevant exposures without some of the drawbacks of very specialized experiences like ICU, surgical, neonatology, etc. My advice to perspective NP students is to work in a nursing role that you enjoy so you can get the most out of the experience.

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