CommunityRNBSN

Yes-- SOMETHING horrible happened here (a baby definitely died) but honestly we know very little right now. Wanting to reserve judgement until we know what happened is not crazy, or evil, or heartless.

Yes, the thread is a dumpster fire. I hope a thorough investigation is done (NOT by the hospital!) to figure out what the hell happened, and who was involved. This is the doctor. Her credentials look perfect; I'm sure I would have felt confident in her too: https://premierwomensobgyn.com/about-us/

You sound really defensive. You came on here for advice, and you got good advice. I'm sorry you're in a tough spot, but lashing out about how anonymous online nurses-- all of whom tried to help you-- must not have "an ounce of compassion" and are sociopaths who "feel fine and dandy" when they see suffering is not a sign of good boundaries.

I mean, of course each province varies, as do each of our states.

Some people love outpatient, others not. Although I did love outpatient and I still don't think I'd enjoy what you describe. I worked in primary care, and I was able to form relationships with some of the patients, which is what I like. But keep your chin up, you'll be back to inpatient soon if you keep applying. Or you could look at something mid-way between inpatient and outpatient, like ambulatory surgery or something.

Okay, well, you asked, and we all told you, "Hell no." I'm glad you decided not to pursue this.

Yes. In many states a CNM is the equivalent of an NP— just a different title. Which is 100%, entirely, completely irrelevant because you're talking about an LPN/LVN giving people questionable shots out of her purse?! What is even in the syringes??

Wow— sounds incredibly unsafe. If the person is in active labor or anaphylaxis, how is anyone going to know?

Thank you for finding that!— definitely adds some context to this question.

I know you said it's impossible, but basically you have two choices: Do it, or find another career. And please don't write it off as "impossible" until you and your wife have really sat down and brainstormed. She doesn't drive— there's Uber. She'd have to quit her job— maybe so. Caring for your child— are there any alternatives (yes daycares are expensive but we are talking about one month, not two years). Really, really, think it through before you just say you can't do it. (I say this as someone whose entire support network is my husband; we have a child and zero family. So I really do understand.)

I see this even in outpatient! We don't have audible alarms. What we have are "critical" pop-up screens. Often they are about drug-interactions that are vanishingly rare, or just not relevant to the patient. Also critical recommendations to do XYZ screening on patients. As a result, you just get in the habit of clicking "close" on a million critical warnings, after barely glancing at them.

I was horrified by it too. I think what happens is, in many online schools, students are responsible for setting up their own clinicals. So they go through the phone book and call anyone with a license or-- even worse-- they get a friend or family member who is an NP to agree to "precept" them. But the schools just require that the student and the preceptor sign some forms that say, "Sure, she did 180 hours with me" or whatever. NO actual requirements as to what those hours entailed. So, if the preceptor is shady and the student is too, they just float semester after semester getting papers signed but getting no clinical experience.

Honestly, it is hard to differentiate idle curiosity from "need to know" sometimes. I was working as a school nurse, and I saw a note in a child's chart about a tragedy that their family experienced. I was really curious about it. To justify it, I could say that as the nurse, I need to know the patient's background, so that I can be appropriately supportive (which is true). I could also say that I have a prurient interest when I hear about a tragedy in my small town (which is also true). Now, I didn't violate any privacy rules, but if I had, it would sort of be between me and Jesus whether I really "needed to know" all that info.

Honestly, it is hard to shift from a PCT role to an RN role with your "old crew.” I'm not saying people can never do it, but it is hard! The people who were your friends and coworkers (other PCTs) would now be under you, and you would give them direction. It is something to really consider when you're thinking about this. When you're doing your job, they may perceive you as "just sitting there on the computer and not helping.” It can cause so much interpersonal conflict! PCTs have been known to say "Susie used to be so cool but now she has too high of an opinion of herself, since she got that nursing license”— even if Susie is literally just doing her job! You know the dynamic on your old floor, and I don't, but be sure you've thought it through.

I feel like if the professor gives you the answer key, it is totally reasonable to expect students to go over it themselves and figure out what they did wrong. There may be a small number of questions where you can't do that, which is what office hours are for. Let's say an exam had 100 questions, and you missed 50 of them. She gives you an answer key. As you go through them and look up the material in your book, I would expect that on 45 of them, you'd say "Ohhh I understand why I got that wrong! I'll remember that next time.” Then there may be 5 that you are truly baffled by. If, on the other hand, there are like 30 that you are baffled by, then honestly you may need to take some more pre-requisites or go back and repeat your coursework. If you truly feel this at sea, after the professor gave you an answer key and had a brief class discussion of the answers, I think your foundational knowledge is lacking.

People are successful nurses with all kinds of disabilities and all kinds of ailments. Don't tell yourself this story about how you "have to be in tip top shape.” Very few people are lucky enough to be in tip top shape!

100%. And I love how you phrased it— "come in a little hot.” I'm guessing you lunged at the patient with a look of panic on your face, and it scared them. Okay, well, you're a human being! The fact that you were afraid for him, and you reacted FAST means that you are a caring nurse.

You have so much staff!! You must work for a large district. My district has five RNs (one for each school) and that is all.

I love a good FNP, but I 100% prefer to see a specialist if possible! I would love to see a WH NP for my gynecological care. I just graduated as a psychiatric NP, and I am so prepared to practice in my specialty. Of course FNPs get hired into psychiatric roles as well, but it isn't the same as having a specialist!

I wouldn't, just because there is so much available. As others have mentioned, many workplaces provide them. My workplace doesn't, but I don't have any trouble meeting the requirements from using various online sources and attending conferences etc.

So are they coming for the psychologists? Every clinical psychologist goes by Dr X, and heck yes it confuses patients (who don't know the difference between a psychiatrist and a psychologist). So... is Georgia going to make them stop too?

Unfortunately, this problem really goes beyond one NP. I am a newly-minted PMHNP, and I've seen a lot of things in my prior RN work and in my clinicals. We received patients from FNPs, PMHNPs, and MDs (psychiatrists) who were totally inappropriately treated. Cutting off benzos was common, but so was over-prescribing benzos and amphetamines to those with addiction. Drugging up schizophrenics until they were drooling, when lower doses would have been sufficient. People given stigmatizing diagnoses on the basis of zero real evidence. Etc. Etc. Etc. It is awful and, as you said, can make you want to cry. And it is NOT exclusive to non-specialists, or to people who just lack training. The thing is, though, you are going to have to get some emotional distance from it. You can make the choice to treat your patients to the very highest standard of clinical excellence, and to educate other providers whenever you have the opportunity, and to advocate within the profession. OR you can choose to become totally overwhelmed and exhausted by all the terrible decisions you observe, burn yourself out, and leave the profession-- which would leave all these patients in the hands of lower-quality providers.

This is such an important piece of it. Life is all about balance I think. I'm a huge believer in living frugally and saving! But also, I have met people who are so focused on that, that they don't enjoy their day to day life. My husband and I are enjoying some fabulous experiences (we have traveled internationally, but we prefer shorter trips and things closer to home) NOW while we are 40 and healthy. He certainly hopes to retire relatively young, but good health and old age are not promised to any of us. It would be a shame to store every penny in an investment account, and then find yourself unable to enjoy it due to hard luck.

Just remember that no matter how well you get along, it is still just a job. You aren't getting divorced! So she may be sad to see you go, but it's not a betrayal or anything. If you know for sure you're leaving, just be straightforward and tell her. If you're just considering it, I'd wait.

I am about to graduate from a PMHNP program. It has been rigorous— all on-campus at a well-established local university. Detailed oversight of our clinicals, with site visitors from the university every semester, interviewing our preceptors. But recently I have met some PMHNP students in what I would absolutely call diploma mills. One of them attends an online university and he described his clinical to me: it is fully on Zoom, with a psychiatrist who does TeleHealth. The psychiatrist is "precepting" 50 students; they all log on and watch his appointments as a group. Another acquaintance of mine has a wonderful work history as a NICU nurse. She was in school to be a pediatric NP, but couldn't find any clinical sites. So she changed to psych— with zero change to her coursework. She took no psych-specific classes at all. Just general A and P, pharmacology, etc. Graduated and is now working as a PMHNP. The psychiatrist I work with told me that, in looking to hire a PMHNP, she interviewed 5 new graduates, none of whom had ever seen any patients during their entire training. She was asking standard interview questions like "tell me about a difficult experience with a patient" and all five responded "Well, I've never seen a patient, so I don't have any experiences like that.” This has to stop. It is a humiliation for our profession. I am afraid that every state in this union is going to move to strip our prescriptive authority— I would, if I were hearing about this nonsense and had the power to. So the question is: Who do I write to? Is it the bodies that accredit the colleges? Or the state licensing boards? Both, neither? I understand so little about how the process works— I just know that diploma-mill graduates with no clinical experience should not be allowed to enter our profession and do harm to the public.