VaniCCRN

Excuse my grammar and spelling as I write this in the midst of a migraine storm. I am an experienced critical care nurse, and recently I’ve had a reality check. I’ve wanted to be a provider since I was a child. Being a physician was originally my dream, life however lead me down the avenue of nursing. To make a long story short, ever since I was in nursing school I planned on becoming a nurse practitioner once I gained adequate experience, so seven years later here I am in my second semester of graduate school. This semester has been a reality check, as I dive into the world of physical assessments, proper documentation, differential diagnoses, and proper clinical reasoning. I’m truly stressed and scared. I’ve always been an anxious person to begin with, I think part of it is because I’m afraid of failing, and well I’m terrified of hurting a patient and I realize the responsibility is tremendous. As if it wasn’t enough, the negative comments about NPs are rather excessive, particularly from Reddit groups and forums like StudentDoctor, where medical students, resident physicians, and even attending physicians rant and complain about “mid-level” scope creeping. They post horror stories of misdiagnosed aneurysm, peritonitis, and ectopic pregnancies. I’ve even seen one Reddit user that devotes his entire account to creating fictional tales of an NP, he portrays the NP in a satirical and sarcastic manner, magnifying their medical mistakes. The pressure to succeed and do well is real. Firstly for my future patients, for I wish not to hurt anyone under my care. Secondly, I do not wish to appear as a fraud. I do feel like a fraud, like how in the world am I entrusted with this responsibility? Don’t get me wrong, I will never pretend to know something I do not know! Lastly, maintaining full time employment whilst going to school. I know plenty of nurses that work FT and do NP school. The thing is that I’m extremely concerned with dedicating as much time as possible into my studies. Full time employment with school is stressing me out. I don’t have a family or anyone to support, so quitting is very tempting. The only thing I’m afraid of losing are my benefits. ☹️

Thank you for standing up for your own. Unfortunately there was a disgusting display of nurses against their own in this thread. I’m reminded of how the nursing “profession” is riddled with a high school mentality, and these CEOs are using these weak minded individuals to do their bidding, via spineless managers and such.

Just because she’s an adult and it was a contract doesn’t mean it wasn’t predatory. There also needs to be accountability on the employers side of the equation. Honestly y’all suck for putting all the blame on this nurse. You people are the reason nursing will never blossom into a full blown profession. Y’all wanting to point fingers at the people with the most to lose, the least to gain, and all the responsibility (THE NURSE). Wanting to throw your own under the bus, SHAME ON YOU. Drop the archaic, back biting, competitive, petty, snarky, and gossip culture - ITS OLD.

First off, the story is confusing because I believe the OP is mixing up AMs and PMs but it sounds like this was the course of care: 8am - post-op period begins. 10am - patient makes 50 mL of UOP; MD orders 500 mL bolus LR and starts 75 mL/hr of LR 11am - Pt voids 100 mL; MD orders 500 mL bolus. 12pm - 50 mL of UOP; bladder scan reveals 200 mL in bladder; foley is inserted and OP states that adequate UOP is made (however doesn't provide a number). ... next "few hours" acc to OP; pt only made 50 mL UOP. MD orders another 500mL of LR. The patient probably received 1500 mL to 2000 mL of LR in total between boluses and maintenance. As far as the patient drinking water? Perhaps it has to do with free water versus providing fluids that are more physiologically similar to plasma. Providing free water (I.e. drinking water/providing Dextrose 5% solutions) is more well suited for loss of free water. In the case presented by the OP, it sounds like it would be in the interest of the patient that the fluid stay in the vascular space so that it may be destined to enter renal circulation, and therefore end up in the bladder. Long story short, OP this is NOT your fault. There are a lot of things that we don't know, like what happened intra-op? fluid loss? EBL? IVF received? What is her PMH? the SODIUM content in LR is I believe about 130 meEq/L and therefore, someone could potentially be made HYPOnatremic by over-treatment. 0.9% NS has about 150 mEq of N+ per liter of normal saline. Maybe she should have been treated with NS 0.9%?

Labs: CBC BMP TSH, T3, T4 Liver Function Panel UA UDS (Maybe, but afraid I’ll lose patients trust) Documents: Need paperwork about her jaw surgery Need paperwork about colostomy and bleeding complications afterwards. From Patient: Current meds? Food log? Time/Frequency of stools Physical Exam: Assess thyroid gland Assess scars, ask patient about scars. Stages of healing of scars?

Don’t lose any sleep over this anymore. This patient isn’t worth it and you did nothing wrong. Say it with B Y E! Only good things will come from this and you will no longer have to entertain this manipulative patient.

If you were on track to complete a masters degree with a specialization in Adult/Gerontology Acute Care and you wanted to continue your academic career due to wanting to be able to influence policies/research and possibly teach. If you had a strong affinity for pharmacology, infection prevention, epidemiology, data-driven knowledge, numbers, statistics, and medicine, health education, and public health would you obtain a: PhD in nursing PhD in epidemiology DNP Doctor of Nursing Practice DrPH Doctor of Public Health My understanding is the PhDs are less work related and more research related while the DNPs and DrPHs are more implemented and practical related. My understanding is also that many places will pay YOU to obtain your PhD how true is this? Do you find this to be true with both epidemiology vs nursing? My take is that an termination my education with a doctorate in Epidemiology/Public health would be a good combination as opposed to having all nursing credentials? Thoughts? Ideas?

I thinking of following through with my program and then hoping for the best. I’m not going to limit myself to a provider position. I’ve already told myself I’m open to education/leadership and that I can always be a provider PRN. It’s not the most ideal situation, ideally if I was going for provider I’d like to submerge myself but life isn’t ideal. I’ve also considered NP fellowships. They are far and few, but they DO exist! I’ve considered hematology/oncology - as I think this field is very much cerebral. I’ve also considered non-vascular neurology. As y’all can see I’m interested in a variety of things. What I am opposed to is purely ICU. Don’t get me wrong, I find the theoretical knowledge fascinating... but I am just so burned out (mind you my experience is chronic type patients in the MICU with a mix of CCU)... I’m sure some units like SICU/Trauma have less of this burn component of dealing with medical patients that are non compliant. Maybe I need a break all together from the actual bedside/direct patient care? like I said.... I’m open and receptive. I know no position is perfect but right now I just dread life in the ICU. Also thanks to everyone that has responded!

Nursing Career Crisis My background: Intensive Care Nurse with 7 years of experience. I hold my BSN and my CCRN certification. I’m 28 years old and have zero obligations or commitments. I’m not married and my partner and I don’t plan on having children/family. I am currently in NP school (2nd semester). I am dissatisfied with my education. I chose a brick and mortar school and still I feel the education is inadequate. I’m disappointed across the board with NP education and NP job prospects. I wanted to be an NP before I even entered nursing school. I wanted to be a provider. Things I’m hating/questioning right now: I’m fed up with the ICU. I cannot stand my nurse manager and neither can the entire unit. I’m tired of bedside at the ICU. As previously stated I’m not satisfied with NP education. I’m fearing what the future holds. NP career and title are being destroyed by diploma mills and people who truly don’t want to be providers. Any John Doe can get into an NP Program, it’s shameful. I even chose a brick and mortar program and I can still point out the deficiencies. I feel trapped. Trapped in a graduate program I partially want to complete but partially feel is inadequate. I’m questioning the NP profession PERIOD because of future destruction of the career. I feel trapped in a job I DREAD. With a demoralizing and terrible nurse manager that isn’t going ANYWHERE. What do I fantasize about? I often fantasize about doing research at a university. Being devoted to my studies and involved in a community of people whom actually are excited about the field! I often think about doing research and projects to improve health of the public. I LOVE patient education. I LOVE family education. I LOVE teaching nursing students. I LOVE unpacking complex concepts. I LOVE delivering presentations. I LOVE reading about the latest EBP. I LOVE learning about research. I LOVE science. I LOVE biological sciences specifically. I LOVE data and numbers. I also aspire to be practical and develop plans of care to help my patients with their health and medical problems using my brain. I just don’t know what to do... sometimes I feel so discouraged I want to turn in the towel and quit all together.

As far as NP. I know I can’t be too picky because of regional saturations in the market. I am however willing to move for the right job, even across the state - especially if it means experience. I honestly do not think I want to continue in intensive care when I transition to the role of provider. I am thinking more along the lines of palliative/hospice or geriatric care. I know my certification is “acute” but I’m hoping that I would still be able to find positions where I can render care to geriatric populations. Learning about the challenges geriatric populations face has really renewed my interest and something about improving their quality of life is of interest to me.

Unfortunately a large part of the reason I want to leave is my nurse manager. A stressful environment such as the ICU combined with his management style make for a miserable experience. The list of things he does is pointless because I know HR will do nothing. I just feel it so pointless to try and tell HR. I’ve checked myself to see if it’s just a personal disagreement, however I find that most the unit highly dislikes him and his style. He’s basically the perfect example of someone who just manages, but doesn’t lead. My coworkers and I are highly dissatisfied. He has no backbone for his staff, only for the unit budget and for appearing great in front of families and upper management. I know that moving units is a bet because I may run into a very similar managing style, but it’s just so unfortunate and unbearable. He seriously makes me SICK. Go figure, most people quit bosses not jobs.

Good evening, woukd appreciate recommendations for full-time employment for a BSN-RN-CCRN with 7 years experience in critical care. I am in graduate school. I currently work ICU and truthfully I’m burned out. I’ve tried taking time off and vacations. I need a change of scenery but I also need a flexible position as clinical rotations for my MSN/AC-AGNP degree will begin this Summer. Warmest Regards Gusto