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Annaiya NP

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Annaiya has 5 years experience as a NP and specializes in PICU.

Annaiya's Latest Activity

  1. Annaiya

    Nursing school has made me not like nursing

    I echo what others have said that nursing school is not like nursing at all. Most of nursing school is all adults and inpatient care. For me, I had no interest in taking care of adults. Maybe try to go into a specialty that isn't adult med/surg and see what you think. As for other jobs, there's tons of case manager jobs, they pay well, you still work in a hospital but no night shift and you aren't working as a nurse. That's just 1 option. Good luck in finding something that inspires you for work.
  2. Annaiya

    NEED HELP! I am looking to interview a Pediatric nurse.

    Although we aren't doing formal developmental assessments, they should be getting some assessment on admission. Every admission isn't intubated and sedated. You should know a baseline GCS and if they are on track with their milestones or delayed. It has a huge impact on your ability to assess if the patient is ok or not. Particularly in patients where you are concern about neurologic decompensation. So to answer the questions from the OP: · What is your role? PICU NP · What assessment do you use to evaluate childrens development between 0 to 3 and why? Physical exam. No formal assessment tool. · What are the strengths of this assessment tool? N/A · What are the weaknesses of this assessment tool? N/A · How do you use the results of the assessment? To evaluate for potential problems and develop a diagnosis. · What is the biggest challenge of assessing an infant or toddler? There is a lot of normal variation between children at this age, so parents are key to knowing what their baseline is. · How are family members involved in the assessment? Parents are asked if the child is on track developmentally or if there are concerns and also if the parents feel that their current behavior is normal or not. · How are other professionals involved in the assessment?
  3. Annaiya

    Acute vs. Primary Care NP? Can't decide

    The restriction on practice based on specialty varies between states, which is why you don't always hear the same answer. However, the trend seems to be moving towards primary care specialties (FNP, ANP and PNP) can only do basic primary care, not a specialty clinic. Where as acute care degrees (ACNP, ACPNP and NNP) can do inpatient and outpatient specialty. However, the lines are not clear. It just depends who will hire you. I know PNPs who are were recently hired to an inpatient setting, but their nursing experience gives them the background they need more than a degree would.
  4. Annaiya

    Does your first job define you?

    I think it depends on your specialty and what you might want to do later. Getting comfortable diagnosing and writing notes and time management all translate across specialties. My thing with first job is it will form the basis of the rest of your practice. First learned habits are the hardest to break, so I wanted to start somewhere where I would get trained in the best way to do things. Every place varies, but at least nothing I learn in my job is the wrong way to do things. This can't be said for everywhere. I also wanted a place where I would be trained in by NPs and they were used to the on-boarding process. If you start with a good foundation, the basics will translate to any other specialty you might want to go into later.
  5. Annaiya

    Vasopressin vs. Levophed

    I don't work with adults or cardiac patients so someone correct me if there's another reason but my guess would be that vasopressin has less effect on cardiac O2 demand than norepinephrine.
  6. Annaiya

    PNP but don't want to be...

    As has been said before on here, you can work as an RN with an NP license. However some places might not hire you because it creates more potential legal liability. Your scope of practice is that of an RN but your level of knowledge and the standard you'd be held to in court is that of an NP. Since it isn't peds I would think that would help. Lots of NPs have RN jobs for various reasons.
  7. Annaiya

    RN that doesn't want to be an NP

    I feel like a lot of this attitude comes from the nursing schools who are pushing everyone to become NPs. My nursing school told my class over and over that they expected all of us to get master's degrees. They make it seem like you're a failure if you stop at RN and work at the bedside, which is so messed up. We need good bedside nurses, and I love working with the experienced nurses at work. I see them constantly suggesting things and intervening in ways that significantly help their patients. Even if other people try to devalue the role, nurses at least should understand that difference. I find comments like the one you mentioned often come from new nurses or nursing students who still haven't figured out what it means to be a nurse. They are so focused on tasks and procedures, they aren't in a place in their practice yet to be able to understand the fine art of being an awesome nurse. And with an attitude like that, she never will. She also won't be a good NP either, IMO. I went the NP route, not because I felt like it's a "better" job. In a lot of ways, an RN career is way better. But for my personality, I am a better NP than I could ever be a bedside nurse. I love pediatrics and my patients, but I don't have the personality to be one of the really amazing pediatric nurses. I hate feeding and holding babies, I'm not the type to play games with my patient and I don't joke around. But I'm great at evaluating data and figuring out what's going on and what interventions and therapies the patient needs. So I am happier in the NP role, and I think I can serve my patients better in this role. I can't understand why nurses aren't more supportive of each other. We all have valuable roles and the same end goal of improving the health and wellbeing of our patients.
  8. Annaiya

    low oxygen levels

    A couple of things that I wanted to clarify. Generally after the 3 stage palliation for single ventricle physiology they do have normal sats. If the Fontan is fenestrated they may be slightly lower, but they usually aren't 70's to low 80's anymore. The concern with oxygen administration isn't oxygen toxicity but vasodilation of the pulmonary arteries and subsequent pulmonary edema. However, if they have low oxygen sats, you still give them the oxygen they need, you just have to be mindful of possible consequences of it. And you target THEIR normal sats, not the usual >92%. I agree you need to know what the defect is and what normal sats are for the child. You can't always treat the congenital heart kids like you do everyone else. So understanding the specific needs of this child will help you take care of him safely.
  9. Annaiya

    Where do I go from here?

    Have you done counseling for your anxiety? If you are picking your career path, because you're worried about your anxiety, then it's something worth thinking about. My best friend is a nurse and has bad anxiety, and I can't imagine her now without all of the therapy she did when she was younger. Critical Care probably isn't a good choice, but there are lots of jobs in a hospital that could be a great fit for you. You passed NCLEX and take care of 18-22 patients, what makes you say you wouldn't be ready or smart enough for a hospital job? After what you've done, how hard can it be to take care of 5 patients? Any decent unit will train you on what you need to know. We all learn something new every day at our jobs, so you aren't expected to know everything. You just need to be willing to work hard (which it sounds like you do already), ask questions and learn. If it is something you want to do, then I say go for it! But if you're worried about your anxiety, make sure you have a therapist before you start, so you have support as you go through the transition process to a new job.
  10. Annaiya

    First NP interview at mayo

    I don't know about the interview process there, but I used to work with them about 10 years ago and was told they pay 10% more than market rates, because they want to recruit and retain the best people in their fields. I was impressed by that considering so many other institutions with big names pay less because people will still work there, just for the name on their resume. Good luck with the interview!
  11. Annaiya

    Pediatric Nurse Practitioner advice

    There have been other discussion on this here. The advice seems to be to check what is being hired in your area. Apparently some areas prefer to hire FNPs, even in a peds practice. But where I used to live they would only hire PNPs for pediatric clinics. It makes no sense to me to get an FNP degree unless you want to work in a family practice or do ER fast track. When you focus your whole degree on your specialty you will be better prepared to work in that area at graduation.
  12. Annaiya

    College advice for a future NP?

    I don't recommend a direct entry program unless you have enough health care experience to know exactly what kind of NP you want to be. There are a lot of different specialties and even by the end of nursing school, you likely won't know which specialty you like best. NP school is too much work to do and then find out you should have specialized in another area. There are 12-15 month accelerated BSN programs. I did a 15 month one and without healthcare experience, I think that's the fastest you'd want to go. The people I know who have done the 12 month programs had a background like dietician working in a hospital, physical therapist, etc. It's hard to learn that much content in 12 months when it's all new. So, I agree with the other posters who said to go to a school with a BSN program and do the traditional 4 year degree. It will be less money for tuition and give you a better opportunity to learn the content.
  13. Annaiya

    So...What Kind of Nursing Task Do You LIKE?

    My favorite was drawing up code meds during a code. It's not my role anymore, so I always look longingly at the nurses in front of the code cart trying to look up doses, draw everything up and label it quickly.
  14. Annaiya

    Hesitant to try paeds-encouragement/advice needed!

    You can't always have someone double check your doses. If you aren't competent to give meds correctly, then you shouldn't be in nursing. One decimal point in adults can be disasterous too. If you don't feel like you can be safe giving meds, then look into nursing specialties where you don't have to give meds. I've known nurses who quit, not because they weren't smart enough to give meds, but because they couldn't handle the anxiety of giving meds quickly due to having so much to do in so little time, and they didn't feel safe. If every time you give a med you do your 6 rights of med administration you should be fine. But only you can decide if you can do that safely.
  15. Annaiya

    Bipap question

    To OP: You didn't really explain why you were concerned that 10/5 BiPAP was too much for a 3 year old. The only thing you said was you were concerned the pt would "blow a lung." But every medical intervention (or lack there of) needs to be thought about in terms of the physiology involved and the potential risks and benefits. Why would you use BiPAP on an asthma patient? What is the respiratory physiology of asthma that you are trying to overcome? How is that different from an RSV Brochiolitis patient? What happens to your patient if they can't be maintained on BiPAP? You seem to think Hiflow would be prefereable, why? I really am not sure why these settings were concerning to you. Asthma is a restrictive lung physiology with air trapping. Your goal is to open the airways and reduce the work of breathing. Hiflow is good at dead space removal in an infant, but isn't going to do anything for an asthma patient. You need pressure in asthma to overcome airway resistance. The pressure can also help stent open the airway and lesson some of the air trapping. The risk with using too high of pressures (the reason you generally want to be careful titrating PEEP (or EPAP) is you don't want to end up with lungs that are so overdistended that you are no longer getting good air exchange. A chest x-ray can help you see how overdistended the patient is. Although there is a risk of pneumothorax with BiPAP, that is a risk in asthma regardless. They can get a spontaneous pneumo if they are pulling so hard to breathe. Also, BiPAP is still much better than being intubated. Intubating an asthmatic should always be avoided if at all possible. Pushing air into lungs that are constricted and full of secretions is just a bad mix. At least with BiPAP they are still doing a lot of the work and that should minimize the actual pressures that the alveoli are seeing. When you have to sedate them to keep them intubated, they lose their ability to control their breathing and lose all negative inspiratory force. But even an intuabted asthmatic on a PIP of 45, the alveoli still aren't seeing that much pressure, because of the airway constriction. In the end, the patient needs whatever settings they need to reduce their work of breathing and keep them from being intubated. If 10/5 is working for the patient, then you go with it. I agree with the other posters who said that next time ask the doctor to explain why he feels like BiPAP is the best option for the patient. Clearly they felt like it was the right decision in that situation.
  16. Annaiya

    Where to begin...........

    How did you decide this was a career you really wanted? I went to nursing school thinking that's all I wanted to do. By the end of school, I knew I wanted to be an NP. I did a new grad residency program and rotated through the PICU and saw the NPs there. I applied to school that week and started NP school 8 months after becoming an RN. How has it actually turned out in reality? What were your mistakes, what would you do different? I absolutely love this role. It is so challenging and interesting. I work with incredibly complicated and/or sick kids and have to figure out what is wrong with them, and why, and how to fix it. The more I learn, the more I love it. I wish I had more RN experience, so I didn't sometimes ask some really dumb questions, but nursing is a second career for me, so it didn't make sense for me to stay as an RN longer. I learn a lot more as an NP, and I just suffer through looking like an idiot sometimes. Are there any good online programs? I did an online program and worked full-time through the whole thing. I went to UAB and thought they were a good school. But if they don't have approved clinical sites in your area, it might be a problem. Any good career books? I think Allnurses is better than any books. Just read through the stuff here. How can I find out what NPs really make? Ask around in your area. It varies so much by area and specialty that it's impossible to make a generalization. I make less than a lot of the experienced RNs at my old job. And the cost of living where I am now is a lot higher. What about working hours.........is it generally better, or more of less the same as regular nurses? My hours are a lot worse now. I rotate days and nights. 12 hour days, 16 hour nights. We are not allowed to sleep on nights. We are always short staffed so I've worked overtime shifts every month for over a year now. I worked my first year and a half without a single day off (including no holidays off) because they didn't have enough people to cover the shifts. Generally NPs in clinics have better hours, but they can still have long days. Any pointers negative or positive welcomed. Also which NP is best & why? Any NPs who seriously regret doing it? Despite the negatives to my job, I love it. I find it so much more satisfying than working as an RN. I like doing proceedures, managing sedation, diagnosing, mentoring and teaching the bedside nurses and working with our Fellows and Attendings. Also I have a great job security. There aren't a lot of places that have PICUs and use NPs, so I'm somewhat limited in that sense, but there is a huge national shortage of PICU NPs, so I had no trouble finding a job coming out of school. And I think the best NP is the specialty that you find the most interesting. There are benefits and downsides to being an NP, so you need to go into an area that you get really excited about it. It sounds like with your background you could do any of them!