Annaiya

Nurses in the US don't specialize. You get your LVN or RN license and then can work in any of the jobs for that scope of practice. Only Nurse Practitioners have specialty areas. There are certifications you can get and training that make you more marketable for a specific area, but the first step is licensure. Check out the Board of Registered Nursing website for CA to see if you'd qualify for a license.

I know this is a super old post, but I just wanted to say thank you for posting this. I was so confused by the form and the transcript request process, and I can't just go to the office. I have to send transcripts from 5 different schools in 3 different states, none of which is the state I live in now. Knowing I only need the form filled out by my nursing school makes it a whole lot easier. I've been calling the BRN to ask this and can't get through. Thank you!

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.

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?

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.

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.

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.

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.

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.

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.

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.

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!

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.

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.

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.

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.

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.

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!

It really depends on where you work fan what you consider flexible. I worked every Friday, Saturday and Sunday while I worked on my masters and the flexibility to work every weekend was great so I could do school during the week. But if you mean flexible as in being able to change your schedule last minute then it's not. Once the schedule is published you're obligated to work your assigned shifts. It's pretty easy to find open teaching positions but the pay isn't great. Which is disappointing given the time, money and effort to get a PhD.

I agree with your decision to not go to law school. I was a lawyer before going to nursing school and I have nothing good to say about the profession. There are some great attorneys out there, but there are very few who are happy with their careers. I get asked all of the time if I will use my nursing and go back to law and I have never wanted to. Very few jobs pay as well as the general public thinks, and the hours worked by the attorneys who make a lot make it not worth it. Not to mention the work is pretty routine and boring. It's interesting to begin with, but the whole point is to become an expert in 1 area and then apply that knowledge over and over again. New cases and new laws come out, but there is very little intellectual challenge after the first couple of years. Whereas in nursing there is so much more variety and challenge with the work. Plus we actually help people as nurses and NPs:)

I don't know why they would be annoyed if you're saving them from having to pay to fly you out for an interview. Good recruiters are interested in everyone and don't "act annoyed" by a phone call from someone interested in a position. Even if they aren't interested in interviewing the person. I think the attitudes reflect negatively on those institutions, not on anything you did.

I feel that our certification should match the work that we are doing. It justifies a lot of the arguments being made regarding why we are competent for full practice authority. That's not to say you can't work a job and then learn what you need to know, but that doesn't mean it's the best way to do it. However, I work with a number of PICU NPs who have primary care certification because they started before the acute care certification existed. They are excellent, knowledgable PICU NPs. You can learn any job if you are given the opportunity to learn and support you need. If you can't go back to school, then look for an inpatient position where you feel you can practice safely while learning wht you need to know.

I frequently have concerned parents be completely wrong. However, I never dismiss thier concern until I've verified that it is unwarrented. Always listen to what the parents are telling you, but don't let their opinion cloud your nursing judgement. Many parents get the medical lingo down and they sound like they know what their talking about if you don't know better. I have seen new nurses put too much reliance on what the parents are saying, instead of having confidence in their own assessment skills and nursing knowledge. Learning the art of the pediatric exam and how to work with all of the many parents is the hallmark of an excellent pediatric nurse!

I agree, don't worry too much about this. Patients pull stuff out. In less than an hour from the start of my first shift on my own in the PICU my patient pulled his EVD (external ventricular drain) out. The neurosurgeon was not happy when I called him!

Where I work the CNSs work with the bedside nurses and are more of an educator role to the RNs. They don't do any direct patient care. Their job is entirely different from ours. Where I used to work they didn't use CNSs. I think unless you have a specific job in mind, NP is the better way to go. There is s lot more options.