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Bumashes

Bumashes MSN, APRN, NP

Hospitalist
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Bumashes is a MSN, APRN, NP and specializes in Hospitalist.

Background: 2 years RN Med-Surg-Tele, 5 years RN Emergency Dept, 6 years NP

Bumashes's Latest Activity

  1. SgonzoCPNP, thank you so much! That really helps. I have gone ahead and submitted all of my required documentation to the NursingCAS so as to hopefully enroll soon. Since I am already an AGNP and an ACNP, I will only be needing to enroll in the DNP portion. And the CMO of my hospital has plenty of projects he would like taken over and figured out (especially for free), so I am hopefully all set in that regard. Thanks again for your help.
  2. Hey everybody! I’m an AGNP & ACNP (have been practicing as an APRN for 5 or 6 yrs now), and I am thinking of going back for a terminal degree. It’s more of a life goal than anything related to wanting to teach or research. I am between a PhD at USM or a DNP at USA. And while USM has been very responsive in describing what it’s PhD residency and dissertation process consists of, USA has not been so forthcoming. I have only what is on their website to go by as every time I ask someone over there concerning their Residency I seem to get the same information that is listed online. It just says the Residency may be completed in my community with a mentor, and that I would be completing a DNP scholarly project during the Residency. I am trying to figure what they mean by “residency.” Am I going to have to find preceptors like in my MSN program? If so, what kind? Or is the DNP scholarly project more akin to a PhD program wherein you go “in the field” and research on your own, perhaps also interviewing people and/or facilities, and with the help/direction of a mentor? I am trying to plan my work and life around this final degree, so I need to know what kind of extracurricular work I am going to be expected to do. If anyone has some real info they would like to share, I would be very appreciative of it. Thanks in advance! Edited for an annoying typo I saw right after posting. Ha.
  3. Bumashes

    How can I help educate floor nurses as a Hospitalist NP?

    I wish I had the time to do this during my day, but I don't think I would be able to do as much if I did. I would like like to be paid for it, but we will see about that one. I am encouraging more educator positions and better orientation, but pretty much if it costs money, then they aren't going to go for it, which is why I said I would come in on my days off and whatnot. It really is sad.
  4. Ok. I'm putting my cards on the table. Putting my money where my mouth is. My boss asked all of us, physicians and nurse practitioners alike, to give ideas on what we can do to help with the flow of patient care at my hospital. In my opinion, right now the biggest problem that we have is that well over half of the staff on each floor have less than one year experience as nurses. New nurses are training new nurses. It's horrible. They leave in droves, and who can blame them? We do not have much of an education system set up for them. The only specialty that has an actual educator specifically for it is the ICU. Everyone else is relegated to one educator who is overwhelmed. So the new nurses go through a kind of rushed two week orientation that includes their computer training, facility orientation, and a series of power points that are pretty much useless. Then they are put out on the floor for only a few weeks with their "mentor" before being cut loose. The reason for the rush is because of the severe shortage of nurses in the facility. It really is a terrible situation. However, I am willing to throw myself into it and help if I can. So I told my boss that I believe that nursing education and orientation is the main problem with patient care and patient flow in our facility. He said he's going to speak with the system educator about possibilities for me to assist with nursing education. This is great because I love to teach clinical concepts. However, I am uncertain how I could be best utilized. I do not think that classroom time would be cost-effective or as educational as actual on-the-floor learning. What I envision is more of me going to a floor and sort of mentoring and guiding new nurses through their day. Maybe showing them how I look at things such as labs and how to prioritize. I worked as a floor nurse for two years and then an ER nurse for five years before I became a nurse practitioner. So I have a basic understanding of how these things need to be done, and I am not so far removed from it yet as a nurse practitioner that I cannot relate to them. But I am reaching out to you all to see if you have any ideas on what I could do as an individual to assist with this. We are a pretty large hospital. Our facility has about 550 beds that stay full. I work as a nurse practitioner hospitalist, so I see all of the nurses from the ER and on up through most of the floors. So they already kind of know me, and I am familiar with the layout of their work areas. I am willing to do this on my days off as well. I really don't mind. It is a problem that has bothered me for a long time now. And I would consider it volunteer work to the betterment of the nursing profession to be able to improve the situation in my facility. There are many things, of course, that I cannot solve. Staffing ratios, pay rates, etc. But the thing that I CAN help with is the every day function and basic working knowledge of the average staff nurse. Now, there still are some experienced nurses on these floors. And I would like to incorporate them as well if I can. However, on some floors it is so bad that the most experienced nurse among them has only two years of experience on some days. And I know that floor nurses have a tough workload, so it is difficult for the experienced nurses to take time out of their already busy day to help train the newbies. Just for an example of what I am talking about : I asked for a JP drain to be pulled on a surgical patient. Unfortunately, the only nurse who knew how to do that was at lunch. So, I instructed the three nurses who were present on how to do this procedure. This is the type of thing that I envision would work best. Going to their floor and being a resource to them. As well as looking into their pts charts and finding teachable items. Not really sure if that is realistic or not. So please, if you have a suggestion, post it. I am open to almost anything. I really want this facility to get better. I love my job, and it makes me very sad that many of my floor nurse colleagues are struggling. Things I see often: Not knowing when to call the doctor/NP. Not knowing what labs correspond to what conditions. Procedural knowledge deficits, such as with the JP drain. Prioritization-the ice can wait, but the BP med cannot. Drawing labs out of an IV line that has had fluids running in it for days just b/c the pt asked why not. Not knowing the appropriate nursing interventions for follow up: example is that if you give IV insulin then you need to actually RECHECK the pts BG (that was a new ER nurse). So you see what I mean? These are kinks that usually get worked out with a normal 3 month paired orientation and some good solid experienced nurses around you. But here they are literally thrown to the wolves and have very little resources in the way of experienced colleagues. So, please help? Thanks everyone!
  5. Bumashes

    Radiology CEUs...where?

    Neat! Thanks a lot!
  6. Bumashes

    Radiology CEUs...where?

    Oh, thanks! Yeah, I know one class won't do it, but I would like a course that covers basics, like just terminology, positioning, determining if there's over or under-exposure, etc. And then maybe cover CXR, KUB, and a couple other very commonly ordered xrays and/or other imaging. Just the basics really. I don't need MRI/MRA training. Basic CT stuff would nice, too, though, for helping to recognize certain things lie an acute abdomen and whatnot. My RN background is ER, so a big issue is that while I recognize major conditions, it is the little things and normal variants that escape me. Huge pneumo? No prob. Weird looking xray just because then pt is hunched over and has some extra calcification in their pulmonary vessels....? Meh. After getting a better foundation/understanding of the basics, I think I'll be better prepared to study on my own with a text or an online course. I just really like having a live person initially to ask questions of. Right now, my NP experience has been outpt Internal Med and Pain Medicine. Then I started at an Urgent Care a few months back, and we do xrays there, which is when I realized how inept I am. And while a radiologist reads our xrays and sends us the report generally within 3-6 hrs after it's been done, I hate relying solely on him, you know. If I can't find a course, then I may ask one of the radiologists at my old hospital if I can shadow them for a while and just learn it like it's OJT. That could be fun anyway!
  7. Bumashes

    Radiology CEUs...where?

    So my program didn't really include much in the way of radiology interpretation, such as for xrays, CTs, etc. Not many programs do from what I can tell; they seem to rely more on where you precept or future OJT as to whether you get much training or not. So I was wondering if there are any good CEU courses for this kind of thing. I would prefer classroom instruction, but online would be nice as well. Would also prefer more for beginner/intermediate level since the most training I have is pretty much just what I had seen as an RN in the ER. LOL! So, anybody know of any good places/courses/etc? Thanks!
  8. Bumashes

    delegating physician

    Yeah, in MS our collaborator has to be practicing a type of medicine that is similar to what we are practicing. So if I do urgent care, then I need a primary care doctor, ER physician, urgent care doc, etc to collaborate with. So for example, an orthopedic doc wouldn't do. And it's all because if they have to be consulted or review our charts, then they need some practical working knowledge of the specialty they are collaborating with me on in order to do this.
  9. Bumashes

    Would you be willing to do this?

    Meh. Nope. I would be okay with a day or two of shadowing someone. Mainly just to see if the pt population was the kind I was looking for and to make sure I could get along with the other provider. But more than that for free? Nah. I'd need some pretty powerful desperation to do that. I've been offered a similar thing before when I was fresh out of school, just so you know. A guy who has NPs round in nursing homes would only hire you as a new grad after you have done your required 720 hrs of supervised practice (MS BON requirement for new grads). In order to get these hrs done, he would cover you with insurance but not pay you per hr. So you work for free but are covered with liability ins for about 4 months. Ha freaking ha. No thanks. Just telling you this so you know you're not alone in hearing an offer like this.
  10. Bumashes

    AGNP Jobs

    Urgent care, Pain Management, and Internal Medicine.
  11. Bumashes

    How many patients are you expected to see daily?

    My part time job in pain management has me see about 30-40 pts per day for either injections or pre-injection exams. I work a10 hr day with an hr for lunch. It's a very focused exam, so it only takes a short time which makes this many pts very doable.
  12. Bumashes

    Nurse Practitioner Salary in Mississippi

    Wow. I know this post has been here a while, but I felt bad when I saw no one had responded. I live on the gulf coast (Biloxi/Gulfport) area. My first job was with one of the Coastal Family Health Center Clinics, and they pay only about 70k per year with fully paid health insurance (so-so coverage), and 2 weeks PTO, etc. My current job is with a pain management clinic doing pre-injection exams, injections, etc. It pays $50 and hr, but is only part time, so I get only one week of PTO and $500 CEU as benefits, no health insurance. I also have a side job at an urgent care a couple days a month that is as an independent contractor that pays $65 an hr (but remember I have to pay my own taxes and stuff). My boyfriend works in a minor care in an ER as an NP and gets $85 an hr with no benefits whatsoever. You can opt for $65 an hr with benefits, but he just took the higher pay. Hope all this helps, though you've probably already figured out the pay situation by now. Not many places pay much more than 40-45 an hr in the outpt setting here in south MS.
  13. Bumashes

    Monetary Consequences for Quitting a Job In Your Contract?

    This is very interesting to hear. My first NP job required a 90 day notice. My current job requires 60 days. And my part time job requires 60 days. This is all in South Mississippi where there is a glut of new grad NPs. But the concern isn't really the length of the notice required, the concern is that if you don't complete all of the required days of notice, then you will owe them X amount of money for each day not worked.
  14. Hi All! I was recently asked if it is normal to have monetary consequences for quitting your job written into your work contract. Such as, "If you don't finish out a 90 day notice, then you will owe us X amount of dollars per day that you don't finish it out." Now, I have had something similar in one job contract before, but I don't know that this is the actual norm for contractual agreements for NPs. Anyone have any input? Thanks!
  15. Bumashes

    Adult-Gerontology NP versus Family NP

    That's how places around in my area do. They may list FNP, but they accept AGNP. We can see down to age 13, so we're not too severely limited. But it's what YOU want to end up doing really. I don't ever want to work in an environment where I would be expected to see kids, no matter how few and far between. They hired me in my current position for Internal Medicine over the other 6 applicants specifically because I was AGNP (they were FNP), and I had done all of my clinical time in an Int Med setting. And that's exactly what I had set out for goal-wise when I went back to school. I have also had another place that I interviewed at think it was weird that I didn't train for peds, and so they went with another candidate. But then, I didn't want to work there at that point anyway because I had found out at the interview that occasionally they see peds. Ick! LOL!
  16. Bumashes

    Adult-Gerontology NP versus Family NP

    I never wanted to see peds. EVER. So I went with AGNP. FNP and AGNP are exactly the same lengths of time to complete, but in the AGNP you get more in depth education on adult and geriatric medicine to compensate for the ped and OB coverage that is done in the FNP program. AGNP was basically like doing an Internal Medicine degree for me. No regrets here! But you gotta look at your area. I live on the MS Gulf Coast.
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