Bumashes

Hey All! Looking ahead, I'm thinking my hubby and I may look to get our NP licenses transferred into Canada. I already know each province has its own specific process and what it does and does not accept. The question I am looking to figure out concerns the Offer/Acceptance of employment form/letter that is supposed to be submitted during the application process. We currently own our own practice in the US, so we were going to open our own clinic up there (self-pay), and so the employment offer letter would essentially be from ourselves. Is that even a thing up there? Where NPs can own their own clinic and thereby employ themselves? In some of the US, it isn't a thing, and that is why I ask. I know everyone has opinions on how a cash pay clinic would survive in a system with national healthcare coverage, but we aren't worried about that, and we would still keep our practice in the states as well, so it wouldn't even have to work out that well financially in Canada anyway. We just need to know if we could own our own business and thereby offer ourselves employment to get there. Because since we never plan on working for someone else ever again, there is no point seeking out moving to Canada if this would not be possible (though you have a lovely country we have visited many times). Thank y'all so much for any advice. I've just come up with half answered questions thus far, and the agencies I've written to have yet to write back.

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.

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.

Wow. That's actually quite an interesting idea. A resource nurse available for paging.... Definitely has possibilities.

Just google Upenn Streamlined post masters ACNP and it will bring up the info from Upenn's website. Email the one of the two ladies they list on there, and they can answer specifics. It seems to be a great option for those like us.

Thanks to one and all for your input. I actually printed the responses and gave them to my boss who is going to go over some of the ideas and bring them to the head of nursing education. I understand some of you telling me that it isn't my job and whatnot. And you're right; it isn't. However, when I see something wrong in the workplace that no one else is actively working to fix, I feel at least a responsibility to mention it so the powers that be know that it doesn't go unnoticed. I may not be able to swoop in and save the day as a single individual, but the more voices raised about the issue the better. And even more so if the raised voices have some workable suggestions instead of just the usual criticism.

I went ahead and have enrolled in the Streamlined ACNP post masters at UPenn. It's a good program, well structured, and designed for folks in my exact situation (working as a hospitalist but with an AGNP primary care certification). I'll start this May. Can't wait.

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.

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!

I attended a mostly online program. We had to attend campus for skills/procedure training, but not for actual lectures. The lecture type material was a variety of things: recorded lectures, podcasts, powerpoint presentations, etc. The assignments were, well, what I expect most folks had to do: some various written reports/reviews on health conditions/topics, independent research, community projects completed by networking with providers and leaders in our geographic location, and some collaborative group assignments (which were the most annoying, truly). We had practice tests and reading assignments and whatnot. When we took an exam, we had to do so either at a proctored exam site, or we could take the exam at home by using this funny little camera doohickey that recorded 360 degree video, audio, and also noted every keystroke on the computer as we took the test. That was a bit weird because you had to make sure there was no background noise, no papers in front of you, nothing on the walls around you, etc. And believe me, the company paid to watch these videos did their darn job. I found out the hard way because I cursed a few curse words during a particular exam and got an email two days later asking me to not use vulgar language as it could offend the people who review the video. LOL! As far as preceptors, we were expected to find our own so that we could get one close by in our own community (but we had to submit their credentials and have them approved by our instructors, of course); but if we had trouble finding one, then the instructors would contact past preceptors for us and line one up (you just might have to drive a little ways farther than desired if you went that route). Anyway, that is all just to give you a feel for how the program was set up. Now, do I feel the program was rigorous and whatnot? Meh. Appropriately difficult, but no more so than my ADN and BSN programs were. It was much more time consuming and, therefore, more stressful, which would certainly add a degree of difficulty. Oh, and I worked full time as an ER RN during my NP school as well, so that didn't help the stress/time factor either. I would have liked to have gone to a traditional school just for the experience, but at the time there weren't any options in my area, and I had no way to relocate at the time. I do believe there is something to be said for face-to-face education. Being in a classroom environment and being able to ask a question and immediately hear your classmates' and instructors' opinions is a much better experience overall for me. However, I do not think that missing out on that has impaired my learning in any way. It just made me have to be more self-motivated and aware. Now, for one problem (of many) that even I have with online schools: They definitely assume that you have a lot of knowledge and experience under your belt prior to beginning NP courses (and they should), despite the fact that many do not require actual nursing experience for entry. I know this is a whole other argument, but still. The online school I went to expected you to be a solid RN with solid RN experience to build on. Without it, my program would be like learning to speak Spanish by starting off in Spanish II, completely skipping Intro to Spanish and at least half of Spanish I. Not impossible to succeed, but it certainly doesn't make it easy. At any rate, I believe if a program is going to assume a certain amount of prior knowledge, then they should vet potential student candidates with this in mind and actually require experience to get in. Other programs may be different, and start off assuming no prior RN experience, and they may begin to build a foundation from a different level. But again, they really should recruit/accept applicants based on what level of experience the program is geared towards, not just how many dollars they can make off of us. That is a severe disservice to the student because it is not allowing for an appropriate learning environment. But I digress..... My husband went to a ($expensive$) well regarded brick and mortar NP school. He did that because, even though he had been an Occupational Therapist for 12 years and a paramedic for a couple years after that, he had only been an RN for barely 2 years before going back for his NP. And he knew that he would need the extra oomph that a brick and mortar school could provide. And he did great. But they really did challenge him and build a foundation from the bottom up, which is what he needed in order to "catch up" with the more experienced RNs in his class. Online schools don't really seem to offer this that I have seen yet, and that is a huge problem for those students with little or no experience. If we are to continue having those with little/no experience as an RN become NPs, then we really need programs that are designed to take this into account so that they aren't short-changed. Anyway, another issue I see with online schools no matter if you have RN experience or not, is that you really need to be a self-motivator. There are a lot of opportunities to procrastinate and end up rushed so that whatever your assignment is, you end up not learning as much from it because you just slap it together. I know you can do this in regular schools as well, but there is something reminder-like about actually having to GO to class every so often that can prompt you to complete your projects in a more timely manner. Just my experience here, anyway. So what is the perfect method of schooling? I believe it is very much based on the type of person the student is. If you have little experience, and you aren't a self-starter/motivator, then I think a traditional campus experience would be more beneficial. And when I say "self-starter/motivator," I do not mean "excited to learn." We are all excited to learn and become NPs, but you really need to self-evaluate and know what your learning pattern and habits are before making such a huge commitment. It's all about knowing what your needs/opportunities as a beginning provider are. Are you starting from scratch? Do you have experience, but it really isn't relatable to your chosen NP degree path (such as having practiced as a Peds RN but going into Adult Health)? Are you sure of your learning habits/needs? Etc etc etc..... Good luck to any and everyone. It's certainly been no Disneyland Fairytale being an NP, but it is what is, and I sure don't miss being a human fecal receptacle when I was working as an RN in the ER! LOL!

Dodongo, best answer to that question. LOL! Everyone works everywhere but no one is ever truly qualified to work where they work. Yep. I am an AGNP and work as a hospitalist in south MS. Meh.

I graduated with a degree as an AGNP and practiced outpt internal medicine and urgent care, then I changed jobs after a couple of years and got a position as a hospitalist. So while I don't exactly meet your criteria of going back to school and then going into acute care, I figured I was close enough. LOL! I am in south MS, and our BON's rules on practice settings are pretty lax. Now, as an AGNP, I am NOT going to work in an ICU environment. Never want to anyway. But being a hospitalist doing med-surg and inpt rehab roundings is actually what I wanted. And during my AGNP program, I was allowed to stay with one preceptor the entire time if it was in an area that I was aiming for after graduation, so I chose an Internal Medicine physician who sees her pts in her clinic and also when they are admitted to her in the hospital. My RN experience prior to NP was about 7 years of mostly ER, with a piddly bit of med-surg right at the start of being an RN. So I felt I had a good acute-ish nursing background to work off of when I did clinicals in both outpt and inpt. My AGNP program was probably focused about 75% on primary care, but it did include some education on the diagnoses most often admitted to the inpt setting: CHF, COPD, A-fib, PE, PNA, etc. So when combined, I feel like my schooling and my nursing background together provided for a good foundation to learn from. Also, the couple years as an NP doing internal medicine and urgent care prior to being hired into my current hospitalist gig helped build my confidence as a newby NP. And the onboarding process at my facility was pretty good, so as to introduce me to my new inpt NP role. The docs I work with are very good at continually teaching and making you think, so I feel I have a great place to learn in and very valuable support from my peers. Was there a learning curve? Duh. But anytime you go from one job to another there will definitely be some deficits needing fixing. But I certainly didn't feel lost or unprepared or anything. It's been wonderful, actually.

Prelift, I agree. There is not much to be said about how our degree programs are built sometimes. The only reason I have more than the required Basic Chem, Micro, and A&P 1 & 2 is because a long ways back, I originally went to school thinking I was going to teach college level organic science courses. Alas, life changed. But, it still gave me more than the basic sciences our NP programs seem to require. And while the additional gross anatomy type classes were helpful, the others like the additional chem courses and whatnot...meh. Just not my bag. But I hear what you're sayin'. And I agree on another point you make, that it is all a money game. Honestly, why not instead of all these NP designations, just have a program like PAs do? Instead of FNP...just NP. AGNP? Nope, just NP. Practice in all settings after a good grounding in each type. If you want to specialize with additional knowledge, then do a fellowship after graduation. But, again, they can more easily get us to jump through hoops and chase certifications and degrees with what little money we get paid. Back to topic. Thanks for the comment. Having another certification for hospitalist NPs does kind of feed into that big money hole that we dump our dollars into to just create another certification. But I just think there could be a better way other than dumping our dollars into another full NP program just to basically come out and do the same thing I already do, you know. Hopefully the Penn program another poster mentioned will offer something along the lines that I have been searching for. Thanks for the response again!

Thank you thank you. This is fairly much what I was looking/hoping for (as long as tuition wouldn't kill me, so hopefully it is reasonable as you said). Would be great to get some credit for current/past work experience. My hospitalist physicians gave me a fairly good introductory onboarding process into inpatient medicine when I was hired so as to better assess my preparation for the job, and it was wonderful to revisit what my preceptor in school had taught me before. And I feel they are a good supportive group, great at ongoing education, so I don't feel I would be doing myself a particular disservice by using work experience for clinical hours. I could even manage a few turns in the ICU if they absolutely had to have me go there just enough to show I had been exposed to it. I just don't ever want to work in that environment, so meh. The additional course work would be a welcome refresher, and would also help count toward my yearly CEU requirements, so yay. LOL! Thanks for pointing me in this direction. I am going to email the Penn program folks shortly....

Probably still got another 20 or so years I will be practicing. Litigation worries? No more than the average practitioner. Been thinking about it sucking it up, though, actually. Only 4 years into my NP career....so it could be worth the effort. However, it isn't the additional course work that I am opposed to, it is the additional clinical time. I worked fulltime as an ER RN while in school for my original NP degree. Would really like to not do the 7 days a week of work and/or school for another 2 years if I could help it. Plus, not sure if my finances would allow for me to screw up my current job by getting fired since they won't allow for part time status. I see someone else here has recommended a program at Penn that I am going to look into. Would be nice to have experience taken into consideration for clinicals. As for the DNP....I won't go there, for many reasons. But that's a topic for a whole other discussion. LOL! Anyway, thanks for the response! All good things to consider.