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  1. SFDRN

    NP vs MD and other discussions...

    I agree with the posters who say that if you really want the prestige, title, and the more in-depth knowledge of basic science, definitely go the medical school route. I can say that as a second-year NP student in a very competitive and highly-ranked ACNP program, NP education is for the birds. I am so underwhelmed by the minuscule amount of patho and pharm in our curriculum (1 quarter's worth of each) and the lack of seriousness given to the clinical rotations. In retrospect I would have chosen a different path--probably PA or MD. But I've invested this much time and $$, so here I am. At least I'm getting a dual certification out of it (NP & CNS). Whenever we students complain about the deficiencies in the curriculum, we are told, "well, you just need to do more self-study and don't expect to feel comfortable in your first job coming out of school." Since when does a profession have such low expectations of its educational preparation that it leaves almost everything of value in the curriculum up to the student to "self-study," while placing much higher priority on one's ability to write "scholarly papers"? I've so had it with the nursing theories and paper-writing. The NP's that I've precepted with are diagnosing and prescribing, not writing ridiculous papers.
  2. SFDRN

    ACNP without research, theory, etc

    Juan and NPreform, I could not agree with you more. We need comprehensive ACNP education reform that actually reflects what ACNP's do on a day-to-day basis. I have suffered through one year of ACNP education so far, have just started my second year. Today, in my ACNP III class, I sat through 3 hours of basic oncology lectures that were aimed at prelicensure students. The speakers didn't even know who they were presenting to--they asked us midway through if we were FNP students. Not even a mention of how to manage an inpatient oncology patient, oncologic emergencies, or anything relevant for the ACNP. Then, in the afternoon, I sat through my "clinical conference" class where the instructor basically walked us through the syllabus AGAIN (she did this last week at the first class, too) and the five different writing projects we're doing for a CLINICAL CLASS this quarter. Every quarter is the same--write at least 3-5 "scholarly papers" aimed at prepping you to write a comprehensive exam which is basically just another paper. Don't get me wrong, I am a huge fan of research and evidence-based practice and am a major believer in using practice guidelines to deliver the best care. But since when does "writing scholarly papers" prepare RNs to become NP's? I can see a few papers here or there. But 5-6 a quarter? Meanwhile, we got exactly 1 quarter of patho, 1 quarter of pharm, 1 class each on CV, respiratory, endocrine, GI, and neuro. But 3-4 classes each on standardized procedures, issues facing NP's, ethical dilemmas, use of theory in practice, etc. etc. Not to mention an entire REQUIRED class on how to build powerpoint presentations and make sure that any health education materials you produce meet the American public's 5th-8th grade reading level (easily done by using the Word Count feature in MS Word). It is time to absolutely DEMAND that future NPs (too late for us, alas) receive the education that will actually prepare them to be functioning NPs when they graduate. And yes, I think residencies are absolutely necessary. But this may just encourage schools of nursing to slack off more on clinical hours (which they already do at the prelicensure level--reassuring students that "the hospital will teach you everything you need to know"). NP's are great and we definitely bring a fresh perspective to patient care. But let's not pretend that for the most part, NPs practice medicine. We need to be trained as such. NPs and PAs should join forces and create a combined midlevel curriculum. Just look at the CRNA curricula--it is so much more focused on the biomedical model of caring for patients--because that's what they need to do!
  3. SFDRN

    experienced nurse with anxiety on the job

    Wow, you guys are fantastic! Thank you for all your helpful and supportive comments! It is so reassuring to hear people say that they still struggle with skills 15-20 years out of school. Hearing that has made me feel that perhaps I have unrealistic expectations for myself to do everything well with only 2+ years on the job. I think my other problem is that I put pressure on myself to get things right the first time and within 5 minutes or so! Maybe I just need to slow down and take some deep breaths, as a few of you have suggested. Yes, I could probably get my CNS to let me have a day in pre-op surgery for IV sticks and possibly Foleys as well. Great suggestion! Also, I definitely do attempt all IV sticks myself the first time when a pt needs a new line (I try 2x and then ask someone else) ... Foleys--same thing--I usually bring someone else in, but I'm the one doing the first pass at insertion, then I hand things off if I get too unsterile/frustrated. We don't have an IV team or a catheter team, so my backups are resource RN and charge RN. If need be, we can also ask our UD, who's an amazing stick, but we try to save her for super hard situations. And, yes, I'm actually pretty good at NGT insertion and don't have a lot of anxiety about that skill--no idea why! Thanks for reminding me that there are SOME skills I'm actually quite good at :) Oh, and FYI, I'm female ... that doesn't necessarily help you Foley other women, though, as many other female RNs have testified here :-) I think it does help female patients feel more comfortable, though, to have a female RN insert a Foley. Anyway, I just want to say THANK YOU AGAIN for all your reassuring, helpful, and confidence-boosting comments. I feel energized by the pep talk! I'll save this thread to my hard drive and look at it when I get down on myself again in the future. Now I'm actually looking forward to going back to work next week.
  4. Dear colleagues, I was searching for pre-existing threads that I could contribute to, but only found ones written by nursing students. I, too, have performance anxiety at work, especially starting IVs and inserting Foleys (on women). Those two skills are the bane of my existence! A little background: I work on a med-surg/tele floor that mostly takes care of >65 y.o. pts. I've been a nurse for 2.5 years, have worked on this unit the entire time, started there as a new grad. I spent a year on nights, learned a lot, then last year switched to days. I've been on days for a year. I'm an academically-minded person (working on my second master's) and am certified in my specialty. I've preceptored several new grads and am known for cultivating good critical thinking skills in the new grads on our floor. It's those damn clinical skills that get me! Most of the time, our patients come up from the ER with Foleys inserted and IVs in place and our pts are in and out in usually less than 4 days, so often I don't get a chance to practice my skills. But when urgent things come up and I need a new line quickly or I need to insert a Foley quickly, I freak out, get all of those bad physiological anxiety symptoms (shaky hands, sweaty palms, racing heart, racing thoughts, crazed/distracted look) and usually end up having to ask for help. I know part of the problem is that I'm rushing myself (going too fast), putting super high expectations on myself (additional pressure than just the situation), and thereby creating more anxiety for myself. AND, I have a history of depression/anxiety, which I mainly have managed (in the past) via therapy, exercise, stress-reduction. I'm not opposed to medication, just don't think I need it that badly. However, all that said--I still want to be able to do these skills MYSELF without asking our resource or charge RN for help! What makes my anxiety worse is that I worry that I'm going to lose credibility in the eyes of my colleagues. I'm scared that they'll think I'm a total fraud who can't do her job. In every other job I've had (I'm a second career RN), I have been a leader and one of the most competent people on the job. It really bothers me that I'm not there yet in nursing--at least skills wise. I see other nurses--totally relaxed (or at least able to hide it well), great at their skills, seemingly no problems with anxiety--and what kills me is that they have the same exact experience level as me (2 years or so) and have spent their entire careers on the same unit! Where the heck did they get so good at their skills? Please share your thoughts with me about how I can get over this low self-efficacy/self-esteem and face my fears! Sorry for the rambling. Thank you in advance.
  5. SFDRN

    Nurse Residency Programs

    Oh, I didn't know that. Maybe that's a new rule or something. Anyway, ask me specific questions and I will try to answer them.
  6. SFDRN

    Nurse Residency Programs

    ASU Student Nurse, Pls private message me your specific questions about the residency program. I'm happy to answer questions, but I'd rather speak to specific points than generalities. Thanks, SFDRN
  7. SFDRN

    is this a dumb idea?

    I currently work nights on a telemetry floor as a newish (6 months experience) grad... I tried to do the 3 nights in a row schedule for a few months, it wore me out and left me exhausted for at least 2 of the 4 days I had off afterwards. Now I'm trying a Wednesday, Friday, and Saturday schedule so that I don't have to do 3 in a row. It really depends on what kind of floor you're on. I'm on a geri/tele/med-surg floor where the patients are total care and can be pretty acute. We transfer to stepdown and ICU floors all the time. Not only that, but the patients and their families are demanding and often entitled, and the residents write for stuff all day and night long. Nights are not easy on my floor, but I've floated to other med/surg floors in my hospital where the pts are walkie-talkie and it's a breeze. Some of the nurses on those floors work 5 nights in a row in order to get a ton of days off! I just don't think I could do that on my floor. Also bear in mind that you won't sleep well between shifts and that you need to factor in commute time. If you leave at 8am, you may not get home until 9 and then you have to sleep until 5pm. It's hard to do that, especially if you have another person around during the day. After two nights on and two days without good sleep, your third night will make you feel soooo burned out, believe me.
  8. SFDRN

    Nurse Residency Programs

    I'm at UCLA Santa Monica Medical Center for their one-year new grad RN residency program.
  9. 1. How long have you been a nurse? Less than 1 year 2. What type of school(s) did you go to? BSN Care to share your school(s)? 3. Did you have any experience working in a hospital before becoming an RN? No 4. What kind of floor/unit was your first position? telemetry/med-surg 5. How long what your orientation/training period as a new nurse? should be 8-10 weeks (still doing it) 6. How prepared did you feel after graduating from nursing school and beginning training? Good 7. How prepared did you feel when you finished your training, and began working on your own? hasn't happened yet, but I feel that I will be marginally good (not better than that) 8. What was your experience(s) with your preceptor(s) like? Very Good 9. In your opinion was your training period long enough? No 10. Did you experience "Reality Shock"as a new nurse? Yes 11. Please describe in a few sentences what your first few weeks/months were like: Being totally overwhelmed with information; not feeling confident about skills; not knowing/understanding policies/procedures of the unit; lacking clinical judgment skills that are only gained through trial/error/many years on the job; feeling petrified that I am going to harm a patient by inadvertently making an error 12. What would you recommend, or what advice would you give to new nurses? Try to practice as many skills as possible in nursing school; rehearse SBAR communication with doctors; make the absolute most out of your clinical days--this is the only time in your life where you won't be totally responsible for everything. And make sure you understand how/when/why charting is important.
  10. SFDRN

    UCLA new grad training program completion rate

    This can't be right. Maybe what she heard was that they have 10% turnover among new grads in the first 6-12 months. That would make much more sense and actually reflects very well on their new grad residency program. They can't possibly fire 90% of their new hires in the first year--that would be totally inefficient from a managerial and economic standpoint--it costs a LOT of money to orient new nurses--it's an investment for UCLA. They wouldn't just throw that away.
  11. SFDRN

    Does UCLA cover relocation costs?

    Also, FYI, relocating to LA is pretty cheap right now. I just moved here two weeks ago and found a 1 bedroom in Santa Monica for $1500 with a $500 security deposit. There are a lot of deals like that. Lots of concessions these days because the economy is so bad.
  12. SFDRN

    Does UCLA cover relocation costs?

    For new grads, they will cover up to $1500 in relocation costs in your name only. (Meaning, the receipts must bear your name, not someone else's).
  13. Hi, I'm contemplating a move to Tucson after graduation from an accelerated BSN program in December 08. I've spent a significant amt of time in Tucson over the past decade and really liked it there. Can anyone give me feedback about the one-year RN residency program at UMC and also what their starting salaries might be for new BSN grads? I'm not ready to speak with recruiters there yet, but I just wanted to get a sense of what the going rates are. Thanks! Sarah
  14. How about "impaired urinary elimination r/t chronic renal disease process"?
  15. SFDRN

    12 hour shifts for students AND Med. school

    They instituted 12 hour med-surg clinicals at my BSN school this semester, too. We'll see how it goes. My first one is next Tuesday. I don't know how your school can accept D- as a passing grade, since it's so close to failing. At my school, they have instituted a strict 80% (or B-) rule. If you don't get at least a B- in the class, you fail it.