SanDiFrangles

So this has been a debate in the medical community for years and has been a reason why some physicians have been reluctant to seek mental health care. Won’t make you feel better but physicians license renewal ask a lot more invasive psychological questions than nursing does. As far as credentialing, if you mislead and they find out your position could be in jeopardy, up to including termination. Just as if you mislead on a job application and the employer found out later. You can always write a statement along the lines of “I’m seeking mental health care for a controlled condition and have been stable on that regimen for many years” … or something like that.

Unfortunately, some of the UCSF MEPN pause of admissions might be related to nuts and bolts in external regulation requirements. I’ll do my best to try to explain: All nursing colleges need to be accredited by the American Association of Colleges of Nursing (AACN -east) via the Commission on Collegiate Nurse Education (CCNE). (Sidebar, AACN -West refers to the American Association of Critical Care Nurses - which does not accredit college programs) Specifically, this might be related to accreditation and a very real fear that APRN certification agencies (“boards”) MIGHT mandate a doctorate to sit for certification exam … (currently all APRN certification bodies accept a masters or higher to sit for an exam … we haven’t seen the organization that accredits the boards (ABSNC) move towards requiring doctoral degrees, but in theory they could at some unknown point in the future since AACN -east has already been advocating this for some time. What does this mean for you as a student? Picture this: you complete the MEPN program with your MS degree, you prep to test for your NP, CNS or CNM boards when you’re told you can’t take the test because you have a masters and not a doctorate. You’d have to spend $ for a doctoral degree or not take the certification which means you won’t be able practice. A few things to point out: -AACN -east has indicated doctoral degrees should be required for advanced practice as the entry requirement in a report around July 2022 and one section states: “The report also calls for engaging APRN certification organizations to build momentum for requiring the DNP for entry into advanced practice nursing and for establishing academic-practice partnerships focused on DNP education and practice.” (https://www.aacnnursing.org/News-Information/News/View/ArticleId/25226/New-Report-on-DNP-Education-2022) So the next question is this, why not offer a direct entry doctoral program instead of a direct entry masters program ? - Currently, no such direct entry doctoral program exists in the United States. - According to accreditation requirements, in order to take doctoral coursework you need a minimum of a ASN or BSN prior to enrollment. You cannot have a degree in another field and take doctoral coursework. - In theory the school could offer this but they’d really be risking their accreditation status and AACN -east could put their accreditation in jeopardy. UCSF SON might be a bit late to the DNP conversion party, which likely explains the knee-jerk reaction we’ve seen. A few other schools have already made this transition years ago … off the top of my head I’m thinking about UMB and UW, I’m sure their are others. In my view, pausing the admission for MEPN was the right decision. CSU and community colleges are set up to educate prelicensure students (albeit in a saturated market in the Bay Area it’s tough) so that might be a route to explore and then apply to the APRN program of your choice. Also, UCSF is a graduate school only, its charter does not allow for granting of undergraduate degrees. I thought perhaps a joint degree with Berkley might be an option but unsure if that’s a realistic solution.

To the OP, I read all threads to date and I think I’d recx that you retrain and explore other opportunities outside of nursing. It’ll be better for you life, mental health and lifestyle. Also for your family as well. There’s no shame in admitting it’s not the career you thought it was. It has changed and it’s quite different. I have a few suggestions you might want to explore. As for me, I worked as a RN, CNS, educator (both in hospital and academia) and as a ACNP. I now work full time in the medical device industry but I work per diem as a ACNP on weekends - I see the burnout on the faces of the nurses I work with. It truly is heartbreaking. A few suggestions that are lateral moves with a nursing background that may or may not have been mentioned — all of theses are not ideal and require some compromise. - Nurse informatics. Some hospitals and systems have nurses that work in this area and serve as a conduit between IT and nurse esp with rollouts, new software and new workflows. It can be done as a hybrid role. Some positions require more training but you could negotiate to get that training while your in the position. - Medical Device. The field I’m in now has both good and bad. Most positions that nurses can qualify for are either in sales or education. Sales you’re pushing the device to hospitals definitely requires a certain personality and drive. I don’t have much experience in this areas so I’m not the one to ask. But for education, you help rollout products alongside the nurse educators in hospitals. Big Downside is the travel, usually 70-80% usually in a geographical area of the US (so not necessarily coast to coast travel). You’ll be in a new site frequently so again takes a certain personality. Some companies you might want to look into that I know hire RNs into roles — GE Healthcare and Philips (bedside monitors); BD (IV therapy), Zell (defibrillator), and a few more I’m sure. Most of these job titles are something like “clinical specialist” “clinical practice specialist” or in Philips case “critical care nurse” - Nurse Educator (in hospital) I find working in this field can be a fairly easy transition you work pretty much 9-5; I have colleagues who negotiated to work 4 10’s and also have negotiated hybrid work as well. There is an INTENSE demand out there. Downside, still got to deal with hospital politics, just differently, being middle management you get squeezed from both sides, and ANY time there is a regulatory survey usually it requires being at the hospital constantly until the surveyors leave. None of these are great options but just a starting point. I think getting a side hustle doing something you enjoy might work out. Earlier in my career my side hustle was renovating houses on the day I was off — it anll started when I was ant the bar with three other guys and we looked at each other and said “we need to do something more productive with our money then drinking it away” … ended up parlaying that into a flipping houses business. Point is, start small and then scale up. If your interested in staying clinical, there are consulting companies that you can start off working for using your current experience. Here’s to hoping you find your bliss !

So in a word, no. But I often come on here and find an inordinate amount of negative ranting, it kinda reminds of the site Glassdoor or apartment rating sites. Usually people seek out these forums to vent and identify a problem and rally those supporters behind them but it is not a reflective sample of the community at large. I’ve been in the nursing arena for about 16 years and despite all of the gripes, occasional 14 hour days have the slightly-more-frequent-then-occasion poo slung my way (literally and figuratively) still find my way back here. My own recipe is to reinvent yourself every few years, it could be thru a job, education or something else, be bold enough to suck at something new. Too many are resistant to retraining because we don’t want to move from our comfort zone. Nursing and healthcare clearly have problems as anyone with a pulse could tell you, burnout is running rampant, and every time I turn around I read an article about resilience that makes me want to gauge my eyeballs out. I To help avoid burnout for me, I tend to work for a bit, save up, take time off and then do it again. I often rotate between, patient care, nursing education and consulting which in my view can help and you won’t feel pigeonholed to a particular setting. (I’m back at patient care after some time teaching for the last three years). For some reason, this works for me and it keeps me from becoming too jaded, although I still find myself laughing hysterically at Gomer Blog articles, so I’ll leave that for you to judge.

So going against the grain here … I looked into a ACNP residency for close to a year, and applied to a bunch but never heard back, so I started applying for a staff NP positions and got offered three positions. I’m about six months into my role now and feel comfortable and don’t regret not attending a residency or fellowship. In my role, its a pain management consult / perioperative service, see patients on my own, bill and practice independently, so it’s a bit different then what I trained for in school which was mostly working in ICUs and with the hospitalist and surgery teams. Although we have anesthesiology attending as resources, most of the time they like prefer to be independent and so they can focus on the OR cases. My background is 13 years as a ICU nurse in academic medical centers and 3 years as a critical care CNS, but initially still have issues with time management as one would expect. I think for me is truly being on my own and being confident in my plan is the hardest part since as a new grad you tend to second guess yourself a lot. Maybe a residency or fellowship would have helped with that, I’m unsure. But I had a decent three month training and I felt good to go when I was done with that three months. Still obviously have lot to learn, I saw 26 patients yesterday writing notes until 9 pm and that was a little rough, but overall I feel like I’m on solid footing.

Hi all, in the past I had worked as a ICU clinical nurse specialist and have intermittent dealings with leadership regarding budgets, even though it is not really my favorite thing to do. First, I completely agree with the theme of this thread that hospitals need to do a better job at retention by offering more attractive financial packages, that include retention of nurses. As mentioned by one of the other posters, there is a significant financial cost to re-training nurses. I think the cost differs based on where in the country you are actually working, however I’ve estimated it to be as low is $40,000 and as high as $75,000 a year depending on specialty. As far as pay and compensation and why a hospital might hire travelers instead of permanent staff, there are often two buckets in a hospitals budget when it comes to labor. The permanent staff budget and then the temporary staff budget. Often times permanent staff budgets are established early in the fiscal year (starts in July at most places) and the monies are spent immediately in hiring new people. Whereas the traveler budgets are often spent throughout the year and there are some reduced costs in travelers for short term although they do cost more for the long term. Like many things in life, it is cheaper to buy things in bulk and travel agencies are no difference. Hospitals may sometimes get a special deal for multiple travelers at once at a significantly reduced rate. Another thing to keep in mind regarding travelers versus permanent staff is that permanent staff are actually a bit more expensive aside from salary alone, benefits, training, PTO all are expenses to the facility. Another example is orientation, a traveler would typically get 1 to 2 days of orientation on a unit where a new employee might get about 3 to 6 weeks. During that time the orientee is considered non-productive (fiscally) and there’s a significant cost. But as you might imagine this significant cost becomes even more expensive if somebody might leave therefore this whole argument comes full circle that hospitals really need to do their very best to retain their experience people because if they don’t in the end it cost them way more money and then they will also need to supplement with travelers. If they do supplement with travelers then it can get quite expensive especially if we’re talking more than six months.

Hi all, Pain Management Adult ACNP here based out an academic medical center in Baltimore, MD. 100k/year starting as a new grad NP (My experience 13 years RN ICU, 3 years as a CNS), base rate approximately 49/hr Weekend differential additional 7/hr, additional shift 75/hr 800 in CE and education reimbursement 7500 loan reimbursement one time Expense reimbursement except for MD license 403b with dollar for dollar up to 4% of pay, partial vesting after 2, full vesting after 5 yrs Medical, Dental, Life (small amount), FSA, HSA, about $60 per pay deduction for a mid tier plan, myself only. Overall, I feel like I'm getting pretty screwed in compensation. However this was my first new grad position and I wanted to get some experience first. Ultimately, I will probably go back to working as a clinical nurse specialist, since my compensation for that role was significantly higher. I applied for a CNS role in a similar size institution in Baltimore and was initially offered about 127,000 per year without any negotiation. Previously was working as a contract CNS was taking home about 4K weekly, in SF Bay Area - so take that based on cost of living. I'll probably hangout in this role for a year or two and then reshop the market. One piece of advice I might add, is I bought a Salary report off of salary.com and am able to use that in the negotiation process.

As someone who deals with the BRN on a regular basis I can tell you that this is an issue with YOUR school - staff at regulatory agencies are under strict guidelines to only accept courses as written and must write full course names on transcripts. Unfortunately, syallabi are. Or considered official and can be forged so the best bet is to have your official transcript resubmitted. Most registrars can submit a memo attached that can clarify these issues.

I may be able to provide some help. I relocated to the Bay Area about five years ago and currently work as both a bedside RN and as nursing school faculty at one of the nursing schools in the area (not mentioned in your comparison). I've "job shopped" as a travel RN quite frequently in the area and have worked at CPMC, John Muir, Eden, & UCSF. I haven't worked at Kaiser. I'm familiar with SMU and CCSF. If your planning on working at the bedside is echo our colleagues recommendation that RN employment in the Bay Area is competitive and that most employers prefer BSNs. There are always exceptions. In terms of overall cost, and if your not in a hurry completing training at CCSF would likely be the most cost effective. Many students get trained there and go on to pursue a BSN in an RN-BSN program. It might save on money but would take longer. On the other side, completing the ABSN program would be the minimal amount of time but perhaps cost you more $ in the long run. So I might sit down and crunch some numbers. For CCSF factor in the cost of the CCSF program and a RN-BSN program. California as a whole has a huge deficite in nursing schools which is the reason why many nurses are educated outside the state. The job market: I came to SF with acute care ICU experience and I found the market to be fairly challenging. It's not impossible if you have experience but for new grads it's a little rough IMO. If your experienced, then the transition is a bit easier. With larger employers, it sometimes easier to come in as a traveler and then get hired on as staff since HR departments are inundated with applications at times. As for previous experience outside the US, you have to reasonably consider whether that experience is translatable to the US system. I have a friend who moved from another country who had a hard time getting a job in the ICU due to the technological gap between the two systems. But once he completed a graduate program here, he was able to work in an acute care telemetry unit. Truth be told, I think his issue stemmed from his undergraduate degree not being verifiable or accredited in the states - not so much his experience. As far as the schools by quality. I think they are both good schools; SMU will give you more 1:1 attention but you'll also pay more, plus you get a BSN. Also - since cost is faily low or free for CCSF, I've heard that they are very strict on student progress. They're more willing to drop students from the program who don't meet the academic expectations. Best of luck, overall you'll succeed I'm sure !

I'm a past ICU RN at UC San Diego so I can give you some more information and I've precepted and mentored new graduates in the ICU - so feel free to reach out.

Yeah that's a good point I guess I didn't see that Cabot but perhaps you can say that on your interview and enter into a agreement that you'll earn your masters. There's always ways to get around strict requirements like that.

Hey JD2RN: I think you plan sounds great and it's something I'd recommend doing a ADN and then doing a bridge to a BSN or MSN. Also, I think doing a CNL MSN is a smart move. Although a CNL, is not an advanced Practice nurse, it provides a good launching spot for candidates who want to pursue nursing but might want to transition into quality or management roles. Just a word of caution, most hospitals now prefer to hire grads with a BSN or MSN if they're aspirating or a current magnet organization. Magnet makes the distinction that BSN are what they prefer AND a BA or BS does not count towards the hospitals numbers. So it turn, even though you might have a BA acute care hospitals might take a BSN head over a ADN grad with a BA or non-nursing BS. Natalie, congrats on your acceptance and I'm confident you do exceptionally! All all the best for your future success!

At the MEPN program at UCSF, you may petition the admission office to waive the 3.0 GPA requirement by emailing the office once an application is completed. It's not a guarantee of waiver like SMU and others but it is a option. Masters Entry Program (MEPN) Admission Requirements | UCSF School of Nursing In my view, if you address this in your interview or written statement, most admission committees will waive the overall 3.0 requirement and recalculate on the recent coursework. I was in the same boat you were and had a rocky start to undergrad but was able to get into great undergrad and graduate nursing programs. Best of luck for the future!

Hi all: Just a quick question regarding tax filing here in the US. Prior to the end of this year, I last traveled in 2006-2008. I wondered if most travelers file their own taxes using a third-party software/web app (TurboTax, TaxAct) or if you use a CPA. In the past, I've used a CPA that does travel nursing taxes specifically - and although the CPA cost a bit more, I have always been happy with the results. However, now with Turbo Tax that I've been using for the last few years, I'm curious if this is just the easier way to go as I enter all my expenses. Curious, if anyone has any comments specifically regarding the per diem rate rule and if these programs are able to calculate that out. The only thing I'm not sure if I can itemized is gas expenses while on assignment.

So I agree with the the consensus here. 1) MET/RRTs should NEVER be discouraged/reprimanded/disciplined because all that does is make nurses reluctant to call which doesn't help patients and is actually compromkses patient safety. 2) Managers hear both sides of the story and was likely giving into to pressure by the medical service. When emergencies everyone involved looks to cover their butts - even if they know know they were in the wrong. A good manager is able to porifice out the important issues. 3) in your detail of the meeting, I still couldn't see anything drastic that you did incorrectly. Sure you couldn't check a blood sugar but that's not the priority. You need to feel good about yourself that you did the right thing. 4) I'd reach out to your union rep if you work for a unionize hospital and discuss it with them. If not, I actually would write it up as an incident report as "delayed care" if the patient was indeed having long pauses and a change in clinical condition. Reason being, incident reports requires multiple leaders to weigh in and formulate a correction plan. If you write the report, focus less on individuals and more on patients on safety. Try to avoid placing blame. If your unionized, discuss this with your rep first. 5) You're a rock star so don't sell yourself short, you utilized the chain of command and acted appropriately there wasn't even a hint of neglect. 6) Managers can make or break a nursing unit and are healthy working environments are highly dependent on good managers. Sounds like this manager took the route of "corrective counseling " without looking into all the facts. There should be an RCA meeting done that might shed some light - writing that IR might move this along. Ps. You could always say "do we prefer our patient is grey and mottled over their controlled blood sugar?"