Freedom42

I'm about to start my first job as an FNP. I did an accelerated BSN to enter nursing as a second career and worked as an ER nurse for four years while pursuing my master's degree. Some thoughts as I read this thread: How much you'll earn depends on where you are in the country. I had no trouble finding work. My base pay will be 90k, and I'll be eligible for up to 115k based on productivity. No weekends, nights, holiday or call unless I choose to work for overtime pay. That's pretty standard for new grads in the Northeast. And that's about 30k more than I started out at as an RN four years ago. There are experienced NPs in my neck of the woods who are making upwards of 150k. ER and derm pay the most. Is there a bias against online programs? In my experience, yes. My preceptors commented that students from online programs did not have advanced assessment skills. That's not a slam on all online programs; there are some excellent programs out there. But the consensus among the NPs I worked with was that students suffered from learning in isolation. Finally, not calling NPs "midlevels" is not about political correctness. It's about legalities. NPs are not midlevels, no matter what docs like to say. NPs don't take orders from physicians, and they don't "extend" the work of the physician. They are independent and have prescriptive authority. That's not the midlevel.

The largest private psych hospital in Maine is at St. Mary's in Lewiston. It's a unit of the larger hospital, but it's around 88 beds plus a psychiatric ED. They hire ADNs.

I don't have the option of belonging to a union at my hospital. I haven't had a raise since 2009. I have no guarantee of health insurance, retirement benefits or paid time off. I can be fired at any time without cause. The doctors at my hospital, however, all have negotiated personal service contracts that are packed with guarantees. They know exactly how they'll be compensated and under what terms. They meet together quarterly to talk about how they're going to negotiate. None of them is sent home without pay when the census is low. Unionization, demeaning? Hardly. I'd welcome the opportunity. Protection against being fired without cause is but one aspect of unionization. (And before you tell me that unions protect poor workers from ever being fired, please remember that it is management, not the union, that has the authority to fire; it is the union that has the legal obligation to protect the worker from being fired without cause. A worker who remains on the job despite performance issues is a reflection of management that has failed to document and act.) Unions do far more than offer job protection. If you look forward to a good job in nursing that pays well, you can thank unions for that: They've led the charge in improving wages and working conditions for nurses across the country. I appreciate that you want to learn. There are plenty of professionals who have unions, including engineers and doctors. I fail to see how negotiating compensation, benefits and job terms demeans any of them.

This isn't rocket science. I pick up my meds at a supermarket. The pharmacy has a sign posted that asks other customers to respect others' privacy by coming to the counter only when called. There's a small rope line just like at the bank. The pharmacist keeps his voice down. Problem solved. No special architecture required. I agree with GrumpRN63: I'm disappointed at the number of people who think this is no big deal. As for the nurse who says that's "just like giving meds in the ED," I beg to differ. If there's someone else in the room, I warn my patients that I'm about to ask personal questions and ask them if they'd like privacy; when appropriate, I ask people to leave. And I always close the door when I'm talking regardless of who's in the room. The OP dealt with someone who was behaving thoughtlessly. The problem needs to be brought to his employer's attention so that all who work in that pharmacy respect customer privacy and comply with the law.

Room them somewhere north of Siberia, without a phone or a TV. When they ask for a meal tray, tell them that you only serve meals at designated times. Period. The doc will more than likely recognize the patient's name and, presuming it's the usual symptoms or complaints, leave them waiting for a long time -- so long that some will decide to leave. If they come in drunk, they are required to either a) commit to detox or b) remain in ED Siberia until a breathazlyzer registers zero. If there's clearly nothing wrong with them, remind them early and often that they will have to arrange their own transportation home (presuming, as my hospital does, that yours no longer provides cab passes). And if the patient is unhappy with their care (i.e., prescription), make sure you chart any remarks along the lines of, "Well, I'll only come back tomorrow," each and every time he or she says it so that your department head can report them for abusing the system. That's what enabled our local paramedic service to refuse to stop transporting two FFs several times a week. Sometime in the past year, I saw an article -- on Medscape, I think -- about how to deal with "ultra-high frequent fliers." Maybe it offered some helpful information, but I'll never know. I couldn't get past the definition of an ultra-high FF as being 15 or more ED visits a year. Seriously? Our champs rack up 100+.

No, I don't see any incongruity. As I've indicated in my posts, I consider my BSN education valuable, but not all of it is relevant to the education I am now pursuing to become an NP. Much of it is; however, I don't believe that an NP needs bedside experience to manage hypertension and diabetes. Working as an NP beyond one's educational preparation is a completely different issue and, as indicated by LACE, won't be permitted for much longer. I'm not sure on what you base your declaration of "the role of the NP." The NP and PA roles were developed in the 1960s in part to alleviate physician shortages and in part to create jobs for medics and nurses coming back from Vietnam. Yes, NPs and PAs focus on pathophysiology. I hope anyone who prescribes drugs does. Your post then reduces the work of the ED NP to "sutur(ing) minor lacerations" and draining butt boils. That's a pretty broad brush. Again, the OP did not take pot shots at NPs. She wrote that she was frustrated by the attitudes and behaviors of some while noting that others are excellent. The thread was then hijacked to NP bashing.

I presume you're referring to my post. As an RN entering my fourth year at the bedside -- including two in the ED -- yes, I do count my BSN education toward my clinical hours. The PA student has not accrued those hours prior to the start of his or her education and, like the non-nurse NP student, acquires them as part of the master's degree. I don't take issue with differing opinions about what an appropriate education is for an NP; personally, I support the DNP requirement. But I find the resentment toward NPs by some posters -- not, notably, the OP -- to be curious. I wouldn't compare a PA to an MD. Why compare an NP to an RN? The jobs and the skill sets are distinctly different.

As an NP student, I will have completed 1350 clinical hours, including BSN clinicals, by the time I graduate. Classmates who are in the three-year entry-to-practice program will have accumulated the same hours. Although they do not receive the BSN, they must complete the undergraduate program before moving on to the master's portion. I have no interest in "playing minidoc." I'm a nurse. I'm working on an education that will support my limited scope of practice as an APRN.

People who think they know everything -- or who are not secure enough to admit that they don't -- are a problem in any setting or profession, regardless of the initials they have after their name or how many years of experience they have under their belts. These characteristics are hardly limited to freshly minted NPs. That said, an NP is not an NP is not an NP. Just like RNs, they have their specialties and education to support them. The problem is, we've got NPs practicing beyond their educational backgrounds. Should an FNP with no experience as a practitioner be able to go to work in an ICU? No. He or she has been educated for primary care, not acute care. Yet we see hospitals across the country putting NPs to work in settings for which they have not been educated. Nowhere on this thread -- and forgive me if I missed it -- do I see reference to the APRN consensus model for self-regulation or the statement issued in 2010 by LACE. As I understand it, these statements are essentially closing the window on FNPs working in most acute care settings by 2015 unless grandfathered. That will be restricted to NPs specifically educated in acute care. FNPs will still be allowed to work in ED settings when under the direct supervision of an MD. At least, that's how it was explained to me by the head of the NP program in which I am enrolled. (Any clarification or correction is appreciated.) So, as I understand it, part of the problem identified by the OP -- the NP who has neither the education nor the experience to recognize a particular issue, apparently -- is going away. The other major theme here is how much bedside experience an RN should have before starting the process of becoming an NP. I'm going to risk the same "perfect storm of feces" that Ruby Vee took in her original post and say: none. I am in my third year as a hospital RN. I completed an accelerated BSN for second-degree students because, though recruited for a three-year entry-to-practice NP program, I agreed with my adviser, who told me no hospital would hire me as an NP without hospital experience. With two years of hospital experience under my belt, I started going to school part-time for my master's degree. By the time I'm finished, I'll have five years of RN experience. Will that bedside experience be valuable? Absolutely. Is it, however, essential? I don't think so. Without question, experience helps the practitioner to recognize the varying trajectories of illness. But as an NP student, I see that a significant portion of my BSN education, though valuable in itself, is not relevant to learning to diagnose, recognize differentials, and prescribe drugs (and I don't mean to reduce the role of NP solely to those tasks). The RN and the NP play very important roles. But those roles are very different, and they require very different skill sets, something I didn't fully appreciate until I was well into my NP program. As for listening and learning from others, I'm all for it, no matter what your job or title.

Again, the issue was not the quote from a 14-year-old. It was the praising of the quote by an adult. And I'm quite confident that neither the teenager nor the adult considered "retarded" anything but pejorative. However, I'm sure the posters on this forum who have retarded children will take comfort in knowing that English is dynamic.

Thank you. I understand why kids use the word that way; after all, they hear adults use it that way, unfortunately. What bothered me was the poster's "well said" response to the remark.

I don't mean to digress from the topic of this thread. Call me old fashioned, but I still prefer my booze in a glass. This quote, however, is troubling. It's offensive. Can we please stop using the word "retarded" to refer to things that we think are stupid? If you think that the above is "well said," I ask you to substitute "disabled" or "handicapped" for the word "retarded." Then see if you think the use of the word "retarded" in the above sentence is still acceptable. I don't mean to attack the poster, because I know this use of the word is widespread. It drives me crazy when I hear it at work. On behalf of my mentally retarded friends, I suggest that nurses should know better.

It's true, some people are nearly impossible. But I'll say this, as one of my patients recently pointed out: My charge nurse could start an IV on a dead man. She's that good. I have never seen her miss. When I started, she told me to find a man with muscular forearms and study his vasculature so that I could understand where to palpate. She's right. That's better than looking at any text book.

The lower the albumin level, the tougher the stick. My supervisor gave me a good tip: Use two tourniquets, one in the usual place, the other about three inches above that. Works well with hands to really concentrate blood in a small area. You might also have a colleague pull back the skin and hold it taught. When all else fails, I look along the ring finger, along the feet, and between the armpit and breast.

Do I have this right? Obstructive lung disease: FEV1 is low, FEV1/FVC is low. Restrictive lung disease: FEV1 is low (?), FEV1/FVC is high (latter ratio may be normal or high, actually). I can't find an answer to the FEV1 status for restrictive (interstitial) lung disease in my text, and I'm not finding what I'm looking for online, either. Any help appreciated.

I admire your perseverance. It takes a lot to fight your way back from what you've suffered. It's a shame that we don't take better care of our nurses after they've spent so many years giving care to others. What about volunteering? It might not fill your wallet, but it might help your soul. I've volunteered at public schools in my area to give vaccinations. It's fun to work with kids, and I enjoy meeting nurses from different specialties who like to volunteer as well. It's a short-term commitment, just a few hours at a time during the fall months. Schools also look for substitute nurses. Another alternative might be hospice. I would think nurses would find someone with your experience invaluable as a volunteer. Good luck to you. It's out there. Someone who perseveres as you have is bound to find it.

I would check the website for the department of labor of a particular state. They do frequent wage and salary surveys, although they don't necessarily break them down by level of experience. I do think they're a lot more accurate than sites like monster.com and salary.com, however.

It means that the people who sued lost. A defense verdict is returned in favor of the defense, the people being sued.

You need to look beyond your scenario to understand the complications. You're almost there. If the blood cannot meet the body's metabolic demands, what happens? What happens if organs are not adequately perfused? What happens if the heart cannot move fluid forward? Find the answers to those questions, and you'll find your complications.

What does your pathophysiology text tell you?

I read nothing in the OP's post that suggests s/he thinks CNAs are beneath her or that she is unwilling to do what she asks of aides herself. What I read was that she expects professional conduct. I don't think a nurse has to have worked as a CNA -- or in any other capacity -- to expect that people will meet their job responsibilities.

A course in statistics enables the nurse to read and appraise research in order to make informed practice decisions. It is crucial to evidence-based practice. If you think chemistry is "questionable," I'm guessing you haven't pursued courses in pharmacology or pathophysiology.

I recently had a patient literally begin wailing when I walked into her room with a basket of IV gear. She was, of course, covered with piercings and tattoos.

Interesting. Why right AC?

Not sure what you mean. Not in the hand, period.