Corey Narry

I know that this post is old but the institution should be able to tell you the timelines. In our experience (California here as well), the longest wait is on-boarding/credentialing (3 months for new NPs). State NP certification happens rather quick these days if you take the boards soon after graduation.

I used to work in Adult Critical Care Medicine and we had a similar on-call commitment. Large group of APPs working 3 12-hr shifts a week with days and nights rotation (nights is by percentage based on seniority -> high seniority = less nights or no nights at all). Hospital is in CA and APPs are union represented. We had the whole year of call pretty much scheduled but our turn-over was not bad. It's usually just 2 on-call nights a month as a way to cover that night shift when an APP calls in sick (we did not need on-call for sick calls during the day as it's easy to pull a resident who is on jeopardy). Per our union rules, on-call gets paid half of hourly pay multiplied by the number of hours you are on call and waiting at home for the possibility of being called to work (which would be 12 hours). If you get asked to come in to work, that becomes time and half for all hours you worked. I got too old for the nights and days and doing Hospitalist Cardiology on straight days now.

We have those TUGs at work. They deliver supplies, pick up lab specimens...they take the elevators on their own and sometimes cause traffic in the hallways.

I worked both as an RN and NP during paper charts so here's what we did: 1. When new notes, orders are added to a chart, how were you made aware? You flag the chart either with a tab on the chart itself that says "new order", bring the chart to the unit clerk, or if there is a chart holder - the holder has a color coded flipper (like a mailbox) that signifies that a new order is written on the chart. As for new notes, you just expect that a new one is written when a provider finishes rounds. They also communicate their plan better than nowadays. 2. were RN orders ( or RN tasks) placed on the blank Dr order sheet or was there another location for RN orders such as vitals, wound care etc? The order sheet forms have 2 columns - the first column is for "care orders" such as VS, diet, telemetry, etc. The second column are for med orders and are faxed to the pharmacy by either the unit clerk or the RN. If a wound care order involves a medication it is written in the med column. 3. How were active meds kept track of? In the paper MAR? The ones Ives seen only have 3 days worth of dat, so did that have to be transcribed again and again? I remember at least 5 days of med columns. Nurses put a line on discontinued meds. There is a whole list of "legends" used to signify a med is discontinued, not given, held, etc. There are places that even asked for specific color markers to mean something on the MAR so a lot of RN's had pens of different colors. 4 when a Dr placed orders, how were you alerted to review or check the chart? see my answer to #1 5. If an order was for an ancillary dept, who's job was it to let them know? The unit clerk and the RN both can execute those. Usually a fax is what they do. In other cases they actually enter it to an antiquated DOS-based computer system.

The NP route is a good recommendation. Just be aware that in California, MEPN programs (UCLA, UCI, UC Davis) have been restructured to graduate Master's prepared nurses that are eligible for RN licensure only. The route to NP has mostly transitioned to DNP (at least in the UC system). UCSF's MEPN is currently paused. I would actually suggest PA which would be a faster route.

Your ENT specialty is nowhere near similar to what most nurses do at the bedside. You have to get accepted to a nursing program, graduate, pass the NCLEX, and get registered with the BRN, then you can be a Registered Nurse.

I work in one of those hospitals you mentioned. If I remember right, because this was years ago, I was moonlighting with the Cardiac Surgery service and there are dedicated Cardiac Surgery first assist RNs and there are dedicated circulators. They don't seem to cross over for both roles.

It is not uncommon in community hospitals. You have to clarify the statement - "They get the extra night shift pay to stay in house, but go home at night" - physicians are typically salaried. They have a week of ICU duties typically and is on call at night but do not necessarily mean they have to be present physically. There are various ICU staffing models depending on the type of hospital. Some have residency and fellowship programs that have physician-in-training staff night shifts. Some have APPs staff the night shifts (NP or PA). Some use a combination of the two. Some use an eICU model where a remote physician or APP is called at night for issues. In high acuity ICUs there may be a full-fledged intensivist in house 24/7.

I know of a Critical Care Medicine PA that did something similar at our hospital. Most of the in-patient APPs work 3 12-hr shifts a week. Anything over 40 hrs a week becomes overtime (per union rules). He signed a waiver that he will work 6 12-hr shifts in a row over a 2 week period (rest of the days of that 2 weeks he is off work). The waiver allowed him to do this without having to be paid overtime for going over 40 hours per week. It worked for him because he lives out of state and has teaching commitments as a faculty at a PA program.

We actually casually speak about this at work, sure AI can process objective information (VS, labs, test results) but can't do a physical exam. It can probably do a good job reading imaging studies using computational logic (after all, EKG machines have for the longest time spit out prelim reads instantly). It can come up with differential diagnoses and even offer treatment algorithms based on national treatment guidelines. At the end of the day, if AI screws up and causes harm, who is the patient going to sue?

If you sign up with an NP preceptor service. If you're active in healthcare social media (LinkedIn for instance), they aggressively pursue preceptors for desperate NP students. I am not familiar with the fee schedule and what percentage goes to the company and what percentage goes to the preceptor. I do precept AGACNP students as an employee of a university medical center and don't get paid (but avail of perks for clinical ladder advancement and ANCC renewal). In principle, I would never sign up to those companies that seem predatory and take advantage of students enrolled in schools who should be securing clinical placements for their students.

You should pursue it, I'm sure there are other male midwives. In San Francisco, I know of one...SFGH Midwife This is a commentary written by an Australian male midwife: Men in Midwifery

I would recommend listening to podcasts. What is your specialty? there are many Family Practice related podcasts that discuss specific cases, treatments, recent evidence, etc. There are ones for specific specialties too.

Many institutions are using AI Scribes now. It does not replace the provider, rather, the AI program with the patient's consent, transcribes the entire provider-patient interaction and creates a formatted SOAP note that details the patient's chief complaint, the provider's dictated VS and physical exam, and the provider-patient discussion of the plan of care including treatment options discussed. The provider can edit the note afterwards. I can see this being useful to bedside nurses to document a similar note based on their assessment of patients.

San Francisco NP here. Nurses in union-represented hospitals are paid well but that is because the cost of living is high. So to answer your question whether it's a fair pay, I would say it is absolutely fair because you can afford to live here with a nurse's salary. Unfortunately, in San Francisco, it would be hard for a new grad to get a job apart from getting into a competitive new RN grad program. Individual salary negotiation in a hospital represented by a union does not exist, rather, the union facilitates collective bargaining and a contract is made that details RN pay (or NP, CRNA, etc) through a step-wise progression based on years of experience.