mom2cka

Hello! I am interviewing for an NP position at my local VA (primary care) and am just looking to connect with current or former NPs who have worked in this environment to answer a few questions. I realize each location has its own quirks but looking for some general answers. Thanks in advance! - Is there opportunity to pick up shifts (weekends or holidays) in other areas (Urgent care, rehab/subacute, etc)? - With no CME allowances - do they offer APRN-focused learning opportunities or do you pay for these out of pocket? - Do you tend to work with one or a team of LPNs or MAs in the clinic? - How do you coordinate care with patients who receive care from multiple settings? (Currently it can be difficult where I'm at trying to get VA records for patient (local hospital/clinic) - Is it relatively easy to change positions / specialties once you are in, should the initial position not be a good fit? - What is one thing you wish you'd been told when going from a community hospital/clinic to the VA? - Appreciate any advice or tips!! Thanks again!

St. Scholastica has offered this one

Thanks for your feedback :) I probably am hard on myself - but I don't feel incompetent at work, see patients on my own in the clinic and hospital, and have great colleagues to help advise me when I need help. My concern is - NPs are being trained that they can go out and practice "just like a physician" once they are licensed. Open their own practices. Work without help (no supervising or collaborating physician). Our time as an RN helps, but many who are getting their MSNs and DNPs now don't have that. And it is very different being an RN when you compare it to what we do as NPs. We aren't trained to transition into a residency program - we are trained to hit the field running, and I don't feel that we are getting the experience or training in school to do that. Just take a look at how many people struggle to get clinicals - a good clinical can really make a difference. I practice in a specialty field I have nursing experience in, and enjoy - I don't feel out of my depth, I just don't feel equal to a physician and I think that's OK to admit. In fact, I think NPs need to talk more about that. There's a vocal group that talks about how good we are and how we can compete against physicians in so many ways - and in some, we do, but when it comes to the medicine and the science - I think the NP programs are extremely lacking. My 2 cents :)

You can message me but... I'm not on here too much so if I don't get back to you, it's not personal :) I'll do my best though.

I had good luck in rural clinics; worked with a midwife at a birthing center for my OB hours too. Starting to get tough, I hear from current students, even in MN schools. good luck!

I think of the time spent in the cadaver lab (when I hear the MDs talk) vs my time with a cat; the time spent in residencies, the time spent preparing to present a patient to a preceptor or colleague (touched on very little in my own schooling, but a focus of a clinical with an MD, not as big of a focus with my NP clinicals), time spent with labs - not just looking them up, or getting a 30 minute lecture or a book, but really diving into those day in and day out, the knowledge of the systems and ability to know such obscure things without having to look it up on UTD and having it be correct when I do later, etc. I very much know that I don't practice medicine, and perhaps this is just me, but don't feel I'm on an equal playing field with my MD or PA colleagues - simply because my schooling was so different. Now, as I have my 1st year under my belt, I know where my weaknesses are, and am actively working to get up to speed so I understand some of the discussions they have when it comes to the finer points of "medicine." I may not be the only one who feels this way, but I find it unfortunate that too many NPs will complain about schooling, preceptors, etc. but not speak up about the fact that we are NOT physicians, and really shouldn't be thought of as "about the same, just the same, almost like" etc. My RN experience did NOT prepare me for being a practicing NP in so many ways; my education helped. But the majority of what I've learned so far has been OTJ training, as a physician would receive during residency. In 10 years I might feel differently, but not now. On that same note, however, one of the physicians I work closely with values my nursing experience and often shares that with me, because of what I do bring to the team with my own training and education. My 2 cents.

rehabnurse.org has great information about what a rehab nurse does - I highly recommend this site. I work inpatient, not TCU, but we give IV meds, antibiotics, blood, work with trachs and pegs, and often have patients for 2-3 weeks, so focus heavily on patient and family education to prepare them to go home. Good luck!

My state (MN) tells me to use RN, CNP so I do... my ANCC is FNP-BC - it's a mouthful when I use the whole thing on anything professional

I had an ipod touch and it was priceless. I used the apps, was able to access things with wifi, logged clinical hours, did some research when requested by my preceptor if we had downtime (especially since computers at the clinic were at a premium). Fits in a pocket like the iphone (which I upgraded to my last semester)... for practice, though, I'd move up to a mini (on my 'to do' list)

Check out rehabnurse.org and review the article they have about FIM; the CAT exams are also very good. They have role descriptions that can help you figure out maybe who does what. You will spend a lot of time on FIM, documentation, and patient education, so if you can focus on the client populations (for me, it's stroke, neuro, spinal cord, TBI, etc.), it might increase your comfort level. Coming from LTC will be beneficial for some of that (knowledge of bowel programs, family relationships, etc). Good luck!

I agree - the exam was fairly easy, with a lot of common-sense style questions. I reviewed the sample questions online and felt comfortable with those and the exam was similar. Good luck!

I bought tea for one (and a cup) and coffee for another (and a cup) as they both tended to drink quite a bit of it

I graduate in May (just finished my last clinical today!) and started in February - I had several interviews and inquiries from both rural and metro facilities. Good luck!

I learned in a different way from each of my preceptors; I was with a pediatrician for my peds rotation, and an internal medicine physician for another rotation, and am with 2 NPs now. Sometimes, it's what's available and what you can find, and other times, it's purposeful. I wouldn't discount any opportunity you might have to learn.

I started in a CNS program, switched to ANP, and am finishing with my FNP. I made those changes as I heard more / learned more about limitations that others have had with their initial degrees - I don't hope to go back to school, so felt I should be as flexible as possible with one degree. Good luck!