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chiromed0

ICU, Telemetry, Cardiac/Renal, Ortho,FNP
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chiromed0 has 14 years experience and specializes in ICU, Telemetry, Cardiac/Renal, Ortho,FNP.

Parker University 1999-2002 Excelior College 2006-2010 Samford University 2012-2015 Chiropractor FNP RN

chiromed0's Latest Activity

  1. chiromed0

    NP vs MA vs MD power struggle

    Well, I can't speak to your case specifically but my view is if the paycheck clears then I do whatever it takes to clock out at 5:00. If that means doing my job, the physicians job, and the MA then so be it...other days just the patient care. Personally, I don't care...I look at it like they rent my time and credentials for $$$/yr or hr and ego aside, I'm going to do whatever it takes to get the job done and go home. However, your case....office mgr (if they have authority) meeting and get things clarified according to your contract...in writing or it ain't real.
  2. chiromed0

    Ortho NP interview in NY state

    Well, good luck. I'd say study some ortho NP material. Learn from some ortho clinic websites the most common conditions/procedures. That is an excellent opportunity for you so I hope you get it. Interviews usually just cover the big picture stuff anyway--they want to know if you can spot post surgical problems, pain management, and rehab. Usually they will take care of the pre-surgical workup but you need to know what to look for and what they would suggest doing. It is all doable and after you get some time in it, probably common sense. It might help to look at interventional pain management websites to get familiar with some of those procedures (common to ortho too) and the lingo...pulling off the interview is doable. If you have the time this site is very useful: Orthobullets.com
  3. Not always better in the city either. More expense and movement so staffing/budget/overhead decisions made at the drop of a hat. I was hired for one location, they shut it down w/i 5 months and now have been at another for 3 years, however, other locations that were stable have been closed almost immediately after a new physician was recruited and move there! It's a gamble anywhere you go. I'd say ALWAYS have some fresh coals in the fire b/c you have to expect the unexpected...meaning better to keep interviewing while you have a job vs when you need a job. Good luck.
  4. chiromed0

    Unhappy as new NP

    I'm not ACNP but I would think the main barrier is your patient age population restrictions. So if you pick an adult field like Pain management (no kiddos) then I don't see why you would be restricted from this field. It's not exactly a "happy" place but it's stable and more routine.
  5. chiromed0

    I am new to nursing but I don't want to do this anymore

    Generally speaking...you're freaking out too early. EVERYBODY feels overwhelmed the first year even if they say they don't. Heck, I felt overwhelmed year three! I got anxiety the day before my shifts started. In a way that's good-you don't get complacent but it does age you a little. Nursing is everywhere and pay depends on your level of competence or risk so you have options. Bedside care ain't for everybody but if you are doing a good job then I'd say stick it out for at least that first year, you are already done with half or more, then move on. The job is supposed to be intense-people live or die by what goes on there so it's not for the faint of heart. If you decide to stick it out then know that you will change and adapt if you just let it happen, I experienced it and saw it happen time and time again. It's the nature of the job. Good luck.
  6. chiromed0

    Should I work in ICU before becoming an NP

    For FNP I'd say no. For AGACNP or CRNA then I'd say yes as you will pick up things there that help. Lots of hospitals now are making a rule for AGACNP for inpatient provider and FNP for outpatient. There's lots of examples of cross over but I've noticed it recently on job boards so decide which kind of NP you want to be then make the call. If you want that experience anyway I'd say go for it--it's a little more interesting to be sure. I did some before FNP and I don't see much direct application but it helps to know some of the practices, protocols, and meds used.
  7. chiromed0

    Is there any hope for me at this point?

    First. Do not give up. Period. Second. There are those who have taken and failed more often than you and have moved way beyond this hurdle. The NCLEX is just an exam...and it tests certain areas of your recall, base knowledge, and ability to apply both to a given situation. It is not a predictor of how good a nurse you can be in the real world--that takes in a whole lot of other factors believe me. Third. The key to passing is a full understanding of how this exam works...it's a "trend"... if there is a strategy it's answer the easy questions right and then the progression is linear until you've satisfied the benchmark of what is expected for you to know at a degree of difficulty set by the test makers. If you get one wrong it will back up to your baseline (lower difficulty) until you get it right (unless you consistently are tanking on progressively easier ones) then if you don't trend up, it's game over b/c your baseline difficulty of questions is too low. I can also tell you it's hogwash that they don't repeat questions...I've seen it with my own eyes. No test is perfect including the NCLEX. Resources? There are tons and tons. I believe there is no better way than to sit in a room and literally answer thousands of questions on a computer and "learn" how to dissect questions for clues to the "more" right answer. Some questions you will literally have to possess the direct knowledge, many and most questions it will be the "better" answer given the situational factors the question provides--ie "do you have the judgement of an RN?". So my suggestion is DO NOT READ into the question past what it is asking-get used to answering quickly judgement type questions b/c the level of content in those isn't that deep so your nursing judgement should be sound enough to answer quickly. Know your nursing protocols (this is a broad and general statement I know) for a given patient situation--the details don't matter if you are violating a basic tenant of nursing. Those questions fly right past your eyes b/c the details crowd out what they are basically asking. Also, because it happened to me, get used to being able to focus on the test in a noisy environment (I know it's supposed to be quiet) because someone coughing/talking outside the room/rattling air conditioning can throw you off too. I hope this helps b/c I felt like a complete idiot having failed and so have many others. It's not that the test is hard, it's that you have to learn how to take the test. There is too much information to give a general knowledge test to a prospective RN so they have to test your ability to apply what you know--meaning don't study every s/sx of every disease you've studied for the last few years...that's not what they are looking for. Good Luck.
  8. chiromed0

    Pain patients being denied their medication!

    Hmm...You are right that the CDC recommendations are speaking mainly to acute pain. Chronic pain is a different management issue and individualized. However, that being said, let's get real...in this climate asking your PCP to manage narcotics is not a good idea either for you or them. Go to the Pain Management practice and eat the bill. It's expensive but also one needs to remember opioids are NOT the only way to manage pain "symptoms" and will make your pain worse in the long run. So in reality managing with opioids is an elective choice and you will pay more for that. In PM we struggle to find if the patient is treating the pain anymore or the early symptoms of withdrawal (meaning the "coming off the high" vs BP changes/sweats/etc) and if so how do we determine an appropriate dose for the original pain? It doesn't mean you did ANYTHING wrong but there is a price to pay treating pain with narcotics-it fixes nothing. So yes, your PCP is oversimplifying the truth (although he's right-narcotics are NOT the first line for anything including chronic pain) so he can get you dosed down or off the narcs but he's doing it for your own good in the long run. Even if you've tried interventions in the past you will be asked to try them again and some new ones. The prescribing guidelines, CDC recommendations, insurance coverage, State Board regulations, Mfg. inventory, etc. is ALL changing so it will leave many people to be forced down in the next few years--better to find your options now vs later. Good luck to you-
  9. chiromed0

    Orthopaedic Certification

    Yes, got my ONC. Waiting to retake the ONP-C. Practically the same exam! There is a textbook-I got it used (NAON : Core Curriculum for Orthopaedic Nursing, 7th Edition). There is a study guide that's basically copies of Powerpoints and very basic. There is also a CD with questions--it is filled with errors, misspelling, and poor quality but useful enough. I would suggest knowing signs/symptoms/treatment protocols for the obvious musculoskeletal conditions plus genetic/cancers. I haven't used any PA study guides but this link (http://www.nbcopa.org/uploads/3/4/9/4/34943214/nbcopasourcelist.pdf) is a list of resources the PA Board lists. It might be overkill b/c they do surgery too.
  10. chiromed0

    How much narcotics have YOU prescribed?

    I work in PM and there would never be a legitimate reason for those kinds of doses. That is NOT "management" of chronic pain, that's being a narcotic distributor.
  11. chiromed0

    Looking for schools in texas to become a Nurse Specialist

    Get your NP if you want to be in this field as a provider, RN to MSN-FNP. The way the field is going you will need to be able to prescribe, perform procedures, and pre-qualify patients for advanced procedures. The field is predominantly NP or PA's. He may just be confused on the titles.
  12. chiromed0

    Do you use the title "Dr."?

    Well, my .02...I am NOT a CRNA or DNP but I'm a D.C., FNP. I work with a number of anesthesiologists, a psychologist, and other physicians. In general, do not EVER expect to be called "Dr." as long as you are in a state that requires physician supervision to practice. The way "they" see it is in their presence "they" are the only Doctors, not anyone else if they have to supervise YOU. It's stupid, egocentric, and demeaning to other practitioners but that's just the way it is. It can eat away at your self esteem if you let it so be careful how much you "cherish" that title. As for me, I am attentive to this fact since that's where my bread is buttered but I NEVER correct a patient that calls me doctor (as sometimes happens even when one is an RN!) as it IS correct but I am quick to point out that I am not their physician. If it ever gets into a ego wrestling match - that's my out. Otherwise, I personally do resent the fact that I have to go out of my way to have staff address me differently so patients won't get confused who 'officially' sets their plan of care. However, nobody forced me to take this job and if they told me tomorrow morning I'll pay you $XXX,XXX to go and eat crow all day with an egotistical physician I would still get up and say when do I start? We are Robin even when we wear a cape and mask, too. We will never be Batman in this comic world.
  13. chiromed0

    Oversupply of Nurse Practitioners

    Yep, Texas is the same way. Sad but as a former chiropractor the same thing happened. Schools pumped out grads and need vs supply was drastically changed. There has been a sizeable change in the DFW market (which a few years ago was one of the top in the country) and now I've seen salary offers (hope nobody accepts) dwindle back down into RN territory. Unbelievable how misguided leadership is in these professions. They have DNP's without any real experience now either in nursing or advanced practice...how in the world?
  14. chiromed0

    Being both a nurse and chiropractor

    Old thread but just to clarify chiropractors cannot become RN's or other by a 100% online program. None exist. How do I know? I'm the last one allowed to enter such a distance learning program that was 100% distance learning by virtue of being a DC first. The program no longer exists. And to address the earlier post about "Anyone with a modicum of sense will not take you seriously as an NP. The scary part is that you will take advantage of the ignorance of many of the public, just as you always have, but now you will have NP after your name with the authority to prescribe medications and take people off of medications with absolutely no understanding of differential diagnosis." To that I will just say that now, as an NP, I am taken as seriously as any other NP. Clearly in that diatribe there are some personal biases expressed albeit probably not unfounded. However, not every DC that changed career paths needs to be ashamed of being a DC. That would just be stupid. I do take issue with any RN going into advanced practice nursing without the requisite experience but not in general with DC's concurrently practicing as an NP also if they garnered experience as an RN. Although that gray area probably needs to be addressed more specifically by the state boards. A DC's education is solid and does stray into the controversial w/regard to the subluxation theory etc., however, all professions clearly support the benefit of joint manipulation in general. Yes, there are some quacks in chiro but behold...they exist in medicine too! I welcome any DC who wants to use their education, experience, and talents to convert to NP/PA practice so long as you respect being an RN first and get some first floor experience b/c if you don't ... you really can't say you are an advanced practice RN honestly, legally yes...honestly...uh no.
  15. I am not PMHNP but to just comment on general as a newby (kind of). My first NP job, I was there 1 hour, handed a laptop (no training on EMR), and told "go see patients, you know what you're doing". Okay, so I did know but in the beginning nobody knows if they "really" know what they are doing. Odds are you are fine, know enough, and you are just wanting reassurance. Unfortunately, I don't think there is much of that in "provider land" in most jobs. So, yes, it probably is typical, not unique to PMHNP, and as my wife said, "When you make six figures or more they expect you to walk in and do the job otherwise they would have hired someone else". She's got a point. It's not the best way to "on board" someone but feel some confidence that you DO know enough to do the job, maybe not as well as a seasoned provider but you do belong, you are capable, and you will survive. Just know you are not alone in this adventure, still reach out to find a confidant (even someone not a provider but can guide you to right people/process...you'd be surprised who can help you), and take it day by day for your first year. Good luck.
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