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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

    Dallas, Texas Family Nurse Practitioner Salary

    Don't know if you moved yet but the market is crowded. Yes, lots of jobs listed, some real and some recruiter bait. Many hospital systems. Since you have experience it will make it much easier for you than all the new grads which are killing the market. Lots of schools here. Pay is NOT exceptional even as recently as 2016 I have seen a 10-20% drop in what is offered. You can still get what you want, it will take more effort. The jobs are listed everywhere and if I were coming from out of town I'd say hit up the recruiters first to get shopped around. They don't eat unless you get hired.
  6. chiromed0

    Got Written Up, Cant Stop Thinking About It

    Don't sweat it. Seriously. I was in a similar circumstance where my mgr. asked me for constructive feedback since I came from a different hospital chain. I gave some regarding collecting lab samples on the unit, it was a flawed system and prone to error of mislabeling. Well, I got stung and mislabeled a sample from the very problem I pointed out and he was more than happy to write me up instead of fixing the problem. There will ALWAYS be people like that. You are not here (in nursing) to appease the knuckleheads, you are here for your patients. Let them do what they want and you keep doing the right thing. The beaurocratic nonsense will, unfortunately, always be present.
  7. 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-
  8. 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?
  9. Well, doubting yourself is normal. It's a tough job. Confidence comes with experience and knowledge. NOBODY knows time management right off the bat. Heck, I was at year 3 and switched hospitals and was ALWAYS behind at shift change b/c of the stupid policies at the new hospital vs at my old one I was rockin it. So every situation is different. Give yourself a break. Make sure everybody is alive at shift change and get better every shift at SOMETHING and you will be fine.
  10. chiromed0

    Stopped at 75 question. I'm almost sure I failed

    75 questions tells you nothing. It's the trending that determines whether it passes you or not. I think I answered every NCLEX question ever written and have some dispute over the "the same question is never repeated" diatribe. At any rate there used to be a way of unofficially checking your pass/fail by simply signing up for the test again and it would let you pay if you failed but not if you passed. There's info on that out there if it still applies...you didn't have to wait for a letter in the mail.
  11. chiromed0

    Hostpitals no longer hiring for ADN?

    Boy..that's pricey...$80K for $60k job. Anyway, rural hospitals are hiring ADN's, for now, because most of the programs at junior/community colleges are associates degree programs. How are they going to support the local RN programs if they don't hire their graduates? It all works hand in hand. Also, let's face it the first two years teaches you more "what" to do as a nurse, then more about "when" and then in graduate school more about "why". But the what is what keeps things rolling along...the rest is academic or cerebral. Hospitals run on what, get certified/paid on appropriate when (compliance) and get notoriety on having more why people around (research, etc.). I just don't see it at this point but I do caution the idea that they will always hire ADN's is also false hope...the trend is NOT in that direction and some will hire ADN's ONLY if they are promise to start/finish a BSN in 2 years. So bite the bullet and get the BSN in the near future and avoid the headaches.
  12. chiromed0

    NP Orientation period

    Haaa ha...I've been waiting to tell my story. My first day on the job, heck my first hour...I was handed a laptop, spent an hour with the clinic mgr logging in, getting set up, then the doc/owner tells me, "okay, you logged in? Alright go see some patients, you know what you're doing". Sounds like a vote of confidence, nope! Just an overbooked schedule! Second day...shadowing him in another clinic (that I did not apply for and haven't been able to stop filling in a couple of days a week at -- it's been over 6 months now) we get to lunch time and he said, "go get you something to eat and come back". Okay, my reply, "what time should I be back (ya know 1/2 hr or an hour)?" He replied, "NO, I said go GET something to eat and come back, you're a provider now--you don't get a lunch if there are patients." WTH? So that can be your experience. I hope not but be prepared. Most people say 3-6 weeks and ramping up from a few pt's/hr to a full schedule.
  13. Hmmm...if you are "normal" (yes, that has now become a qualifier in my book) I know my clinic chain in Texas/Fl would probably pay your asking price but 2-3 pts/hr not likely maybe 5 (pain mgmt) and 5 days/wk plus 1 wk call/yr. I know a place in Oklahoma that you could manage a 4 day/wk in a small town at a community clinic, low pressure and great people for $95-100K IF you're easy to work with. You'd get bored with the town but it's right in the middle between OKC and DFW. You'd better like summer heat. On the deep end keep heading north of Seattle to Alaska where I've seen job offers there above $130k/yr.
  14. chiromed0

    Any NPs miss being an RN?

    I miss the gratification of seriously helping a grateful patient. YOU are their connection to feeling like they are still human as an RN. In the clinical setting that feedback is muted. And it is nice working 3 days/week. However, after one gigantic BM cleanup as an RN I am sure I would miss being an NP. So overall, like most, I miss some things but would not trade advanced practice nursing.
  15. chiromed0

    Those who have done distance learning

    I would add that distance learning is largely for self disciplined students...ie...YOU are your teacher. Your on campus instructors just guide you for the most part. So if you are not disciplined, don't do it. Also, as to how prepared you are to enter practice I would say it depends on the practice specialty, your preceptor experience, and how comfortable you are now as an RN. I had no problem with patients-my problem is other doctors or mid-levels egos. Patients are helpful and understanding whereas new co-workers or employers are sometimes measuring you up as soon as you step in the door which is unfortunate. If you can handle the patients in a hospital setting and stand on your own with the docs, you can do it as an NP, too. For what it's worth the doc's don't impress me all that much. I'm of the mindset that any good mid-level on the job for 5-10 years matches what most docs can do in the office. Exceptions are in the OR.
  16. chiromed0

    How do I get over my shyness?

    Coming from a doctor and APRN your instructor is an idiot. Who the heck does that? Points out other people's faults in class...what a moron. Look, you are who you are and everyone is a buffoon and a genius depending on the situation. Nobody is the "right" profile. I was told I was "shy" and "reserved" and "laid back" or "too quiet" all my life. What a crock. I was none of those things. I simply don't like talking to people I don't want to talk to--i.e. small talk UNLESS it's in a professional scenario. And I think I have done perfectly fine just being ME. You can point out to your instructor the main reason you don't converse much with them is because they are BORING. Yes, try to be more social as a professional skill, NO-do not change your personality b/c someone teaching a nursing class said so. Unreal. If you REALLY WANT PRACTICE go to Toastmasters and if that don't cure you, nothing will but again I don't think there is anything wrong with you in the first place. Not everybody needs to be wearing a lampshade over their head in a crowd---just the attention seekers and THEY have a problem. So professionally, just feel comfortable with feeling uncomfortable...for a CNA, GN, etc. I'd say go one larger is my rule. Go find a doctor or mid-level and ask to observe, etc., and get experience BEYOND what your peers are getting. By the time you graduate you will be comfortable working around professionals while they are stumbling around, feeling awestruck, and totally unproductive. As a side note though if you ARE getting in the habit of being unprepared then that's got to stop...get ready...be early...be confident.
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