ACNP-Ray

As Lisa stated the Master's is not a Certificate, it is an actual degree much like the DNP is a doctorate of Nursing Practice degree. Their are Post-master certificates you can earn to add onto your masters. But to your original question, there it no mandate to having the DNP as of yet, nor will there ever be in my humble opinion. Many moons ago, there was talk of getting rid of the ADN programs and going strictly with a BSN....still hasn't/nor will it ever happen. If your not willing to put in the work for a doctorate, then don't do one. Get your masters and be happy. And after you have your masters you can go get those certificates in another area of practice

If you and the OP are doing this only for the money, then Admin is the way to go and not bedside nursing or NP route. According to all the nursing salary surveys I'm in the top 5-10% for NP's, but I don't make anywhere near what CNO's make. One of my recommenders for NP school was our Vice CNO and he told me flat out what he made and told me I was going into the wrong field. But I enjoy patient care and actually making the decisions that will affect my patients lives...That is why I went the NP route...not to get rich, or "be on top" Lord knows I have an attending I answer to and to the big boss of our group and I'm also answerable to my patients....I do work for them after all.

One of my professors at Tech was dual board certified in both Family and Acute Care. I asked him about it and he said he loved working in the ER so he went back for his post Masters certificate as a FNP so he would be covered to treat kids as well as the adults and that opened up the ER for him since a lot of places require you to be able to treat kids as well. It's a good move to cover yourself legally and it opens up a lot more jobs to a person to be dual certified.

I spent most of my time at Brook Army Medical Center in San Antonio between the ER, Trauma ICU, and medical ICU. I did a full semester with a urology group as well. For my assessment course I did time with my kids pediatrician, a womans health NP doing more paps than I ever thought I would do and I spent time with a Geriatric NP in some nursing homes doing H & P's. That course alone I had over 100hrs of assessment. I graduated with over 600 total hours, which to me is still inadequate but the knowledge and experience I've gained since graduating in 2013 has brought me up to a level I feel fairly comfortable now. As far as Acute Care NP's market a lot of the places I tried getting on with wanted experienced people to fill the roles and I got lucky that I finally got with a company that had a rural hospital that needed a hospitalist for nights. Once I had that one year experience behind me, things definitely opened up as far as both the intensivist role and more hospitalist jobs opening up

The hospital I was working at last year hired an FNP as my opposite on the night shift. I did 7 on and then she took the next 7 nights. I can tell you only what the ICU nurses said to me while I was there. She wasn't an ICU nurse before she started her FNP program and she was ill prepared to take care of the patients we admitted into the ICU. Codes with her tended to be disasters and the ER doc would usually have to take over in those situations because she didn't have the needed experience to deal with it even though it was a small country(out in the boonies) ICU. Now on the med/surg floor she did alright but she had no business being anywhere near that ICU....So find out who your charge nurses are and LISTEN to them. If they want levophed, don't second guess them and give them an order for dopamine. At the same time read all the material you can find on ICU patient management if you still decide to take this position.

I graduated from Texas Tech's Adult/Geri Acute Care NP program after having been an ICU/CCU/ER nurse for 10 1/2 yrs. I was trained in school to do central and art lines as well as lumbar punctures. Spent an entire day at my clinical site going from OR room to the next just doing intubations. On the job as far as getting privileges I had to be again precepted with another provider doing 15 intubations, 10 central lines, 15 art lines here in Dallas. The NP's usually run the night shift in the ICU but we can call a resident or our attending if we need to. As to the type of NP she wants to be I can tell you it was difficult at first after graduation to get a hospitalist or ICU position due to not having the NP experience. So even though I'm acute care, I had to take some clinic/Internal Med jobs just to get a paycheck and get some experience behind me as an NP. FNP's on the other hand tend to have it a bit easier to find a job because a lot of docs don't mind training them right out of school in primary care. I have considered going back for my FNP to make myself more marketable and be dual certified. Also it depends on the kind of money she wants to make. I know I'm going to step on some toes here but at least here in TX I've seen FNP's being paid far less than what I make in the hospital. I made well over 160k last year working both as a hospitalist and part time as an intensivist whereas I don't know a lot of FNP's making over 115K This is also dependent on where in the country you two will end up being either for your residency or where you finally decide to live. Just my 2 cents, hope it helps.

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For the anxiety you might consider a short term script for Adderall so you can get through the test. I too had the xrays and ekg's on my test. Another crazy question I had was on Rocky Mountain spotted fever...no clue where that one came from. Have you checked for any resources on Half.com or Amazon? You might also look at some of the other books out there, even though we aren't FNP's I would check "Family Nurse Practitioner Certification Intensive Review: Fast Facts and Practice Questions by Maria T. Codina Leik (2013) for more questions and review on "Roles" you might be surprised

What type NP are you? AG-ACNP Where (state)(rural/urban) do you practice? TX Urban Are you independent or in a group? Independent practitioner in the office How many years experience? 3 as an NP; 10 yrs as an RN before I became an NP What is your before tax paycheck amount? 4616, take home is 3300 Monthly or bi-weekly? Bi-weekly Salary/hourly/other(explain)? salary Avg hours on check? n/a What are the perks of your contract? $1500 for CEU's and 10 days for Conference attendance, 2 weeks paid vacation, Medical/dental insurance paid for by the practice for me alone, I have to pay for my 2 children. Malpractice is paid for by the practice. I also teach part time in an RN-BSN program (one class a month) on the weekends but I did not add that into the above information

My condolences for not passing, it was a difficult test. I used Barkley's book and CD's exclusively to study for it back in '13 and that was really all I did for about a month or perhaps a bit longer. Did you have any overwhelming anxiety before/during the test? I cannot recall more than 5 questions over the subject matter that you scored lowest on. Perhaps going back and reviewing your notes from your roles class would help. Good luck on the retest!!!!

I see no reason why as an ACNP I cannot manage somebodies DM, HTN, cholesterol, etc. If I can manage a pt in the hospital while in the hospital, then I can do it from my office as well and I frequently do. Sure I may not have a pt on an insulin drip but based on my education and training I'm able to prescribe the correct medications for my patients. The only reason I would go back for my FNP was if I wanted to take care of children. But having said that, here in Texas it was difficult finding a hospital job after I graduated unless I wanted to be paid less than what I was making as an RN with a few hours of overtime each paycheck. But FNP jobs are plentiful, I get tons of emails daily from headhunters looking for FNP's all over country and here in the Dallas/Ft Worth area...not so many looking for ACNP's

Doc, It really does depend on if your dealing with a Family NP or an Acute Care NP. As an Acute Care NP I did 3 of my semesters at Brook Army Medical Center in San Antonio with one of their ER docs along with splitting my time in the Trauma and Surgical ICU's. As you can imagine I saw a huge variety of cases that included intubations, line placement and management of problems, lumbar punctures, reading of xrays, vent management, interpreting labs(I spent 10 yrs in various ICU's and ER's as an RN before going back to school). Unfortunately, a lot of it was left up to the student to find their own experiences. I spent an entire day outside the OR's just to get intubation experience. None of my fellow students thought to do this. I had learned quite a bit before going back to school and felt pretty knowledgeable about procedures prior too going back as I would always try to find docs who like to teach and would help them place lines, chest tubes, etc. So I would say it depends on the NP or student and how much they want to get out of their program. The only down side to being an Adult-Geri Acute Care NP is I cannot legally see children. While working fast track the PA saw the kids and I saw most of the adults. Now that's not to say I didn't with my supervising physician while in the ER and I sutured a couple of kids up and helped cast another. In my Advanced Assessment course I had to have so many hours of children/women/geriatrics. As far as my didactic courses I did have an entire semester on procedures/labs/xray/chest tube placement, etc. Hope this gives you another perspective.

First I'd like to ask how long you've been an RN? I went through TT AG-ACNP program and all the NP students take the same courses until you get to your FNP 1,2,3 classes. We had a couple of students do exactly what your doing but they had not been RN's very long. One gal who was in my track only had about 6 months as an RN before she started the RN-BSN and then went right into the ACNP program the following semester. Long story short she still has not passed her boards to this day and we graduated Aug of '13. I don't know how she got into the program without any ICU/ER experience but it is what it is. I loved the program and for me writing papers was a breeze. The two hardest courses were Advanced pharm and Advanced patho. I actually put in more study time for those two courses than all the others combined. I had references from my CNO, a PhD, and a co-worker who had her MBA and they accepted me. Great group of instructors there but as I posted on another forum here, its all about what YOU put into it. If you can embrace the active adult learning style and don't want to be spoon fed then you will do fine there. If you need somebody to hold your hand while you're putting sutures into somebody then perhaps it's not the program you should look at. Good luck, but if you don't have a couple yrs experience I would hold off applying until you do....it will pay off

To address that first issue; you are correct it's not the preceptors job to teach me, although, a lot of the MD/DO's preceptors I had did just that. But this is where active adult learning comes into play. I went and bought and read 3 different books on procedures. My instructors didn't tell me I had too, I wanted too. You can watch procedures on Youtube if you don't work in a hospital that does a lot. I have worked in various ICU's for so long I knew there wasn't many procedures the docs did that I couldn't do, including floating a swan ganz cath(which I have). Now I've never done a Craniectomy or put in an ICP line(don't want too either) I actively went looking for docs at work to help when they were doing procedures so I could learn how to do it, and how to manage the pt if something went wrong. I don't need an instructor for that. Your next statement about getting what you paid for was a common complaint at my program but I felt if they(my co-students) were more proactive they would've done more and learned more. Not one of my peers in class ever went and spent the day outside of the surgical suite asking the CRNA's or Anesthesiologists if they could intubate patients. I did and had about 45 intubations in a single day. Not once in my program did they ever mention Mallampati scores but you better know them if your going to intubate a patient. You get out what you put in. I'm just the type of person who looks for a challenge in everything I do and I actively pursue it. Everybody makes mistakes but having a preceptor there to back you up if your mechanics on the procedure are shaky or knowing how to manage that mistake when you make it is invaluable. One of the older docs I loved working with who taught me a lot had a saying he would bandy about "See one, do one, and teach one" that was his philosophy with the residents and I took it to heart.

I understand everybody learns differently but the way I viewed it was school was for the core knowledge but the practical knowledge came from my clinicals and what I was learning in the Trauma ICU with my preceptors. You don't need to go to a sim lab when you can actually do those same procedures on real live people if you have a good preceptor and a busy hospital. I did clinicals at Brook Army Medical Center in San Antonio and worked in their ER, Trauma ICU, and medical/surgical ICU and got to do everything from starting Art lines/CVC's to intubations to bronch'ing patients. Only thing I did not do to a live patient was a chest tube placement(cooks cath(pigtail) doesn't count). But as I said everybody learns differently and some need more hand holding than others. That's alright too, I'd rather people be safe and have confidence in their skills. But I also want somebody who has the actual hands on experience because intubating a dummy is a lot different than intubating a live person or putting in a TLC into the subclavian and dropping their lung and having the actual experience in how to take care of that patient....Just my two cents

I spent 10 1/2 yrs in various ICU's and ER's before going to Texas Tech for their AGACNP program. A large amount of the program is online but you had to go back to campus each semester(once) for a couple days to go through clinical testing and for your procedures class I think we were there for 4 days during the summer. As a Texas Vet I didn't have to pay for school, so not sure as to the cost. Now, for me it was very hard to find a decent paying hospital job because most wanted someone with experience. So I have done home visits, low-T clinics and am currently running a men's clinic in my hometown for a dermatologist who's practice is in another part of the building. And I am making about 40K more than what I would have working in the hospitals. Having said that, I am planning on going back for 3 semesters to get my FNP and be dual board certified so I can pretty much work anywhere and see anybody across the lifespan. There are a ton more jobs available for primary care, at least here in Texas. But a lot of the emails I receive on a daily basis from recruiters are looking for FNP's around the country. Just because I am an ACNP doesn't mean I can't manage DM, HTN, or cast a fracture. The only limit I have is I don't/can't legally treat kids. Hope this helps Yes you can work while in school, depends on what kind of student you are, how easily you retain information and can apply it and how much time you need to study. The two hardest course I spent the most time studying for was Advanced Pharm and Advanced Patho but I worked and graduated with a 4.0 gpa Also if you're serious about ACNP then get at least a year if not more time in a busy ICU. It really helps. I graduated in 2013 with another girl who's experience included hospice nursing for less than a year and she's still not passed her boards. Experience counts.

That "Vital signs WNL" will get you in a lot of trouble should you ever have to go to court. DONT ever chart that. It can be argued that what is normal for a 2 yr old is not normal for a 22 yr old...etc. It doesn't hurt to actually put the vital signs down. Yes it may be double charting but it shows you have actually looked at said vitals and did see they were in fact (ab) normal for that patient. As far as charting goes get to a point where you can see that patient laying in bed in your mind and hit each point from head to toe on what is happening with the patient, same way you give report to the oncoming shift. If you can visualize your patients you know who has an NG tube and who is on the vent and what those vent settings are and where their IV's are and what gauge they are and when they need changed, etc. It comes with time but I can tell you when your giving report(which in my opinion should read like your notes) going from head to toe is the easiest fastest way of doing it. Then leave the equipment attached to the pt for last or address it depending on where it's attached.

I would first contact who ever is servicing your loan and ask them directly. Now off the top of my head I would say "Yes" they will pay it but it's always nice to hear it from the "horse's mouth" to be on the safe side.

Very interesting article on Gleevec and yes your correct about the kinase inhibitors, not all of them will work in all instances. Some like Gleevec are very specific, fascinating how they went about developing it. I also agree that drugs are too expensive, but where I disagree with you and a lot of others is I don't see healthcare as a right, it's a commodity to be bought and sold. I recently went to the ER for a kidney stone and for my 2.5 hrs in the ER the bill was 8900 for a bag of saline, a shot of Toradol and an ER nurse who took my vitals, started an IV and a doc who I told my symptoms too that wrote the orders for the saline and toradol and my discharge orders. 8900 bucks. Now my insurance paid all but 1869.00 which was my cost. Wrote them a check today...why? Because I was sick and I received a service. I could gripe and complain but to what end? Will the hospital forgive my bill? Not hardly. They did their job and I was happy to pay the bill because pain is a strong motivator. Now I could move to one of those other countries you mentioned and have all the universal healthcare I could ever want but I am still going to pay for it through a much higher tax rate than what I am taxed here. Being prior military I've been to all the aforementioned countries and I will take the USA every day and twice on Sunday with all her faults and jacked up politicians. And I have to ask, why are Canadians coming here for operations. As you mentioned they do have Universal Healthcare, why are people flying in from all over the world to come to the Cleveland Clinic or the Mayo Clinic to be treated when they have Universal Healthcare in their countries. I know our health system is far from perfect as I can see it from both a patient's perspective and a provider's perspective. So if people want universal healthcare I think they have two options; 1. move to one of those other countries and pay their high income taxes, or 2. do something to make a change. The government has already pushed Obama Care down our throats so it wouldn't surprise me if that was next.

Was actually responding to Alisonisayoshi, LVN response to my initial "rant" and I hear what your saying about him/her taking a lower salary but honestly who wants to make less money. I know I would balk if my employer came to me and said "Ray, I want to offer botox to everybody at 50 bucks a pop but in order to do that I can no longer pay you 120k but I will pay you 90k per year. Well if you know me or anything about me then you know I'd tell him where to put his botox and go find another position paying me my original 120k or more. Yes newer drugs are more expensive I understand that but due to the marketing and R&D that goes into that drug they are free to set their price. Now getting back to Gleevec; there are a ton of Kinase inhibitors on the market. If your doc thinks you need one ie Gleevec and you cant afford it, find another thats less expensive or have them find one. When I run into docs that are pushing "New" drugs I often raise an eyebrow at them and wonder if they aren't on the payroll of these corporations. I have been to several "educational dinners" at fancy restaurants paid for by the drug companies and the educational portion is by a Doc on their payroll. Doesn't mean Im going to prescribe it just because it's the newest thing on the block. One big thing Texas Tech hammered into us as NP students was that you always look for less expensive alternatives for your patients. At times it can be a balancing act of what the pt can tolerate, the efficacy of the medication and cost.

Once again you ask your doc/np/pa to change you to Novolin R instead of Humulin R and go to Wal-mart and pick it up for 27 bucks. There are usually always other alternatives. That was one of the first things I did at my last job, going through and finding the most low cost alternatives for my patients. Never once did I prescribe Humulin R at 130 bucks a vial compared to the 27 for Novolin R. A large percentage of my patients were non-workers who relied on the government. But as I stated before it will always remain a sellers market and they are free to charge as they wish because they are in business to make money. People will always be sick and in need of medicine. It may sound callous but I understand it and I'm alright with it because we live in a free market society. I don't like the fact the Mobil oil made 4 Billion in profit while charging me 3 bucks for a gallon of gas but it's their price to set, I don't like it then I go to the Wal-mart down the street and pay 2.75 for a gallon. You start price regulation and then where is their incentives for making new drugs....It would kill innovation.

Not to mention the fact that healthcare and "big" pharm is a business. It's simple economics. As an NP I expect to be paid for my services, if I wanted to do charity work I make that choice for me and my two little ones. Drug companies are in business not charity. They don't make drugs out of the goodness of their hearts, they make them to make a profit. People stop buying them at the outrageous prices and make their docs/np's/pa's give them the more affordable choices eventually big pharm will get the message. But it will always remain a sellers market.

I have to admit even though I took my exam back in 2013 it was more difficult than I expected but I did pass. I bought both Fitz's book and Barkley's book and CD's off Ebay. Fitz's wasn't cutting it for me, so I took the CD's and copied them to my Ipod and listened to them non-stop for a month of studying. If I was in the bathroom, I had the Ipod going, if I was in the car the CD's were playing. I even went to sleep with Barkley talking me to sleep. That is the only thing I used, but it was literally non-stop for a month. Knew every single thing about Hepatitis and not one question on the exam covered it..LOL One of my current patients used Adderall all through college to keep him focused in class/on tests and he graduated with a 3.8 So you might look into getting a short term script for it and see how much more focused you are while studying and taking the exam. He too has bad test anxiety and he stated it really leveled him out for test time.

Ya'll with test anxiety....get yourself a script for some propranalol.....Smooths ya right out according to one gal in my class who swears by it. I personally have never experienced it even when I took the nclex I went in knowing I was going to beat it down and 75 questions later I had....that's my approach to all tests.

You may want to join the state and local NP groups to get to know NP's in your area and smoooze with them. Let them know your a student and will be looking for preceptors in the very near future. Texas Tech ACNP 2013 grad