OB/GYN NP

That's what I'm thinking too...

I hadn't been able to find any info on their C/Section rate. They do require contractors in L&D to have ACLS, which seemed a bit odd to me. That typically means they expect to handle their own codes within the unit staff, or the hospital is too small to have a code team. In some cases, they just want you to have ACLS so they know they're getting highly-trained staff, even though they don't expect you to use it. But I can't help but wonder how many codes they expect the staff to have to handle in L&D....

Thanks ACNP for the update on your dinner lecture! (And dinner sounds yummy too! :chuckle ) Zias also mentioned fibromyalgia. I have a patient with fibromyalgia that I just put on Cymbalta yesterday! So I'll let you know how that goes. I thought if it works well for neuropathy, it's worth a try for fibromyalgia. And she definitely has the depression indication.

Sorry to hear of your difficult situation. I guess it would depend upon the hospital. Nearly all of the larger hospitals would require a pre-employment physical with blood work first, which may disqualify you when they find out that you have Hep B. I know there are nurses out there who are practicing with HIV, but their hospitals support their right to work, since Universal Blood and Body Fluid Precautions protects not only the health care worker, but also the patient. Are you licensed in any US states? I wouldn't think that states would decline you for licensure because of your Hep B status. I don't know of any states that ask on the application for licensure about any infectious diseases you may have. Where were you originally licensed as a nurse?

Hello California! I'm wondering if any of you can give me any advice on Cedars, specifically L&D there? I'm considering a summer contract there, and I'm wondering about the work atmosphere. I searched this forum and found some older posts stating that Cedars isn't the best place for new grads (apparently they are not the best at taking new grads under their proverbial wings), but I am an experienced L&D nurse and WHNP. Still, I would prefer not to work in a "cold" environment. Anybody have any thoughts/experience on the L&D department there, or the hospital in general? Thanks in advance!

Thanks everyone for sharing your experiences. I have also checked the local pharmacies and definitely found Cymbalta to be more expensive than Effexor XR (expected, since they won't NEARLY have covered their R&D yet). ACNP, thanks for the relevant info on pain management. I was curious as to how well it actually worked for pain. My patients' pain is typically GYN-related, as opposed to neuropathy, so I get very little experience with treating neuropathy (maybe the occasional diabetic pt. with neuropathy). So it's good to know that it is actually effective for pain if I need to use it for that indication as well. Thanks also for any feedback you can give me from your upcoming dinner lecture! (Maybe you can also report back what you had for dessert...I'll have dessert vicariously! ) Jan

Thanks for the first-hand reports! It definitely does help....sounds like at least a looong discussion about potential side effects is in order! Jan

Hello all! I'm wondering if any of you have used Cymbalta in any of your patients? I have a few patients who are currently on Effexor XR and are having side effects, but need an SNRI as opposed to just an SSRI. I'm thinking that Cymbalta may give them another option, but the side effect profile looks remarkably similar to that of Effexor. Anyone have any experience using it in your patients? Thanks in advance! Jan

Hi "antsy"! First of all, let me say how sorry I am that you were assaulted. I feel for you. It changes your perspective on things, doesn't it? I see your dilemma, wanting to go, but unsure if you've had enough time in nursing, and what you should do if you do decide to go. It sounds like travel nursing really would help you to see the world, and maybe help to "scratch your itch" for travel. The thing I might caution you about, though, is that by learning new specialties with a travel agency, if you don't have a lot of experience, or if you're looking to be trained in a new specialty on the job, you may not have as much choice about where you go, as far as locations for assignments. And the pay will probably be lower as well, with fewer years of experience, or NO experience if you want to take a "orienting" assignment. My other concern would be that it is in the best interest of the travel agency to get you working ASAP.....so does that mean a short orientation to a new specialty, leaving you with less-than-adequate training in that new specialty? I don't know that they would do that, but thought I would offer it as a consideration. You might want to consider simply starting out in med-surg for a while, doing what you know, and what you have experience in, just to start traveling, and get out of the unsafe place where you are. Then later, after you have more experience, you might have better luck getting assignments in areas that "stretch" your skills a bit. I'm not saying by any means that you may not be smart enough to handle the training in a new specialty, just that it might be better for your career and your sanity to take one step at a time. :) I haven't begun to travel yet, but many nurses who are experienced in this tell me that it does take a while to get used to the whole traveling experience, and you don't want to have the added stress of being unsure of yourself at work, in addition to a new town, new living quarters, no friends close by, etc. I would be afraid that you might set yourself up for failure by taking on travel nursing AND a new specialty, right out of the gate. Whatever you decide to do, I wish you the best, and hope all goes well in your travels!

Hi Just passing, I am an NP, and work in an integrative medicine practice (we combine herbal/"non-conventional medicine" with traditional allopathic medicine), as well as in a hospital setting. Chelation therapy has been practiced for over 50 years in Europe, with great success. The problem is, there are no large-scale studies on its effectiveness, so its success has been largely anecdotal to this point. The NIH and Duke University are in the process of doing a large-scal national trial on the effectiveness of chelation therapy. If you'd like to read more about it, you can go to the National Institute of Health website, and search for TACT trial, or chelation therapy, and you can read about chelation. I was skeptical myself at first, because it was nothing that I had encountered in my traditional RN or NP training. But after having been diagnosed with mercury toxicity, which was leading to a myriad of neurological symptoms, and being treated with chelation therapy, changing nothing else in my lifestyle, and seeing my mercury levels drop dramatically, and my symptoms improve dramatically, and seeing this process repeated multiple times in my patients, I'm a firm believer. The disease processes that benefit from chelation therapy are two, primarily. The first is heavy metal toxicity, as you mentioned in your post (heavy metal toxicity can occur for any number of reasons, but the most common is mercury, tin, and copper leeching out of metal fillings (especially broken ones) in your mouth, and also from contamination of food or water supply, etc). The second disease process that benefits from chelation therapy is heart disease. Chelation therapy is very useful in decreasing plaques on the walls of arteries, but especially beneficial in cardiac arteries. We have several patients who have used this therapy with astounding results, including one who had pre- and post-chelation therapy (a series of 15 treatments, once a week for 15 weeks) angiograms, showing a decrease of obstructions in every one of his coronary arteries by at least 50%, and in one coronary artery, by 70%. If you or a family member are considering chelation therapy, I would just do some research on chelation, make sure you're comfortable with it, and try it. Many of our patients have some to us with no other option but bypass surgery, and their attitude is "what do I have to lose? If it saves me from undergoing surgery, it's worth a try." Make sure that you go through a reputable practitioner. You can find a reputable practitioner on the ACAM website (American College for the Advancement of Medicine). They usually have practitioner listings across the U.S. Hope this helps! If you ahve any other questions, feel free to e-mail me privately. I'd be happy to help. :) Jan

Thanks everyone for your replies! I'll check out Cross Country!

Good for you, Dixielee! That's how you make the system work for YOU, and not vice versa. I think it's wonderful that you had the desire to make what you want out of your career. I've been around the block a few times myself, and what you said about units not really caring about you, only about what you can do for them, is so true. In general, it's all just a business. Now of course, you make friends with people you work with, and they care about you for more than just what you can do for the unit, but still.... Anyway, just wanted to applaud you for your choice. I'm glad that agency nursing has worked out well for you. Jan

Hi all! My husband is being relocated to Boston, and I think I'm going to give this whole travel nursing thing a try, in order to "play the field", if you will, before we decide where exactly to settle. Plus, the money and housing will be better as a traveler than just taking a job somewhere. I'll be working in L&D. Has anyone had any assignments in Boston who could give me some info about hospitals? Another nurse told me that Mass General and Brigham and Women's are both good hospitals to work for. Anyone know anything about any of the outlying hospitals in the towns around Boston? I know the housing is ridiculously expensive, which is one reason why travel nursing there looks so appealing to me. Also, if any of you have any ideas on particular travel nurse companies that get a lot of work in the Boston area, I'd certainly appreciate whatever info you can share. I've also been on the Delphi website, as another nurse suggested, and found it very helpful. Thanks in advance for your help! Jan

Thanks for your reply goody two shoes (cute name, btw :) )! My husband used to travel to Boston a lot for work, so at least HE was prepared for what it costs to live there--JEEZ! :uhoh21: I didn't realize that Massachusetts had any nurse unions, so I'm glad that you mentioned that. I'm currently practicing in Indiana, and there are no nurse unions here. I guess I don't know what to think about unions yet, since I haven't ever dealt with being in one, but I guess my gut tells me that they're a good thing...more money, lower nurse to patient ratios, more job perks...how can that be a bad thing?! :) I have seen some job postings for BWH, and went to their website. It seemed like they have a lot of good things going on there from their website, but that doesn't always translate into a good working environment, ya' know? So thanks for your input on BWH. I will check into that one a bit more. I had also considered a travel assignment, since it is so expensive to live there. Maybe I could get my housing paid for, at least for the first few months, until we know where we want to settle for sure. Thanks so much for the info. That helps me to at least get a feel for the nursing climate there.

Hi all! My husband and I will likely be relocating to the Boston area in the next 2-3 months. I wonder if anyone could give me some insight into the nursing community there, which hospitals are well-respected, etc. I am an OB/GYN Nurse Practitioner (as my screen name implies), but I also still work L&D PRN (for the pure joy of labor and delivery). So I'd be looking for probably part-time NP work and part-time or PRN L&D work. I'm searching all the websites out there for jobs, and am also searching area newspapers, and there doesn't seem to be any shortage of nursing jobs, but wondered if anyone could give me the inside scoop on if there's anyplace I should steer clear of. Thanks in advance for any help anyone can give me! :) Jan