MissDoodaw

I add coping skills to my visits and bill for it 90833 - 30 min followups for most of my pts. My pts get batter faster and like it. I am not replacing their therapist. There is a psych med app that incorporates coping skills for each diagnosis with pdf's I can print and give pts copy or just look at to see what coping skills would be most effective for say social anxiety for example https://www.sigmundpsych.com

Hi Mica, That's a pretty big jump from retail to er. My guess is it will be a lot of learning the first two years. I was an ER RN, as an NP back in the same ER after a year or so in clinic. Epocrates and uptodate will be your friends. Check out your hospital's antibiograms to decrease your bounce backs and increase effectiveness. Someday lots of procedures, other days not so many so you will become good at them and fast with practice. Most ER providers are not great with derm in my experience and most of the derm stuff is not truly emergent anyways. What is more important are your EKG interpretations as an ER RN I assume you're good with these. I was the first midlevel in one of our ER's and working with RN's I had no previous relationship with I had to blow off the sandbagging and prepare a lot of my own procedures for the first couple months until they realized I knew what I was doing and I was good at it and all of a sudden my orders were being done promptly, procedure set-ups were done, pts were being discharged promptly, but I had to be patient and give people time to adjust to the change. My advice to newbies in the ER..... Know your belly pains and workups for these. Know your geri pharm and ADE's in the Geri population. Make sure you have good outpatient settings to refer people too. Know your 4$ drug list/5$ drug list. Know what community resources there are for the underprivileged. Supplemental training: the ER bootcamps are a good refresher if you can find one, Im sure you have TNCC and ATLS, Foundation for critical care course I found helpful for some of the higher level acuity pts. Listen to your gut. Good history and good exam always. Chart really well -yes, take the time to do this every pt every chart- it will pay off in many ways. I was surprised when a MD would come back and comment about one of my cases that he had read my chart as part of this or that oversight committee or ER director position. It gave me a good reputation besides covering my backside. Ask for help when you need it. Good home and look stuff up when you aren't familiar with things or the depth of knowledge isn't there. Good Luck and have fun!

I am curious about working in the surgical field. I am an FNP, and as an RN have no experience in the OR. Are there courses that one can take to become trained in the surgical setting as an FNP? or am I doomed because I will never be able to get my 2000 hours to become RNFA? Thanks for your help!

Perfect opportunity to send a letter of intent besides your CV. In your Letter I would let them know what you are looking for in a position and why you are interested in this position, I would also include things like I earned all excellent scores from my preceptor in the following rating categories.....if you can include this in a non-braggy way. In your Cv inculde student clinicals- clearly marked under a category such as Student CLinical Experience -with just a sentence or two explaining each clinical like : SO&SO Cardiology -Dr so, Worked with Dr So and adult pt population focusing on HTN, HLP, CHF, and post-MI pt management in clinical setting as well as rounding on hospital pts for cardiology consults. (Date).

Congrats! I would see if you could spend a day or a few days with a radiologist- I was woefully unprepared for reading imaging -luckily the Doc I work with has been working with me on it....but a few days with a radiologist is kind of a dream for me -maybe on the next Staycation...? Also get Epocrates the full program or Lexi-complete something like that to look up off labs and see what your next step shopuld be or why the Doc is ordering a certain test -has been very helpful for me! Enjoy!

Also many practices need growth to stay equal with decreasing insurance reimbursement- but as a NP you should still be paid what you are worth. It would be useful to figure out what you bring to the practice but I think very few NP's are in a position to know the cost of overhead, the actual collections, etc, which makes calculating what you bring to the practice a tricky discussion to get into for the purposes of a raise I think.

I have lived in both places- Miami and Texas- though a I live few hours from Houston -good job market there, affordable living -I often receive offers from recruiters there looking for NP's. -Miami very affordable living -no state sales tax, home taxes very low (100K house taxes in Houston = $350K home in Miami taxes +/-), Miami= Home prices very affordable right now, job market not so hot...-pretty poor for NP's. Many folks lost their jobs and lost their benefits...

I saw 15-24 pts a day working in specialty -(less when I started 1 an hour then) now I see about 40 (with a scribe in a 10 hour shift working fast track in er) or 15 working in the main er. and working in urgent care walk-in about 26 in 7 hr shift

Wow, I am continually challenged by the new things I learn every day being a np. It will never become dull or lack challenge for me and I a surprised to hear others say so. I think the great benefit we have in the becoming a NP vs DR question is that as a N you can spend years in any specialty and then move into another without more education or training, and then another. Dr's train in one specialty and then they are stuck pretty much! PS I am A FNP - I am proud to be a RN and I love my job!

I am a FNP and worked in the ER. This experience was invaluable to me. Not to downplay other units but it gave me info on how pts with conditions present with my own eyes, inpt vs. outpt care, and exposure to a million things I would not have ever seen otherwise plus the confidence that comes with knowing you can manage quite a bit on your own. PS -this is also very marketable as every position I applied for could see how my expereince working as an RN in the ER would overlap w/ their specialty/practice. I now work in the same er's I was a RN and tech in and I love it!

Look for another PT position. This will ensure Advance is correct for your local market. Then once position is attained review with your employer (before accepting new job) that you like work and like the boss, but you have another offer for x$ and are hoping they would be happy to match that and see what happens...but you have to be prepared to walk. Some caveats: Advance may not be specific to your area and population. Talk to local NP's doing what you do. Obtaining another offer at your desired salary may negate this arguement. I do think many NP's are underpaid. I am not sure why our profession accepts this. Perhaps we have the personality that we want to help, even to the point of self-sacrificing (in this case our income). I personally have decided this trait is not professional for me -I am a professional-I behave like one, and will be reimbursed like one. A prospective employer that does not offer a salary and benefits that recognize my value would not be a good fit for me. This does limit some of my opportunities. I am ok with this decision, but I think we all have to decide for ourselves.

3 reasons to stay... 1. B+M school may not be any 'better' 2. Leaving in the middle will raise questions with your resume -r u a preson who can't stick with it? Did you not research appropriately before you choose? R U only attending b/c employer paid and situation changed? will you stick to your first job? etc...whether valid questions or not, unless the rest of our resume sparkles with longevity at your previous posiotions this could be a problem. 3. It is paid and you are 1/2 done. REasons to go... 1. B+M school might be better. Also, I think probally everyone faces the question at some point "Am I learning enough so that I deserve the trust people will place in me by coming to me for their healthcare?" I still ask myself this question almost daily. And I answer it for myself the same way. I do a good job, in fact I do he best job I can or every pt I see. I ask ?'s when I am not sure, or things are beyond my knowledge base. I continue to seek out and learn things I don't know -or relearn things I've learned and forgotten :) In the end you will know the right thing to do, and you are the one who has to live with your decisions. I think you shoudl consider finishing the current program and doing a post -master;s cert at the other school. Good Luck - it's a tough spot.

Also, talk to your instructors regarding realistic salary, they should be able to guide you for appropriate salary for your position and area.

What area of the country is the op in? Will she be expected to write scripts for the other providers? How many hours a week will you be starting out at? Will there be training? bonus?

Yes. Your job is to accept the position that is the best for you financially and otherwise. You owe company no1 an explanation and notice you will not be accepting the position as soon as you know so someone else can be offered the position. PS make sure the nonprofit is not eligible for hrsa reimbursement b/c that might tip the scales the other direction! Good Luck!