apocatastasis

It is truly bizarre and inappropriate for schools to expect students to find their own preceptors, especially when the search degrades into trying to find a warm body with an MD or NP after their name who will take you on. That said, I'm an NP and maintain close contacts with my school's faculty. I understand that it can actually be very difficult for schools to find appropriate preceptors- I imagine the attitude is, why not just dish the leg work out out to the student? It's not right, but until students vote with their feet and attend only legit programs, this trend will continue. I, for one, would never even consider getting a DNP or post-Master's certificate at a school that didn't help me with preceptors.

I'm a successful nurse practitioner, and a guy, and I have 00g ears. Anyone who doesn't like them is more than welcome not to be my patient.

I'm a psych NP, but I did have to do some primary care rotations-- my ICU experience was not very helpful, but my ER experience proved INVALUABLE. You get to see everything from STDs to wounds to life-threatening medical conditions.

As I commented in another thread, boards of nursing are cracking down on this. From what I hear, according to Texas BON, FNP scope of practice does not include inpatient work.

You need to check with your board. In Texas, the board has really cracked down on scope of practice issues like Adult Health CNS practicing psychiatry and FNPs doing inpatient rounding.

I moonlight inpatient with a psychiatrist (who owns the group) and a NP friend of mine on occasion, I call them both colleagues because I don't consider either one of them to be my supervisor. In my full-time job, I have a chief medical officer and assistant chief medical officer-- I call them my bosses because that's what they are in my organizational structure. And, even though they're my supervisors, they leave me alone and let me do my job, which is really the important thing.

I work primarily outpatient in community psychiatry, though I have also worked at a crisis facility and do some inpatient rounding PRN. There are a number of specialties in psych which are quite different from the kind of work I do (e.g. substance abuse, working with TBI or HIV patients, crisis work, mobile outreach or ACT teams, eating disorders, liaison work in hospitals [which is very interesting if inpatient and medical comorbidities are your thing]). Psych has much broader applications than most people realize, though you must always be mindful of your scope of practice. I currently work 8-5, M-F. I'm on call 4 days out of every 3 months unless I want to pick up more, and I am compensated well for it ($300 a night for F/Sat/Sun call and $125 a night for weekday). I do not do any counseling, but I DO do psychoeducation, try to throw in some basics of CBT, talk about engaging with group therapy, etc. Unfortunately, employer does not want me doing therapy, as that can be farmed out to the LPCs and LCSWs. I have a caseload of over 1,000 patients and have only 20 minute appointments, so I feel like a conveyer belt towards a prescription pad at times. However, you can still make a big difference even given 20 minutes... meds aren't miracles for most people, but I've seen some amazing changes which make the work seem very much worth it. As far as what I see patient-wise, it depends. I've worked at a few different facilities; at my current position, I have mostly stable patients... however, I am occasionally floated to cover for other prescribers, and the NPs who work at our crisis facility and on mobile crisis team frequently have medically and psychiatrically ill patients. When I was in Seattle, I worked with forensic and supportive housing clients who were about as medically and psychiatrically ill as they come. All this business about NPs don't take sick patients, the MDs take those-- very much NOT true in psych. If anything, I had patients who were quite a bit more ill than what most of the MD colleagues had. As for the money, a lot of it is how shrewd a businessperson you are. I can't speak for other specialties, but I personally would not take a job as a psych NP in a major market for less than $90k a year. You have to negotiate with employers and insurance companies. A lot of nurses and NPs are not good at this, which is probably part of the reason our wages are generally lower than they should be.

This is true generally. HOWEVER, in urban areas, in specialties, I do not believe this is the case.

Yeah, I saw that, sorry, I finally cleared out my inbox! Is there anything in particular you want to know? I have licenses in Washington State and Texas. Had no trouble getting a job in either state. There is high demand for psych NPs nationwide from what I can tell, especially if you want to do child/adolescent (I get ten million e-mails per day from recruiters... never give them your real e-mail address!).

And, I for one, am pushing for equal pay for equal work.

Most MDs don't make that much? Maybe not in primary care, but otherwise this is definitely not true! My community mental health center in Austin, with a low cost of living, STARTS brand new NPs at 120k a year.

I'm a psych NP, employed in an outpatient community (=not high-paying) psychiatric setting, one year of experience, and make 6 figures.. More than just a few of the psych NPs I know in private practice make between $200,000-$300,000 a year. At least one significantly out-earns both of her psychiatrist partners. I'm looking into starting a telepsychiatry practice, and factoring current reimbursements, no-show rates, etc., working 35-40 hours a week and earning in the $200s is definitely doable looking at the longer term if all goes well with the practice. Money isn't everything, but, since that's what we're talking about... it's all about how aggressively you market yourself, your business sense, and what kind of market, practice, and practice climate you're in.

I have a MSN and am a nurse practitioner, but I also earned a BA before I became an RN. I worked for 3 years as an RN while obtaining my MSN. I could never, and still can't, see what the big deal about having a BSN was/is. It's a freaking bachelor's degree, like every Tom, Dick, and Harry has these days... almost embarrassing that we as a profession are arguing about it.

I've heard a number of people try to justify "sontimeter" as a French pronounciation of the word. Yeah, well, I have a French degree and speak French and Italian and studied Latin for two years. The word is CENTimeter. Whenever I hear someone say "sontimeter," what comes into my mind is, well, google "Emily Howard at the Swimming Pool."

The only reason I would intervene for any reason is if someone were clearly having trouble with ABCs. And, in that case, I wouldn't even ask them, I'd call 911. I have absolutely no desire to meddle with the health concerns of people who are not my patients.

1. For a new nurse, you seem to know an awful lot and are displaying an attitude that is inversely proportional to your purported knowledge base. 2. The med surg preceptorship at the hospital that trained me was the same length as my ICU preceptorship. Med surg is its own animal and deserves a proper preceptorship, just like any other "specialty" setting. 3. The second hospital I worked at as an ER RN provided a preceptorship and training program that was year-long and offered to anyone who met the requirements, regardless of specialty, again INCLUDING med-surg. The fact of the matter is that, very frequently, it does cost many, and frequently dozens, of thousands of dollars to train a new nurse.

Part of it depends on what kind of training you get and what setting you work in. Like 8mpg explained above, I had a relatively short (compared to some new grad RNs) 12 week orientation in a high acuity ICU. Some ICU RNs I know at other hospitals were on orientation for 6-9 months with a preceptor FT. Just in my preceptor's pay alone, that probably ran them between 15-25k. They also had to pay to have us take critical care courses, classes in e.g. ventilator, balloon pump, and dialysis management. There were about 6 of us on new grad orientation between June 2009 and December 2009... I'm sure it cost over 200-300k when all was said and done. Not exactly chump change.

Morally abhorrent?. I bet you'd be a ton of fun at a cocktail party. But you probably don't go to those either. I agree that the state BON and employer really end up with the final say. The wise would think that use of marijuana, prescribed or not, is taking a risk and should be calculated in context of what his or her license is worth. For me, not worth it... and my state is one of the ones that is (probably) going to legalize it in November. I find it interesting that the OP is absent in this discussion after stirring up the hornets' nest.

Rlianne, I agree that the scope and standards of your certifying body in concert with your board's rules and state law would dictate what you can/cannot do. It is a very gray area, and very state-dependent. This is the difficulty with the varying quality/scope of NP programs and with the wide variations in state rules... I would think that in an ACNP program, there are far more conditions in your scope of practice than what you truly can be prepared to manage in school... there ends up being a lot of on-the-job, real-world training that needs to take place, and this is true whether you're an RN, NP, MD, PA, RT, PT. "Whatever I learned in my MSN program" is also not always true. As a psych NP, I had to take one of the three semesters of primary care theory/clinical that the FNP students did... but according to ANCC standards of practice, it is NOT in my scope of practice to prescribe or diagnose anything that isn't psychiatric. Even though as a student I diagnosed/treated more people with bronchitis, scabies, ringworm, and ear and sinus infections than you can shake a stick at. Still... some psych NPs manage hypothyroidism... and some prescribe metformin to try to ward off metabolic syndrome caused by antipsychotics... etc., etc.

This is entirely ridiculous. 1. Getting into and graduating from an NP program has nothing to do with getting a DEA number. They have no way of knowing your eligibility for a DEA number. 2. People with DEA numbers receive prescriptions for controlled substances all. the. time. The DEA has no say over the medical care of registrants who possess prescribed controlled substances for legitimate medical purposes.

It shouldn't necessarily affect you either way. You may have to disclose to your board what your diagnosis is. For instance, in Texas, you must specifically answer if you have ever been diagnosed with Bipolar Disorder, no distinction made between I/II/NOS. In Washington State, on the other hand, the Nursing Commission simply asks if you have ever been diagnosed with a mental disorder that affects your practice, which is much less specific. Even if you answer yes, they are simply going to want to know if you are receiving treatment and to be sure that you aren't going to endanger anyone. As for your employer-- a whole other story. I would not disclose anything at all, except possibly prescription meds during the drug screen. Your employer has no right to protected health information. You should not be discriminated against based on any physical or mental condition-- this is illegal.

I generally try to be polite and inoffensive. However, I resent having my time wasted, and when I'm forced to go to useless mandatory trainings that last hours upon hours (e.g. three hours of, "this is how you use a mouse"), which nursing/hospitals just LOVE to do... my iPhone comes out of my pocket and gets 90% of my attention. It's either that or the sound of me constantly flipping the pages in the newspaper. Your pick.

That depends on the state, I would think.... "nurse" isn't even protected in every state.

A bunch of random things: My most difficult thing coming from ICU was getting to the point where I wasn't anal retentive and obsessive about every detail. Nursing school makes you obsess over details. In the real world and especially the ER, details are great if they are relevant... but many people provide lots of info that has nothing to do with what you are concerned with. (E.g. in triage, "What brings you in today?" can start off a story like, "Well I was at my uncle bob's a couple of months ago and he had a sandwich and I like blue posters and....[ten years later, talking but still no answer]." Ok... so, again... why are you here today?) Consider your chief complaint and ask yourself... is this detail important? Do I need to follow up on this? Redirect the patient if they get off track and focus on the NOW. Your focus in the ER is NOW. You don't need to be rude, but cultivate the art of turning the conversation towards the issues at hand. You deal with chief complaint and potentially life threatening issues. If they come in complaining of a stubbed toe or jock itch but their BP is 220/125 or 82/40... which is your priority, the CC or the BP? If they come in saying they want a refill of their clonazepam, and can you do a pregnancy test, and can you check their BG because they're peeing a lot and last time this happened they ended up in ICU, which is your priority? You will have patients where your major concerns are not even on the patient's radar, and vice versa.. You will develop assessment skills as time goes on. I used (and still use) our charting system's templates for each variety of chief complaint as a cue to remind me what to ask. Know your body systems, especially neuro, cardiovascular, and respiratory. Problems with these systems can make your patients crash very quickly if not caught soon enough. Review how to do a basic neuro exam. Review signs/symptoms and treatment of common but potentially life threatening conditions that should always be in your differential depending on chief complaint (off the top of my head, especially MI, COPD, PE, pneumothorax, A-fib, CVA, renal failure, status epilepticus, aortic dissection). See your sickest patients first. Put the patient on the monitor if you think the issue is serious; treat the patient and not the monitor, but the monitor is a great thing to have sometimes and has saved or alerted me many times (it has also irritated the hell out of me for no reason an equal number of times.) For psych patients, you need to do a medical screening but also remember that the environment can provide lots of life-threatening utensils if they are really suicidal. Patients can try to kill themselves and/or staff with monitor cables, bedsheets, trashbags, metal forks. Always assess your environment (takes no time but frequently ignored). Your hospital should put you through a critical care course to help you review info about patho diagnosis and management as well as assessment.

An MD is not, technically, a doctoral degree. It is a professional degree, as is the DNP. The JD, obtained by lawyers, is a Juris Doctor... again, it is a professional degree and not a doctorate. It is equivalent to a bachelor's degree in other countries (e.g. in the UK it is equivalent to the MBBS). Residency is graduate MD education. There are MDs and JDs who go back for further doctoral-level training and are MD PhDs and JD PhDs, respectively. Nursing wants to adopt this model. The University of Washington, as one instance, requires 1,000 hours for the DNP degree. However, I can apply my 700 Master's-level clinical hours towards my DNP. So, a DNP (in addition to the ridiculous coursework) would require only 300 clinical hours, which is slightly more than what I was doing every semester for my last two semesters of grad school. (And would probably add little to nothing to my clinical knowledge unless I were able to pick my clinical site and focus.) In any case, it certainly does not compare to physician training, though I wish it did in some respects.