Iconoclast

I'd jump at that, it is exactly what I want. However, I'm 350 miles away and must go with one of the distance options. Based on the website, the FNP/ACNP looks like an on-campus program. Am I incorrect?

BSN program graduation is 15 months away, but I have to begin the app process for grad school soon to begin immediately upon graduation from my current program. I am gearing up to take the GRE, knowing I may have to attemp more than once. I had just average SAT scores, oh 25 years ago when I took the SAT, lol. I am worried I won't do well on the math portion at all. I am going to take the sample exam tonight and see just how bad it is. I bought several study guides. I am considering a prep course, however it is very expensive and money is tight. I am looking at Vanderbilt, ETSU, WNC. What kind of scores do I need to be accepted at those schools? I have a 4.0 and stellar references.

Another thought. Is there an avenue to expand education and practice i a post masters program? For instance, if I did ANP and later decided it was too limiting, is there a way to get additional education and test for the pedi part later? Or would I have to begin again? The crux of the issue for me is that here in Western NC, the best option for me is Vandy's distance program and FNP is not an option. To do FNP I'd have to go to ETSU and their distance program is through Regents, which is a big turn off to me. It is also 3x as long as Vandy's. Western NC Univ does not have a set up that would mesh well with my family at this time. I can make ETSU work, but it is unappealing for some practical reasons. The school is 90 minutes away and I'd be going 3-4 days a week for three years. With gas at $4 a gallon here, Vandy would be cheaper, lol. Can I do an ANP through Vandy and expand practice through further Ed later, is the short version. What about DNP after ANP? Or is the DNP only for FNP?

Thank you for your response. There are not enough words in my lexicon to describe just how much I despise caring for pedi pts (and their parents). I do it all the time, and no one knows how much I hate it, I'd never let it show. So I could do it if I had to, and I don't want to find myself marginalized careerwise by closing that door. My dream job would be NP in a University health clinic. Second to that my preference would be to see adults in hospital, but in my area neither is a likely option in the next ten years. I'd like to move to a more urban area, but my husband likes the rural south, so unless I get divorced, I don't know that I could find employment as an ACNP within 2 hours of here. Or can an ACNP see pts in a clinic/office setting? I guess what I really need to understand is how much crossover there is between them. Who has the most flexibility? Physicians cross over all the time. My ED is staffed with emergency med guys, family practice, and an internal medicine doc (who does see the kids who come in). Does AP nursing offer that flexibility, or is it far more specific? If I do ANP, no doc is going to hire me into his/her family practice, and that is pretty much all we have around here. There are no specialists in town (except a urologist one day a week and a neurologist that sees chronic headaches -oh joy- in a rented trailer office twice a month). If I do FNP, I'm broader, but only to include a subset of patients I can't stand and it will require going to a different program that will take, in effect, two years longer due to it's set up and my schedule, etc. I have to make a choice by this fall so as to get applications in on time and other than ruling out psych, lol, I'm nowhere. ALL comments are appreciated!

Can some of you speak to the career opportunities that may be unique or specific to each? I am leaning toward an ANP program, but the school also offers ACNP. Am I wrong in assuming that I could probably have a wider range of options with the ANP? I don't know if I'll always live in this area, in fact I doubt it, but at this time, the hospital system here will not credential advanced practice nurses(the medical staff opposes it and the chief of staff says he will leave if they ever do, and he has the largest practice in the county and RULES the roost). Assume I move to a more civilzed part of the country. What would be different ANP vs. ACNP? As to FNP, I really have ZERO interest in caring for children under 12. I avoid those patients in the ED and CCU where I work (it is a general critical care unit, all diagnoses, all ages) at every turn as it is! Am I shooting myself in the foot by not considering a FNP program? We have 3 NPs in my area and each of them is an FNP. They run the coumadin clinic, work as back up in the doc offices (urgent care stuff). They do not have their own practices or patients. I am going to put serious strain on our budget to get the MSN, and I want the most bang for my buck. Not the highest salary, but the widest range of options. I don't want to fnish one and wish I'd not pigeonholed myself. Advice, suggestions, general thoughts? Thanks.

I am in the same situation. My husband's employeer offers much better coverage at better rates, so I am under his. I tried to negotiate more money, but all they would do is offer me prn, but I'd also have to give up PDOs (all 8 of them a year, woot) and retirement (my 2% matching, woot woot). It isn't much, but I'm not giving it away... I'll be watching this thread with interest.

I agree with all the others. I would also add to keep documentation. You can't go in there 6 months from now and say "We always have too many patients, once I even had 13...." Dates, times, acuity levels. Document all of it. Good luck.

There are too many variables to say. How many patents I have, how many calls per patient and all the other things that might be going on. When it gets to be too much, I just tell them I don't have time to talk to them about it, but I did speak to so ands so earlier, perhaps they could touch base with them. then I ask whoever seems "in charge" of the family to designate one caller. It usually works. What bugs me are visitors. JimminyCristmas, when did it become OK to have a ******* party in the CCU at all hours of the night? They ring the dam doorbell every ten minutes with their contant in and out, make a ton of noise, lounge all over the place and make me climb over them to get to the patient. THOSE are the people I find annoying, not the concerned worried people on the phone. sorry, end rant.

I work in Southern Appalachia and I see A LOT of pts like those described by the OP. They are either completely or functionally illiterate and very "backward" (no offense intended, can't think of a more PC way to say it) I frequently have patients that have no electricity or running water in their home. Incest is not uncommon, alcoholism, marriage and childbirth in the early teens is the norm. Generation after generation. Add to that the loverly fact that we are now the meth capitol of the US, and I often feel quite hopeless. When I feel that way, I tell myself that in all likelihood they are going to forget or ignore any/everything I tell them, so I try to just get ONE thing to count. Maybe my 20 year old DKAer that I seee twice a month will NEVER "get" or comply with her tx, but maybe something I say will get her out of the abusive relationship she is in. Bad enough to be 20 and in the shape she's in, but she and her kids are routinely beaten. Cops and social workers try, but the effect is always temporary. My position now is: "Have a twinkie, but leave the bastard." sigh...I dunno. Sometimes, the best you can do is the best you can do.

I'm sorry you are so down. That is a lot going on all at once, I too would be overwhelmed. I hope that one of those jobs you applied for turns out to be a really great opportunity, ripe with warm people and satisfying work! Best wishes for your dog. Be well.

Thank you all for the respectful discussion and helpful posts. I feel much reassured and possibly bolstered enough to help my patients more with their spiritual needs in the future.

Angus, I don't disagree, which is why I have always been OK with providing a hand to hold along with respectful silence when my patients engage in prayer. However, being asked to actually do the praying threw me for a loop. I wouldn't know what to say. I'd no more know "how" to pray than I would know how to waterski. Secondly, even if I could manage it (I cannot begin to fathom what one might say in prayer) it seems highly dissrespectful to people of faith to have some poser "fake it." It seems on par to me to wearing blackface. Innappropriate at best, probably downright offensive to many. I wouldn't wear a hijab either. I don't know, it just doesn't seem like the right thing to do. It is inherently dishonest. We atheists are not ammoral ya know.

Western NC, 15 years exp. Base pay is $18.83/hour, plus 50 cents for CCRN and $1 for night diff. The top of the nsg pay scale at my hospital is $23.85 right now for more than 25 years experience, the bottom (new grad) is $16.25 (or thereabouts). We are not premitted to have any OT. They will pay you for it if you end up with it, as per the law, but then you get fired, so not a good idea, lol, I was making $36/hour 8 years ago in AnnArbor MI, so it is definately regional. The average income for a family of four where I live is under 25K a year, so by those standards, nurses are making gazillions!

Thanks. Those are good suggestions, but I am at a disadvantage in that we don't have a chaplain (only a volunteer chaplain on some weekdays) and on weekend nights. In fact, I am the only person there. No other staff of any kind. I don't know if any of the nurses next door in the ED would have come over to pray with him; I honestly didn't think of that at the time. They usually only grace my doorway if I have a code, lol. I just feel uncomfortable with the whole thing. I don't go about proclaiming my atheism, because it would bother people and they would judge me very negatively for it, but neither an I going to lie about it. I just try to dodge the issue as much as possible, and I am pretty good at that after all these years. This is the first time I can recall every having patient care affected by an issue of this sort.

How do you handle it when a patient asks you to pray with them? I do not have the same belief system as my patients (I live in the Bible Belt) and when asked to participate I have always tried to skirt the issue by standing silently/respectfully/supportivley while they did the praying. Recently, I was asked to do the actual convocation/prayer. I was speechless. The patent assumed I was Christian. Everyone around here is, it is a pretty safe guess, lol. I am an atheist, but I largely keep that to myself. I told him I wasn't comfortable but that I would stay with him while he prayed. He got very angry and started accussing me of being a Muslim (!?!?!) and a terrorist (?!?!?!). At that point, I just had to leave the room, b/c how do you respond to that? He was VERY upset, VERY hostile to me after that, and complained about me all the next day. They had him transferred to med-surg even though he wasn't really ready b/c if he stayed in the unit I'd have been his nurse again (we only HAVE one nurse in the 4 bed CCU) and the charge nurse decided that was a recipie for disastor. I have felt uneasy about it since then. He didn't get the nursing care he should have because I handled it poorly. However, I don't know what else I could have done. I don't think being dishonest is the answer. Prayer does not offend me, though I'm acutely aware that my atheism would offend many. :shrug: I am very happy to be respectfully present. I am not going to fake pray though, I thnk that is very innapporpriate for a number of reasons. Any suggestions on how I could do better next time?