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?

I know a nephrologist who thinks nurses get can their RN from Sally Struthers. His position is, why should we "respect" nurses or pay them more? After all, they haven't even been to college.... Another doctor some years ago, after I called him about changes in his pt's assessment told me to "stick to wiping asses until you have been been to college, I'll decide what's best for my patients." Pt turned out to have infarcted bowel, so i was right, do you think he aplogized? Sort of. He acknowledfged that I did in fact know what I was talking about and concluded that I was "too smart to be a nurse." anyway, there are a lot of misconceptions out there.

Going on 16 years, does that make me "old school?" I don't think people are ruder, but I am much less tolerant of rudeness. When I was new, I could be intimidated by people. If some old lady snapped her fingers at me, I'd have hopped to. Now I let her know in no uncertain terms that I don't work for her, and she had better not do it again and expect the hoped for response. Make sexually innappropriate remarks, deliberately let me "catch" you masturbating, I will give you what for (both of those happened to me last week). You may not see anyone except the security guard for the rest of my shift, lol. 15 years ago I'd have giggled and run off, now I confront it. I do not put up with abuse form anyone. Innappropriate patient behavior is addressed immediately and professionally. Families feel more empowered, ask more questions and they aren't always tactful. Some coworkers seem to feel threatened by that, but I think that is a good thing. I really believe it is their responsibiilty in fact, so I don't begredge them getting as much info as possible. It is rare that I am treated rudely by family members. It happens, but not frequently. If it is bad enough, I just walk away or have them escorted out of the bldg. Really irrational people aren't worth trying to deal with, so I don't pay them any mind.

I have worked in places where there was a modest differential, 25 and 50 cents. My present work place does not offer any difference, and AFAIK there are only a handful of BSNs in the hospital. Our VP/Dir of Nsg is one of them, and she is returning for her MSN next fall. There are no MSNs presently in any capacity (my hospital will not credential NPs or CNS). That said, ITA with all the inciteful comments regarding the inherent value of a college degree, and ITA that the BSN ought to be the minimum for entry. Iconoclast, RN, CCRN (BSN in progress)

I think NC is expensive too. The Raleigh area especially so. We lived in Lochmere in Cary while I was in nsg school at WTCC in what was then a $250K home, 2500 sq ft, 4BR 3 Ba. We sold it for about that, and last year that very same house sold for over $600k. I'd cry over the lost equity except I could not have afforded to stay there anyway. I was making $12.25/hour at Wake Med then! The taxes in Cary were going up a lot more than my salary would have. Now I live in western NC, very rural area, making about $20 an hour and we really struggle. 3000 sq ft, 5 BRm 2 Ba, 2.5 acres costs the same here now that that house in Cary did all those years ago. I paid $4.05/gallon for gas yesterday, food is going up all the time, electricity is $200 a month, kerosene heat another $100 (and we keep the house at 60 degrees!). We have not gotten raises at my hospital in 3 years and were told we will not be getting one this or next year either. The paper has ZERO RN jobs, and the other area hospitals are only hiring prn while laying off FT nurses. Every nurse I know has a second job (usually not in nursing) just trying to make ends meet. My nursing coworkers also do sustitute teaching, drive school buses, work at the video store, the YMCA, Curves, wait tables. Those are just my friends!

I'm not suprised. I worked at Cape Fear years ago and we all knew FSU ws BAD bad bad.

I graduated from WTCC 15 years ago. Except for one very traumatic experience, I had a great learning experience there. I took my first job at Wake Med on what was then 2C med-teaching (that unit no longer exists) went to Cape Fear in Fayetteville where I started out in MICU, went on to manage the SICU and NeuroICU before coming to western NC. I was well prepared and rose up the ranks quickly, without a BSN I might add. It ws demanding, especially the first year. There wsa A LOT of busy work, and the exams were tough, not run of the mill mx choice. I think my class began with 68 students, 30 finished. All of us passed the NCLEX 1st try. I am glad I went through such a demanding program, it has really given me confidence to tackle other challanges over the years. I agree the adjunct faculty were the "nicest." I am adjunct faculty now myself at a different CC, so I get it. We adjuncts don't have anything invested in departmental politics. Clinicals were at Wake, Rex and Raleigh Community. I was able to do many of mine 2nd shift. I don't recommend trying to work while in this program. I am a good student, always straight A's w/o much effort, but the sheer amount of busy work they give you (I had care plans over 50 pages long) will take more than 40 hours a week. Good luck!

I looked at several, but going BSN first was less expensive. There are two state universities in my radius offering it, but they were overcharging for the degree by virtue of the fact that I would have been paying graduate tuition rates for undergrad hours (300 and 400 level). I was lacking 27 credit hours for my BSN, and I was able to do 7 of them at the local community college at $45 a credit hour. The bridge program was going to charge me $350 a credit hour for those same classes. The other 20 credit hours are costing in state tuition of $86 an hour. It will take me an extra year to graduate because my program doesn't offer summer classes, but I can pay as I go. I'll still have to borrow for the MSN, but not as much.

Wait a minute, I was just reading some other threads on Vandy, and I'm seeing numbers like 90K thrown around. I could swear my friend told me 30K for the one year ANP/cardiac subspecialty, so that is what I was figuring on. I'm not talking Bridge programs, just the BSN to MSN/NP degree. What numbers are you hearing from Vandy and how much of that are you seeing in aid? TIA

I am finishing my BSN in Western NC right now, looking to apply to Vandy next year for either ACNP or ANP (can't decide). I have a friend who did the ACNP at Vandy and loved it. Her company paid for it, so cost was not an issue. She thought it was very easy, very flexible and she feels she was exceptionally well prepared. She worked FT, homeschooled 3 kids and maintained volunteer positions as well, and did not feel the work load was overwhelming. She now does all the post catherization assessments and discharges for her cardiology group (after 5 years of being the head office nurse and 10 years of ccu before that). She only makes 60K a year while her least paid doc took home 3 million last year, so she is somewhat disallusioned now, but they did pay for her degree. She has a 5 year contract or she has to pay it back, and then a 5 year no compete clause after that. If I go to Vandy, I'll be borrowing the money. In WNC RNs are making $20/hour, nights! And I have 15 years experience and a CCRN. I just feel like the debt will be worth the pay off. Western NC University is one day a week for 3 years, costs a third of what (I think) Vandy does, but that is two more years of shift work with crap pay and zero respect. I can't take it that much longer. I'll sign whatever I need to!