northwestwind

It sounds as if you want to either be an NP or PA. If you like people alot, being a CRNA is not for you, because the patient is asleep. 6 figure income - but you will be on call all sorts of hours, and again, little patient contact. You'd have to like working with machines and numbers, too. PA pays $80K and up. You work the days the MD has office visits. You may do rounds in a hospital and write medical reports, which means you may work weekends and be on call. You have prescription writing privileges. However, the poster is correct when she/he says that alot of patients do not like to see the PA. They want to see the doctor, so you will hear this alot if you become a PA. However, the insurance companies reimburse the PA less than the doctor, so they have really pushed this profession into the forefront. 2 year study after a 4 year degree I think, but check on that. NP's make around $70K. Some much more if hired into a hard to hire rural area. Can become an NP in one year at Vanderbilt's fast track, as already posted, after a 4 year degree. Can write prescriptions. May work in the doctor's office seeing patients and rounding on MD patients. Write medical reports. NP's run the drug store clinics and walk in clinics. RN. 2 or 4 year degree. Money less than the others, but if you work alot of shifts, can do very well, $60K and above (but you'll work your tail off.) Typically start out in a hospital and go into specialties from there. Right now it is tough to find a nursing job because of the economy. PAs work almost exclusively with docs. NPs work almost exclusively with docs and other RNs. RNs work with each other - the docs give orders and we don't see much of them except maybe at rounds and phone calls. RNs work their tails off from day one and have alot of patient contact. Depends what you want to do and what you want to earn. And what kinds of responsibilities you want to have. My advice is to talk to some PAs and NPs and hospital nurses to find out more.

I would encourage you to find a program that bridges you to MSN without first getting an ADN. You have a 4 year degree already, you do not need a 2 year degree in nursing. Find a program that takes you straight to the MSN now, through bridging. When you get into this bridge program, stop the ADN. You might even get into a bridge MSN more readily than those without any nurse training. The point here is that you are wasting your time and dollars getting a 2 year degree, when you could be spending the same time and dollars getting an MSN, because you qualify for one based on a 4 year college degree. Why get a 2 year degree, only to have to go back to school yet again for a master's? You will have more opportunities knocking at your door with an MSN vs. ADN. The point here is you want the quickest and most valuable way to become a nurse. Make sense?

I have serious issues with your judgment. Yes, it is abandonment to be scheduled for a shift, and leave without permission. That you didn't get report is not the issue. Who's to say you wouldn't leave in the middle of a shift, because you didn't like the workload? Your license is on the line. You would be better off in another industry where personal accountability for a person's life isn't part of your job.

I have not read the book, but judging from the title, yes, it is an accurate portrayal of nursing. Nursing is EXTREMELY difficult these days. The shortages make the work environment brutal. The focus on financial resource management in nursing is very prevalent. You will be called to come in during your days off, and you will feel guilty when you say no! Just try it out. If you like it, stick with it, if you don't like it, then find something else. You might want to interview the nurses you see during your clinicals to find out how they feel about nursing. Just try to keep in mind how you will feel when you work for one or two years. Will you still have the same passion as when you were a student?

I think nurses get burned out because of a lack of nursing leadership. While the patient load, lack of enough registered nurses, lack of support services, and dwindling reimbursements (hospitals actually lose money on med/surg floors) have negatively impacted the nursing experience, the nursing leadership has not kept up with these changes. Take for instance that the nursing process is still the cornerstone of most nursing management techniques. There is no time for the nursing process in today's world. What is needed instead are good retention policies that reward nurses for their work. These can come in the form of job sharing, i.e. floor nurse development of work schedules that allow for greater flexibility in scheduling that is developed with new HR policies, systems that support nurse errors with constructive vs. punitive outcomes, and development of professional tracks so that nurses are encouraged to become financial experts at budgets and labor productivity that matches the patient census by time of the month, day of the week, and time of day (getting real metrics and working with them with finance, IT and HR) when nurses want to become managers/directors. Another trend that is positively impacting nursing care is the development of innovative case management teams made up of RNs, coders, and physicians. This all takes great nursing leadership at the top. And last but not least is a CNO who effectively makes the business case to other executives on the value of nursing care to outcomes. When it can be shown that the hospital actually lost money due to hospital acquired infections or care for avoidable medical mistakes, it prompts hospital officials to consider adding nurses. They can do this by downsizing other nonproductive areas (too many associate VPs who do not add value, too many nursing projects that take up valuable time that could be spent with patients, and asking nurses to be responsible for coming up with ways to deliver more effective care by changing inefficient processes. The bottom line is that when nursing departments do nothing to innovate, nursing as a whole is seen as nothing short of a labor center, costing the hospital too much with nothing to show for what nurses really can do every day. We have settled too many times into the discomfort of being an oppressed group with no voice. Talk to your nurse managers about process changes. Get these process changes in writing to your managers. Ask that the managers create a process to review these with Nursing Directors. Get the directors to show the CNO these process improvements, and document negative outcomes as a result of sticking with old, outdated care delivery. While working as a nursing systems finance manager, I presented data from the SCUs on back injuries/time off from work because those rooms did not have patient lifts. We calculated the cost of time off from work (bringing in premium per diems, for example), and patient outcomes as a result of not being turned (development of decubiti.) The CNO took this data to her weekly VP meeting and within a month, every single SCU room had a patient lift. The CNO had NO IDEA what was happening on those units because of not having lifts. So get out there with your ideas and turn nursing into a department that other managers can benefit from by using some of the same measurement techniques - evidence is the key. Use real patient scenarios. It works! And once you realize you have a voice, it begins to transform nursing culture. You won't win every time, but you can't stop, either. But as I said, it takes strong leadership to support new initiatives like this. Without it, burn out is very likely to occur. Start the fires in good ways!

I hear you, and hopefully I can explain a few options to you. I think money is, or more aptly put, future earnings are something you need to look into, to decide if certain healthcare jobs will support the kind of lifestyle you want to live as you look out 5-10 years. Nursing doesn't pay all that well, and the stress these days is unbearable. Moving into a nursing manager position is a very stressful job, as you are on call 24/7 and you will be called in at all hours, be faced with constant shortages of nurses, and be overwhelmed with the financial budgeting end . A Rad Tech earns less than a nurse to start, but a rad tech's job is not as complex as a nursing job, and has future opportunities that are somewhat different than nursing. Let's say you decide the 2-4 years for nursing is not what you will ultimately do. Rad Tech schooling is done in much less time. You get a Rad Tech (by the way, an acute shortage area so you will find a job in no time), and then go to work in a pediatrics office, or in a Children's Hospital. If you are really good at that, you can advance into the management end of radiology which will not place you in the same hot seat a nurse manager finds her/himself in. If you do Rad Tech long enough, and work your way up the chain, you could become the manager and then director of radiology - an incredibly interesting position given all the new technololgy in xray these days (PACS, new scans, etc.) and earn a very good living. If you like being a Rad Tech, you could be a travel Rad Tech, earn good money, and see some exciting places. The bottom line is that nursing is eroding for a number of reasons: faculty shortages, shortages on the floor, meaning your job will be beyond stressful forever more, and you will not have the respect you deserve. If you really want to work with kids, you might consider teaching. Get your Masters and you can earn up to $75,000 a year, something nurses just don't have. Another option is becoming a Guidance Counselor in high school, working with them. My warning to you is to be careful about going into nursing, and staying on the floors for a long time---it is getting worse all the time. Again though, if you really want to work with kids in a healthcare setting, become a Pediatric Nurse Practioner. Your career begins with a really good market analysis of what you want to do, and where you can work in good working conditions. Just keep in mind that nursing is falling apart, and if I were you, I would do that only if I knew I wanted to be a Pediatric Nurse Practioner. This gets you out of the hospital crisis in nursing, though you will have to earn a BSN in nursing first....do a bunch of research and talk to a ton of folks already doing all the things I mention so you can get a feel for your direction. Give yourself time to do this and don't rush into anything. I hope this helps!

Culture, culture, culture! Sounds like a power struggle between the resident, you, and the attending. Hospitals often put out an ethics policy, but many residents are not fully aware of their role implementing the policy. Attendings may also not be fully aware of the written policy as it relates to how an RN may respond to a DNR decision when that decision has not yet been put in writing. Like many posters have commented, even if the attending felt the patient should not be a DNR, it is still up to you to keep the family in the loop, and do what you can to bridge the decision between the PATIENT, the patient's family, and the attending. A DNR on a chart, in writing, means that everyone, everyone, is on the same page. If the DNR is not there, and the family continues to request one, it is then time to quickly go to your manager, if he/she is there, or the nursing sup for sure, and make sure you define how you followed policy. This probably should have been done when this first occurred. In any event, your manager did not handle this appropriately. She/he should be your leader, your mentor, and your supporter, in situations where you do things right, and in situations where you may need to do things differently. This is a situation for the Medical Affairs Director's input, too. If your manager and resident both opposed your consulting an ethics person, why is there a policy in place at all? This sounds like a good learning case for everyone involved, and at some point you, your manager, the resident, the attending, the ethics officer, the compliance officer, the Chief Nursing Officer, and the attending need to sit down and go over this. Like today.

Welcome to nursing. This kind of job related behavior is all too common, and at some point we as nurses have to stop this, rather than accept it. Stand up for yourself, and go to your manager and tell her/him that you are going to HR with all your documentation. This includes getting copies of your good reviews. Ask who else on the unit has committed med errors, and ask whether or not they were fired after the first error. A med error is not an acceptable reason to fire someone while they are still in the probationary period, in fact, there are laws against retaliating against someone for a med error, especially since you are new, and learning. New nurses can almost be expected to commit errors, and your hospital has the duty to help you through these errors. There are policies and processes in place to remedy med errors, and you should find out from your manager and HR what that process is, and that you were not entered into this process. If your manager placed you on days, that is the manager's decision, and cannot be used against you later. You have 2 wrongful reasons for termination: being placed on days (out of your control), and retaliation against a med error. I would tell your manager and HR you were wrongfully terminated, and unless you are placed back into work, you will file an EEOC form. It is against the law to retaliate against an individual, and fire that individual, without good cause. You have a case, and I would strongly encourage you to step up to the plate and uphold your employment rights. Yes, the manager was looking for a reason to fire you, but a med error is the wrong reason and will not stand up with the EEOC. While you are in HR, ask for a meeting between your manager and the Chief Nursing Officer to discuss this termination. I imagine if the CNO finds out about this, she/he will be smart enough to know this can't be done. They broke the law - and it is up to you to be the one who is strong enough to go up against them, retain your rights, and demand your job back. Nursing will never change unless we change the way we are treated.

This is something that needs to rise up through the chain of command by your nurse manager. This resident should be reported to the Medical Affairs office, and ultimately to the Chief of Medical Affairs. This is an HR issue and this behavior by the resident is very close to being illegal. There are laws against pursuing relationships between coworkers, especially when the advances are unwanted. Do not delay - talk to your nurse manager. Residents are expected to uphold the highest of ethics, and this is an ethical violation as well. It makes me wonder what kind of professional this guy is with patients. If he feels free to harass you, what will stop him from a patient violation? Hop on it, this is serious stuff that needs to stop. You will in no way be punished, written up, etc. Laws are laws!

May I ask, what is your field of specialty - in other words, what type of nurse are you, and what floor are you on? From there can give you some advice!

Oh, this is tough. I hear you, empathasize with you, and at the same time have to agree with Jolie's reply. Let me give you a bit of history to help you out. None of this is your fault. It is what happens now with putting new grads, and early nurses into specialty areas. I want you to understand very clearly what your initial post is all about - just ending the first year of nursing. I graduated from nursing school in 1986. No one, no one, was allowed to enter a specialty area without at least 2-3 years of med surg experience. In fact, you could not go to a tele/critical area as a new grad. And the last place you would qualify for after only one year or less is L&D. Because of the nursing shortage, early nurses are put into positions simply because there are no other nurses to fill those positions. Nursing schools are not about to tell you what you will face. So you wind up in places for which you are not qualified, because you do not have enough years behind you. Once you get there, the few experienced nurses who are still around can't train you, because they are too busy getting emergencies done on their own. They are EXTREMELY frustrated that they have no experienced nurses working with them, and they have to do what they have to do for safe patient care. No one wins. It's not that you aren't L&D, or any other specialty. It's that you have no available full time preceptors. They are too busy working on their own with the shortages; and in a high acuity area such as L&D, they will express their frustrations to you because what they really need is a few more experienced nurses working along side them, so they have the time to train you. I think you need to become more clear about what type of nursing you want to do. If you really want L&D, just hang in there. You will learn. If you don't like it after a few months, figure out what area you might like. You will figure it all out - but because of the nursing shortage, new nurses are overwhelmed with things to which you are not prepared. Just bear with it....

Are you an IMG? I have to ask. And if you are, you need to say so here. Foreign doctors and nurses are coming into our country. My concern is that their initial training is not as good as here in the US. Patients also have concerns about someone with whom they are expressing their greatest needs/emotions while dealing with language and cultural barriers. I am not all that happy about the US physican and nursing shortage, resulting in foreign imports. I am concerned about ultimate quality care in this country...and I have been in it 26 years. Welcome to the new US Healthcare System. I am torn about this. I want it to be good, but am just not so sure it will be....

Absolutely, positively, do not give up on your goal of becoming a Registered Nurse. You have wonderful healthcare experience, and you will be a terrific nurse. While you may feel being an RT goes unrecognized by schools, there is no denying your 8 years of patient care - which will serve you well -and has nothing to do with a GPA - patients don't care, they just want you on their side. Plus your GPA is fine, it's average. Your drive, your compassion, and your healthcare knowledge will ultimately outweigh any obstacles you now face. Are you saying that your current university offers an accelerated nursing degree in one year, after June 2009 when you get a bs degree, and are you guaranteed a position into this program? Feel free to [PM] - I can help you figure this out. I am a master's prepared nurse. By the way, my husband went through the same thing. He is now an Internal Medicine doctor. He was born to be one, and he knew it. He was turned down by many medical schools, who said his GPA isn't good enough, and his MCAT (the test you have to take for med school) scores were horrible. He impressed the Dean at Columbia Med School with his drive. He got in, and failed his first year there, because he isn't good at hard science, plus he is color blind, so he couldn't get through the slide portion of histology, etc. He got through the second time. I am talking Ivy League education all along - undergrad and graduate. He is now the top producer in a large medical practice. And his patients have access to his cell phone, 24/7. 5,000 patients. They call only when absolutely necessary, which isn't often. He takes such good care of them that most of them do not need to call him. He has had patients for 25+ years, and he goes to each and every funeral or calling hours. Does this have anything to do with GPA? No. And it doesn't mean anything for you, too. If you want it, go for it. Please do [PM] me!

I know you can't disclose the details, but without the details, it is a bit difficult to comment. Except to say that you ran straight into the culture of silence in hospitals these days. This will pull at your heartstrings, and give you good reason to think alot about this ethical and practice dilemma well into the wee hours. Unless you have strong leadership from the CNO which filters down to Directors and Managers, creating good feedback communication loops for you, you will be seen as the black sheep. Sad, but true. You have some decisions to make: continue to take this scenario up the chain (not recommended), document everything in a time chart with who responded when and why, who did not respond, etc., (recommended) or drop it (not recommended). While the patient was OK this time, next time it may turn out differently. Your license is the most important thing you need to protect. So let's say you do a time chart. Give this to your Manager, and keep a copy. This document will support nursing practice and your State Nurse Practice Act. Whether the manager chooses to do anything this time is not your problem. Next time however, if a patient has a bad outcome, and you get caught up in a real mess, you still have to do everything possible to inform those direct caregivers to get involved, and you need to document in the chart the name of the people to whom you reported the problem. Part of the issue here that is gray is that you responded while the direct caregivers did not, if I am reading this correctly. Makes no difference in court - if you knew about it, and did nothing, your a-- is on the line. If the people you document as having information from you do nothing, then you are free and clear; they are the ones who the lawyers will go after. The biggest problem as I see it here is that you may be in an organization who does not have strong nursing leadership. By the way, was the doctor ever informed, and when, by whom? Ultimate responsibility is with the doctor, too, and a good doc will not like hearing your story about this incident. Be careful though, because you do not ever want to, on your own, inform the doctor re. all events without your Manager's knowledge. There is a chain of command that is very, very important, and extremely inflexible. This is both good and bad. Protect your license, bottom line. This is a good scenario for Quality Committee review. You might ask your Manager about that, too. Hope this helps. You are experiencing one of the most difficult challenges about being a nurse, and trust me, this will happen again, more than once. You must learn to appreciate the culture and the chain of command, and how you can most effectively balance both. You also must be very clear about your own boundaries within your job scope. You might ask your Manager, as you hand off your time chart, how you could have handled the situation differently. Put it in Management's hands. Stay positive, stay involved, and protect patient advocacy all at once. It takes years to do this right....each event is a learning opportunity. Finally, keep a watch on your emotion of anger about this. I would be angry too, but after 26 years of doing this, I would turn my anger towards standard of practice, and best practice, and especially take the opportunity to become closer to my manager, who can serve as a mentor. No one can ever fault you for doing the right things for the right reasons. But you must learn to differentiate between the two in the context of culture, your role boundaries, the makeup of your unit management, and passing off responsibility to those responsible at the right time, documenting such, and then LET GO. Stay away from emotional cat and mouse games with your colleagues - you will never win. Some are very good, and some simply are not. Take the high road. You are a professional; prove to everyone and especially yourself over time that you know how to handle these situations. It will take a huge load off your shoulders! As I mentioned, you may not have management who will support you, but you still have to do everything I mention. You never know - poor management sometimes results from floor nurses who are not willing to take anything to the next step, and they become demoralized. Help them out, you know?

I love that you are choosing between the very best. Both are excellent. I did not attend either, but I would encourage you to ask the schools if you can talk to some of their graduates to learn more about their actual experiences. If one of them says no, then you will know not to go there, because they have something to hide. Both should say yes though, and that will give you an opportunity to learn first hand. Get a bunch of questions together on a form for interviewing, and fill in the blanks as they talk to you. Then do some comparisons between the 2 schools. Hope this helps, and Good Luck!