Joan Z

Suckasaurus, funny... I agree that chronic pain is a terrible thing to manage, especially frustrating since you can't SEE anything. And I admire anyone who can treat this and remain compassionate! My concern other than being worn out--since this is not my area and I book 20 minutes per pt--is the feeling of being rushed, or taking time and then running late. A couple of these pts and the day's schedule can be shot to hell, not good when you're trying to be there for all the pts.

But, some pts ARE draining and will suck as much out of you as they can get--it is essential to set limits! We have a few such pts and what the group has taken to doing is seeing so many visits and then saying "and next time I want you to see X so we can get a different perspective" or some such. Because sometimes a different perspective helps, plus it helps prevent burnout. There are some issues (esp when you get beyond the physiological) which don't have a solution but are still a major issue and affect health--like a parent's decline or a spouse who isn't supportive. You can't say "too bad so sad"--sometimes you can try to reframe or offer advice and sometimes you just have to listen. But burnout isn't beneficial to you or the pt.

I practice in Michigan. I have never figured out why some pts prefer certain providers--I know when I see some folks who usually see the physician they are disappointed when they see me (or the other NP). I'll try to have the MD stick his head in the door to bestow the blessing with them. Others would rather see one of the NPs.

I am extremely happy to have made the transition to NP. At one point I remarked that it was so great, I'd do it for free... well, no, I couldn't really unless I had some income from elsewhere. After a lot of number crunching I went from salary to being paid by RVUs--so I have incentive to see people. This was scary, as if I have holes in my schedule, I don't get paid--plus I don't get paid on days off. Plus part of my job is calling after hours to talk to people, get an update, give results--I don't get paid to do this. No I don't have to, I could delegate this to the office nurse who is getting paid by the hour, but I actually do enjoy this part when I have time for it. And, as the word gets out that here is a person who will take care of you in the office and will take time to talk to you outside of the office, my caseload is growing. I have paid off my loan. I have no doubt that I made the right decision, both for my own personal growth and for my financial security. BTW no one calls me "an angel" anymore, but they'll tell their friends to come and see me anyway... and I have never had complaints from folks paying up what they owe.

You're not automatically a NP if you complete a MSN program (or even a DNP)--you have to pass a certification exam and then get licensure in the state you're planning to practice in. It sounds more complicated than it is--plus while you're in the program you'll learn more about the requirements for practice.

It is scary in this economy to not have a job or to leave a job which isn't right--that's not to say you shouldn't try different jobs. If (like Nursesabeti) you know what you want, then you should focus there. However, if you're thinking IM/hospitalist/where you did your clinicals pick one and try it, go for a short-term contract and keep your eyes and ears open. I learn more every day at work than I could believe possible.

Given that I did not want to move away from my three young children and husband, nor did I have the ability to support us if he quit his job to move us all to a brick/mortar institution town, I did not have any choice if I wanted to advance my education but to use a distance-learning format. I worked my a** off to get the most from the program plus really dug in to find high-quality local preceptors who included NPs, DOs, MDs--and even a couple of PAs although these were more for consult as they were not able to officially precept me. I went beyond the bare requirements both in terms of hours and in terms of types of clinical encounters. What you put into your personal education is more important than checking off boxes on a program's to-do list. If you see someone who is working a job where you want to be, ask them what they found most important in their training and make sure you get that. For instance: no requirement for "urgent care" type experience, but I knew from family practice that I might need this. I think I was one of the few in my program who had sutured wounds and reduced dislocated shoulders. I also got to see tons of acutely sick children who did NOT want to have their ears or any other part examined but got checked anyway (many useful tricks not discussed in my program). Do I do these every day in the FP setting? No, but when I need the skills they are there. I don't know that this would have been any different in a physical class setting. Just as with brick/mortar there are many variations in online programs. Ask other NPs or other providers what programs they would recommend or NOT recommend, find graduates and do your research. Just don't expect it to be easy. If it is, be very suspicious.

Hi Chris Sorry about your life upheavals, I was hoping you'd post to say you'd found another job... but it will happen, some day! I don't know if you are interested in moving to Michigan but here are the Michigan Council of NP job postings: http://www.micnp.org/displaycommon.cfm?an=14

A couple of comments-- being in a major university town, I disagree that "doctor means physician"--where I am it is just as likely to mean "Professor". Many of my pts--who have PhDs--wish to be referred to as "Doctor" and they are very much entitled to this. They know that if I refer to the physician as "Dr. X" I am referring to a very different kind of doctor. Also, I have gotten the comment (after explaining that I am not a physician) "but you're MY doctor" or similar. I assume this is a compliment and say thanks, but... maybe these folks don't know how to acknowledge what you've given them otherwise.

I had more years of beside nursing (not as much as some on this forum, think there was a posting about this recently). I don't think it will matter. Good luck.

I can't speak to the lack of experience, but as to age would have been very happy to have started as an NP at the age of only 47. I had no problem finding a job as an entry-level NP. I believe your skills will speak louder than any number of calendar years of experience.

Hmm, I have lived in IL and saw several NPs there (where I first learned about them) and they were fairly autonomous so must be some mini-Twilight Zone you stepped into... So, you worked with the medical director before and had a good relationship, he seemed to get the concept of the NP, but now he is setting limits on your scope of practice? Why the change? Is it the physicians in the ED? I won't generalize that it is only the older MDs who have an issue with the concept of the NP (frequently the ones who step into the hall and yell NURSE! and expect everyone to come running) because I have seen plenty of younger ones--who may be new and insecure in their roles--do the same. People's preconceived notions are based on what they have seen or what they have been told and are very difficult to change. Even if you demonstrate competence and show them the legal authority they may still think of you as NURSE! (and what is worse, the nursing staff may not support you either). You still have your day job, did you do this for extra $? Is it worth it?

No wonder the "midlevels" didn't work out... What is the advantage to having someone else doing the procedures if they need to be there anyway? How much autonomy do NPs have in your state? Is the hospital not aware of what you could legally do on your own? Maybe if you explained (and showed them) what you could do legally and what you have been doing they'd let you go more independent. I was in the ER as a student with another NP and she was pretty much on her own, they figured she'd ask if she needed help or just a consult. And she did.

I have a PhD (in chemistry) and the joke among some of my RN coworkers was to call me 'doctor Joan'. I do see pts who refer to me as "the doctor" and I will always correct that. As for the serious part of your post... yeah, that'd be great, wouldn't it? It is so much easier to focus on little silly things than the major stuff (look at the new president, I have seen more stories about the puppy than the plans for the economy or health care). I think as long as health care professionals are more concerned with turf wars the patient will be an after-thought. My experience with "organizations" is that they devolve to the level of self-preservation, and the folks who might get involved to try to make a change just stay away--or are too busy to take on more.

Have you worked nights before? I know some people are great with them, some get sick. I learned it was really different to have to be up all night and work (as an RN) as opposed to hanging out with friends or lying on the couch reading. If you can bunch your shifts together it really helps.