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squinky12

squinky12

pediatrics
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  1. I am a certified Pediatric Nurse Practitioner in primary care since 1990. About 2 1/2 years ago, I developed some serious health issues and had a lot of treatment and a couple of surgeries. I had a severe car accident in 2014 and had to leave my job of 7 years in 2015 due to ongoing issues. I did locum tenens for a couple of years after that with my last contract ending in November 2016. I am now completely recovered with no restrictions, medications or other things keeping me from working and I really miss working. I have been actively searching for at least 6 months. Apparently, I can no longer do locums since the malpractice carrier will not add anyone who has not worked in over 24 months. I have applied for several jobs in my area (Central Texas) and can not even get an interview or a response of any kind. I do feel I still have a lot to offer in terms of ability and experience and would love to hear any suggestions about returning to the workforce. I have maintained my license and certification. It is frustrating that a family nurse practitioner who graduated last year has a better chance of working in a pediatric clinic than I do.
  2. squinky12

    how to gain confidence

    If this is your first job and you have only been a NP for 5 months it is pretty scary to think that you are basically "on your own" with your MD in another office. Having an OB/GYN and a DO (probably family practice??) does not represent a safe or supportive situation for you or your patients. Perhaps spending half a day on your own doing well child visits and routine followups and half a day with your MD seeing acute and more complex patients would help you build your confidence just knowing you have someone to "take a look" at something with you. I have practiced for 20 years but still welcome the opportunity for one of the docs or other NPs in our practice to help me out when I get stumped. I do practice sometimes alone in our office but I would not have felt comfortable doing this 5 months after I graduated. Good luck to you!!
  3. squinky12

    Would home health care be a bad decision

    Now, you have to remember that this was in 1990-1992 but it seems that we paid a minimum of $40 per visit back then (more for infusion visits) and the nurse was expected to do the visit and deliver the blood sample (if needed) to the lab as part of the deal. Mileage was paid extra using a per mile amount. I did quite a few early post partum visits and literally drove around with a portable infant scale, a sharps box and PKU slips in the trunk of my car for a year. We were willing to pay $60 per visit but most nurses were either afraid of the baby or afraid of the mom. I LOVED doing these but it can be a LOT of driving. Don't know what type of a visit the doctor was expecting you to make for $25 but that seem awfully low. I have heard that some ANP/GNPs do nursing home rounds/visits and that $25 might be a little better if you could do a number of visits in the same setting.
  4. squinky12

    Would home health care be a bad decision

    If you are interested in home health care as a career as a NP then by all means get some experience doing it before entering a NP program. My very first job after graduation as a PNP was the Director of Nursing for a pediatric home health agency. We did both skilled nursing visits (IV therapy, phototherapy, early post partum discharge visits) as well as long term staffed cases (vents, central lines, etc.). In addition to the "nursing" part of the position (doing intake assessments, attending discharge conferences, etc.) This was actually my goal as I was going through NP school. I also was involved in negotiating contracts with insurance companies, contracting with DME, lab and pharmacy companies, hiring and training nurses, writing policies and procedures, etc. I think this field is wide open for nurse practitioners but it does have it's own set of problems (long hours, on call, family "situations" being less than optimal, ENDLESS paperwork)--maybe try it out and see what you think.
  5. squinky12

    How do you spell relief?P A S S E D B O A R D S

    I am curious as to what state you live in that requires some type of test to practice as a PNP. Or are you talking about the certification exam (NAPNAP)? Either way, CONGRATS :yeah:on passing your boards. Here in Texas we practice with an RN license with a designation as an Advanced Practice Nurse in Pediatrics with limited prescriptive authority. There was no test, just documentation after graduation sent to the board and additional continuing education requirements (and of course more FEES) to maintain the designation as an APN. Additionally NAPNAP requires additional CE and/or clinical practice documentation or the completion of the annual self-assessment exercise to maintain PNP certification. I know things differ from state to state. Again, WTG on passing your boards!!
  6. squinky12

    any PNPs out there??

    I guess I am just really lucky because I have a great situation and have always been treated well--I really like and respect the docs I work with and I was their first NP. Our second NP was a new grad 2 years ago and was actually my student for a semester. She does a lot more "consulting" than I do and is still on a salary type situation but is also treated well. In the past, I have had a couple of HORRIBLE jobs but never for long because I am not the "suffer in silence" type. The worst was a "med-ped" who could not understand why I would need longer than 10 minutes to see any patient AND wanted me to see some of his adult PHEN-FEN patients for him (no way) when I was not busy (and we all know how THAT turned out).
  7. squinky12

    NP by state or USA?

    The only exception to the state rule is if you work for the federal government (prison, military base) either as a GS employee or civilian contractor. You can work in these settings with any state license. I only know this because I have a FNP friend who works in a clinic on Fort Hood in Texas and she is licensed in Utah.
  8. squinky12

    NP Education and Practice

    In my opinion, nurse practitioner education gives you a foundation that prepares you to learn to practice as a nurse practitioner. I was lucky during school since I already had 8 years of pediatric nurse experience and only had to learn about kids in NP school. However, I did have to learn circumcisions, suturing, pelvic exams, male prostate exams, ADHD evaluations, developmental testing, and many other things I was unfamiliar with. I think having good preceptors is crucial and taking the time to focus on learning and understanding a given situation rather than pressure to "see" a certain number of patients is helpful. Having worked in a "teaching" hospital with med students, interns and residents I can honestly say that most of them have very little idea what to do with an actual patient at first and learn by doing. Just be gentle with yourself and don't think you are going to graduate and begin practice "knowing it all". I still learn new things all the time (medicine constantly evolves--we all learn as we go) and see conditions/problems that I have never seen before after 18 years as a nurse practitioner. This is what makes my job fun and challenging. Plus, the ability to use words like "boogers" and "poop" on a daily basis.
  9. squinky12

    any PNPs out there??

    I have continued to think about this and have a few more thoughts (I am a math geek so bear with me): If your friend is earning 120K per year then this works out to slightly more than $2300 per week. If this is based on seeing 300 patients per week (100 per day for 3 days per week) then she is making $7.69 per patient seen. In our office, I work on a percentage based on the amount of money I bring in to the practice. This is good because it shows the total amount I bring in and I have a computer log of all patients I see. Once you have this figures the possibilities are endless... As a math geek :imbar I did some statistics based on my earnings over a 3 year period and learned that I made approximately $18 per patient seen on the average. This is a mix of payors and a mix of sick and well visits and includes some inevitable write offs that occur when accounts go to collections. Surprisingly, Medicaid and CHIP pay more than many of the private insurers for the same service. During the same 3 year period I saw an average of 28 patients per day and worked a total of 47 weeks (not paid for vacation time, sick days etc. So, this comes to an annual salary of $118,000 per year which is pretty close to what is being offered to your friend. In her case, assuming anyone could consistently see 8 patients per hour, they should make $144 per hour so working 36 hours per week should yield $5184 per week/$269568 per year which is more than double what she is being offered. Hmmmm---someone is making a whole bunch of $$ here and your friend is only receiving a small percentage of that. Of course, paying for her lodging and whatever other benefits are provided would also have to be taken into consideration. Hope nobody's eyes glaze over when reading this:D
  10. squinky12

    any PNPs out there??

    There are a few issues with this that I can address: First of all, the border clinics advertise CONSTANTLY offering high pay and great bonuses. Tells me something, since it would not seem that hard to fill those positions if they were worth having. Secondly, your friend must be FLUENT in Spanish to even consider doing this since she will most likely see mostly Spanish speaking kids/families. I do know some Spanish and can often use another kid in the family to help but it takes a bit longer to get a straight history and give instructions. I have a nurse in our office that is fluent and she helps me as needed (right in the room with me:)) Third, many of the patient are illegal immigrants which presents certain other issues that your friend needs to understand. There may be no followup and prescriptions may not be filled unless you can provide them samples. Unless they are to the point that they need an ambulance to take them to the hospital, you will have no ability to follow them up or make a referral. Fourth, 100 patients in 12 hours is insane. I don't care who you are. I worked last winter on a Saturday (we are open from 8:30 until we are done) and saw 31 patients in 4 1/2 hours. Keep in mind that we take only established patients for sick visits on Saturdays--my nurses do a rapid strep on anyone with a fever and sore throat/vomiting/rash, dip a urine on all urinary complaints and start breathing treatments/get a pulse ox on known asthmatics before I see them. Plus, I dictate my notes for the transcriber which cuts down charting time and have scripts that allow 3 separate drugs on one form. I could not see 100 patients in 12 hours. Fifth, there are some nice places to live on the border but there is also a lot of crime, poverty, drugs, car thefts, etc. She needs to make sure she is comfortable where she is considering going. JMHO, her MMV and I hope it works out for her.
  11. squinky12

    Howdy from Texas!!

    I just found this site and am really enjoying it. Who knew there was a site like this for nurses? I have been a nurse (LVN/RN/PNP) since 1980 and have only recently begun reflecting on my many years in our profession. I started my career in an ADN program in the local junior college in the city I grew up in in West Texas. I was an LVN for a year then returned to school for a year and became an RN. My original career goal was to be an L&D nurse--I thought it was the coolest job ever since the nurses had a lot of responsibility and you were able to share one of the true miracles of life with others. Plus, they didn't make you wear the cap and the white hose (yes, it was THAT long ago:p). I was a bit of a rebel in nursing school but made it through... Anyway, clutching my GVN permit I applied at the local hospital and stated I wanted to work in L&D. The DON (a 50 something woman in a starched uniform and cap chain smoking Marlboros) looked at me and said, Mary, where I really need someone right now is on pediatrics. If you will work pedi for 6 months then I will put you in the L&D orientation. I was devastated---PEDIATRICS---I hated pediatrics in school and the students never got to do ANYTHING other than look at the kids in the oxygen tents and maybe take their temperature. But, my 22 year old self smiled and agreed. I was assigned 3-11 on a 32 bed pediatric floor and started in January. I was scared to death but went to work and was really overwhelmed for the first few months. This was back in the days before HIB vaccine and we would do 5-10 spinal taps PER DAY and it was just exhausting work. However, the peds docs were really cool and I had some great mentors...fast forward, six months later I was offered a spot in the L&D orientation and turned it down cuz I couldn't bear the thought of leaving the pediatric floor. Back to school as a RN student a few months later and still worked part time. My coworkers were so supportive--let me start IV's and hang blood, etc. to the point that when I got my GN permit I was the charge nurse on the night shift. Lots of ups and downs in the next couple of years--lost a couple of chronically ill kids (CF and Hirschsprung's) that I was REALLY close to and learned alot about nursing and myself. Then, enter MR RIGHT :heartbeat:heartbeat who convinced me to move to the big city (Dallas) with him and off I went to the Children's Hospital there with a brand new job in the PICU. OMG, it was worse than nursing school....it was like watching ER on TV. I felt so stupid and inexperienced but hung in and stayed there 6 years. Learned how to care for heart and liver transplants as well as siamese twins as well as more common patients. Decided at that point to return for my BSN due to rumors (in the mid-80's) that it would be hard to find a job without a BSN While there, got lucky and was invited to apply to grad school and became a PNP in 1990. Still worked in the PICU part time during this and did lots of my preceptorship in the hospital where I worked and at Parkland. Have worked a variety of PNP jobs (hospital specialty clinic, low income clinic, private practice) and have truly enjoyed my adult work life as a nurse. Reading this forum fascinates me--so much has changed. For all you newbies working on (or considering) nursing for a career--it is what you make it and I can not think of another job more rewarding or important. Sorry for the long post, I just got started and couldn't stop:bow:
  12. squinky12

    Does what school you go for your FNP matter?

    I wondered that EXACT same thing at the time--I had no idea that becoming a FNP could be the FIRST job you could have as a nurse and it really scared me. I precept students most semesters but will only agree to do it if they have at least a few years of pediatric nursing experience. I truly believe there should be a RN practice requirement before entry into an NP program and/or recognition by the state as an APN.
  13. squinky12

    any PNPs out there??

    I have been a PNP for 18 years and have worked in a variety of settings--hospital based, specialty clinic, private practice--and currently work (for the past 7 years) in a group practice (3 docs and 2 PNPs) and I see everyone from newborns to teens. I do nursery rounds one morning a week in the hospital and see kids in the office the rest of the time. It is usually a mix of sick and well visits--I devote one afternoon per week to adolescent gyn exams since I like doing them and no one else really does :) Not the exams per se--but the chance for some "girl" talk with girls I have known for quite a while. Pediatrics is a seasonal business and the winter months are tough. The most patients I have seen in one day is 47 . I am very lucky that we have an excellent staff and a transcriptionist who make my job MUCH easier. I take (phone only) call 1-2 nights a week and some holidays and am paid a percentage based on what I bring in to the practice. No holiday or vacation pay but I do get a good annual CME stipend paid by the group and some 401K benefits. I don't know what area of nursing you currently practice in but if you like NICU then a NNP might be an option for you since they are in HUGE demand. If you don't like cranky kids and crankier parents then you really need to look closely at the PNP role:twocents:
  14. squinky12

    Does what school you go for your FNP matter?

    I started my career as an RN in 1982 with an ADN from the local community college. After 3 years, got married and moved to the "big" city and got a job in the PICU of a nationally known children's hospital. Three years later, went to a ADN to BSN program at a "state" school (in Texas) and while there was personally invited to apply for the master's (PNP) program there and graduated in 1990. They paid my tuition and gave me a monthly stipend to become a PNP. I trained with some excellent preceptors (docs and PNPs) and by the time I graduated I had 3 job offers. After 18 (gasp:eek:) years as a PNP in Texas I can honestly say that where I went to school has never come up but my varied experience in pediatric health care has helped me land a few jobs. I worked with a relatively new (1 year) FNP graduate from Vanderbilt (as a young nurse I worshipped Mary Fran Hazinski) a few years back who had never in her life worked a day as an RN and was truly amazed by her inexperience and ineptitude (at least with treating kids)--it was frightening and she lasted only a few months in our clinic.
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