medic97RN09

Things I HATE: #1. Charting. For every minute of face time with a patient there is at least 2+ minutes of pre/post charting. #2. Charting/Meaningful Use. Even though the patient came in for XYZ complaint. I have to address: colon screening, Flu shot, PAP, check allergy button, check the PMH button, check the Medication button, and check the PMSH button (even though I'm doing this during each encounter). #3. Charting/labs. Calling patients back getting their voice mail, playing phone tag with lab results, dealing with nurses playing phone tag with patients and then the patient asks a stupid off the wall question which then gets routed back to me to address #4. Charting/Doc of the Day/covering for other providers on vacation/sick time #5. Getting my mailbox stuffed with ASININE letters from insurance companies telling me they won't cover a medication OR the patient is not taking their medication correctly OR did I know the patient was on GASP!: aspirin and plavix at the same time.... #6. Fighting with pharmacies on drug coverage. Such as tablet was covered last week but now have to get a prior authorization to pay for tablet. 15 minutes on the phone with the pharmacy and MIRACULOUSLY they cover the medication in capsule form!!!!!! #7. Peer to peer phone calls. I ordered an MRI. Insurance refused to pay. Spend an hour on hold, finally talk to a doctor and spend 30 seconds explaining case when they give me the approval number! #8. Getting messages from local Home Health agency from local hospital ALL on the same EPIC charting system sending me HANDWRITTEN NOTES ON DRUG ALLERGIES that I ALREADY HAVE TO CLICK ON a button accepting drug allergies prior to the damn charting system letting me send in a refill... #9. Charting/EPIC MyChart messages. Patients sending off the wall questions that take time away from seeing patients #10. The inefficient bureaucracy of medicine. Im able to bill 50-60% of my time (face time encounters with patients scheduled that day). 40-50% of my time is spent on UN-billable time (inbox/refills/mailbox/phone calls/etc) #11 filling all the patients meds, hit the send button, THEN they ask for it to be printed OR sent to another pharmacy OR asking for a 90 day supply #12. I once filled out a prescription 5 TIMES for a walker. (1) Patient asked me for a walker. (2) They then asked me for a rollator walker. (3) The rollator walker has to specify 4 wheels and brakes. (4) The rollator walker has to specify 4 wheels, brakes, and a basket. (5) The rollator walker has to specify 4 wheels, brakes and a basket PLUS ensure the diagnosis was attached PLUS date it. #13. Opioid Pain meds requests #14. Disability requests #15. FMLA paperwork requests #16. Unrealistic patient expectations. For example, seeing a patient who has had 42 back operations over 20 years comes to me with back pain complaint (instead of going back to the surgeon) SMH! #17. Never getting a lunch because of charting #18. Never getting a bathroom break because every second of every day spent on being as efficient as possible. Everything NOT addressed during the day rolls over into personal time at home. #19. Working 36-48 hours a week as a nurse and getting paid for every hour that I worked. Now as an NP, I'm supposedly a professional (salaried) and I put in at least 50-80 hours per week. AND the nursing/ancillary staff wonder why I don't look them in the face (instead of eyes glued to the screen charting) #20 Dealing with soul-sappers. These are the vampires who will drain your soul dry. They are the non-compliant patients who promise the world but never make any changes. They don't have any money/finances/insurance/homeless and ask for more money/services/free stuff... Things I love (which makes me go back to working da grind every day). #1. Making a connection with a patient. I love walking into a room and the patient glances at me with a distrusting and hostile look (because they don't know me). 1/2 way through the encounter they start leaning forward, paying attention to everything I'm talking about. And at the end hearing them say "can I come see you again" #2. Catching bad things others have missed (cancer/autoimmune/etc) (Again, not that I'm that good, most of the time its being in the right place at the right time to catch the diagnosis.) #3. Doing the right thing for patients and earning their trust. For example, seeing the wife, husband (farm worker) walks in behind patient with an obvious basal cell cancer underneath eyelid. Whole encounter stops and I focus on him (MOHS surgeon got to him quick enough they were able to save his eyelid...) #4. Making an impression on a patient THEN start seeing their spouse THEN start seeing their family THEN start seeing their church members (because of #3 above) #5. Calling and checking up on sick patients. #6. Hearing 3rd hand on how good the care you've been providing #7. Bending over backwards for a patient (my usual care) who come to find out is the cousin/family member/church member of administration/employee's and word gets back to you on how they appreciate the care which was provided #8. Learning new stuff every day #9. Challenging patients #10. I LOVE humble patients!!!!!

Just to clarify, on your 2nd day of orientation they changed what they were going to offer you? If so, walk away and cut your losses. If this is what they do on the 2nd day. Guess what they are going to do on the 3rd day...

Going to nurse practitioner (NP) school requires a tremendous time commitment which will take time away from your toddler. Only you can balance the scales and decide whether or not the sacrifices you will need to make are worth the time away from your family. YES, you can go back to school (at any age) and get your NP. However, there is a price to pay because your focus is on school/papers/tests and not being able to simply relax and enjoy family time. With that said, I have precepted several female NP students who had both a FT job AND small children while attending NP school. If they could do it, you certainly can, however, you better have a supportive spouse/family.

North Carolina requires one to maintain both their RN and NP license (see below). I would bet that all if not the majority of states have the same requirement. I recommend that you look through your state Board of Nursing rules/laws/regulations. Once you have the regulations pulled up on a web page, type CTRL-F (this is the shortcut for "find"), then type in "Registered Nurse" This will allow you to quickly scan the NP rules/regulations/laws fairly quickly to find the answer you are looking for. North Carolina Rules/Regulation/Laws SUBCHAPTER 32M - APPROVAL OF NURSE PRACTITIONERS 21 NCAC 32M .0103 NURSE PRACTITIONER REGISTRATION (a) The Board of Nursing shall register an applicant as a nurse practitioner who: (1) has an unrestricted license to practice as a registered nurse in North Carolina and, when applicable, an unrestricted approval, registration

I have nothing against anyone who attempts to further their education. However, I don't understand why anyone would go through all the headache of becoming a NP without EVER being a RN. A Physician Assistant can go from nothing to a PA with no problem. Someone who goes from nothing to NP raises flags in my mind. The FIRST question that ALWAYS pops in my head was why didn't you go to a PA program instead? The SECOND question that pops in my head is were you TOO GOOD to work as a nurse? With that said, this past Friday at our practice, we had a "roundtable" interview for a potential candidate (NP) to join our practice. I can honestly tell you if that person had ZERO experience as a RN they would NEVER have received an invitation for an interview. Just to be 100% clear, this is NOT my intent to start a FLAME war. This is NOT a personal attack. Its just MY honest 2 cents. I graduated from a bridge program myself and went from nothing to NP. However, I was ADAMANT about being able to put on my resume that i had 4 years of FULL TIME ICU experience on my resume. I paid my "dues" as a RN and in my opinion, my resume shows this. If you spend any time perusing the discussion boards on Allnurses.com you will see numerous posts of NP's experiencing difficulty obtaining employment. In the city where I live the University is churning out class after class of BOTH Physician Assistants and Nurse Practitioners PLUS there are 4 other NP/PA programs within a 3 hour drive churning them out also. UNLESS you networked your way into a job. UNLESS you know a physician who is ready to hire you already. You would not be able to find a top-tier employer willing to hire you in my area. (Even if you have a 4.0 GPA)

I could care less what i'm called. On a daily basis, I get called Doctor, Nurse, Extender, Physician Assistant, Resident, Medical Student, Provider, and even sometimes a**hole when I don't fill a narcotic Rx. What motivates me is providing high-quality care and making a connection with patients in order to make a difference in their healthcare needs. Not a day goes by that someone doesn't ask me if I can be their PCP (instead of the doctor they've seen for many years) OR patients tell me they "opened up" to me and confided in me things they've never discussed with their PCP. Every day I routinely see patients who give me the ole "stink eye" when i walk in the door but leave with their respect and confidence in my capability to manage their health. These are the things that let me know that I am making a difference and earning the respect of patients, staff, and peers. Not whether or not someone calls me a Nurse Practitioner or not. So, as Ray Jay Johnson Jr used to say... You can call me Ray, or you can call me Jay, or you can call me Johnson...

You (personally) have to make the best of your clinical exposure! I am getting ready to leave the house in less than 5 mins to spend all day in GYN clinical. I am a male A/GNP student in a GYN setting. I feel like a fox in a hen house. I have to fight and claw for every patient encounter that I get. Now don't get me wrong, the staff is great and my preceptor is awesome but as soon as the patients see a male they are like "NO! I don't want to see a (male) NP student". Thats Ok, I make the best of my clinical every time I show up. I listen, I spend time on the microscope practicing, I review charts, I overhear a patient has XYZ and I start looking it up on UpToDate to become more familiar, and I am constantly picking my preceptors brain about any GYN guidelines, medications, etc. If I was in your shoes, I would take one of the harder patients after they were reviewing and perform a chart audit. Look up every diagnosis, medicine, etc and then ask questions. Why did you do XYZ, why not this. What were your differentials, etc. Hope this helps.

CRF250Xpert, can you clarify your "Adult is going to disappear" comment? If A-NP is going to disappear, whats going to happen to those with this degree? Thanks in advance for your comments!

I don't study any the day of a test. I basically get into my test taking zone and i don't stress by taking a f***it attitude. If you don't know it by now, you're not going to get the material by cramming trivia at the last minute. Now afterwards, alcohol is a good stress relief! C

I am getting nervous myself. I'm gonna schedule to take the NCLEX at the end of this month. Everyone has told me that i'm gonna do fine and that i'm gonna pass with no problems. I still don't believe them and i'm just gonna spend the month of August stressing and studying. C

Congratulations!

The whole hiring process is well, a process. I was offered an interview but it took 2 months before I finally was able to get a little face time with the manager. Luckily for me, they told me that i should hear something from HR within a couple of days. HR called me at 9am the next morning. So either the sun/moon/stars were in alignment or i was just plain lucky. C

I would say it depends on your grades. If you can maintain your GPA and work, by all means, i would recommend keeping on working. I know that others will tell you to stay at home and study BUT i would disagree. Working would be a great stress relief when you can't stew about your nursing instructor ripping your paper apart because you didn't follow APA format. Plus, the extra money comes in handy when you need a drinking binge following a bad day at school/clinical. C

Buy a 1/2 gallon or gallon size jug of Tylenol & Motrin. :)

I've just finished my rotation on Cardiac ICU and i experienced the same problem. My preceptor used neonatal POX probes and put them on the patients ear lobe. Seemed to work every time. C