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  1. wyosamRN

    ER patient wanting pain Meds

    Did the lidocaine give you an arrhythmia?
  2. wyosamRN

    University of South Alabama Dual NP Summer 19

    Write a decent essay and you'll be fine with that GPA. Best of luck!
  3. wyosamRN

    Prescribing Medical Marijuana

    It has really got to get out of its current legal limbo before I would consider prescribing it (not to mention I probably live in the last state to legalize, and am not yet a provider). 1.- still federally listed. That is a big problem, since a provider needs the DEA to continue to allow them to write prescriptions. 2. It is not FDA approved for anything- not that it is not useful, just not approved. 3 When a provider writes a prescription for "medicine" it contains information like dose, route, frequency, amount to dispense, refills, etc. Yet with pot, it is just a "so and so can have some weed".
  4. wyosamRN

    Oversupply of Nurse Practitioners

    That is an RN job. it is a PT infusion therapy gig at a med-spa. They do list RN or NP, but if you want to do RN level work as an NP, it would be expected that you will receive RN level pay.
  5. wyosamRN

    Stop the preceptor madness!

    I suspect that what was being referred to as regulation was mostly in terms of education, not practice. As long as the education system for NPs is as it is now, the field is in serious jeopardy of losing all credibility. There are many great providers out there, and even many great providers out there who went to horrible schools. However, as long as we (the groups that accredit NP schools) continue to have such minimal standards for entry to the profession, we are cheapening (both literally and figuratively) the profession.
  6. wyosamRN

    Starting from zero, want to do ACPNP

    Time to work is key, and assuming peds is similar to adult acute care, most programs want relevant experience anyway. Lots of "direct entry" Primary care roles, but thankfully the acute care programs are avoiding that. Best of luck with your goals, peds hospice sounds like incredibly hard, incredibly rewarding work.
  7. It is funny that LPn's are used in this way- phone triage is way outside their scope, assuming there is anything to the triage, and not just referring everyone to the ED (which, based on experience, is what many phone triage nurses do, because CYA makes sense when the only assessment data you have is speaking to the patient or parent). As far as how common RNs are in OP, it must be fairly regional. The pay is certainly less here, but they are common, and not necessarily well-off. The job choice frequently seems to come down to "what can I do that allows me to work when day care is available?" It does seem that the clinic RN role probably makes no sense if they are not utilizing their skills and knowledge. Let the MAs have that role. In many cases, they are probably more useful anyway, since they can be task trained as techs in many states, and they are not subject to the limitations of NPAs, while able to perform many of the same tasks.
  8. So what is the role of the RN in the outpatient setting? Why the heck is the clinic paying them? Why have someone with training and a license (and the salary that goes with it) if their knowledge is not going o be utilized? Assessment data collected by an RN is valid. The provider could absolutely note in the chart that the embedded tick was removed, and that the patient requested that areas she could not visualize herself be checked, and that an RN performed that task and that no further ticks were found. Does the provider need to get their own VS, since they are responsible for including them in documentation for the visit? The opinions being expressed in this thread make RNs in the outpatient setting seem like a complete waste of money. Maybe that's why we're increasingly seeing MAs take over the role.
  9. Again- the patient came in fully equipped with the perfect training tool for how to find an attached tick. She was there for an attached tick. Surely whoever roomed the patient looked at the tick? I can't believe this is being made out to be so complicated. Surely people see patients with conditions/injuries/chief complaints that they have never seen or had formal education on.
  10. Exactly- if not an appropriate assessment, what exactly is the role of the RN? As far as long term management- at the time of the bite, other than good wound care, there isn't much to do (at least with the potential tick borne illnesses in my region- we don't have lyme, and maybe there is some initial management in that, or other cases). The potential tick born illnesses in my world are fairly rare after a bite, and all we do initially is give them instructions on wound care (soap and water), and signs of complications, including those that might indicate tick borne illness, and when to seek care if symptoms occur. Still doubt we'll spend much time on it in NP school, if any. Last summer I saw a jellyfish sting. In Wyoming. Don't see many of those here, but both the provider and myself (neither of us had ever seen a jellyfish, much less a jellyfish sting- he trained inland, too) did some quick research, and did just fine. That was after my initial assessment, which did not require me to know anything about jellyfish. Describe what you see, just because it is something different, does not mean the basics no longer apply.
  11. But here is the whole crux of the issue- I would bet your NP program will not, as I'm sure mine wont, give you an education on ticks. It might, but I would be pretty surprised. Given the limited amount of time we spend learning to be providers, I sort of hope we don't spend a bunch of time learning about ticks. I actually ran into this once at work, only it was a provider new to the area, who hadn't dealt with ticks before (he said that he vaguely remembered covering them in med school, but it just wasn't something he been exposed to). Patient has a deeply embedded tick, and another area that I had noted as a possible second bite location (as an RN! I never realized how advanced I was in my field until this thread! A skin assessment appropriate for the chief complaint! I should get an award!). He admittedly had no idea what he was looking at- so he spent 3.2 seconds doing a google image search for tick bite. Then he spent 45 seconds reviewing on you-tube how to best remove an embedded tick. A quick reference search on potential tick born illnesses for the area to educate the patient to look for signs of, and we're done. Weather as an RN, or as a provider of any type- you are not, and never will be educated specifically for every possible thing you might have to do. What your education is supposed to do is teach you to think your way through problems, and how to use resources to work through the problem.
  12. It really doesn't matter. Its a skin check. Given the chief complaint, if you see something that is suspicious as an insect bite, document it and let the provider know it is there. If you see an embedded tick, same thing. Even assuming the RN has no knowledge of ticks, in this case I don't see what is so complicated- I'm assuming that one of the same nurses asked to complete this assessment looked at the tick the patient was there for before the provider saw the patient. That's what you're looking for. Freckles with legs if we're talking about little deer ticks, or moles with legs if we're talking about wood ticks/other large species. Either of those things would be charted as abnormal and passed on to the provider on a skin check, even if there was no knowledge of a possible tick, no? What am I missing that makes this complicated and outside the scope of an RN?
  13. wyosamRN

    Which NP certification is better???

    I'm fairly certain that employers, and everyone else, do not care. Who has the closer/more convenient testing location for you? That's my plan when the time comes.
  14. Ok, I'm an RN, have been for some time now, and am starting NP school in August. I do not get all this "not in the RN's scope, it's an unusual task, blah, blah, blah nonsense." A skin assessment is not in an RN's scope because it relates to the chief complaint? WTF does that mean? Does that mean that if a patient comes in with a CC of shortness of breath, that the RN shouldn't listen to their lungs because the provider will do so as well? Frankly, if you are not doing assessments related to the chief complaint as an RN, then you are working as an overpaid CNA. If you don't understand a particular assessment that you do not do often, then by all means, ask the provider to clarify, or consult whatever reputable sources you typically use to learn new things as an RN (yep, lots to learn outside school, and even whatever education your employer provides). Quite frankly, whoever roomed this patient should have had them in a gown and discussed a skin check with the patient before the provider ever saw them. The reason for the areas the patient wanted checked that people are questioning? Its in the original post- she lives alone, and she wanted someone to check the areas that she cannot check herself. Not an unreasonable request in my mind, particularly if you are already there to have a tick removed. Sam
  15. wyosamRN

    Specialty for introvert?

    I don't agree that changing yourself would be ideal. You are who you are, and don't let anyone make you think that you are "broken". I'm an introvert, and used to think the same way. If you haven't read the book Quiet- the Power of Introverts in a World That Wont Stop Talking by Susan Cain, it is a great read, and is very informative. I've worked ED, OR, and oncology. Oncology was tough for the same reasons people have mentioned about hospice. OR I didn't care for too much. Intubated patients are all well and good, but surgeons and other staff tend to drive me nuts. ED is my home- I've figured out how to make it work. As you said, patients are easy, co workers can be less so. Biggest problem I've found is that my wife (also an introvert) does not get as much "socialization" at work, so she is more likely to want to do things with people on her days off. I get all the people time I can handle at work, so I tend to want to be a hermit in my off time. Working nights is key for me. Too much staff/administration around during the day.