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I've been an NP for about 3 months now. I make about 30k/year more as an NP, but I also work a lot more hours (usually about 50 hours a week) and as a previous person said, obsess a little about things when I'm home. BUT, I typically enjoy my work more and don't mind working. Its such a weird experience for me - I feel like my work/life balance is a little unbalanced right now, but also don't really mind it since I'm a new NP and feel like this is the time I SHOULD be working like this. Plus, my colleagues are also working hard so it makes it feel a little more reasonable it makes me feel like we are all into it together (unlike how I felt as a nurse, to be micromanaged and unappreciated by nursing management). This is the start to a weird journey for me, I will say!

Primary care all the way! I tell people only to acute care if critical care is what you want. I know plenty of primary care people that work in all those areas. Good luck!

Two points I think I was trying to make in my last post that I didn't do a very good job being clear - and this is me under the assumption you want to go back to school and haven't started yet or are fairly early in your training as an APP - First is that as a provider, its a different relationship that you have with your patients than as a nurse. Until you experience it and see it, you can't quite understand the trust people put into you until you realize that there are people that just trust you to tell them what to do because they don't know. Can you really have enough faith in what you believe thats against the CDC (or whatever the guideline) to guide every patient down that path? Because they will trust you. Which brings me to my second point, is that a lot of your practice is, and SHOULD BE, very guideline driven. How to work up, rule out, and treat disorders. So when you stray from those guidelines, you have to have a really good reason and research to back you up incase something happens. (For instance, I know Keppra is the drug of choice for this seizure disorder but the patient has a history of aggressive behavior and I know keppra can intensify that, so I will pick a less desirable medication). I'm not saying everything is black and white and you don't use your brain (def not), but when you go against whats recommended in all the medical literature because you are a "read the fine print on the insert" kinda girl, well, that goes back to my last post that your job to lay out the fine print and present it to the patient and let them decide what risks they are willing to take. For example, "For the HPV vaccine, it prevents you from several viruses that could cause you to develop cancer. Like with most vaccines, there is a risk of pain at the injection site or muscle pain, fever, fainting, or in some cases, a severe allergic reaction does happen and it can be serous. This is the information about the vaccine and after you do some research on your own, you can let me know if its something you are interested in for next time". DONE.

My sister has endometriosis and goes to a gynecologist that suddenly decided to stop prescribing birth control, no matter what the condition. I would also like to clarify that this wasn't part of a religious healthcare system, it was just because of his personal beliefs. My sister is non-medical and liked/trusted him while he offered her "other alternatives" and suffered for so long before (thankfully) having her first child. I just couldn't understand somebody going into that field and not offering such a major service. It still gets under my skin. I felt like it was unethical in a way - like a previous person said, as a provider its your job to lay out all of the options and give your patient the choice if they understand the risks. If you feel strongly against the CDC vaccine schedule, I would suggest finding a job where that wont be part of your duties. I'm just not sure what your response is if you are ever questioned by a lawyer about why a child died of meningitis or epiglottitis or pneumonia because they were not given the HiB vaccine when indicated, especially if you were following your own schedule and the parent didn't know it wasn't CDC guidelines. In general, I have a lot of difficulty understanding a provider that puts their personal beliefs ahead of research or patient autonomy. I feels like it crosses a line and makes me feel uncomfortable. I wouldn't want my physician to withhold treatment from me or slant their "speech" about treatment options and leave out certain ones based on personal beliefs. If they disagree because of experience or research, thats totally justifiable. But patients put their faith in you as a provider to guide them. If you have personal beliefs that aren't backed up by evidenced based practice and practice guidelines, I would really just suggest finding a job where those beliefs don't conflict with your job. All this is said with respect and isn't a personal attack, I promise. It really is just to give you perspective from the other side.

In my state, the only thing that getting a primary care degree prevents you from doing is PICU, really, and thats mostly just because of preference. They actually care more about RN experience in PICU than they care about an acute care degree usually. For some other inpatient services (especially some of the surgical services) prefer acute care but I know a person that is primary care that just got a job with surgery so it doesn't apply to everybody. There isn't enough acute care programs in my area to really support an "only acute care APRN's can be inpatient" mentality. But, like a pervious poster said, some people get duel degrees to avoid any of this. My advice to you would be to reach out to the people that are working in the area that you think you might want to work in and see what they say. I feel like the preference is probably very institution specific. But in short answer, you dont have to just do primary care pediatrics with that degree - every person I did clinic time with was primary care and I did endocrine, pulm, child abuse, neurology - and I am starting in palliative care. Just reach out to people and see what your institution prefers.

I would also like to add that most PNP programs wont accept you without so many hours of peds nursing experience. I really think you need to focus your interest or just take some time - which is TOTALLY FINE - to really figure out what you want in your career. Take some time and work as a nurse. Take a job you dont think you will hate. Feel it out. If you get a job in adult ICU and like it, you can always do the adult acute care program. I, personally, know that I never want to treat an adult again so the PNP way made total sense to me. If you love both adults and kids, you could also do the FNP route. Good luck.

If schools are your number 1 factor, I think Johns Creek and most Cobb county schools are going to be your top options. I have a friend that lives in Johns Creek and commutes into Atlanta because the public schools are just as good as most private schools. When I have children, these areas will be what I look into. Good luck. Feel free to reach out with any questions.

Do you have kids? Only because schools are a big deal depending on the area so I thought it might change my advice for you. None of those areas are bad really. It just depends on what you are looking for. Do you have sometimes keeping you from living inside the perimeter? (besides money... haha). Just trying to get a better feel for what you are looking for. I'm more familiar with the north and west areas you are looking at. I can't provide much info about Buford. Johns Creek is a good area, for sure. Dont discredit the Marietta area, too. Especially East Cobb, which has real nice houses and great schools. The Acworth/Kennesaw area can be tricky because traffic is a BEAST on I75 these days. I actually moved away from that area in order to get away from it to an area thats in every other way less desirable so I can do down and hit I20 and avoid I75 all together. (For example, working night shift, I would leave at 5:!5 most evenings to sometimes be late clocking in at 7pm. That was terrible. To be clear though, I was working at the CHOA campus thats inside Atlanta near the CDC). I have worked at CHOA for over 6 years now and think its generally a pretty good place to work. I have heard pretty good things about Northside as well. As far as the CHOA campuses, they are the same company but different in a lot of other ways. Egleston is a teaching hospital where Scottish is not. Egleston has the cardiac kiddos and SR does the rehab stuff. As far ad EDs go (if thats what you really want to do), i can't provide much insight but I think they are both probably fine. Hope this helps. Good luck.

In my area (Atlanta), its very similar which is why I went the PNP route - I knew I wanted to work for CHOA and thats what they want. However, they will under certain circumstances hire an FNP with a significant amount of pediatric background, but its rare to be honest. If Pediatric Primary care is specifically what you want, I think its totally fine to stick with FNP, but look for primary care locations not affiliated with CHOP and I think you'll have more success. Even if they are affiliated with an adult driven hospital system, they are more likely to not have the "PNP only" policy. Good luck!

I am by no means minimizing PA programs or anything of the sort. I do think they come out (generally) better prepared on the textbook side of things. But, regardless of what that reason is, I don't think its because people don't work during those programs. Maybe it is because of admissions standards or because they find good clinical placement or for whatever the reason. But for Dodongo to essentially say its because people are lazy because they dont devote their whole life a "go above and beyond!" is a little unrealistic given the current restrictions of NP programs. That was my only arguement. I respect PAs a lot. I feel like I can learn a lot from them and by no means think their clinical experience is less valuable to mine.

Sorry its taken me a few days to respond, I've been working (although it seems like thats probably frowned upon by you). To answer your questions, i'm saying that even if I didn't work, it would've been really really difficult to to obtain the kind of hours that you are suggesting. Because its so difficult to find good preceptors and there are plenty of students, theres always another student in line to begin a rotation once I have finished "x" number of hours for that term. And I can say I am an exceptional student - I come prepared and I'm a quick learner. But my preceptors have students booked for a year and a half out and quite frankly, almost nobody wants a student all the time. Who would? Theres no compensation and for me to really see patients and write notes and develop plans, its kind of a headache for them logistically for us to see patients around each other and it slows them down. I can also say that in Georgia (where I live) and to do a pediatric program (in which I am completing), the ONLY program that fully finds placement for you is Emory, and who in the hell can afford that? They also are required to do 100 hours LESS than what I'm doing. So how is that any better, really? Another point that I would like to make is - of course PA's and residents dont work in their programs. Whatever work they do WOULD NOT BE MEANINGFUL in their career because they only have a degree to fall back on, not anything they can actually do anything clinically with. My work in the PICU along with school is ABSOLUTELY helpful in my future career. I learn things every day that will ultimately help me in my future practice, but where would a PA work with their science degree that provides them with patient interaction? While I understand your point (work less and do more clinical hours), I still feel like you are dismissing that barriers that would allow a person to reasonably do so. Of course I could quit my job and try to do more clinical hours, but what happens when I can't get them and I just sit at home instead? At least what I'm doing for money is expanding my brain and contributing to my knowledge. As several NPs have said to me before - you can be a bad student at a good school or a good student at a bad school. It really doesn't matter where you go, just how well you are suited for it and how hard you are willing to work.

This would be awesome, except I barely was able to complete the amount of hours required because of lack of preceptors. I wish I could have all the time and resources at my disposal, but as somebody that graduates in two week, I'm literally going to the last day and the last hour to finish my required hours because it was so difficult to nail down time with preceptors. It is what it is, just saying the "do more!" opinion is a little unrealistic unless something changes.

You should for sure look into pediatrics. Its almost none of your "dislikes". I actually didn't like doing adult nursing for most of the same reasons. I do work ICU now and will tell you that the fear of messing up is really high - BUT, those parents are usually so stressed out and shocked that any amount of kindness and teaching you give them is helpful. Everybody says the parents in pediatrics are terrible but really, that hasn't been my experience. If you take good care of them, tell the parent what/why you are doing what you are doing, and are generally kind. I feel like most people are reasonable. I also think sometimes it takes the personality of somebody that doesn't mind letting mom run the show every now and then (within reason) just to let them have some control.

The people that say not to do compressions first, I have one question and one statement... How (and why?) would you pull a kid up (especially if they bigger- like, are older than about 5 years old) to do the heimlich maneuver on a kid that now is a limp rag doll? Chest compressions makes more sense because it will not only pump blood but also provide pressure that will dislodge what they are choking on. Also, whoever says "but they are choking so why do they need CPR?!" has never seen how fast a kid without oxygen loses their pulse. its fast. like sometimes REALLY FAST. Kids are not small adults, guys.

SO MUCH OF THIS! I always knew I would do peds in nursing school, so I can't say that I knew this as the "most enjoyable" thing until a few years into my nursing career. But saying that they dont "enjoy the sick role" is right on point. I've seen an 8 year old up and ambulating the halls a day or two after a liver transplant. I had a kid last weekend that was intubated for over a month, extubated a few days before, but was wanting to play peek-a-boo and blow bubbles. They literally are just such resilient creatures and thats the reason why I don't mind working so hard every day.

PICU is hard. PICU is stressful. PICU is exhausting. Its okay - its not all terrible. Theres so much to learn that you can't feel comfortable within the time you are orientation. You just need to focus learning the basics that will help you keep you from making a mistake (common sedation dosages, actually checking 5 rights of meds, preventing pressure ulcers/Ventilator pneumonias/etc) and help you recognize and respond to an emergency. Otherwise, the diagnosis and medications and the other "stuff" will follow. Just realize that theres A LOT to learn and even after almost 2.5 years, I still don't know a lot. If you are humble about it, people will teach you and you will be fine. Good luck!

Maybe I'm just feeling snarky, but this post kind of annoys me. What kind preceptor do you need? What program are you in? What area do you live in? How many hours do you need? How in the world do you expect people to help you without any details? Please be more thoughtful and detailed in your future practice as an NP.

Heres the thing that I think you don't understand - nursing school is hard for even very very smart people. Its a different way of thinking and sometimes people that struggled in A&P actually do very well in nursing school, but on the other hand I knew a girl that had a previous bachelors degree in biology fail in my class. But the bottom line is, and what I think people are trying to tell you, is even talking about your 4.0 and offering to help will only alienate you from the 90% of students that are probably stressed out about tests and grades. There were a few people like this in my nursing class - ones that always answered the questions and argued "but the books says..." and yada yada. And I'll tell you that the perceptions was this - "yeah, they may be book smart but they can't critically think their way out of a bag" or "yeah they can pass a test but I dont want them to ever take care of me". And I'm not saying you are a terrible person and that any of this is true, but i agree with other posts saying to TONE IT DOWN. Eat a slice of humble pie. A REAL BIG SLICE. People can't relate to you. People think you are a know-it-all. You have to take it down. I've been a nurse for 7 years now, and I'll tell you that I still learn stuff every day. I have to eat a slice of humble pie all the time because I miss something or get busy and I'm not perfect. Thats what it takes to be successful in nursing school and as a nurse. Good luck to you.

For little ones, I always talk about whatever they are doing/wearing/watching. I'll be like "ohh, those are some pretty shoes. Show me your toy. Does this baby (stuffed animal or whatever) have a name? Your dress is so pretty!" I dont know. Just make stuff up and talk about things that they enjoy and it really does help them warm up. When chronic kid's parents disagree with the plan, I straight up just get the provider in there to explain further. Sometimes, those parents really do know their kid better than i do, and I'm not about to try to talk a parent into the plan of care if they disagree. For frustrated parents, they really just want somebody to agree with them and give them a little control. So sometimes I'll be like, "we can let the baby sleep now and change the diaper in 2 hours or we can do it now and we dont have to again for 4 hours" or whatever it may be to give the parents a little control in their situation. Hope some of this is helpful!

While I will agree with this - some - I will say that I dont think parents are any harder to deal with than when Grandma is in the ICU and how her family can be so demanding. I bet some adult ICU nurses will say the family is one of the hardest things about it. For me, its having to be in the room with parents that are so neglectful or abusive and having to pretend its just another day for me. This can happen for a variety of reasons, but mostly because either there isnt enough proof or the police haven't actually made an arrest yet. That can be some hard stuff to deal with. Otherwise, I feel like dealing with death is hard, but mostly because the parents will break your heart.

I commented on Minniemickey's post, also, but essentially I will say that I think most pediatric specific places are going more towards hiring PNPs and not FNPs. It does give you SOME flexibility, but if you dont have any interest in adults (like me, the idea of FNP clinicals made me feel like ew), go with your passion and you can't go wrong. Its an investment in the rest of your career to go with your passion and not just what you think you "should" do. I would suggest looking into what jobs you think you would actually want and see what they are hiring for. Children's healthcare of Atlanta is now only hiring PNPs - no FNPs at all, and are actually really apprehensive about PAs as well. Just saying - look in your area and see what they are hiring and go from there

After being a nurse for almost 7 years, I've decided this - sometimes your senses go off that something isn't right, but your assessment is fine. Then all you need is TIME. Eventually, there will be more signs and be able to point you in the right direction. I'm a pediatric nurse, so my patients can't usually tell me what they need, but sometimes I'll notice something that isn't explained yet - like they are a little more tachycardic than the rest of the day. They seem fine, so do they need to poop, do they need to vomit, are they in pain, are they getting a fever, are they getting dehydrated? Time will give you more clues about what it is. So I feel strongly that nothing could've been done, she just needed time to do what she was going to do. Hope this helps and makes you feel better.

I totally understand your ethical dilemma. It feels wrong, and is one of those ethical areas thats not warm and fuzzy and doesn't feel good as a nurse to see. I will say this though - you need to have an internal change on opinion or this patient will be very difficult to take care of for you. I say this because you are essentially powerless - the patient wants it and the physician has signed off on it. Is it ethical and right? Maybe not. Does it feel pointless? Sure. But legally, you have nothing to stand on. Its frustrating, yes, but I can tell you from experience that you have to find some kind of peace in this situation or it will nag at you. Perhaps look at it from a perspective of, she's getting to fight till the end and thats what she wants. Also, this is coming from a peds nurse, so I can tell you that age doesn't matter. Its the same dilemma with an 8 year old that has a huge, invading tumor that you feel is suffering. Its hard, but sometimes finding some sort of perspective that gives you peace is the better approach.

In peds, we do this all the time because the little veins can't handle the pressure of the tube suction. So we draw blood with 3 ml syringes and do one of three things - do exactly what she did and take the top off, take a needles and poke the top (which like somebody else says, risks you sticking yourself), or put it in the tiny pedi tubes that require the tops to be taken off anyways. As far as the blue tops, taking the tube off wont really skew the results as long as the right ratio of blood is used (which thats the only one that matters, anyways). Hope that helps.

Absolutely, hands down, do it. You worked hard to be able to sit and take that test. So do it. My suggestion to you would be to do what anybody preparing to sit for them would do - take tons and tons of practice questions and read EVERY rationale. For those exams, its all about test taking skills. Paying attention to the wording and being able to eliminate answers. You can do it!!