grapejuice01

Thanks all... I pretty much have the same opinion but feel bad because everyone here is so great. I hate to let them down by leaving but, ultimately, it is a business and I have to do what is best for me and my family. Its unfortunate that the numbers are so low now and I know no one has control over that. Im certain that it will pick up October-January but I cant continue to work at a low pay rate strictly banking on 4 months of the year to be busy. Flu season didnt even last thru February this year so 8 of 12 months being this slow is not going to work. I applied for the other position yesterday. Will keep my fingers crossed. Thanks again.

I am a FNP working in primary care. Graduated May 2013 and have been at the current job for 1 year. It is a good job with good doctors who are willing to answer questions and give me as much autonomy as I wish to have (I realize that this is sometimes more important than salary, so I want to point it out). I was hired to replace an MD who was retiring. Our practice consists of 3 MDs, a PA and me. Since the beginning of Obamacare in January, we have seen a marked decrease in the number of patients that we have been seeing. Many of our patients simply dont come in because they cannot afford their deductibles or their insurance is not accepted anywhere so they have to be seen as a "self pay" which can become expensive, as well. The PA and I are both salaried employees and have a bonus structure based on the number of patients that we see (The bonus structure was recently changed which reduced our bonuses by about 50% beginning in June of this year which has made a substantial difference in our incomes). With the lower numbers, the schedulers have been giving more patients to the PA than they have been giving to me. In a sense, I understand this as the PA has been here for nearly 4 years and has a client base already built. Completely understand when "her patients" return to see her. No issue with that. My problem comes when the majority of new patients and patients that are "overflow" from the doctors who have full schedules, are also placed with her. I am literally seeing 5-8 patients a day at this point. I understand that they are trying to help her by giving her more patients but it isnt doing me any favors by a) leaving me completely bored all day and b) seriously affecting my income. I have had only 1 patient complaint since I started (no additional refills of pain meds for a patient that had narcotic prescriptions from multiple providers per pharmacist) and, according to the schedulers, they have not had patients request not to see me. I have discussed this with the MDs and the practice manager several times and it will improve for a few days but then I go right back to Thoughts or advice? Thanks

I am an FNP working with a base salary plus bonus potential. Basically, if I see >300 patients per month, I earn 17% of my net income for the practice. My company is changing the bonus structure, however, to a work RVU model (which has not yet been fully explained to me but my basic understanding is that I will now receive roughly $9 per patient with the quota remaining at at least 300 patients per month in order to be bonused out). The new system was implimented last month and, of course, I am now earning less, which was expected. My concern, though, is that I found out about what I feel is a questionable tally system that I am uncomfortable with. Last month, I got married so I was out of the office for a week and half. This left me with a total of only 301 patients for the month (a "month" was explained to me as including the last three days of the previous month and excluding the last three days of the current month -- ie: January 29-February 25). I was not bonused for last month because I was told that the accounting department doesnt always count the way that it was explained to me so that any patients that werent counted for that month will go onto the next months numbers... this sounds fishy to me and obviously I was frustrated because I didnt not receive my bonus despite the fact that I saw >300 patients within the dates that I was previously told would be considered for the month. Is it reasonable for them to change the way that they count the "month" each month? I asked my regional director if he could tell me how they were changing the count and I was told that there was no way he could keep up with that to tell me because its always different.

Im taking the FNP HESI in a week and I purchased the Leik book but was very disappointed. Its riddled with incorrect information, incorrect answers in the test questions, grammatical/spelling errors, incorrect drug brand/generic name combos, etc. I had to stop reading it because Im afraid that Ill mistake an error for something that is factual and it will lead me in the wrong direction on a test and in future practice. Steer clear of this one!

I am an ER nurse looking to make a move to a trauma center. Currently considering Parkland and BUMC but wanting to hear positives and negatives (not just rumors... which seems to be all Ive heard lately) from those who actually have experience in these facilities. Any opinions/advice to share?

Im in the process of interviewing for lung transplant coordinator (pre or post... whichever they feel that I fit better in). Ive already completed the interview with the director and I am scheduled to shadow a coordinator in clinic and in the office and meet with the cardiothoracic surgeons next week. I was wondering if anyone could give me some info on what a typical day in the clinic is like so I can do a little research to prepare (or if you have any suggestions on particular topics to brush up on, that would be helpful, too!). I ordered a few books that should be here on Wednesday to help me prepare, as well, but if anyone has read anything that helped them to build more of an educational background on the profession or to clarify the transplant process, I would appreciate that, too. I do not have a transplant background (Ive been in the ED since I graduated nursing school) and I want to make myself the strongest candidate possible. Any other tips?? Thanks!

Im currently in an FNP program and am considering CRNA... Im in my third semester and I cannot wait to be done. I have been working as an ER nurse for three years and have found that much of the information that we cover I am already familiar with because we treat such a broad range of illness in the ER. (Not to say that I "know it all" because I have learned a great deal from my instructors, Im just not as interested in studying the topics because most of it I am familiar with or I can figure it out) My assessment instructor actually failed me on my final practicum (a head to toe assessment) and made me repeat it with the director of the program (who said she didnt understand why I had to repeat in the first place) because she said I went through it too fast; yet she couldnt name a single thing that I did incorrectly or omitted from my assessment. I dont feel like the program is challenging at all and a great deal of it seems like busy work. Im looking to be in a field that will not only give me the autonomy and challenge that I want but also not be so monotonous as Im afraid ear infections, UTIs and abdominal pain day in and day out for the rest of my life would be...

Deb- Did you complete NP school prior to beginning the CRNA program? I am in my third semester of the FNP program at TWU-Dallas. Frankly, its not a challenge for me. It feels like a lot of busy work and Im already bored. I started looking into CRNA about a month ago. Im currently an ER nurse with three years of experience. I am ready and willing to transfer to an ICU to gain more "intensive" critical care experiences. I guess my question is more related to how to make myself a stronger applicant. Would it benefit me to complete my FNP degree while I get my ICU background under my belt? Or would ACNP be more beneficial? Im scheduled to graduate in May 2011 and am looking at Texas Wesleyan and Texas Christian as possibilities. I have no husband and no children, so its a good time for me to gear up for the program, I just dont know if its worth me finishing my FNP degree first. (Obviously I wouldnt just quit until I were actually accepted into a program... I just dont want to keep throwing money, time and effort into something that Im already bored with). Any and all input is appreciated!! Rachel

The hospital I currently work for will be paying for my tuition, but I didnt think about that being an issue... thanks for making that point!! Ill be calling HR to look into that.

I am applying to the FNP program at TWU in Dallas. Originally I was intending to begin in Spring 2009, but I recently decided that I would try to get in for Fall 2008 if possible. My application was submitted two months prior to the Fall deadline, so I emailed the FNP advisor to see if there was any way to work it out. She said that the only way to do it would be to re-apply as a non-degree seeking student. I emailed her back to ask how that would affect my degree and my place in the program longterm and she hasnt responded yet. Has anyone done this before? I dont want to finish the program and then end up having problems at graduation... Any advice would be appreciated! ~~Rachel

So my eardrum ruptured. It started hurting at 0630 Wednesday and by 1030 it ruptured... never knew it could happen THAT fast! Anyways, Im not looking for medical advice (I know there isnt much to do but let it heal)... just want to know how long this ringing is going to last. Ive had about enough and its only day 2!! I never knew how irritating this could be!

We have a team of 2-3 social workers who are in the dept from 7a to about 2 or 3a to assist families, keep them updated, etc. If its after 3a and we dont have a social worker available, usually it will be the clinical coordinator or the charge nurse. In our ED, parents (or any family members that want to, really) are allowed to be in the room to witness the code if they wish. Our hospital has different grief resources and the social workers usually provide the family with all of the information before they leave-- they also call the parents a day or two later to follow up and answer any additional questions that they may have or assist in getting counseling, finding a support group etc that may be needed. In the event of a miscarriage, our social workers work with the parents as well, but if the fetus is >20wks, the mother is taken to L&D where their social workers/nurses will clean up the fetus, take pictures for the parents if requested (very tasteful, by the way-- the fetus is wrapped in a blanket- usually a tiny cap is placed on its head, etc) and we have a garden where (if the parents choose) the fetus can be cremated free of charge and the ashes can be spread- there are also several support groups for miscarriages through the hospital as well.

I agree... Sounds to me like its one of those tricky nursing school questions which makes you think WAY harder than you need to... I would have answered 12units of the 70/30 NPH, 0 units regular

If you're already wearing whatever you want to, though, pts cant really identify you from any other staff member now, can they? We've always had dress codes... royal blue for nurses (RNs and LVNs), teal green for PCTs, teal with black pants for RT, maroon for housekeeping Its really not a big deal... makes scrub shopping quick and easy!

I would think that as long as you held pressure until bleeding stopped, made sure circulation was still intact and made the doctor aware/documented, no real harm was done. In our ED, the radial artery is usually the first place RT sticks for ABGs and we do those all the time. I wouldnt worry about it...