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...

I did an externship in the ER when I was in school because you truly see EVERYTHING there. I wasnt entirely sure where I wanted to work when I got out of school at that time, so I figured the ER would give me the opportunity to see such a variety of patients/medical issues that it would give me an idea... I ended up falling in love with the ER and stayed after graduation! If you know where you want to work, though, you should try to get in on that type of unit. You could also talk to the nurse managers to see what types of things you will be doing in each externship... Compared to other students that did externships when I was in school, the ER externs got to do many more skills than an extern on the floor at my hospital (its where I learned phlebotomy/IVs, EKGs, caths, and got to experience codes, etc on real people rather than manniquins that are used in school) and the nurses were all very eager to teach and to get the extra help. Good luck with whatever you choose!

My best friend is starting the Accel. BSN at BJC in May... we're heading to St Louis in two weeks to go apartment shopping but neither of us is very familiar with the area. Anyone have any suggestions of apt properties and/or areas to look in/stay away from? Any opinions are greatly appreciated! ~~Rachel

Im hoping someone can clear something up for me here... My best friend is starting the accelerated BSN program at Barnes Jewish in St Louis in May 08. She was apparently told by a nurse friend of hers that new grad RNs start around $44/hr base in Southern IL (where she currently lives and is planning to move back to after school). Im an ER RN in Dallas and we dont start anywhere NEAR that... I cant imagine the cost of living in Southern Illinois is that much higher than Dallas that it would warrant such a dramatic change. (LA and NYC dont even start new grads that high!) Any insight? Im concerned that she's making a lot of plans for after graduation based on false information that she was given and that she'll have a rude financial awakening with her first job.

"Last weekend we had a 15 yo admitted s/p tonsillectomy. I took her breakfast tray into her, and she cried hsyterically because there was no sugar for her tea! She also threatened to leave AMA because we would not let her 19 yo boyfriend spend the night, in the same room, in the same bed." In situations like these (and almost every other "do what I want or Ill leave" situation) Ill happily witness the AMA form for a patient... The sad fact is that we, as a society, are raising new generations of ER abusers every day because children who are treated for routine ailments in the ED will see this as the norm and do the same with their children and continue the cycle. A lot of it is the fact that many people dont have insurance and therefore cant afford to see a PCP but thats not to say that the insured dont abuse the system as well. Many hospitals in my area (Dallas) now have PAs functioning as screeners in their triage areas to help decrease the load that we actually see. From what Ive heard they do a quick assessment of every patient after they are registered and seen by the triage nurse-- they can write an Rx and discharge for easy cases like ear infections and sore throats that they would normally see in Fast Track and other non-emergent pts that would require any sort of workup are required to pay an upfront fee if they do not have insurance to cover their visit or they are referred to a PCP/dentist/what have you and sent home. Of course our hosp refuses to do this because we're a "faith based hospital" and our president thinks it would be against what we stand for so we now get all of the non-emergents who are sent away from other EDs and instructed to f/u with another provider... its frustrating and our triage overflows nightly. The only positive is that when we have 30 pts in triage we "advance triage" (labs, xrays, CT, etc before the pt gets to the room prior to seeing the doc) That way labs etc are back by the time they make it back to the room and the pt can usually be discharged immediately or tx right away for whatever the issue is and sent home rather than waiting on labs etc.

A friend of mine asked me to do a little research on a problem he's been having for the past 15 years that his doctors havent been able to solve... 15 years ago, he smashed the tip of his little finger on his left hand with a hammer. Since then, the skin at the tip of his finger began to dry and crack... over 15 years it has progressed about midway down his finger AND to his other fingers on that hand starting with the 4th digit and progressing toward the thumb. The drying/cracking/bleeding only goes about halfway down each finger and does not affect his hand. There is no numbness, he has good circulation (rapid cap refill and the hair growth/nail growth & appearance on the fingers of his left hand is the same as on his right hand); he said the tips of his fingers are very tender. The right hand is not affected at all. His doctor thinks it is related to a foot fungus... no medications, moisturizers, etc have helped over the years and the condition is obviously getting worse. It seems to me that if it were a fungus that he picked up from his foot that it would have affected the right hand as well (he's right handed, afterall!) or at least would have progressed to his hand rather than only affecting his fingers. Its really rather strange... Have any of you seen anything like this or have any ideas of treatments he might consider? Thanks for your input! ~~Rachel

Are any of you who are in the El Centro program current THR employees who will be doing the tuition reimbursement program? My best friend is interested in starting nursing school and I recommended that she look into El Centro's ADN program (Im a THR nurse) but I wasnt sure how the tuition reimbursement worked... if she were to start an externship or work as a PCT after her first semester (which I think is the "required" amount of experience for the position), at what point would she be able to take advantage of the tuition reimbursement? Would she have to be a THR employee for a certain amount of time BEFORE she starts the program in order to qualify? Any insight would be great! Thanks! ~~Rachel

Are any of you who are in the El Centro program THR employees who will be doing the tuition reimbursement program? My best friend is interested in starting nursing school and I recommended that she look into El Centro's ADN program (Im a THR nurse) but I wasnt sure how the tuition reimbursement worked... if she were to start an externship or work as a PCT after her first semester (which I think is the "required" amount of experience for the position), at what point would she be able to take advantage of the tuition reimbursement? Would she have to be a THR employee for a certain amount of time BEFORE she starts the program in order to qualify? Any insight would be great! Thanks! ~~Rachel

Try this: Go to the TWU website and find the section that shows exactly which classes are required for admissions... figure out your GPA for those classes ONLY (because thats all they use to rank candidates) That will show you where you stand. I graduated in December 06 and the semester that I was admitted to the program the GPA cutoff was something like a 3.8, I believe (based on the pre-req classes)... the cut off goes up a little every semester, so I have no idea what it will be now. Also keep in mind that TWU gives a 0.4 point GPA boost to students who have done a certain number of pre req hours at the Denton campus. I would suggest applying now anyways and if you dont get in, you can always retake the classes at that point. Good luck!!

I did an ER externship when I was in nursing school... I applied for it in April (right place, right time-- externships held by May grads would be opening up). I did the online app, faxed my resume to HR and to the unit manager and then found out who the nurse recruiter was and called her frequently to check on the status of my app. (I felt bad about bothering her all the time, but its true that if they know who you are, you have a better chance at the job than if you're just a random name on an application... I wouldnt suggest bothering the unit manager like this, but I think they're used to it in HR... also, email can be your friend!) Most hospitals wont hire you until after your first semester, so you will probably have to wait a few months to get an externship (you can probably get a PCT job now, though the externship will give you more experience/opportunities because you are allowed to practice more skills) Presby Dallas hires a lot of externs and I know several people who did externships at Parkland, Childrens and Methodist, so you might try looking into those. Good luck!!

Are you sure the HESI is your entrance exam and not an exit exam? Unless it is a different version, I dont see how anyone could be expected to pass the HESI without having already gone through the majority of the nursing program. I just graduated from TWU Dallas and we took HESI about a month and a half before graduation. It was a VERY big deal... it was difficult and there were several people who didnt pass on the first attempt. In my experience, most schools require the NET as the entrance exam-- that's just basic math/english/etc... pretty easy. If it IS a HESI exam that you have to take, I think the website is Evolve. They had a great review book for the exit exam, so Im sure they'll have something that you can use to review for an entrance exam if that's what you have to take. Good luck! ~~Rachel