loriann

So, I haven't been to this site in quite awhile, but it served me well in the past, so I figured I'd give it another go. I graduated in May 2012 with my ANP/GNP. I will take the boards in the next 1-1/2 months and have been offered an NP position at a hospital different from the one I currently work at as an RN. I am going to pick up my credentialing package on Wednesday and was asked to bring in several documents (licenses, etc.). What sorts of references do they ask for in the credentialing package? I ask because my current supervisor does not like me, so I don't want to have to use her as a reference, not that she would do it anyways. I was hoping to use an NP that I have worked with and is with my current employer, a professor from NP school, an MD on the unit I work, and possibly a preceptor I had in school. I am not ready to give notice, and I cannot use my current supervisor as a reference. Any thoughts are greatly appreciated!

I've actually heard some great things about Minnesota. I guess that's one to keep in mind!

Thanks for the replies everyone. I have family in Houston and they constantly tell me about the opportunities there, however, I just don't care for the heat. A friend who is an NP spoke to me recently about having to make a decision about location vs. position, and I realize now just what she meant...will probably hit home even more when I graduate. I do appreciate the responses!

Wow!!! $160,000 is a lot to pay for an NP degree...possibly any degree. I'm spoiled in that my current job pays for my NP education. Is it possible to work and go to school, maybe a staff RN position where there are education benefits?

Thank you for your responses Juan de la Cruz. I know that getting experience in NYC is probably the smart thing to do, but I'll be 42 by the time I graduate and I've lived in NYC for so long and want to leave asap...never planned on living here for as long as I have!! The market here is saturated and I find NYC is more PA-driven, so not even sure what the job market will be like here.

So, basically, by the time I graduate, it would probably be difficult to find an NP job in San Francisco, especially given I will have no experience as an NP? I'm in NYC and really don't want to stay here. I was hoping to move to an area that I liked

Hi Everyone: I have 2 more years till I finish my NP and have started to think about areas of the country I would like to live and practice in. I realize this may be a bit premature to do, but I like to plan. My question is, what is the best way to find out if a certain area is saturated in NPs? I'm really interested in San Francisco and Seattle, but I really can't get a sense of what the market is like in those areas? Any ideas as to how/where I should look for answers to that question would be greatly appreciated. Thanks! Lori

How is Illinois given the AMA presence...just curious.

I have an MSW and decided after 8 years to become an RN, which I did. I did an accelerated BSN and graduated in 2006. So, I have 2 years into my RN career and am happy that I switched careers. My experience as a social worker definitely helps, so that won't go to waste. Financially, the pay is better and the opportunity for OT is always there, especially in this economy--not good for the safety of patients though. There are days that I wish I had become a fry cook, especially when you are short-staffed, have no aides, and patients are living on the call bell. Keep that in mind as you consider your choices. On the positive side, I enjoy learning and cardiac nursing is a place where you are constantly learning. I just started an NP program and will probably graduate in 3-4 years, so I hope to have 6 years experience as an RN before I do anything advanced practice. I also would like to work in a CCU, but I would have to switch back to nights and I don't think I could handle nights and school at the same time. It definitely feels a little strange going for another Masters, and some people say I am crazy or a perpetual student, but I like what I am doing and look forward to doing some good work with cardiac patients in the future. Good luck with your decision! Lori

Columbia Presbyterian in Washington Heights is, but NY Presby-Cornell is not union.

I would definitely take the boards first. I didn't, but found that orientation can be stressful enough, and add to the boards critical care exams...a lot of stress. So, if you can afford it financially, take the boards. HR departments take forever to call back. I worked p/t as a social worker at my hospital and gave my resume to the unit manager I was interested in. It still took them 3 months to call, and then you go through the round of interviews, etc. Many times, there are only a few recruiters for an entire hospital, so that makes it even worse. Also, if you are set on L&D, keep in mind that a lot of people want that. If you really want a job, you may have to consider another unit. I know that NY Presby has L&D openings, but you may be working nights for a long time. Good Luck and Congratulations!!

I second the CNA job, however, I'm not sure how long it would take you to become certified. It would be great experience and put you ahead of the curve in terms of floor experience and total patient care. Good luck!!

NY Presby has 13 shifts per month. Would love to get rid of the extra shift, but since we are not union, I doubt that will ever happen.

I'm not in a relationship with anyone who smokes, but since I'm dating, I often worry that I will find someone I like who smokes. It's really a deal breaker for me, as I can't imagine kissing the person, smelling the smoke and all that. Hopefully she quits!!

When nurses say "I did my time in M/S and so should you," the picture I conjure is one of a prison where a person is expected to x, y, and z before he/she can move on. Seriously, I didn't start in M/S, never want to go there and never will. I don't think I'm a horrible nurse for not going and as long as a person continues to learn, ask questions, apply himself, I see no reason why a new grad can't be successful in a specialty area. Learning is something a person needs to continue to do throughout life, new or seasoned nurse. If you want to go into a specialty area, jump in, embrace it, read up in your spare time, and ask questions.

I agree, patient care suffers. I see it all the time. You feel like you are doing medication drive-bys and treated like a waitress at times. I think there are probably several reasons we have such large nurse to patient ratios...too many to list. I think the obvious one would be budgeting concerns of the facilities we work in. They simply do not want to pay for more nurses and would rather throw a tiny bit more money at the nurses working, hoping they can maintain the balancing act of patient safety and patient numbers. One more nurse to the schedule sounds better, looks better and IS better. Bottom line from every manager is always, "We are allotted 12 nurses from our budget we can't pay for 13" or whatever the number. So, nurses are left working with large numbers of patients. ICU nurses have better ratios, sicker patients. Bottom line is money. It's like the idea of a national healthcare system. It sounds great to everyone, but nobody wants to pay for it. Maybe some of this will change as the baby boomer generation gets older and we are forced to deal with crazy numbers of sick patients. Of course, now I'm heading into a political rant so I will save that for another day. Sorry if this sounds so negative. I really like being a nurse, but it's difficult.

I agree that Tele is an excellent place to start!!! I am on a telemetry unit and find that we get a mix of patients, both critical care and med/surg types. We obviously need to know our cardiac drugs, rhythms, etc., but we often end up taking boarders if we have open beds. We also get tons of post-procedure patients (PTCAs, EP, etc) and sometimes post-surgical. I would honestly move on to the CCU if it weren't for having to take a night position and the fact that I think my time management skills are really good having to juggle assessments, procedures, tele monitoring, plans, etc. Good Luck!!

Hospitals can take a very loooong time to hire. Basically, they're huge bureaucratic messes with lots of red tape and hoops to jump through before you are hired!!:chuckle I actually worked at this hospital I work at now while I was in school. I sent my resume to the nurse manager of the unit I wanted to work in during the month of April, was called in early June, and was hired at end of June for start date in October. I graduated in August and then had to take the calculations exam, critical care course, ECG course, and the rest of orientation. I put off taking the NCLEX until the end of November just so I could catch my breath. So, don't fret over a week or two. Hope this helps.

Based on what I've seen, you typically will see ratios of 1:8-10 on med-surg type units, 1:4-5 on stepdown/telemetry units, and 1:2-3 in ICU settings. I think the acuity of the patient obviously plays a role in the final number, but I wouldn't assume with higher ratios you have easier patients to work with. For example, on the geriatric med/surg units, if you have 8 elderly patients admitted for pneumonia, falls, etc., you will have to make sure they are turned and repositioned if they can't get out of bed, you might have some wound care if they have had surgery (ie. hip replacements), checking their electrolytes and repleting, they might be demented and require a 1:1, etc. This could be A LOT of work. The med/surg RNs where I work do not have patients on vents, you find these in ICUs. As for cardiac monitoring, some units have a tech that does the monitoring and others have the nurses do the monitoring. These are usually stepdown units where the ratios are smaller. I would suggest finding out what the nurses aid ratio is on the unit you are looking into so you can see what type of help is available to you. Also, think about what type of patient you want to work with, are you interested in cardiac, medicine, surgical, renal, etc, and see what is available in terms of openings.

It seems most people are talking about Nurse Educator roles in the colleges and universities. Does anyone know what an MSN Nurse Educator would earn in the hospital setting?

I think when people talk about going to "The City," they are picturing sights of Manhattan in their minds, not the outerboroughs. Nothing against Queens, Brooklyn, etc., but tourists generally don't leave Manhattan. My native NYC friends who live in Queens always say the are going into "The City" when they come in for dinner, etc. As for the OP and the car, leave it or sell it. It's definitely not needed.

I'm from Syracuse and I know the cost of living is fairly low. I'd love to hear what nurses living and working in the area have to say!!

I honestly don't think hospitals look at where you went to school. I went to a state school and the complaints that I had about their lack of organization, problems with clinicals, etc., were the same complaints that my friends who went to NYU, Columbia, Pace, etc. had. Good luck.

Very funny...unfortunately I can't get the song out of my head. Wonder what Justin Timberlake thinks?

Is it possible to be a nurse extern? Is that the same as a nurse graduate? I know of some hospitals that allow for nurse externs.