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  1. East coast FNP here, and working for a large health care organization in a primary care setting. We, all the primary care providers including MDs have to cover 2-3 weeks in a year as an on call provider, and we don't get paid for this time. So, you are expected to answer any calls which come between 5 pm to 8 am next day until the offices reopen. This is for 7 days, including weekends. This means a patient can wake you up from your sleep, and you are expected to go to work next day regardless how much sleep you lose. The calls average 20-25 a week. I was wondering whether this is the case - no compensation for on-call - for majority of the primary care providers.
  2. Saflanut

    Oversupply of Nurse Practitioners

    I want to feel optimistic about future of our profession. I think problems start at the beginning. Education of NPs is (Both MSN and DNP) lagging way behind PA schools. I still don't understand the fact that how can some schools including really reputable ones requiring NP students to arrange for their clinical placements after charging them thousands of dollars in tuition. NP schools are not as selective as PA schools, a lot of them don't require GRE or any other examination. RN experience at some cases reduced or not even required. Online programs are not helping either. It should be more standardized approach to NP education. Unfortunately, it became a financially lucrative option for colleges and universities. in the meantime new grads are stuck with student loans and low paying new grad positions. Quality of the NP programs vary, yes but I think clinical hours should be be increased.Pediatrics, gerontology, women's health rotations should be more robust and supported by the NP programs should not fall on student's shoulders. I think that would increase our negotiation power.
  3. I did not want to further comment on this issue but I felt that I can provide more insight and update. On Monday we discussed how we can improve patient care regarding this type of scenario with the nurse manager, NPs and nurses. If a pt is presenting for skin conditions (including tick bite, poison ivy/sumac etc) whoever is rooming the pt will provide a gown for them to put on.Ask pts whether they want to have their skin checked for other tick bites, so they don't just ask that in the middle of the exam and catch us off guard. Here is the deal, if NP is ready to see the pt at that point, she will just go in and do the whole exam, including skin check. But if NP is with another pt or running late, nurses will do the check and report any findings. No, nurses are not required remove and identify any ticks. All of our nurses have been living in this area for sometime and knowledgable about the ticks.Problem solved! Somebody made a comment that I should learn how to order not request. Here is a little education on that -risking sounding "snooty" here, I know. Orders go on pt's EMR with particular diagnose attached to them and you choose from pre-populated options. Then you sign the orders for nurses to complete in the office such as throat swabs, labs, ear irrigations etc. Tick check is not one of those orders. Therefore it was a verbal request because I don't bark orders to nurses, I request them to complete a task. As a NP I am well aware that I don't make rules or policies as I go. I work for a big health care organization. On the other hand we can bring issues forward to discuss with management to provide better and safer pt care. Thank you again for your comments.
  4. While I appreciate you taking time and commenting, it is clear that a lot of nuances getting qlost in this forum. I was not mad, I was disappointed as I mentioned these nurses are good nurses who work hard. I did throat swabs, wound care and check throughout the day in order to speed up pt care and lighten up their load. I was let down by my team. I never see them as my subordinates, we work as a team. Difference is I have walked in your shoes but you have not walked in mine. So I don't see any further utility on posting or explaining because some of you got your panties in a bunch. Btw nurses can do tick check if requested by pt per our policy. Have a wonderful week you all
  5. I don't know what are you implying and what kind of picture you are getting. You don't know me.
  6. Wow so much hate and anger in your tone. This has nothing to do with NP education. You obviously did not read all of my comments. Not going to waste time repeating. I sense insecurity in your tone, no need to resort to name calling.I give credits where it's due in regards to nurses whom I work with. I am glad there are not like you.
  7. I find it interesting that a lot of RNs are commenting on my topic, and I greatly appreciate your inputs. You definitely provide me different perspectives which precisely why I posted here.On the other hand being NP and provider , comes with more responsibility and accountability. We cannot accomplish this without support of our team (LPN, RN and MA). We work together to provide best care that we can. That day I felt abandoned by my team. Being alone with a pt who was wearing underwear and a gown was not the problem, I can assure you. I was a bedside nurse once, I have given many bed baths to young, old, male and female without chaperon. Also, as a female provider I have examined male pts for STDs, inguinal hernia, hemorrhoids etc , without a chaperon,you get the picture. AS someone pointed out, gender should not be the issue. We are professionals. yes, it is still good idea to have female chaperon if the provider is male. In this case all involving parties were female. Also, working short handed and long hours make people not willing to cooperate. But I am in the same boat. Another point I am wondering that if this request was made by a physician, would they say no to him/her? In any case, thank you all for your comments. I am planning to talk to them to understand exactly what went wrong.
  8. As I pointed out she was not undressed and I had another pt waiting to be seen. I see your point though
  9. I guess I should clarify. I removed the tick from her lower leg and she was fully clothed. When she asked if we can check her for other ticks, I told her I need to go see the next pt. The she said I am OK if one of the nurses checks me for ticks. So,I gave her a gown to put on and exit the room to ask the nurses. She was only asking for her back and her neck area to be checked, no private parts or front of her body. Yes it would be a quick glance if she was already undressed. Also, nurses are thought to do skin assessment on patients in the nursing school. This wouldn't be much less involved than a skin assessment. Both of the nurses were females also. In any case, I felt unsupported by my team, this is why it is an issue in my opinion. Thank you for your inputs though. Always good to look at things from different perspective.
  10. I work in a primary care office which also functions as walkin-care. There are three NPs in the office and we work 12 hours a day usually with two nurses. Last week, we had a really busy day. Patients were coming in waves, as always towards our closing time we had four patients checked in. I was 45 minutes behind at that time. Anyway, one of the patients came in for tick bite, and tick was still attached. I removed the tick. She was a young woman and was very distraught about the tick bite. She asked if we can check her body for other ticks because she lives alone. It seemed a reasonable request even though we don't usually have patients ask this. Because I was already running late and I had one more patient to see, I asked the nurses ( one LPN, one RN) if they can check her for ticks. Both of them flat out refused, saying that:"we don't do that in this office", "I don't feel comfortable doing it". I was really appalled and exasperated that they were refusing my request. Both of the nurses are very competent and good at their jobs. I had no prior issues with them. Anyway, I ended up doing it. As a result, I left the office more than one hour after closing and with some open charts for the next day because I was just exhausted. Both of the nurses were gone at this point. When we are really busy, I do my own swabs, wound care etc. As a NP we can still do what nurses do, but they cannot do our jobs. I don't want to create a toxic environment but I strongly feel that this behavior should be discussed. Now, I want to address this issue when I return to work on Monday. I don't think I am being unreasonable. I would like your input on how to address this with them. We have an interim practice manager who is overworked and a nurse manager about leave in two weeks. I don't want to necessarily escalate to upper management since these nurses are most of the time do pretty good job. .
  11. Saflanut

    CEN study tips

    Mark Boswell's youtube videos are concise. BCEN hand book and the his videos were enough for me. Good luck!
  12. Saflanut

    Two nurse practitioners Murdered in their home

    My prayers with their families and God bless them for their work!
  13. Saflanut

    Help.. Need advice, planning to take CEN on June

    I passed my CEN exam in February. I did Boswell's reviews on youtube along with his study book. He is very good at explaining and pointing possible questions. I thought the exam was not hard compared to practice exams. I have 13 months of ED nursing experience in a busy ED which helped a lot. Don't be nervous. Just do some questions everyday and positive thinking should calm your nerves. You got this!
  14. I had my first job interview while I was still in NS and I was offered the job. It was all exciting, shiny and new. Jumped in with both feet. Six months later, two of the managers who hired me quit their job due to stress etc. After that everything started to fall apart. Slowly, I saw nurses leaving right and left due to new management. While I was hired as a day shift nurse, now they wanted me and some of the new hires to rotate. Started to moving us all over and trying to fill the holes. After 13 months of employment, I found another job and decided to leave. Unfortunately, this was a contracting job with the governments and they wanted a full year of independent nursing experience and I had only ten because of the fellowship program. So two days before I was scheduled to start orientation, my contract was invalid and now I am jobless. I had two job interviews, one of them went really well, I thought I was going to get the job. But less than two days after my interview, I got the email notification saying that I did not get the job. The other interview went pretty bad, I stumbled some of the questions and lost my confidence. Even though I have all the certification and requirements for the jobs, I feel that my short experience is causing me to loose the jobs to other candidates. I have applied to roughly 12 different jobs and only two interviews so far. It has been only three weeks but I am looking for other options like volunteering. I cannot move due to family situations. At this point I also started to wonder whether my previous employer "blacklisted" me. Would it be smart to ask one of the interviewers whether they heard anything negative from my first employer? When I left, manager was not happy and from the start she did not like me anyway. I started to feel some desperation and helplessness. Now I am wishing that I stayed on my first job for at least two years. In any case, would love hear from people who has similar experiences. Thanks
  15. Saflanut

    No teamwork in ED

    Team work sounds nice, but most of the days I feel that I am alone with my pts. Not everybody is willing to help in the ED I work. Onetime charge nurse got irritated when I asked if the float nurse can give meds to one of my patients because I was tied with a particularly hard stick patient. She said, I need to manage my time better, went on lecturing me for 5 min instead of finding a solution. Another charge nurse told me that she rather have three ED techs to stock up the rooms than start a line in one of my patients when I was triaging another patient who was brought in by medics. So I learned not to ask certain charge nurses for help. They make you feel inadequate and incompetent. And some of the ED techs play favoritism, they only help the nurses who they are chummy with. In short, management is the key for smooth running ED. But I learned how to fly solo and do my job. Yes, sometimes I fall behind but I don't want to chase a tech and asks them to do something or explain to charge nurse why I need extra help. I find it exhausting. We do have few good charge nurses and techs who jump in to help without me asking. Those days are usually more pleasant. Also, I do agree with the sentiment that ED is an extremely busy place, sometimes everybody is barely keeping their heads out of the water.