Saflanut

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.

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.

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

I don't know what are you implying and what kind of picture you are getting. You don't know me.

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.

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.

As I pointed out she was not undressed and I had another pt waiting to be seen. I see your point though

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.

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. .

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

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

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!

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.

I was a new grad who did the last semester preceptorship in the ED which I am currently hired. I was proactive and asked to speak with the nurse manager. I worked really hard and showed good attitude. I was fortunate enough to get into their 4 months fellowship program. I am on my own now for about a month. I would not deny that there are days that I feel really inadequate and incompetent. But I am constantly affirmed by the some of the experienced nurses that this is normal. Everybody has good days and bad days. I like the variety and fast pace that ED brings. Sometimes it is overwhelming though. Hoping to get my grad degree and be a NP. We have NP in the ED settings.

LunahRN, I salute you and women who are in the Army! Stay safe! I have two girls who are doing Army ROTC! Army strong!

I too have similar issues with IV insertion. Nothing more frustrating than getting 3 patients at once with tons of blood work orders and all the other tests that you have to do and you are still trying to start an Iv on the first patient. Yesterday, I had a dialysis patient, homeless IV drug user and really skinny older lady with veins that rolled. I had to ask MD to start IV on two of them because even very experienced ED tech could not get it. Everything was backed up, I was running around crazy trying to complete the orders. Got yelled at by MD and everything went downhill from there. I finished my Fellowship program a month ago. So I am not experienced and still trying to get used to being in ED. I have good days and bad days, but IV skills are so crucial in ED in terms of completing MD orders in a timely matter. I appreciate the tips on hard sticks. I have no problem getting the easy ones, but a lot of times we are faced with hard sticks in ED. Anyhow, I would love to hear more tips from the experienced ED nurses.

Thanks! You make a good point!

I have this pocket guide also. I am starting on February 4th. I have 12 weeks of fellowship. I want to make most of it and learn as much as I can. I consider myself book-smart but not too much hands-on experience with IV insertion etc. we will be trained and I guess I should get over my nerves and dive into it. I would greatly appreciate any advice on how to conquer self-doubt and fear. I am expecting to have anxiety and timidness but I don't want these emotions to hinder my learning. Please share how do you conquer them.

Hi there,I graduated with my BSN last December and passed my NCLEX last week. And got the job two days later. Pretty excited. I am starting my ED fellowship in February. Ed was my first choice. I would love to hear everybody else's experiences. I did buy one ED book called Emergency Nursing Secrets after reading it here from amazon. I would love to hear the "tricks of the trade" from the experienced ED nurses. @sharon, I have the same worries about being a good nurse and learning skills that are essential to become a good ED nurse. In any case please share and I'll do the same. Life is good! God is good!

Soooo frustrated with the school now. They are placing me in a medicine unit apparently while I asked repeatedly and nicely for an ED preceptorship. I know for a fact that there is an ED preceptor available.My complain is I know some of my classmates got their first choice hospital and units. They are definitely playing favorites and these people know how to manipulate the instructors. Should I make my case and pursue an ED preceptorship or just suck it up and take whatever they give me? Did you have similar experiences? ANy suggestions will be appreciated. I feel that I would be learning more in an ED preceptorship because that is something that I want to do. A medicine unit sounds really not my cup of tea. Anyhow, love hearing from fellow nursing students who had similar experiences.

C-diff stool, toes with fungal infection, dry flaky skin particles that float in the air when you take out pt's socks, BO of pt, crusty skin on the skin folds, uncircumcised member with crusty stuff, doing oral care on pt after they are extubated... It is a long list, I know. I gagged so hard and almost vomited one time front of a pt, when she was using bedside commode and had really bad diarrhea. She was also in isolation in a negative pressure room which felt so stuffy. I had to take stool sample which made things worse. I don't think I am going to develop strong stomach anytime soon.

Riagant, Very true sentiment but it is not exclusive to Shenandoah Uni. at all. Unfortunately, I have seen this phenomenon at our clinicals among nurses and have heard from other student that are attending other accelerated programs in NOVA. I am graduating from SU accelerated program this December. I was also accepted to GWU, but I decided to go to SU because of the price difference. Plus, I got scholarship and grant offers from SU. Before I made my decision, I talked to many nurses about schools, most of them agreed that school name does not matter that much when you are applying for a job. The only important thing is to pass NCLEX. SU has 95% passing rate. Because of the nature of the accelerated program, it is a high stress environment. During summer semester, we have regular exams, ATI exams, two days of clinicals with care plans and etc, every week. My take on this: you get as much as you put in. There is a lot of self directed learning. But we all have degrees and should be able to to this. Back on the subject of woman hating woman, nurses eating their youngs, unfortunately, it seems like there are women out there who believe that in order to succeed, you have to step on others. Women gossip, talk behind each other and yes we all do get our emotions take control of us especially during our monthly hormonal changes. I have seen this among my classmates and nurses on the floor. You will have some women like this anywhere. So, "name " schools, in this case GWU will come with higher price tag, but at the end if I am able take my NCLEX exam and pass it, it does not matter that much. BTW, talking to other students from schools like Marymount, George Mason, they seems to have very similar issues. Just wanted to give another perspective on this issue. Good luck!

Hi Ethanphil, congrats! It must be pretty sweet feeling! Would you mind sharing your study guide also? My email: [email protected] Thanks and enjoy the feeling of satisfaction of completing this long and hard journey!

Get up at 5 AM for clinicals: check Do 25 pages of care plans that includes useless information: check Ugly scrubs: check Opportunistic CNA's: check Tests and quizzes every week: check Unhelpful staff nurses who forgot how it was: check Sleeping less than 6 hours consistently: check Expect to practice your skills but all you do is do vitals and bed&bath: check Can't commit to any social or family events on the weekends: check I think I can go on and on. There it is, feels better to complain!

HI jmb12, I am a current student at Leesburg campus. Just wanted quickly answer your location questions. Leesburg is a satellite campus, so there is no on-campus housing. A lot of single people share apartments in the Leesburg area. OUr clinicals are all located in NOrthern VA. Loudoun Inova is the closest (10-15 min) to Leesburg campus. Fair Oaks Inova and Reston about 25-35 min driving distance. We have a lot of commuters also. But I would recommend getting an apartment with some room mates in the Leesburg area.And you will definitely need a car. Good luck!