Aymese

Thank you so much!

Lol, agreed.

]Ditto to above. I encourage you to reach your goal of ACNP if that is what you desire. However I really think you should get some ICU nursing experience for 1-2 years before entering grad school. I don't think it's really necessary to have floor experience beforehand. Others have different opinions about that too, I'm sure you will fid. In ICU, you will find it very fast paced, challenging, and sometimes even scary as you first start. Just food for thought...Do you know how to troubleshoot or analyze PA catheter waveform? Do you know the differences between assist control, pressure control, pressure support ventilation and when a patient should begin weaning trials? Have you been involved in codes? These are just a small example of valuable experiences that you will gain as an ICU nurse. To have a basic foundation in critical care before becoming an ACNP will be very valuable to you. I believe you will feel much more confident as a new ACNP.

OP, Glad you finally got your letter!! I found the red tape associated with the NP hiring and credentialing process to be stressful myself.

I agree with the above poster. My BON processed by APRN license in about one week.

I think it's crazy that they are giving you nursing students already!

Also keep your ears open for job fairs in your community or colleges. I highly recommend getting the business card of the HR or nursing representative. Follow up with an email to them the next day, thanking them for meeting you. This is also how my resume got through HR to the nurse manager for the position I had applied for. Sometimes all you need is to get through HR!

I agree with the above poster. Apply everywhere you can. My first nursing job 6 years ago was to a CCU that had one year experience as the desired minimum to apply. You never know how much action a job posting is getting and they may just be willing to spend the extra time training you if they need the position filled but have few applicants. I'm sorry you and other new grads are having a tough time in this market :\ If possible for your life situation, seriously consider relocating for a job. New grad hiring varies on the region. Congrats on passing boards, Don't give up!

STEMI (ST segment elevated myocardial infarction) patients can be very unstable or can quickly become unstable. If you think about the pathophysiology of what is going on in this clinical condition, the patient is demonstrating ST segment elevation because a coronary artery is completely obstructed with thrombus. This typically results from a nonobstructive plaque inside the wall of artery that ruptures. The clotting cascade is initiated and a blood clot (thrombus) forms which may completely block the artery (STEMI) or cause an incomplete blockage (usually NSTEMI). In the case of your patient (STEMI), this complete lack of blood flow deprives the heart muscle of oxygen, causing the tissue to begin dying within minutes of the blood clot forming...causing associated clinical symptoms (hypotension, Chest pain, dyspnea, N/V, diaphoresis, etc). This ischemia in turn leads to many dysrhythmias including PVCs, vtach, vfib. Oftentimes depending on which artery is blocked (Right coronary artery or a dominant circumflex either of which may feed the SA Node) you may see bradycardic arhythmias like 2nd degree type II or 3rd degree AV blocks. However another possibility can occur when reperfusion of blood flow to the heart muscle is established (either by angioplasty or administering a thrombolytic drug such as TPA, TNK). This is called reperfusion arrhythmia. It can be any number of abnormal rhythms. Usually transient but can be life threatening. The nurse should always be vigilant of the patient and the bedside cardiac monitor when administering a thrombolytic agent to a AMI patient in the ED or ICU. Sorry to hear about the loss of your patient. Hope this response helps in your learning.

STEMI (ST segment elevated myocardial infarction) patients can be very unstable or can quickly become unstable. If you think about the pathophysiology of what is going on in this clinical condition, the patient is demonstrating ST segment elevation because a coronary artery is completely obstructed with thrombus. This typically results from a nonobstructive plaque inside the wall of artery that ruptures. The clotting cascade is initiated and a blood clot (thrombus) forms which may completely block the artery (STEMI) or cause an incomplete blockage (usually NSTEMI). In the case of your patient (STEMI), this complete lack of blood flow deprives the heart muscle of oxygen, causing the tissue to begin dying within minutes of the blood clot forming...causing associated clinical symptoms (hypotension, Chest pain, dyspnea, N/V, diaphoresis, etc). This ischemia in turn leads to many dysrhythmias including PVCs, vtach, vfib. Oftentimes depending on which artery is blocked (Right coronary artery or a dominant circumflex either of which may feed the SA Node) you may see bradycardic arhythmias like 2nd degree type II or 3rd degree AV blocks. However another possibility can occur when reperfusion of blood flow to the heart muscle is established (either by angioplasty or administering a thrombolytic drug such as TPA, TNK). This is called reperfusion arrhythmia. It can be any number of abnormal rhythms. Usually transient but can be life threatening. The nurse should always be vigilant of the patient and the bedside cardiac monitor when administering a thrombolytic agent to a AMI patient in the ED or ICU. Sorry to hear about the loss of your patient. Hope this response helps in your learning.

Goofeegirl, This link to UAB's RNFA may be an example of what you are looking for. One of the prereqs if you do not have previous OR experience is a MSN degree: http://www.uab.edu/nursing/images/stories/info_sa/msn_flyer_rn_first_assist_post_baccalaureate.pdf

no advice here, just congrats!

Don't change your answers! Don't even go back over the questions after answering. Usually your first instinct is correct. Do you have any outside stressors that are interfering with studying or test-taking day that could be adjusted for the semester?

In interviews with 2 separate practices, I have been directly asked what I am looking for in salary. I did some research beforehand into each specialty within the region. NP/PA Advance has some good salary survey info. Also have been asked about my interest in NP run clinic in certain area of the practice (pacemaker, lipids, etc). If in school you were able to electronically log your clinical encounters, find out if it can generate a summary/graph of the types of patient you saw. The practice I was hired by was impressed that I provided them with that data as a large majority of my patients as a student fell within their patient population. Good luck!

Advance NP/PA recently released their salary survey results. Maybe it will be helpful to you: http://nurse-practitioners-and-physician-assistants.advanceweb.com/Features/Articles/National-Salary-Report-2011.aspx

I think Valparaiso University in Indiana has a BSN to DNP program.

Update: I received my ATT today 7/5 after sending my application on 6/4!

When I see FNPs working in the hospital, they are mainly in the ED, particularly because of their peds portion of training. With regard to FNPs working in ICU, I do not feel that they are educationally prepared to work in this area as an APN. One may have many years of critical care experience as a nurse, however transitioning to FNP in critical care, you are still operating off your RN training in critical care, not your advanced practice training in acute care. With the growth of acute care NP programs and certification over the last 15 years, my bet is that the practice of hiring FNPs in critical care will become less common.

I too am waiting for my eligibility. I sent my app in on June 4th. My friend sent hers in the week of may 13th and received eligibility on may 31st.

Congrats on your first job! I started out in CCU and bought the ICU/CCU Made Incredibly Easy pocketguide (2006). It is part of a series made for nurses which also includes Cardiology and EKG Interpretation guides. I think the cardiology one may be useful for you in your new job. I also really liked the EKG guide if you were looking for another resource. Here is the amazon link Amazon.com: Cardiovascular Care Made Incredibly Visual! (Incredibly Easy! Series) (9781608313396): Lippincott: Books

In an attempt to locate preceptors in Atlanta, I utilized linkedin.com and came across several NPs recently graduated from Emory. I would recommend searching on that site if u don't get a response here. U can message people on there if u have a profile.

My adult acnp program requires 630. 135 IM, 135 hospitalist, 360 in up to 2 different services in hospital setting. I feel well prepared, but may do some more hours in my last rotation just bc I may have an opportunity to take a job with the pulmonary/critical care group and want to learn the ropes as much as possible.

A year after this thread was written, I am so glad I stumbled upon it. I am finishing up my last semester in my ACNP program and feel exactly as the OP! I have good days and bad days, good patient assessments and then things that I get mad for overlooking in my assessment/plan. I too felt like I've always been told that I am smart, an excellent, critically thinking RN, always told I needed to go back to school, enjoy reading CEs as a RN, etc. But man, in my final rotation through critical care, I feel so over my head at times. I frequently freeze up when asked questions by the MD or NP preceptor, aghhhH!!! I hate it. I feel like if I could have a few minutes to myself to think through a problem, I could do better. I also feel like I have a really bad memory and have to work really hard at reviewing things multiple times in order for it to sink in. I admire the knowledge base and experience of the MDs and NP/PAs that I work with in my rotation. My preceptor isn't the greatest as she frequently only tells me what I am missing or have gotten wrong in my notes. She hardly ever says "this is good". Fortunately, sometimes I have spent shifts with one of the PAs and she is an excellent teacher, using constructive criticism while also providing positive feedback. Thanks again OP for sharing your experience.

In defense of my online MSN education!!: I don't know about other online MSN programs, but in my ACNP program at the University of Alabama at Birmingham, we are required to come to campus for our midterms and finals in all 3 of the acute care theory courses. The exams are closed book/notes and proctored by a professor and camera monitored. 80% or greater is required to pass the courses. Students performed 5 OSCEs (on-site clinical evaluations in which we are video-taped in the med school mock clinic and assess, diagnose, and treat a patient with a specific cc) throughout the final 4 semesters of school. We also receive clinical site visits from faculty once/semester. Like a previous poster mentioned, the reputation of the school I chose was extremely important in my decision to pursue my degree online. I would not have even looked at Walden, Phoenix, Kaplan, etc. Many physicians throughout my clinical rotations have regarded UAB to be a prestigious establishment for medical education. The School of Nursing takes pride in its reputation and holds its online students to high standards. Most of our video-taped lectures were from the MDs and ACNPs that work at UAB Hospital. Adv pharmacy was taught by Samford University school of pharmacy professors. Online live classroom sessions were taught by our professors and had supporting powerpoint and attendance is taken. Finally, having standards for waiving the GRE if you achieve a certain GPA in undergrad should not devalue a degree achieved online. You have to evaluate all aspects of the school you are choosing and be ready to back up the quality of your education for skeptics (understandably so).

I work as an RN in an interventional cath lab and am also finishing up my NP schooling. To be honest with you, I could not see how having an NP in the cath lab would really be useful. We have many standing orders for labs, EKG, PRN meds, etc and autonomy. The offices fax us the patient's recent H & P's, so most of the time there isn't a need to perform one the day of the procedure. In terms of discharging a normal cath patient home, while the MD is dictating, he checks off a couple of boxes (2 hrs bedrest, discharge in ___hrs, maybe writes a prescription, etc). Most of the time, the recovery for a normal cath is completely uneventful. We handle all of our sheath pulls, hematomas, and BP issues. Cath lab has a great working relationship with the cardiologists and they are only a phone call away when something comes up. I just think you would be bored more than anything. Unless you worked for an interventional cardiology group and had other tasks such as managing/discharging their PCI patients post procedure on the floor or ICU, performing consults, going to ED, spending some hours in clinic, etc. One of our interventionalists has a new grad NP and that is mainly what she does. He hardly ever utilizes her in the cath lab. I really hope that helps!!