JDPBSN

i agree with the person who posted; use that as a teaching moment. if a patient is in crf- maybe 125cc/hr is due to the lack of perfusion of systemic blood to the kidneys. maybe the patients gfr/bun was increased and they wanted to increase absorption/ reabsorption for natural diereses. maybe he was worried about a uti, stones or maintaining systemic volume. if there is decreased volume to the kidneys, adh is stimulated and the patient will retain even more fluid and go into chf. maybe he was thinking he could use a k+ sparing diuretic to get off any excess fluid, once renal homeostasis is obtained. then consult a nephrologist. you always want to perfuse the kidneys and maybe he didn't want to resort to a pressor. the edema is probably due to hypoprerfusion and perfusion will naturally diereses. ask why? most of the time, they have a pretty good reason why they are doing what they are doing. just my opinion.

Hi there, I am an RN in OMFS. A couple of things I could share with you. My background before the RN was in dental and OMFS—so, I feel at home working with the head and neck having years of experience. You would have to check with your states BON and BOD on the regulations of the RN in OMFS. OMFS is a dental specialty, although it encompasses much of medicine and surgery. In some states RN’s cannot take orders from DDS/DMD’s. If the person you are looking to work with has a dual degree; DDS/ DMD, MD then you would be fine, but check with the boards. As far as duties and job description: it is a dental specialty, so you would have to become well versed in dentistry—it is the foundation of the practice. Procedures include first assisting in removal of wisdom teeth, extractions, apicoectomies (surgical root canals), orofacial orthopedics, maxillary and mandibular jaw reconstruction, TMJ treatments, oral oncology/ biopsies, dental implants, facial trauma, clefts and cosmetic facial surgery. If you are queasy with blood and open anatomy, this may not be a road to travel down. OMFS’s deliver there their own anesthesia. Duties include prepping the patient for surgery, IV initiation, health histories and physical exams, delivery of fluids, invasive monitoring, IV drug administration, recovery of patient, discharge instructions and follow-ups. Other duties include: changing dressings, removal of sutures, lines and drains. You would have to be ACLS/ PALS certified and obtain an IV sedation certification. The pay is pretty good. I do both hourly and per case for the sedations. Hourly $32 and per sedation $50. What I mean by this is: if I am not there a full day (8 hours) doing other things, I get hourly but if there is only a sedation or two, I just bill for the sedation and leave when I am done. I work in private practice, paid vacation and benefits. Having both dental and nursing backgrounds would allow for a greater compensation. It is a great specialty. Truly, none like it. I will say, it is much different than traditional bedside nursing and often RN’s may feel a bit lost, due to being in a “dental” world. You will feel pretty autonomous and with training and time it will come easy and fun! I hope this helps!

Hi there I’m and Acute Care/ Critical Care NP student. Here are some answers to your questions. After looking at your last comment, the reality is this… Your comment on “95% of what comes in” bothers me. I don’t think most MD’s can diagnose 95% of what comes in without consulting attendings, specialists and experts in a particular field. Medicine is just too complex and no one is the see-all-end-all, hence the terms specialist and expert in practice. If you come out thinking as an NP, or even as an MD, you can diagnose anything that comes through the door without referring or consulting, you would be danger to the population period. - In most states the NP has a collaborative agreement with an MD/DO, i.e. looks a few charts a month, available for phone consult, can see a patient that is beyond what I do/comfortable treating, covers me when I’m out of town. Some states require supervision—working with the MD/DO in the setting. As stated, “you are technically under the doctor”, this is not true. You have your own license; you recognize what is beyond your scope, refer and consult with attendings, and specialists. Going into court and saying “well that’s what the doctor said and wanted…” will not fly, you would be held accountable and so is your license. - There are different NP roles and educational preparation. Although the same degree (MSN/DNP) different scopes and population of patients provided for. Pediatric NP, Adult NP, Geriatric NP, Family NP and the Acute/ Critical NP- the title suggests their populations. - Yes, we learn diagnosis and symptomatology—comparable to the MD/DO, but pertaining to our population. Some practice more holistic and use the nursing model as a guide, whereas some adopt more of a medical model because that is the setting we practice in i.e. hospital wards. Yes, we can prescribe narcotics—but state specific. - There are NP residencies available post graduation, or you are taught/ precepted under practicing NP/DO/MD’s until deemed competent in that specialty. - The DNP is a real movement, whether the state/ nursing organizations adopt this or not. Most schools are leaving the MSN for advanced practice nursing and moving towards the DNP. There are 3 NP programs in my city, 2 which have moved their NP’s completely to the DNP. NP’s are getting 55-60+ credit hours in a masters and the hours in this degree are close to a doctorate level as they stand. - My diagnostic abilities are clearly this: I am boarded pertaining to my specialty, I can treat and diagnose according to my states laws/ hospital policies, I know what my training consisted of and practice within that mindset, if I want to do something beyond my initial training—I get adjuvant training and documentation/ credentialed, and always practice within the scope. I hope this helps. Please be aware that some schools require an X number years of experience as an RN, before NP matriculation. As stated, there are NP forums. You should shadow an NP for a day.

Male NP student here. To answer your question, as others have said--there is an APRN thread on here. There are plenty of male NP students. I am in a MSN class of 50. 15/50 are men, which is a pretty nice representation. 4 are acute/ critical care, some in adult and some in family. I don't think any are in pediatrics and none in obstetrics. Salary...it varies. I know 2 of my ACNP peers that are graduating have been offered over 100K, and I believe 1 is making 120K--this person has many years in critical care and landed a pretty sweet deal in with an ER MD/NP group. My girlfriend is a PNP student, she says they start around 80K and higher, especially if they are acute care PNP's. Most have worked out deals where they are getting their licensing, certification and DEA licenses included in their salary package--which is expensive. Many work deals where they can have CE allowances, where they are able to travel, stay, entertain and eat on the organizations budget. The key is to know your market, be willing to relocate to the bigger salaries and network--if that's what you are looking for. All-in-all, from a personal perspective the NP gig is pretty sweet. Not only can you make a descent salary, but you're able to be flexible, work in different areas and enjoy you're life. Hope that helps, BTW I'm a VW guy, but would love an Audi A8--maybe soon enough...

This is misrepresentation to the community. I am not sure the legal standing on this, but like it was stated in a previous post—if the granting institution were to find out, the would be some ramification. On CV’s you can write for exp. BSN ©, C for candidate, but this is not appropriate for clinical setting identification. This is like a foreign trained physician using the MD, when been granted a BMSc or a dentist using DDS/ DMD, but earned a BDSc. True, they are both dentists and physicians, but different levels of education alike the nurse. Ethically wrong…

yeah, i hear this too. i work on a surgical service and i am the only rn- all ancillary staff are ma's. although i have not directly heard a ma refer to themselves as a nurse- the md's do to patients. legally, the rn is a protected title and credential. calling oneself a rn without the dully granted license is illegal period. i recall post graduation we were instructed that until we passed nclex- we could not present or refer to ourselves as nurses. the bon has strict policy regarding this. i would recommend holding a staff meeting, and addressing this. if reported, there could be an investigation conducted, were the entire clinic and md's can be reprimanded or action taken. as far as pushing drugs, to my knowledge ma's cannot, but i'm no expert in ma scope. i do know that with training- some techs can start iv's. i am flabbergasted that the ma's have cards with the rn credential- is that what you are saying? if this is their policy- to impersonate health care personnel, then i would report and get out of there before you are dragged down with them. if law suits were to happen and one of these “nurses” were to testify, you could be held liable for aiding in the practice without a license. i do know that it is difficult to find employment and the market is tight, and you may need the job. but, at the end of the day you will have the license you worked hard for and you can find other jobs… good luck- protect your profession!

Agree, Hurst review. Was entertaining too.

Joel- are you all on that side of the world going to a DNP education? What's the consensus over there?

believe me. i know it can be overwhelming! the good thing is you do have options, right! i would do some shadowing of different np's to truly find out what type of np role you want to fulfill. the acnp is designed for hospitals. so, if you want to be in a clinic setting doing the 9-5, this may not be for you. depending on the states rules and regulations each np specialty has their own scope and standard, which can be very practice limiting and specific. anp is a good route, if you don't care to see children. some hospitals will hire anp's and fnp's, and i've seen more hospitals going to the acnp role. take the time to figure out how you really want to practice and lifestyle you want. i am at johns hopkins. best of luck!

btw, i am curious about your accelerated msn plan? there are programs that are offered for those that have a ba/bs in other fields to get a msn, by passing the bsn that is at the generalist level. i could be wrong, but to my knowledge- there are no np, crna accelerated programs- i mean you could do a full time plan of study and be out faster than part timers. are you maybe thinking of a post-master? this is for people that already have a master: like an fnp going back for acnp, it is shorter, but the fnp curriculum has already built the core foundation. i would look into that to not be confused.

hi there. i'm in an acnp program. here are some answers: if you have an adn and a ba, you may need to get a bsn. most programs (3 in my city) will not consider an undergrad degree other than the bsn. you may want to look into an accelerated bsn program and apply for direct entry msn. depending on the university, some fnp programs require a year or two experiences, some do not. acnp programs require at least one year acute care experience to matriculate, but most students have 2-5 years experience and admissions committees consider this a requirement. i would get a gre prep study book and start studying it, more and more institutions require a gre. the msn is a generic degree offered to all, but has different concentrations- then you apply for board certification to be credentialed in a specialty. most programs are going to a dnp; you may want to consider this. although the dnp is a recommendation, but you'll see that a master’s curriculum is currently busting at the seams and most programs (esp. fnp) are awarding credit hours close to a doctorate level as they are. i would call and schedule a meeting with an admissions counselor; they are truly the expert of what ever school you are applying to. best of luck to you.

Dental and nursing trained here. From what I've heard, dental pronounces it buckle- as it pertains to a tooth surface and cheek mucosa, medical usually pronounces it beuckle. The correct is buckle, but always an inside chuckle to hear it pronounced wrong by many. Kinda like duey-den-um vs. doo-aud-nem or fem-er-al vs. fe-moral. It all depends on where you train...

whether or not the dnp will be "mandated"; it looks as if the governing boards and heading in that direction. the biggest move that i am seeing (4 np programs in my city) is that all the universities are in the process of dropping the msn for aprns- keeping them for advanced nursing practice, but moving all aprn education to a dnp level, happening as we speak. many advisors are urging potential students to seek the dnp, so that they are not lost in this msn or dnp limbo. all np programs are busting in credit hours, and are respectively very close to a doctorate program as they stand now. a 2.5-3 year curriculum is simply too much for only awarding a masters degree. i would suggest looking into the lace regulatory issue, this may help as well.

don't be discouraged... new grad here, i'm employed in 2 rn positions. graduated in 2010, all of my classmates are gainfully employed. employers like those who are persistent and go-getters; you have to do your footwork. i don't post on the site much because of the amount of negative and "ventng" posts. good luck to you, things always work out for those who really want it.

canesdukegirl- thanks for your interest! yes, i am a nurse- but, my focus prior to nursing school was in anatomy. although, i can't speak for where you are from, and procurement practices- if i have limited time (i.e. rolling up on that 12 hour window), i will close the curtain, set up my sterile field's and remove corneas, whole globes or facial dermis (bone, vessels ect require an or) in the ed. there is a lot of paperwork, documentation, investigating and examination that goes on before a scalpel even enters a hand. sometimes it can take hours, just to go through a chart to look for contraindications to procurement- so time is critical. i think what you are inferring is whole organ donation (heart, renal, liver...). yes, this would never be done in any other settings than an or. but tissue... i've harvested in some pretty random spots of a hospital. research is huge. say i get paged to go and remove bone, fascia and some major vessels- some of the vessels may be too shot to transplant to a human, so we remove them for research and teaching purposes. some families will opt just for donating only, some will say- if you can't use the tissue for humans, use it for research. whether for research or donation, it is all removed the same way- with the same standard of care (just paid a different fee). hope that helps!