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BmoreCRNP

BmoreCRNP

mostly PACU
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BmoreCRNP has 13 years experience and specializes in mostly PACU.

A 30-something wife, mother of a 6 year old man.

BmoreCRNP's Latest Activity

  1. BmoreCRNP

    Desperate need of Adult/Gero NP Preceptor

    If you wouldn't mind doing clinicals in a nursing home you can try going through Evercare. They are a company that employs NPs to see patients in nursing homes. Look them up online and see if they operate in your area.
  2. BmoreCRNP

    Having anxiety over my decision to be an FNP

    It really depends on where you end up. Some NPs are being treated like the Doc's servant. Other NPs are a respected member of the team. I'm working in LTC, and that is a very interesting environment to work in. Some MDs are okay towards me, and others talk to me as if I'm the maid. It's usually the jerks with huge egos that act that way. Your best bet would be to work in a state where you could practice independently.
  3. BmoreCRNP

    If I want to work in ED as NP

    What you just quoted here seems to address how Advanced Practice Nurses have to identify themselves legally. In your state they use the initials RN/NP to identify Nurse Practitioners. Where I am you have to sign CRNP (certified registered nurse practitioner), regardless of what your actual specialty is. My state also has laws regarding where certain specialties are and aren't allowed to practice. As an FNP I am not allowed to practice in the in-patient hospital setting. I am allowed to work in the ER, but in a limited capacity. There should be something in your state practice act that specifically addresses practice.
  4. BmoreCRNP

    Anemia: am I the only one who thinks it's all complicated?

    I rechecked it twice after she came back from the hospital just to make sure. Another reason I think it's the kidneys is because along with the falling H&H, her K+ has gone up and I had to give her Kayexalate for that. Also her GFR dropped. Now it could also be that the acute illness made the kidney disease a little worse for the time being. I'll probably have to repeat the BMP as well to see if the renal failure is indeed getting worse, or if it was just the acute illness making it temporarily worse. I hope I'm making sense. Anyway, her PMD will be back Monday and I'm going to see what he says.
  5. BmoreCRNP

    Anemia: am I the only one who thinks it's all complicated?

    I've noticed, for whatever reason, they don't use PO B12 in the nursing home. I know that unless someone is missing the intrinsic factor in the intestine there's no reason they shouldn't be able to take PO B12 for a deficiency. My personal opinion is that the B12 shot is easier for the nursing home because they just worry about it once a month rather than having to give someone yet another pill to take daily.
  6. BmoreCRNP

    NP or MD?

    Well hopefully you won't read the thread I started about this. Mine was more negative! Anyway, like everyone else said, you really have to weigh a number of things and decide what's important to you. You are the only one who can answer that. It would be interesting to hear from someone who was an NP first, then became an MD later. They could probably offer the most objective opinion having gone both routes.
  7. BmoreCRNP

    If I want to work in ED as NP

    Yeah like they said, it depends on the state. I know of some FNPs in other states who are working in the ED, however, they are mostly limited to fast track or minor cases. You really don't get much in the way of managing acute situations in FNP programs. At least I didn't.
  8. BmoreCRNP

    Anemia: am I the only one who thinks it's all complicated?

    Glad to see I'm not alone! I was beginning to think I was just stupid! (well not really, but kind of, lol)
  9. BmoreCRNP

    Anemia: am I the only one who thinks it's all complicated?

    The attending MD is involved for the most part. He is on vacation right now, so in the meantime I'm doing some investigation so to speak. I definately will need a more experienced person to help me. If the patient needs something like Procrit or B12 injections, etc. I would not feel comfortable initiating something like that.
  10. BmoreCRNP

    Anemia: am I the only one who thinks it's all complicated?

    No, and I doubt she will go on dialysis. I work in LTC. Most of these people are not candidates for extensive treatment such as dialysis. She will not likely see a nephrologist, but be managed by myself and the primary doc until she passes away.
  11. BmoreCRNP

    Anemia: am I the only one who thinks it's all complicated?

    I just realized today that the retic count is separate, so I ordered it. The repeat labs showed a lower H&H. I think the Hct went from 29 to 28.4 or something like that in one week. So far the patient is asymptomatic. I'm pretty sure the problem is chronic disease, but I just wanted to make sure. My other thought was something GI related, but I'm not ready to send her to the GI doc yet.
  12. BmoreCRNP

    Anemia: am I the only one who thinks it's all complicated?

    Thaks guys, that was very helpful. Like I mentioned in the previous post, she is supposed to have labs drawn again on Monday so that I can continue my investigation. I'll let you know what I find. I might have to add a differential though, because I just ordered a CBC. I don't think I'll see the retic count with a regular CBC, will I?
  13. BmoreCRNP

    NP Salary vs. RN salary

    The thing is, depending on the region you live in, any RN can bust their butts with overtime and make tons of money. I knew a number of nurses where I used to work in NYC who made close to 200k a year!! How did they do that? Well they basically worked nearly every damn day of the year, all holidays, some nights, etc. Their life was the job. I don't know about any of you, but I'm not willing to do something like that just so I can say I make 100+ thousand dollars as an RN. My current job has so much flexibility that I can honestly show up and leave when I want to. I actually don't spend more than 6 hours physically present on the job each day. I have to be available by phone, but that certainly isn't the same as being present on a unit for 12 hours straight. The point is, no matter how many hours I work, as long as I get my work done, I'm still getting paid! So I'll keep my little under 100K-a-year salary any day over killing myself working 5 or more 12 hours shifts a week to make that much.
  14. Hey all, new FNP here. I wanted to know if anyone had some easy or quick tips for diagnosing and treating different types of Anemia. One of the things I'm noticing is that a lot of my patients were placed on iron supplements without really having the diagnostic work up to determine if iron deficiency is the true cause of their anemia (I work in LTC). What I have been doing is d/c'ing the iron and ordering an iron panel. Then I'll decide what to do from there. The problem is, I'm not that great at interpreting the results! For example, I have a lady who's H/H dropped over the last month. I think the Hct was 34.5 or something like that and is now 29.7. I did iron studies and everything was within the normal range. Fe, Ferritin, TIBC, etc. were all normal. This lady does have CKD. I think it's stage 3 now. Her last GFR was in the 30s. I'm going to recheck a CBC, BMP on Monday because she was recently hospitalized for urosepsis. So I'm not sure if the worsening kidney function and anemia was really a reflection of that. OR this lady needs to see a GI doc for a possible bleed. Anyway, just want to hear some of your thoughts. Thanks
  15. BmoreCRNP

    Corrected Serum Calcium

    This was very helpful to me as well. I work in LTC, and some of my patients have low Calcium. Usually it's in the high 7's to low 8's. In addition to that, a lot of LTC patients have low albumin levels. The dietician is usually the one who deals with that and often places the patient on a protein replacement shake or something of that nature. I don't usually correct hypocalcemia either, as it has usually self corrected OR it's been that way for a long time and the patient was never symptomatic.
  16. BmoreCRNP

    NP Salary vs. RN salary

    This is soo true! I would NOT go back to staff nursing for anything! Money simply is not my #1 motivator for anything in my life. It was very important to me that I improve my quality of life, along with furthering my education in order to enter a different role. When my son was a baby it was HELL for me to be gone 14 hours a day (gotta count the travel time to and from work). I would come home late at night exhausted as all hell, only to have him wake up as soon as I walked in the door! Then I spent the next hour trying to get him back to sleep, often falling asleep on the couch while holding him in the process. My husband was great, because he was there during the evening with the baby and probably did the most work. But that doesn't make me as a mom feel good. I personally would have traded the evening/night differentials, weekends, and holidays for evenings at home with my baby.