TammyG

I disagree with babyNP. I am a NP-attorney. State laws require employers to pay wages within a certain amount of time (usually 30 days). Go to your state Department of Labor website, there is an on-line form you can usually fill out requesting payment of back wages. The Department of Labor will be aggressive about this. Second, if they do file bankruptcy, the highest priority of ANY creditor under federal law is back wages. And in most states, there is an automatic lean placed on the company's assets for two months of back wages for all employees. So, I am reasonably confident that you will get your wages with a minimal effort. I would not be embarrassed at all to tell people that you walked off the job (or however you want to put it) when they were unable to pay your check. You did the right thing.

All new NPs feel incompetent. I promise. It will get better. The BMT role sounds like a good one -- you can use your background in BMT from your RN role -- but you will be bored fast. The same thing happened to me. I went back to hospice/palliative care after a short stint as a primary care NP for the comfort, and was bored to tears in a few months.

The billing is an issue, unless the MD will also be seeing the patient. Private insurers all work slightly differently, but I don't think that any of them would be happy reimbursing him at MD rates if he never saw the patient.

I assume you are a fairly new NP. I would take the first one just to get some treatment experience under your belt. Then you can move off to case management or whatever else you would like to do.

I understand that the patient was on valium, but in any event, I have prescribed Xanax as well as Ativan in the geriatric setting many many times. No mass murderers yet. It is an extremely helpful drug and it would be a shame if prescribers stopped prescribing because the patient may go out and shoot 500 people.

That is not the law Dizzijon.

Hospice and home health have a lot of similarities. However, hospice is different and that you will get to know your patients and their families much better. You will be with them through the end of their lives, and often when they die, and that leads to a type of connection that you don't have quite the same in home health. You also will probably be with your patients longer as well. Many home health patients only need one – two weeks of treatment. The biggest difference though, is that in home health your patients usually get better. In hospice they do not. There is a huge change and you have to make sure you are ready for it. Good luck in whatever you decide to do!

Nonsense. The only thing that a good hospice nurse needs to have is a passion for her patients. It is a calling. It used to be that nurses often went to hospice at the end of their careers because they wanted to be off their feet. That is not the case anymore. Hospice is it's own specialty, and what with budget pressures on hospices like every other healthcare entity, hospice nurses have larger patient loads and more acute patients. We have many patients in our hospice with TPN feeding, feeding tubes, respirators, LVAs and every other thing. Maybe it was that way long ago, but hospice is no longer a place where you can work short hours and stay off your feet. We have had several very young nurses in our home hospice. Many have not worked out, for whatever reason, they have moved on. But the ones that have stayed are excellent nurses and are much loved by their patients. And every older hospice nurse will tell you that many patients perk up with a young person in the house. I would stop your self doubts and throw yourself into the experience. You will know whether it is right for you, and that will have nothing to do with whether your colleagues think you are too young.

I disagree with DizziJohn on this. You are making recommendations within the scope of your NP license. This is treatment in every respect. An RN cannot make these recommendations within the scope of her license. Further, if you make an error, you will be held to the standard of an NP. Your recommendations require knowledge of advanced human pathophysiology and pharmacology. So I absolutely believe that you were treating within the legal definition and the definition of your nursing board. If in doubt, you can discuss this with your nursing board. Your work as an NP in hospice require skills and analysis at an NP level by law. Legally, and RN cannot do the certification assessments that you do. Your assessments include recommendations for certain levels of care. In addition, having done face-to-face assessments in hospice, I fail to believe that there is not at least one piece of advice that you gave to the family or patient in every assessment. This is treatment.

Wow lots of judgments passed here. Like the OP, I also hated being an NP for many of the same reasons. I tried several different jobs and disliked all of them for different reasons. I longed to go back to the bedside. I chose a different option however, which is that I stopped working altogether. At least for a while. If I do go back to work, I am pretty sure it will be as an RN. People go to NP school for all different reasons. Telling someone that they "should have known" what being an NP is like is not helpful. It is true that there are many different NP jobs, and hopefully everyone will find one that they like. But one thing that almost all NP jobs share in common is that you bill, and with that comes certain pressures and responsibilities. Although the RN jobs I had prepared me well for being an NP, I found the NP job totally different in all respects. If the OP wants to return to the bedside, to a job she was happy and satisfied with, she certainly can do so.

My NP program did not cover EKGs at all, that I remember. That it is rated number one in the country. I had been a tele and critical care nurse so have training from that experience. I have worked in several fields as an NP with no prior experience, including urology, G.I., and orthopedics. No one is prepared on their first day. Almost every NP I have spoken to will tell me about being thrown into situations way over their head when they first started a job. And every MD will stay the same. That is how we learn. I have read post from Boston FNP for years and they are generally helpful and non-judgemental. Not sure why he/she now feels he is in a position to judge competence.

I use my sense of smell much less as an NP than I did as an RN. You should have no trouble at all! Also, like many people with a lost sense, you will learn to compensate with your other senses. Good luck.

You can do whatever you want. It is not true that most NPs (or even a substantial number) went the direct-entry route. That's just nuts in my opinion -- how do you even know you will like nursing? Most NP schools require at least 1 year of RN experience anyway. I know of only one NP who went direct entry, and that was in nurse midwifery. I worked for 2 years full time before starting NP school, then went to NP school for 2 1/2 years while working full time, then for another 18 months while working part-time. Almost all of my NP classmates were working as RNs throughout their school years. But, do they even have NP schools anymore? I thought they were all turning into DNP programs?

You absolutely need a BSN to be admitted to any masters in nursing program. Even if you have 20 degrees in other subjects.

Your taxes as a 1099 employee will be somewhat higher because you must pay a larger share of your social security tax; normally that is shared by your employer, but now you'll be paying for it all yourself. You also have NO benefits -- no health, 401k, dental, holidays pay, vacation, etc which can amount to quite a lot of money. But, you can deduct a whole bunch of stuff from your taxes which might amount to a sizeable savings. You can find lots of guides to 1099 employment online or in a book store that will spell this all out for you.

Agree with Neuro Guy on this. I never understood how that got started, but I have heard of some RNs being hassled because of it. Because you have not been hired as an NP, you obviously do not have a collaborating or supervising physician, and you certainly are not provided with malpractice insurance by the hospital. You are not performing in an NP role and would not be expected to execute NP-level judgment. I would not see why you would have an obligation to inform your employer. However, if in doubt or you are concerned, tell your supervisor.

Hospital nurses working in a hospice ward just work shifts like any other hospital nurse. Same thing with hospice house. So if restricting your hours are important to you, that would be a good place to start. Hospice case managers work a minimum of 50 hours per week in my experience, and are usually salaried. But other RNs in hospice (on-call, weekends, etc) work shifts, so you can work as many or as few shifts as your employer allows you to.

The nursing is very similar, but there is so much you need to learn that is unique to each hospice. I would think that there would be a big start up learning curve. For example, not only the EMR, but how to order equipment, contact the doctor, how to order supplies, how do I order meds, knowing the local pharmacies, knowing how to use hospice pharmacies, not to mention learning all the streets in the area. There are also wide differences in what a nurse needs to do to prepare for IDT. I used to train new nurses at our hospice, and by far the most complicated parts were not the nursing issues but all the specifics of who to contact, how to document, how to order things. I would imagine that hospice travel nursing is more challenging than other types of travel nursing.

The RN case manager position is the most rewarding, but you really do not have flexibility. You need to be available to your patients between 8 AM and 4 PM (or whatever hours the hospital signifies). You can schedule your visits anyway you want, but if a patient needs a visit at 8 AM on a Friday, you need to make it. I know one nurse used to schedule her patients very early in the morning so she had the afternoons to be home and chart when her kids came home from school. I almost never got home before 3 PM, and I often he had two-four hours of charting to do after I got home. It is a very rewarding job but also very involved.

You are out there on your own with no assistance, so you do need to feel pretty comfortable doing those procedures. Plus a family of six will be watching you. I forgot to mention that we also had a lot of patients on TPN, and a lot of patients on med pumps which need constant adjustment/changing and that type of thing.

I would take ANYTHING other than primary care. I totally burned out on primary care in two years. 18 patients per day is a big bucket of patients. The more contact you get with your MD, the better, and the more you will learn.

You can always get it later, even if you are unemployed. I am surprised your employer will not pay -- you'd think that they would want you at least to be able to subscribe pain killers or anti-inflammatories or something. Maybe it is a malpractice issue.

Almost all of the big certifications these days (OCN, WOCN, CCRN, CHPN) allow you to recertify via either re-testing or a combination of experience/education. And most require a minimum of hours in the field. I am semi-retired now and worried about getting enough hours to qualify for my certification next time!

I think it is fine, unless it is like a 200,000 Bentley or something. Even then, I am sure the men will like it! A bigger question is whether to drive a beat-out shell of a car. That might not look "professional." I drove an SUV with a big dent in the side for a while. No one ever said anything but I felt bad. As someone said above, you might want to drive a car that blends into your neighborhoods. There are some neighborhoods where a beat-out shell of a car would be perfect! Insurance carriers will often exclude coverage if you use your car for hire (like Uber). I have never heard of one disclaiming coverage if you crashed on the way to a patient. I am not sure how they'd even know. We had LOTS of nurses crash during working hours, including me, never heard of a problem.

I am so glad you are considering hospice and I hope you will give it a try, if you feel that you are right for it. A typical day is 4-5 patients. You will not be seeing only 2 patients unless they are 100 miles away! I start my day by getting up and checking email to see if I have any new admissions or if any of my patients were seen overnight. I may have calls to make -- either because a patient had a change overnight, or to let patients know I will be coming by. There are always calls to return from patients looking for visits, to discuss new symptoms, or needing refills. So I usually did not leave the house until after 10 am. Each patient is different. Some patients are fairly stable and the visit is more social than anything else. (We love those patients!) But at every patient visit you need to do a thorough assessment, inquire as to med status, symptom management, or personal/social issues that may need the social worker or chaplain. There is a lot of equipment management -- most patients have a bed and accompanying (mattress overlay, overbed table, extension, etc.) and often have nebulizers, oxygen equipment, suction equipment, shower chairs, walkers or wheelchairs. Stuff breaks, needs change. This may mean calls to the equipment company. Patients all use supplies that have to be ordered. Chucks, adult diapers, soaps/creams, swabs, whatever. This all needs to be ordered which may require you to get on line or make a phone call. You may need to call the doc or NP to get a new order or refill. You may need to call the social worker or chaplain. You may need to call the nursing assistant or coordinator to arrange for more or less nursing assistant visits or to ask them something about their observations of the patient. If the patient is having new symptoms, you will need to discuss them at length with the family and give instruction on nursing management (turning, cleaning, applying meds, etc.). You may need to call the doc to discuss new symptom management. You may need to arrange continuous care or inpatient care if the patient's symptoms are worsening. You may need to do a procedure. The most common procedures we did were foley changes/insertions, access a port, draw blood (central line or venous puncture), occasional IV administration of drugs, bandage changes and wound management generally. And that is just for one patient. Repeat x4-5! Oh, don't forget you need to document ALL of the above. Plus do weekly/monthly reports for interdisciplinary team. I loved being an RN CM. It was the best job I ever had.