ROLO

What do you mean by “difficult?” I think I would want to explore the origin of this difficulty. The DNP sounds great. I am an ACNP with an MSN, and I hope to be working on my DNP within the next year, but I wonder if your getting your DNP is going to solve this problem.

I am not in the DNP program yet, but, having done the MSN ACNP track (class of 2011), and holding four other degrees, I am thinking school is what you make it. I would encourage prospective students to be realistic. Grad school WILL require work. If you do not want to work, then do not do it. Do as much research about the school and specific program as you can, which is what people on this discussion board are doing, but do not stop here. Contact USA instructors by phone and email. USA staff were great in talking to me and answering my questions during my research process. I even asked instructors to give my email address to students who were getting ready to graduate, so that I could ask them questions --I got to talk to several graduating students who shared their thoughts on the USA experience, which I found very helpful. I have seen comments about USA being "self-taught," which I translate as "little help from instructors." If you are looking for a spoon-fed graduate nursing program, it is not USA, and I would be leery of any program described as such. Not that I think it should be mandatory, but I think nursing grad students working towards ADVANCED PRACTICE NURSING (NP, CNS, CRNA, MIDWIFE, etc.) specializations should be seasoned and have a good knowledge base. Be realistic. Be prepared. Do NOT give up.

One of the best all-around nurses (emergency nurse) I know took her boards, I think, FIVE times. Not only is she very knowledgeable, but she can get along with anyone --not only difficult patients, but difficult nurses, and difficult physicians. She is just a great person. So, my advice to you is DO NOT GIVE UP!

OH, and I needed to add, I used/use research and theory every day. I am sort of scared of those who do not (or think they do not). Evidence based practice, best practice guidelines, new treatment modalities, patients perceptions of their caregivers, spirituality in breast cancer, the theory of caring...as an advanced practice nurse, SERIOUSLY, how can you not use research or theory to some degree?! The parts of research and theory (mostly research) that I do not care for are the parts that I did not truly master. One of these days I will re-visit those areas that I did not entirely grasp, and I am thinking I will find them interesting and even helpful.

To "8mpg": I would venture to say that no one is excited about taking research and theory, but those courses are required by the "powers that be," and so every NP program has to have them. If you find a program that does not have research and theory, turn and run in the opposite direction, as I am thinking it is probably not "legit"/accredited. Individually, a school can add to the required courses. I started out at a school that had two research courses, instead of the usual 1. I think they went on to add a leadership course, too, that was not required by the "powers that be," but just a course that they thought would benefit their students (whatever, right?). I did great in my courses, even got a decent score in that first research course, BUT I DID NOT PASS IT BECAUSE I DID NOT GET ENOUGH POINTS IN THE INDIVIDUAL PART OF THE COURSE (there were group projects AND individual projects). So, even though I had enough points for a grade of B, I received a C in the course and was told that I had to retake the FIRST research course again.... I transferred. Though I had finished a year of grad school, I saw this as a HUGE "red flag" against this program. I transferred to my first choice of schools --the University of South Alabama (GO JAGUARS!). Ironically, the first course I had to take (or re-take) was research. Research was not easy, and historically it was not known for being easy, BUT MY GROUP AND I ACED IT! The instructor, on our last paper, which was a group paper, wrote, "CONGRATULATIONS, YOU UNDERSTAND RESEARCH!" It was so cool. Chances are you are going to have to take research and theory. Spend your time finding out which school "fits" you. Like me, you might hate research (and/or theory) at one school, but LOVE it at another school. Start asking "why did you like/dislike your research course" at the University of South Alabama, or USC, or Indiana Wesleyan University, or whatever. When a program/school sounds good, then research it a little more. You WILL find your school.

After graduation, I kept the part-time emergency staff nurse job, a position that I had for the last 10 years, and this past June, I added a part-time hospice/palliative care NP job (love it!). Last Friday, I put the 2-wk notice in for the staff nurse job, and I am going to be picking up more time with my NP job. The company is great. I told them that I did not want to abandon emergency nursing, that I would like to pick up enough time to get insurance through them, and then I would like to do some part-time emergency NP work. They totally understood and were supportive. As long as I put in at least 30 hours of hospice/palliative time, then I get my insurance/benefits, and they are good with me working in the emergency department. I did, by the way, secure an emergency NP job a couple of weeks ago. I am going through the dreaded credentialing process. It is a wonder that there are any NPs with what one has to do in order to get credentialed (wish me luck!). I do not check out the discussion boards like I used, so I apologize for the delay.

Forgot to mention: Sign-up ASAP...you can get his CDs...I wish I had had them while I was still in school.

Took Barkley (ACNP) last December (2011) in Mobile, Alabama. I love him. I want to marry him. He is fantastic, and knows his stuff. I studied (off and on) until March (2012) when I took and passed the exam. His study guide is great, too. I take it to work with me (I have a bag of resources that I cannot live without). Good luck!

Beautiful policy/procedure/guideline! I am just "tuning in" and have not seen all of the other posts, but I might remind us of the Emergency Nurses Association (ENA) (check out their web site). The ENA has position statements on various topics and concerns (advanced practice nurses in the ED...difficult IV access...violent patients...etc.). Also, the National Guideline Clearinghouse is a great source of information regarding standards of care (see their web site). I am an ED nurse, and when I was working on the management of the adult psychiatric patient in the ED, the Clearinghouse had already addressed it, and so I was able to find some good information. You may have already talked about these things, but I just wanted to throw them out there:)

BARKLEY = AWESOME!

I just wanted to throw this out there for the student. As you know, there are several types of assessments, and the one you choose is ultimately up to you. I work in a busy ER, but I almost always include the heart and lung with my assessments. They only take a moment to assess. Mind you, I am not talking about measuring JVD, finding the point of maximal impulse, and grading dependent edema. Your question was sort of general, but I can just hear my program director from school telling me, “If you have a little old lady, with CHF and COPD, YOU BETTER LISTEN TO HER HEART AND LUNGS!"

If I understand your question, you want to know if you HAVE to (as in “required”) listen to heart and lungs, and then include them in your H&P when dealing with a possible UTI (or something or low acuity), for example.... 1) YES 2) YES 3) YES

Graduated 12/14/2011 from USA. Did their ACNP track. I LIVED that program! It was not easy, but I liked the format. I recommend USA. If grad school were easy, everyone would be doing it.

Thank you!

I am waiting for the OK to take my exam... Studying Barkley’s review book and listening to his CDs. Wish me luck!

I first joined this discussion (2009, I think) as I was starting my MSN. I was not sure which track to pursue (CNS vs. NP). I just graduated 12/14/2011 with MSN, and I did the acute care nurse practitioner track. I am interviewing now and waiting for the OK to take my boards. I thank everyone (traumaRUs) for their insight into the roles, the good, the bad, and the ugly. ROLO

I am a "male nurse," and I have been nursing for "a while". I have 4 college degrees and am currently working on my MSN (acute care NP). I appreciate the ideas that we can win over patients and people in general by being genuine & doing great patient care. BUT, trust me, it can be rough (understatement) when you are perceived as gay. There is a huge study going on right now by the Emergency Nurses Association (ENA) regarding workplace violence (emotional, spiritual, verbal, physical). Nursing, period, can be abusive, and when you are perceived as gay, or even alternative, you must be prepared to be raked over the coals. I have been called everything but my name. I have had my life threatened by patients (and sort of by staff, too). I do not mean to be be discouraging, or come across as not being supportive. Hope for the best, but prepared for the worst...

KateMO7, keep doing your research, until you think you've done it all. I researced for two years. I am currently enrolled in an ACNP program that is basically 100% online...might be something for you to consider. BUT, even if the program(s) looks good, look closer. Call the college of nursing, and see how their phone etiquette is... E-mail some of the faculty and see how it takes them to respond, OR IF they will respond. There are a ton of things to consider! Look at the web sites, call people on campus/in the college of nursing, heck, even call the bookstore and see how willing they are to answer questions! Grad school is not easy. It is not fun. Set a time limit for researching schools. At the end of the deadline, see what you have. If it feels right, do it, go to school...if it feels "off," then don't do it, don't go to school. Good luck in your search!

I am an ACNP student at the University of South Alabama. Except for a week right before clinicals start, the program is entirely online. I read in a previous post that Vanderbilt's program is online. Unless there has been a recent change, some of it is online, but I believe you still have to go to campus at least a weekend a month...

So, does she ever gossip to you? My boss is "just one of the girls," sort of wanting/trying to be everyone's friend, which I don't think is working. I've made a point, when she "goes there with gossip," to tell her that I probably don't need to be hearing what she's telling me. She knows that I am not into the gossip. I'd like to think that she thinks about what she is saying now, but I am sure that SOME gossip-type behavior continues.

I thank you for your response. There are some major issues at this particular facility, not just minor glitches. I was hoping not to go into them. Rather, I was trying to get some ideas on how to work for someone who is really very nice, but whose managerial skills are lacking, particularly in committing to issues (there is no commitment), confrontation (there is none, or it is so disguised that the meaning/reason is lost), and conflict resolution (no process); and, since confrontation is avoided at all costs, how does one go about "addressing" these issues?

I recall, 20 years ago, when I was getting ready to start nursing school, and I HAD to work full-time. I figured that I would work as a nurse tech, so that I could get my foot in the door, and learn as much as I could. The big medical center, in the town where I was living, decided that they could not continue with trying to have an all-RN staff (no techs, no LPNs, etc.), and so they were hiring techs, just a few at a time, until they got the staff that they wanted... I CALLED THAT WOMAN IN HUMAN RESOURCES EVERY DAY FOR PROBABLY SEVERAL MONTHS, UNTIL ONE DAY SHE HAD TELL ME THAT I HAD A JOB!! I can still remember her name...because I talked to her every (almost every) day. Point is, do EVERYTHING you can (if you haven't). Get e-mail addresses of nurse managers in areas in which you want to work, and e-mail them...tell them they need you & WHY they need you. GO to places...literally get up, get dressed, and go to some hospitals, vacancies or not, and tell someone who you are and that you want a job. After I got that nurse tech job (one of like ten, and many, many more had applied), I worked on the floor for a while, and then heard that they were hiring in the emergency department (ED). The ED was where students needed to be b/c they got to see and to do A LOT. SO, I put my feelers out and fought for another job --and got it! I started working in the ED as a tech. And, when they hired "nurse externs" for the ED, I got that job, too. And, when they decided that they were going to hire two of us externs after we graduated, I WAS ONE OF THEM, TOO! Not that you haven't, but sometimes it takes a lot of work to get that ideal job.

Where do you live? Try a headhunter... Some of the level I, teaching facilities, take pride in their new grad programs, SO they are willing and prepared to take new grads... any of them around you?

I have the nicest boss, but I am not sure that "nice" = "good" and/or "effective" manager. My current manager and I have been together for several years now. While initially, like a lot of nurses probably, I was worried about producing some good results (I have high self-expectations) on my part (good patient care, supportive, on time, continuing education, etc.); now, I am wondering when she is going to be producing some good results for me and the staff. Staff have no responsibility or accountability...we can do whatever we want...we can say whatever we want... If my boss says that we are trying something new in regards to staffing, for example, we can refuse to do it. It is pretty much a free-for-all! If you don't take your work seriously, then you would probably love it! But, if you DO take your work seriously, are educated, and try to implement evidence based guidelines and practice, then you'll probably want to work elsewhere. I am a pretty laid back person, but this work environment (apathy) is even too much for me. So, what are your suggestions? BTW, this is a small town, a good 1 -2 hours from the bigger, more progressive hospitals. Quitting and going elsewhere is an option, but certainly not convenient. I would really like to work on this relationship & stay where I am, but it is not easy to do. Part of being nice means that there is little to no confrontation, but I still believe in confontation. And, if confrontation is not encouraged, how does one go about addressing these issues? I appreciate everyone's feedback!

5-Minute Clinical Consult: "Zoster patient may transmit virus-causing varicella (chickenpox) to susceptible persons." Sorry about the start of your new year! Sounds as though this was caught early, so it should be getting better. I know it is on the back of your neck. If anything, might just be worried about infection of those lesions, but make sure it stays away from your eyes!