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Nurseboy1 has 12 years experience and specializes in MICU, SICU, CICU.

Nurseboy1's Latest Activity

  1. Nurseboy1

    Pros and Cons to becoming a Nurse Practioner (NP)

    I thoroughly like being a NP and would not change my career pathway. I have a good scope of practice and wide prescriptive authority. The hospital I work for compensates very well, and covers the costs of my malpractice insurance. They also provide a yearly stipend for educational needs. But the catch with that is its in a rural area and I had to be willing to relocate to get what I wanted. Bottom line, do what will make you happy. Graduate school is hard and will consume a large amount of your life. I would suggest shadowing with a NP in the area that you want to work in and see if you like their role.
  2. Nurseboy1

    ACNP scope of practice in the hospital defined

    I primarily have responsibility for all the patients on our census. The nurses call me first with issues or needs for order clarifications. If I'm tied up with one patient and another patient needs help then the attending steps in. If I need help my attending is right there for me. If we need consults, I put the order in and call the consulting doc and go over the patient situation with them.
  3. Nurseboy1

    ACNP scope of practice in the hospital defined

    I'm an ACNP in the ICU at my hospital. I work primarily at night. Our practice model is that it is me and my attending for the whole unit. Generally I do most everything for the patients. If an admission comes I see them and take a history, I do the H&P, write the admission orders, if they need any procedures like central lines or a-lines I do them. My attending will see the patient and then we review my plan and make any modifications if the attending wants them. My colleagues on the dayshift are the primary responsible ones for their patients. They present the patient on rounds, write the daily ICU note, do the orders and they also do the procedures that are needed. I often go to the intermediate unit to do critical care consults for patients that are decompensating. I usually am the one doing any procedures. My attending is required to be in the room for high risk procedures such as intubations, PAC placement, or TVP placement but they aren't right at my side telling me how do to them or anything. I'm credentialed in central lines and A-lines and I do those without the doc in the room. So at least in my unit I have a lot of autonomy. If I think the patient needs something I do it. I keep my attending in the loop as far as patient condition changes, they are ultimately responsible, but I'm far from a glorified RN.
  4. Nurseboy1

    The Nurse as a Patient

    A couple things I took away from a prolonged inpatient stay as a teenager: 1) The NG tubes are no fun no matter how you sugar coat it, just get it in as quickly as possible 2) A surgical intern abruptly came in my room to tell me I was going to the OR, not the way to break the news to someone who has never had surgery 3) When I got to preop, they parked me beside the door to the main OR, I was so scared and without my parents, I just wanted to cry on the gurney 4) When the cancer diagnosis came back, my docs thought my parents needed to know first. But sitting in my room for 45 min alone only increased my anxiety. PS I'm not stupid, when the child life person just "happens" to drop by late in the day, something is up 5) After my second surgery I was taken intubated to PICU. I awoke restrained, intubated, without my glasses. I couldn't see, move my arms, or talk. My parents were no where around due to visitor restrictions, talk about being scared. The child near me was unstable and there was always lots of commotion. 6) The first time I was gotten out of bed after major abdominal surgery, I felt like I was being ripped in half. But my nurse was a rockstar with pain meds. 7) Post-op pancreatitis is a miserable experience 8) I cannot understate the importance of pain medication in procedures. I had many painful procedures done that I did not receive much medication due to fears of respiratory depression. I still have nightmares sometimes about the pain. My experience as an inpatient has been valuable in shaping the nurse and now NP that I am. I can truly empathize with my patient and I try to remember the fears and anxieties that I felt, and seek to prevent or allay those fears in my patients.
  5. Nurseboy1

    Is it still financially worth it to become CRNA?

    ACNPs in my area have a pretty decent job outlook. However most hospitals around here are not going to hire a FNP into the ICU, so if ICU is what you want then you need to do an ACNP program. My salary is significantly higher than it was as a bedside nurse, however I was willing to relocate to another area in my state to get it. Its all about what you want, I wanted to work in critical care so I went to the program that would provide me the education and training and I was willing to relocate to get the practice environment that I wanted. You have to be willing to make some compromises sometimes in order to get what you want.
  6. Nurseboy1

    Is it still financially worth it to become CRNA?

    Lol its north of 100K
  7. Nurseboy1

    Is it still financially worth it to become CRNA?

    I work in an teaching hospital, however the ICU that I work in is exclusively run by intensivists and NP/PAs we don't have residents in our unit.
  8. Nurseboy1

    Anticoagulant Preventing CVC Insert?

    Working with cardiac patients, I routinely place central lines on patients that have received loading doses of plavix, aspirin, brilenta, or are on infusions of heparin, integrilin or aggrastat. I even place them on patients who have received thrombolytics for STEMI prior to cath. For me site selection is key, IJ or Femoral, somewhere I can compress the vein if necessary. I avoid subclavian veins in these patients.
  9. Nurseboy1

    Is it still financially worth it to become CRNA?

    I am an ACNP in the ICU, I'm very hands on with the patients. I can intubate, place central lines, swans, A-lines, do bronchoscopy, chest tubes, LPs. And my salary is nothing to sneeze at. Just pointing out that there are places where NPs can have a pretty wide practice
  10. Nurseboy1

    COB rollcall

    Then only 9 more years to go before I can join the COB society ADN-2004 BSN- 2006 MSN- 2014 Aspiring member of the COB society
  11. Nurseboy1

    The Overly UN-zealous Hospitalist

    I don't see the provider as being dismissive of nursing. I was a bedside nurse for 10 years before becoming a nurse practitioner, and I remember the days of frustrating encounters with providers. Increasing my education and becoming a provider lets me see things from a point of view that I wasn't able to see before. To go back to the beta blocker example, yes it would exasperate me for a nurse to question the order with a patient with COPD. I would expect that the nurse would have the baseline knowledge to know the difference between a nonselective beta-blocker like propranolol vs a cardioselective beta-blocker like metoprolol. In my practice setting yes I will write for beta-blockers in patients with marginal SBP, the benefit of cutting their risk of death outweighs some of the risks. No I don't spend as much time directly in the care of the patient as I used to, but I still know the issues that are going on with them and are attuned to their needs. Sometimes I feel that nurses don't understand the amount of thought that goes into writing an order for a patient, or the amount of risk we assume in the care of some of our patients. I also agree that OP engages in hyperbole quite often, and I say that from the perspective of reading her other posts. And no before anyone suggests it, I am quite well liked by the nurses on my unit. They know that I will do what is necessary for any of my patients, and that I have their back 100% of the time.
  12. Nurseboy1

    COPDer de-satting? What do you do?

    How recently has the patient had a cardiac workup? Cor Pormonale occurs with COPD and this new apparent activity intolerance makes me concerned for heart failure. Have they had a recent ECHO? Regardless the patient's symptoms are consistent with hypoxia and they should be given oxygen. It may be prudent at this point to decrease the amount of activity in his rehabilitation until a more thorough workup can be completed.
  13. Nurseboy1

    ACNP jobs

    I'm an ACNP. I work inpatient cardiac ICU. I work with STEMIs, Heart failure, ECMO, impellas. We also take overflow from the MICU and any other general ICU patient needs.
  14. So with the benefit of hindsight in my career, I have realized that I was very likely the same kind of nightmare to precept. While I never had HR on speed dial or anything like that, I was at times way to cocky, didn't appreciate the wisdom of my elders, thought I knew more than I actually did, and alienated my co-workers from me. My couple of preceptors who sat me down and had some very frank conversations were a huge wake up call for me. It took me several years to repair the perceptions that others had of me, and some of my co-workers never did change their mind about me up until the day I left that job. I would encourage the frank conversation. When I received mine, it was never framed with malice or any blame. They brought written accounts from my co-workers about things that I had done that had caused problems. At the end of the meeting we had a written action plan that I had to sign along with my manager. They had a couple of nurses who agreed to further mentor me, since I was off orientation. We had regular meetings and progress was documented on the action plan. It really worked for me, taught me a lot of humility and end the end made me a better nurse and a better co-worker for my peers.
  15. Nurseboy1

    ME results in Joan Rivers

    Now that I did not know, I assumed that the sedation was provided by a nurse in the clinic. I guess that makes it a bit more shocking to me, if the anesthesiologist missed the patient going deeper.
  16. Nurseboy1

    ME results in Joan Rivers

    According to Huffingtonpost: The New York City Medical Examiner has finally revealed that lack of oxygen to Joan Rivers' brain caused her death over a month ago. According to the medical examiner's report, her death was officially caused by "anoxic encephalopathy due to hypoxic arrest during laryngoscopy and upper gastrointestinal endoscopy with propofol sedation for evaluation of voice changes and gastroesophageal reflux disease." I had wondered if the endoscopy center was using propofol, I have admitted several anoxic brain injuries from some area endoscopy centers that used propofol. How many more people must die or have significant brain injury before people wise up that NAPS is not safe. I am not an anesthesia provider, nor do I pretend to be, if you need anesthetics in a procedure get an anesthesia provider.