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It was typically a week per month for 3-4 months per semester in fall and spring semesters. Then the summer was usually 1-2 weeks. I know some people would meet another distance student and share hotel expenses. I had a friend that I stayed with which really helped. I know a lot of people shared rooms, etc which helped. And packing lunch helped as well. Nashville is expensive to visit and eat out all the time. I don't know how much airfare costs because I commuted via car. I know that Southwest flies into Nashville and they're usually cheaper.

Hopefully you will have a good experience and I suppose it all depends on how your company looks at on call and what the expectations are. I know that the places I have worked do not keep on call nurses long, but that is because they are scheduled visits on top of doing on call visits. I think that the expectation for doing everything is a little undesirable and too stressful for the people to handle, therefore the places I have worked have had a hard time keeping an on call nurse. I am sure it will be good and as long as you are getting compensated well I think that you will be fine. Also sounds like you have a lot of support with other nurses, so it sounds WAY better than the other setups I have seen. Good luck to you!

I have a small hard cover notebook that is about the size of a grocery list pad (like maybe 3 inches across and 6 inches in height). When I open the notebook it lays flat and so I use the opened and exposed pages for one day. Therefore the left side is the back of the previous page, the right side is the front (or the usual place you would be writing in a notebook). I use both for the same day so that I don't have to flip pages (as inevitably I don't have enough room to write everything on just the right side (regular page). I am sure I said it where it is confusing and too complex, but hopefully I have illustrated what I mean now. Anyway, I usually space out the patient's names and have their addresses and phone numbers and small reminders about the visit written under (or around them). Then I also number the order I will see them and also the time frames that I am going to see them (so that I have a reminder in case I am running behind and also have handy info so that I can manage things easier without having to open and log on to my computer). Then as the day goes by and I complete (finish charting on them) I strike a line through the patient's notes on my notebook page and that way I know that I did everything that I needed to (charting, phone calls to MD, etc) and I don't have to click and look back on the computer to make sure all my areas were charted and covered. If I don't have a line through the name then I know there are some loose ends that I need to get completed. I also use the notebook to jot down notes (around the appropriate patient's name) to help me remember things (such as need to call MD Smith about PT/INR, or make a note about supply needs next visit, etc.) that way I can do those things later when the time is more appropriate. I just find this easy for me to stay organized, make notes, yet not have anything tied to the computer (which mine constantly loses charge, so depending entirely upon it for all patient info---like phone numbers and addresses--would be harder for me to use and I feel like constantly rebooting my computer really sucks and takes too long when I just need to know something quick). My little notebook also helps me remind myself about a patient from a previous visit, like if a name is familiar but I can't think of the patient offhand, then I can look back on previous entries and maybe trigger something about the patient or their location--like how to get to their house). Again, it is just something that helps me and may not be for everybody. I have also utilized the "post it notes" feature or program on my computer which allows me to add little sticky (or post it) notes on the desktop screen of my computer. Of course I still like a physical piece of paper, but this helps keep phrases or details that I need for my note handy where I can just cut and paste.

AZMOMO2, I think you should definitely have something in writing regarding the caseload expectation for a full time nurse. Of course it won't always be the agreed upon number, but say if it is 6 to 8 patients per day, then you will know how many you are to see, then if for some reason you are always having 10 per day and you are overwhelmed and getting burnt out then you can call it to your supervisor's attention that 10+ was not whatever you signed on for (I am just making up numbers just for sake of example). Also I just know from my own personal experience, I was MUCH HAPPIER when I was hourly because I would say to myself "well if they want to pile it on, then they are going to be paying me for it" rather than how I felt when I was salaried "I work all the time and never get a break and make pretty much nothing for the stress." While the job is the same essentially, I am a MUCH HAPPIER employee now that I am hourly (my current place is hourly, and I had worked as salary for them before). I actually volunteer to take some of the crappier assignments and do some overflow because HA HA I am hourly and I get paid for every minute I work. I have to say my attitude is WAY BETTER being hourly (or per visit) than when I was salaried. And by all means make any expectations/negotiation about your role known...have it out in the open so that there aren't any "surprises" later on down the road.

I have gotten really good at redirecting patients/families when they start to yak on and on about irrelevant information. Of course as we all know people are lonely and we are sometimes the only people they see and talk to. I basically multitask. If they are a chatter then I will let them talk on and on while I chart on my computer. I make eye contact intermittently while they talk and have found that they actually add little bits that can add to my assessment while they are talking. Also I will interrupt them and just point blank ask them a question that I need for my assessment. I haven't found that anybody gets offended by this. For the most part they know I have a job to do, that I am there for a purpose and me letting them talk about the weather or the holiday food prep is just bonus. Again, it is an acquired skill and I have realized that while they are talking I can get things I need to get done, killing two birds with one stone. If you sit there and not chart while they drone on and on about their grandchild, then you are wasting your precious time and will have a ton of charting to do later. I agree with charting at bedside or out in your car immediately after the visit. I find that if I force myself to do it then I am much better off in the long run because I am not annoyed, stressed, and anxious about having to do all my charting at the end of the day when I am already tired and ready to be off work. I keep a notebook and use the front of the right side and back of the left side to do my day's schedule and notes. That way I can look at it quickly if needed, such as addresses and phone numbers. I also number the order that I am seeing people and the time ranges I have given them, that way I don't have to open my computer and log on to see their number and address. One thing that we do with supplies is place them in separate paper bags, and put the patient name on it. That way all you do is grab your regular kit and the patient's paper bag with supplies and you are on your way. No more sorting and digging. I also like to fill out lab forms at the office before I get in my car. I hate having to write stuff in the car. Paperwork, I organize in a plastic bin (one that is file folder sized) and keep things in labeled folders in alphabetical order. I will have to check out your patient education website.

I agree with NoviceRN10. You don't have to tell them that it was in the plans, rather you can be honest and say that you have to move because of your wife's job. They can't hold that against you because you have to move for your family. There are tons of reasons people quit their jobs and family is one of them and they cannot hold a grudge against you because of that. Either way, it sounds like you will be moving and you will have some good experience to help you get a future job. Additionally, like the others have said, hospitals train people all the time and while it seems like they are doing you a huge favor, really they are looking out for themselves, plus they are used to this. Turnover in hospitals and healthcare is high, so you aren't catching anybody off guard! Seriously. I know the unit that I first got hired on before I graduated paid to train me and once I got my RN I never worked as an RN there because I got a better job offer, of course I turned in my notice and the manager was rude about it, but whatever. Then two years later I went back to the same hospital system and was not blacklisted or flagged as ineligible or anything and I have worked on two different units for 2 years now. Unless you do something insane and don't give notice and aren't a good employee there is NO REASON they should even consider you ineligible for rehire. PLUS you didn't sign a contract of any kind, so you aren't obligated to them for any reason. Just enjoy your experience and don't reveal the future plan with your coworkers, that is where you need to watch yourself...IMO...people gossip enough without needing to add some fuel to the fire. Good luck to you!

You are NOT doomed. I speak from experience. My first "real" RN job was with hospice and I loved it and excelled at it. I am one of the top RN case managers that the company has and I have stayed longer than some other "experienced" RNs who have come and gone to work with our company. I think that your experience as a CNA and your PASSION to learn and care for these patients is what makes you successful. I don't think that you are missing anything that would make you an awesome hospice RN. I know that a lot of people think that getting all your RN skills honed in on by working med-surg is the only way to do things, but I don't think this is entirely true, especially since you have years of healthcare experience. Any job or role that you do as a nurse is going to require learning and discovering (knocking the dust off) certain skills that you don't use daily, but this doesn't make you any lesser of a nurse. Also there are numerous RNs who do administrative work and who would need help and assistance in doing patient care because they have developed a different skill set. I even knew one of the nurses in the ICU who was afraid and bad at starting IVs and that was because she worked in a unit that had an IV team and she never had to do them and when the time came up that she needed to, she would have to get someone else to do it because she couldn't perform that skill. But back to your question...you are not doomed and it sounds like you are doing an awesome job and are on your way to being an awesome hospice RN. It sounds like you are on top of things, so I think that you will continue to be successful!!

I personally LOVE home health. I know it is not for everybody, but I enjoy it and I find the ability to have a different experience everyday rewarding. I also love the autonomy of it. I have worked in the ICU and in other units in the hospital and I have to say that I prefer the home health (being on the road) scene much more than the hospital. Of course with any job you have to deal with stuff from your supervisors, coworkers, and patients, but for the most part you are able to do your own thing and take care of your patients and feel very rewarded in what you do. With any patient and any family you will have to deal with drama, but it is all about how you handle it (as mentioned in the previous post). I also agree with the livelaughlove09 that you make as much if not more money doing home health than being stuck in the hospital. Also the places I have worked are ALWAYS needing extra help and for me to pick up a few extra patients, which does help your paycheck immensely. Further, you are able to do things at your own pace, you are the one who creates your workflow of the day. You can get done early if you utilize your time properly or you can leisurely take your time all day and enjoy not being rushed. Ultimately it is how YOU handle it. Also I think that you really hone in on your skills as you are the only one out there seeing the patient and doing the care (wound care, IV start, catheter, etc) and you have to be confident in yourself and know that you can do those things. Of course, there are times when we all have an off day and you do have to let the office know that you were unable to do something and they are able to have another nurse go see the patient later to do the task you were supposed to do (which it happens to us all). However, these times are few and far between. I personally love my patients and families, and I love being on the road. I enjoy seeing different scenery, trying new places to eat (when I have time), and just seeing different things in the community. I have learned a lot from doing home health and I have been to many areas that I did not know existed because of it, which I love. Good luck to you in whatever you decide.

I agree. I have done both and depending upon where you work and what the caseload is like, I think that staying per patient pay would be better than salary. I know that having a salary would be nice since you know for sure how much you will get each paycheck, but for me when I was working 60+ hours per week as a salaried employee I was getting burned out and bitter because I was working for less than what a CNA made (at least according to my calculations)...so I suppose it depends upon the census and how many patients you typically see, but I do know that given where I have worked (2 different places) I am much more satisfied with the per visit pay than being salary. At least with per visit you can add a couple of visits (if you can) if you want a little more money. Whereas with salary, they can add patients to you and just EXPECT you to do it and be happy about it cause you are salary. I think the general consensus from my coworkers and others I have talked to who have worked home health is that you should stay hourly or per visit because the duties and requirements never go down once you are salary and the caseload and responsibilities just compile and make the salary pay ridiculous.

I think that if you decided to move to Nashville you could talk to the school and there wouldn't be any problem having you become a local student. I think for the most part things stay relatively the same regarding classes, etc, but if you live in the Nashville area, then you will be set up with a site that Vanderbilt uses that is within like a 2.5 hour drive radius (or something like that). So while living in the Nashville area and being considered a "local" student is helpful in that you don't have to look for a preceptor yourself, you will still most likely have to drive a considerable distance one way to your clinical site. Of course you could have to drive wherever you live depending upon the clinical sites you find, but sometimes distance sites work out to be better (as hinted to above). I personally had to find my own preceptors (as I was distance) and it was stressful to do, but I cold called places and had relatively good luck. One of my preceptors for my final semester fell through and I had to come up with something quickly, but it happened and it all worked out quite well. I think in regards to finding your own preceptors you just have to be diligent and think ahead and start looking early so that you aren't "as stressed" trying to get it done at last minute. The thing about distance preceptors is that Vanderbilt and the site have a lot of paperwork that must be done first before you can actually go there as a student, so that is part of the process that takes a long time. Good luck to you!!

Vanderbilt has an excellent program! I know people who did the program full time and did not work. I know some people who worked full time and went to school full time (which I honestly don't see how they did it). I think if you are going to go to school full time then you should just focus on school and not work (my opinion entirely) as there are tons of things you have to stay on top of and work on, not to mention when you start your clinical hours they are intense and you have to basically "work" full time (as a FNP student in a clinic site) in addition to all the actual school work you are required to do. Working and going to school full time is possible, but I think it would do you a disservice professionally and mentally to cram all that into one day. The distance program is great. I loved it, but you do have to attend block, which is mandatory and you do have a lot of assignments, lectures, and presentations during those blocks. Additionally, it is expensive to travel to block and stay the week each month that you are there, so it is definitely expensive and you need to be prepared for the cost (especially if you drive or fly, and if you have to stay in a hotel). The school does try to give you some resources and discounted hotel rates, but they are still relatively pricey (plus in Nashville most hotels charge you $20 per day parking). I am sure there is a way to do it cheaper, but you should definitely overestimate your block week budget as you just don't realize how quickly the money goes. Basically all the people that I know who did it full time had a PRN job somewhere, but they didn't really work their PRN job much as school was definitely the priority and the main focus (as it should be). The distance program has people who come from all over, so if you find someone who lives relatively close to you (or within the vicinity and you both are driving to Nashville for block), then you may want to see if you guys are compatible in anyway and carpool/share the drive (if you drive there) and hotel. If you are in flying distance, then maybe you can meet a peer that you can become friends with to maybe share a hotel the weeks that you are in town. I do know having a friend to share some of the stuff with can be a good thing, as I did this myself and it was a huge help financially as well as mentally (kind of pep talk each other throughout the program). So all that said...I think that the full time program is really really intense (but doable if you pretty much don't work and dedicate all your time to the program). If you feel like you have to work, then I think you could probably work PRN (working part-time hours, but still being able to get out of having to fully commit to the 20 hours to keep your part-time position when things get intense and you need to focus more on school) and do the program PART TIME. They have a 2 year and a 3 year part time program (from what I recall). I think that 2 year part time program and working PRN (but being able to work part-time hours, most likely) is the better way to do things. That's just my own personal bias as that is how I did things, but I felt that I HAD to work as a nurse just because that would give me an "edge" in shopping for a job, because that showed that I did a program AND I still worked as an RN while doing it....getting me more years of experience as an RN on top of getting the advanced practice nurse degree...PLUS when you are finished with the program you will have a transition period between getting your APN license and getting a APN job, so it is nice to at least have the security blanket of your RN job that you have done the whole time you were in school, just in case the job market is a little less open when you first graduate...that way you will have a little less stress about getting a job right out of school and you can take your time to find the right APN job and not have to settle for something less desirable just because you need a paycheck! Those would be my suggestions. Again, full time is doable, but I strongly advise against working in any capacity. The part time program and PRN working is my suggestion and I think that you can do that and feel good about it. I don't know how far you are traveling, so that may be a factor in how long you want to stretch things out. I just know from the program itself and from also seeing other NP students in other programs elsewhere, doing a Nurse Practitioner program is stressful and you have a lot to learn and it is not always about the race, it is about the final outcome. Good luck to you!!

Agreed, time management is key! I am sure you know this from undergrad, but it is especially important to keep in mind in grad school. Also I think that if you are doing the program full time then it will be hard to work full time. I know people who did it, but they did not have a life outside of work and school...not saying that even if you do work part time and do school full or part time that you will feel like you have a life, but at least you won't have AS limited time to get things done. Either way, that is why having EXCELLENT time management skills is essential! I personally, went to school part time and worked basically full time hours (but was able to have a flexible schedule). It was tough and mentally draining, but well worth it. Congrats to you and good luck in your studies!!!

Wanting to see if anybody had advice regarding good locations to work in the Washington, DC area as an FNP. Since I am not from the DC area, nor have I lived in the surrounding states, I don't know the reputation of certain places that one should avoid. Additionally, what is the typical base salary that FNPs in the area make? I know that these are broad questions, but any help or direction on research would help. I have been slowly looking at things online just to kind of see the areas that people work, live, etc., but again I have no clue. Have a great Thanksgiving!!