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coast2coast

coast2coast

Content by coast2coast

  1. coast2coast

    experience with Barton ?

    Thanks all - the original post was from me but I had lost my login credentials. I have done a lot of boundary setting with this rep in no uncertain terms and he clearly isn't listening. Hasn't brought me any good offers either - similar to BCgrad, he seems to deliberately ignore my interests and push sub-optimal openings which I'm sure they have a hard time filling. I think my next step is to just block his number. Anyone have a great experience with another locums company?
  2. coast2coast

    Per Diem/locums rate in Chicago area?

    Anyone have recent experience with locums salary in and around Chicago, or IL in general?
  3. coast2coast

    Now THAT'S a lab result

    he was severely hypothyroid due to med noncompliance due to mania ...
  4. coast2coast

    Now THAT'S a lab result

    Chronic hgb in the 3.5-4.0 range. Dying of metastatic probably rectal dancer, survived almost a year. a1c 16.9, very alive and one of my best-behaved diabetics now. TSH 490. Manic but definitely alive a1c's of 15, systolic BPs in the 200s, and trigs of 3000 sadly become very mundane very quickly in community practice. It's amazing how resilient the human body can be.
  5. coast2coast

    Negotiating my salary is exhausting!

    I may be too late for this but ... THAT IS WAY TOO LOW! Waaaaaaaaaaaaaaaaaaaay under average for SoCal. New grads in community centers are starting over 90 at multiple locations in metro LA. I know you are a new grad and need to get hired, but man oh man I would tell this doc to stuff it and call me when she was ready to discuss a serious salary. You will never successfully renegotiate for lost income. Realistically you will do well to get 2-3% per year in most places unless you have an RVU structure in place. When you take the job is really your only moment to get what you want/need. anyhow. PM me if you want to discuss the LA market.
  6. coast2coast

    Do you text your patients?

    Never. I have also stopped giving out my direct extension at work and am now directing patients to the receptionist or nursing line. 99% of my calls and messages could/should be handled by someone else. I found that by my being involved they generally took much longer to resolve and wasted a great deal of time. You REALLY, SINCERELY, URGENTLY need to speak to me and only me? You know where I work every day ... If it's not worth making an appointment to you, why on earth should I give you my time off the clock?
  7. coast2coast

    Is it just me, or is this rude, sexist, and condescending?

    More importantly, other women will just assume one of THEM left pee all over the seat ... Let them fight amongst themselves over such petty garbage. yes, it's sexist, but it's also a battle you will never win. Seriously. Just pee on the seat next time!
  8. coast2coast

    California NP licensing and job search

    Until recently I always had the impression that CA BON was staffed by 2 people. The same man and woman always answered the phones. Response times certainly suggested that 2 people were doing all the work for the entire state .... Now no one answers and I'm concerned those two poor overworked souls have finally thrown in the towel, turned off the lights, and left. It could take years for anyone to verify that our BON is a ghost ship
  9. coast2coast

    California NPs feedback

    What is a family care center? $45/hour is the lowest end of the pay scale for so cal ... And the market seems pretty robust right now, you could do better. No benefits for a FT position is just a joke. I wouldn't even negotiate with someone that out of touch.
  10. coast2coast

    Chronic care at retail clinics?

    Really interesting to hear this perspective, thanks for sharing. I always wondered about ability to refer out from this setting. It sounds like you have an official referral network? What about labs and referrals for uninsured patients?
  11. coast2coast

    National Health Service Corps Loan Repayment 2014

    Yes I have wondered about that! I even re-checked my HPSA score and it still says 13. I got funded late in the cycle, maybe I was really lucky and there weren't many 13's accepted. Who knows. They most definitely funded me ! I'm full time.
  12. coast2coast

    Question on the NP Furnishing License in Calif

    a few thoughts .... Something is very wrong with CA BON staffing right now (more so than usual). So it might be a realllly long time before you hear anything official. Depending on how recently you applied they are saying up to 90 day wait for response. It it seems like they might require more recent pharm. I know Fitzgerald has review courses and UCLA is advertising their FNP review right now. It's supposed to be a great course, if you are near the area.
  13. coast2coast

    National Health Service Corps Loan Repayment 2014

    I was funded last year with a site score of 13. I think they give more funding each year to NP's which is why I made the cut.
  14. coast2coast

    Thoughts on designer resumes?

    Pretty but not professional.
  15. coast2coast

    DMII Victoza med management

    We added levemir to formulary a few months ago (in addition to NPH and 70/30) and I have been pushing it pretty hard with my DM2's. It's amazing to see how fast A1C's normalize with a long-acting insulin + metformin after, in most cases, years of struggle and strife with 3 or more meds. It requires a few weeks of regular BG checks by the patient, but then they decrease to 2 or 3 fingersticks/week to monitor fasting BG's. And they feel SO much better when sugars finally normalize. .... Now if I can just convince my colleagues to follow my lead ... I am convinced that half the issue w/ starting insulin in DM2 patients is provider resistance.
  16. coast2coast

    DMII Victoza med management

    Somewhat similarly, my preferred escalation is: 1. Max metformin. Hard & fast. No weenie 5 year slog at 500mg/day. You either need it or you don't. 2. Max glipizide ( and wait for the inevitable ). 3. Long acting insulin (lantus or levemir depending on formulary). Titrate up over a few weeks and then titrate off the glipizide. 4. Bolus with meals if/when the lantus becomes inadequate. My DM2 mantras are K.I.S.S. (for providers)(ie don't waste time and money hand-wringing over 12 orals/injectable for anyone with A1C >10) and "insulin isn't the worst thing that can happen to you!" Repeated ad nauseum to patients until they believe me. I don't have access to invokana (sp?) but am curious... I take it you have had a good experience w/it Boston?
  17. coast2coast

    Debilitating Anxiety

    http://http://www.amazon.com/Feeling-Good-The-Mood-Therapy/dp/0380810336 Feeling Good by David Brooks might be a good place for you to start. The original focuses a lot on depression, but there are some anxiety and self-esteem techniques in there that might help. He probably has other books specific to anxiety by now ... Just search on amazon. Good luck.
  18. coast2coast

    Adult track NP

    reebok, As an NP student I rotated on a hospitalist service at a large hospital. I say that I hated the role because it was very narrow and repetitive and I found waiting for a large team of docs and consults to make simple decisions extremely frustrating. Bear in mind that the way NPs were used in this hospital is not the way they are necessarily used everywhere - but basically we did scut work, managed hypertension for surgeons who couldn't be bothered, cleaned up messes when somebody got overdosed or otherwise med-error'd while on the floor, did discharge teaching for post-op patients who were newly diagnosed as diabetic, hypertensive, etc. Even the smallest and most-straightforward decisions (I'm getting a repeat head CT, I'm titrating coumadin) often required final clearance from the surgical team. They spent as much time approving and documenting these requests as they would have just managing the problems themselves ... I was also VERY unimpressed that NPs weren't allowed to do the initial hospitalist consultation for this particular service. We would go see new patients, write a note, pass it to our supervising MD, they would see the patient, and then re-write our note and sign it. What a joke! The flip side of this experience being - I found independence and challenge in primary care. Honestly I find primary care much, much more difficult than inpatient work and I will gladly take the pay cut to stay in this setting over the relatively narrower scope, easier shifts, and better bonuses associated with a hospitalist position. But to each his own - we need good NPs in every setting ! I suspect that my experience on the hospitalist service is not necessarily comparable to work in an ER - the ER is a world unto itself. You will need a ER NP to weigh in on that one.
  19. coast2coast

    Adult track NP

    I am an adult NP. My experience has been that only FNPs or PAs are hired in ERs and urgent care centers, since those settings typically only want providers who can see whatever comes through the door. However ANPs are routinely used on inpatient services/hospitalist-type services. For example, I graduated from a nominally "Primary care" ANP program. But since I was interested in inpatient work, I was allowed to do clinical rotations on inpatient services and could easily have gotten a job in a similar setting after I graduated. But there is no way I would expect to be considered for an ER position ( no sweat off my back ... I love primary care). Make sense? With the changing of ANCC (and likely AANP) certifications in the next few years, there will be renewed emphasis on the primary care focus of both FNPs and ANPs, and a recognition that ACNPs are the only NPs who are trained to work in the inpatient environment. Of course hiring practice will change much more slowly, but you need to think carefully about what type of setting you want to work in before you commit to a certain type of program. Personally, I thought I would love acute/inpatient-type work but hated it once I saw what the NP role was. Fell in love with primary care and the ANP certification has worked out fine for me.
  20. coast2coast

    So I might be going to China...

    Why would it only be 1 year abroad? His plans sound pretty long-term and permanent. Are you sure you two are on the same trajectory here?
  21. coast2coast

    Dealing with tough interviewers

    I'm sure this was terrifying the first time it was asked without warning. But the next time this happens it is the PERFECT opportunity to sell yourself. Coming from LTC: - you are independent, unlike a new grad - you'll require less orientation - you can handle 10,0000 patients/shift, unlike a new grad (or RN from another area) - you have supervised others and can delegate intelligently (CNAs, med techs, etc) - you have proven that you are a safe nurse (assuming no write-ups!) - you have experience thinking on your feet, prioritizing, and critically assessing situations independently & with limited support, unlike a new grad (or RN from another area) - you are a reliable employee (because you had to be) who doesn't call out sick, show up late, or no-show - unlike a new grad who will take any job they get (just like you did), you have much clearer reasons for accepting their position. you're more likely to stick around past the 1 year mark.
  22. coast2coast

    Family NP Certification

    The first is a scam. The AANP has a notice up that they are NOT associated with this company, even though it continues to use their logo (see The American Academy of Nurse Practitioners Certication Program ). The second website looks pretty fakey to me. I would avoid both of them. Have you looked into the fitzgerald review? You can do the same review course on-line as they offer in person and it's actually a bit cheaper. That includes a practice test and practice questions and has an excellent reputation.
  23. coast2coast

    Does it matter where you obtain your master degree for NP?

    Agree with most of this. I know of some outright discrimination against for-profit graduates (kaplan, UoP) at more selective practices on the east coast. i also get the general impression that hiring MDs are more sensitive to 'big name' schools than HR or nurses.
  24. coast2coast

    Your thoughts on specialty clinical sites.....

    Agree with the suggestions to do derm, ortho, and women's health. I would encourage you to choose fewer specialties and spend more time in them (more than 40 hours!) to get the most out of the experience.
  25. coast2coast

    A proposal for the future of advance nursing practice

    I'm going to breeze right on past the first 10 paragraphs just to say: OP, I think your original post was an interesting contribution that prompted a good discussion (until recently ... ahem ). For all that it can be frustrating for NPs to encounter policy proposals written by someone who doesn't understand the role, it's a good experience for what happens in the real world. As a profession, we have to learn how to react to these situations and I'm sure it's been eye-opening to you to see the whole range of responses to your post. So as far as I'm concerned you're welcome to stay.
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