ERNURSEDAD

PS: I'm also an ER nurse and have been an ER asst mgr. We used FNP's in our fast track and one ACNP on the trauma team.

Here's an educated observation from an APN (certified nurse-midwife) who has taught many APN's in physical assessment, women's health, community health, etc. The ACNP role is still relatively new in the APN world. Many only work in ER's or ICU's. Some as hospitalists, etc. However, there are MANY an FNP working in inpatient roles; in acute care settings. FWIW, I'd recommend you go FNP. Why? More job options and opportunities. Let's say you tire of the acute care setting...you then have outpatient settings and/or retail healthcare positions you can consider who will not hire an ACNP. Just my opinion as an APN of 19 years.

In the last 5 years, I have encountered much of the same. In 2007-2008, I covered a sabbatical at a Chicago private university where my primary teaching and clinical assignments were with ABSN students. There were over a 100 in that program that spanned 15 months. The following 2 years, I taught full-time in an ADN program with ~300 students in the program. Greater than 50% of those students had degrees in other fields. Since leaving there in 2011, I have taught as adjunct faculty in a Master's Entry Nursing Program where a bachelors degree is an entry requirement. It's a sign of the times. It's the economy. It's nursing programs wisening to the market. Gone are the days where your incoming nursing class are mostly young women right out of high school. In the ADN program I taught for, about 20% of our students were men. Culturally and "chronologically" (age) diverse. I had few students under 25 in these programs. That presents a different challenge to an instructor dealing with true adult learners, some of who had not been in formal classes for years. I'm in my mid 40's, but have had several students my age and older. Nursing is seen as a stable career; one that pays very decently, we're still viewed as a noble profession, and we're a profession that offers people MANY options--work 3 days a week and be paid for full-time or work 5, or registry/agency if you already have bennies, etc. The market IS indeed tight; many of my ADN grads (previous bachelor's or not) landed gigs in nursing homes, clinics and dialysis as their first jobs until they got the "golden" BSN. Magnet hospitals are refusing to hire non-BSN's which I think is ludicrous for those nurses with other degrees. They're cutting their nose to spite their face. This comes from 23 years experience as a nurse, advanced practice nurse of 18, with significant clinical, administrative and educational background.

Because students DEMAND it! Does that mean that's the only teaching mechanism I use? No. I find particularly in the sub 30 year old students who have grown up with every ounce of technology at their fingertips that they want power point lectures; they want them posted to Blackboard ahead of time so all they have to do is print the slides and come to class, etc. Old fashioned note taking seems to have lost its value to some; well not to A students in my experience. I agree with those who say that the powerpoints from the textbooks are useless, they pretty much are. I do post those for students to have as a review. If using a power point presentation, I will often print the slides and bring them to class and leave blanks on slides forcing students to remain engaged in the lecture to get the salient message. I also employ other methods of active learning such as small groups presenting a topic or case study; throwing topics on the board and having students come up and write up there what they know about that topic; review NCLEX questions on the relevant topics (particularly right before an exam). As as educator, I know that not everyone learns the same, yet everyone does PAY the same to be there. It is my job to make sure EVERYONE learns. Just because the majority may PREFER powerpoint does not mean I am obligated to provide as much. I use PP presentations in about 50-60% of my lecturing. While I am always interested in constructive feedback, I find it incredibly interesting how students are amazing critics of the teaching methods of nursing educators. Unless a nursing student themselves has been an educator before, I would challenge that person with the question, "What makes you, the novice to my field of expertise, able to judge what methods are the best to convey what I know that YOU need to know to get where you want to go?" Certainly, nursing instructors like anyone else in life exist on a spectrum: a handful are AMAZING and a handful really SUCK (and shouldn't be doing it), most however, land somewhere in the middle. Students often fail to recognize or own their part in the learning process. Many students often have too much going on in their lives (work, family responsibilities, etc). Then when things don't go well academically, it's the fault of the instructor's power points, or the hard exams, etc. When a class does poorly on an exam, I look at the top performers in the class and see how they did. If there are still A's on what the statistics say is a "difficult exam", that means the content still got through. Students may not like that particular instructor's style. Or if that instructor is known to be "hard"; some students won't ever give that instructor the opportunity to be a "good instructor". I would also challenge students to use your voices. By that I mean...if you are not getting what you need...be assertive and let your faculty know what it is you need to understand content and/or be more successful. NO...this does not mean us feeding you answers. But there are several times a semester where a student or group of students approach me with a proposal and I'm willing to re-do something, alter a due date or go over something again simply because I have been presented with an angle I had not previously considered. We are experienced nurses and educators (for the most part), we are NOT mind readers, folks! Great thread. But no surprise...nurses are excellent critical thinkers who ask the good and right questions! ERNURSEDAD/Runningstork Nursing faculty in Chicago

Chiros... Not sure what you mean by Block 1, 2, etc. Tell me where you're getting this from and maybe I can be more helpful. Unreally... Never a bad thing that you took more math, but the only courses that "expire" within 5 years are the sciences, math and english never do...you did not HAVE to take 125. You are correct that statistics will be useful when you go on for a BSN. Re: HESI... No...it's not being done away with, even if you rather it would be. There are strong correlations between the HESI assessment exams and success on the NCLEX licensure examination. For all the "grief" that students may perceive, encounter, and may even endure at Truman (and perhaps other City Colleges), Truman is one of only two accredited nursing programs within the City Colleges of Chicago AND we boast the second HIGHEST NCLEX pass rate for the last 10 years in the state if Illinois (only to Rush University) of ALL other nursing programs. Not just ADN nursing programs. Why? The quality of nursing instruction at Truman as well as the HESI exam used to assess graduates at the end of the program. Last year we began using HESI specialty exams throughout the program to help students figure out how they are progressing along the way instead of learning at the end where they stand. Bottom line, Truman College, like life AND nursing isn't fair nor easy. That just is what it is. But you'll become an excellent nurse if you are successful in the program! Hope that helps, ERNURSEDAD Faculty, Truman College

It can be higher than Math 118/125.

If we're still calling roll...I'm present and accounted for! Nurse of 20 years, CNM of 16. Any other Chicago "guy" nurses out there? Any other man midwives? (I despise the word "male" when used with nurse or midwife...ARGGH!) Darryn D, RNC, APN/CNM, MS Full-time Nursing Faculty & Part-Time Nurse-Midwife Chicago, IL

I am going to politely agree to disagree. If an APN is working in an RN capacity, they should NOT function as an APN in that role, nor will they be held to that standard of care. They will be held to the standard of care of an RN with perhaps a Master's degree. Perhaps opposing counsel would seek an expert witness with matching credentials, but as someone has pointed out, if as a CNM, I am working as an L&D RN...I cannot and should not function as a CNM. Now, because of what I know as a CNM, that certainly augments what I know as an RN...which would empower me to use confront situations (assertively of course; out of the way of the patient and others of course; wink) that perhaps an RN w/o the same experience or education of a CNM might not. I might employ the chain of command sooner. I might make management suggestions to a willing provider. Etc. But I certainly could NOT be expected to supercede a provider when employed in an RN capacity just because by license or certification I am a provider as well. That all being said...I think I'm pretty safe. My "RN" work was in an ER while my APN certification is as a CNM. It's a long story, but after getting my arm twisted into teaching med/surg/gero to BSN students (classroom only...no way was I doing it clinically) after 17 years in women's health (OK, I had 6 months on a surgical floor right out of school...but that was 16 1/2 years prior!), I reconnected with a long ago interest in becoming an ER nurse (it was my "backup plan" in case OB didn't pan out since I'm a man). The hospital where I worked per diem as a CNM had some openings in the ER when my academic year finished, so I took the plunge, got oriented and added to my skill set. That further solidified my interest in pursuing my FNP certification to complement my CNM.

MaineMan, Congratulations! You are likely knee deep in reading, case studies, writing papers, and learning a plethora of new material as you've started your graduate program. I am one of the ONE PERCENT of nurse-midwives who are men. I have been a CNM since 1994 and have enjoyed a fruitful career in midwifery, have attended over 1,000 births, have enjoyed MANY facets of working in women's health: from practicing as a midwife in a private suburban practice as well as an inner city "ghetto" hospital; from running a a midwifery practice to managing an entire obstetric unit in a hospital; from teaching and precepting nurse practitioner and midwifery students to now being full-time faculty for nursing students; as well as having been Vice President of Medical Services and the Associate Medical Director for a large women's health/reproductive services organization where I oversaw the clinical operations of 12 health centers and all the healthcare providers and clinical personnel. I have been compensated well, however, the non-tangible rewards have "compensated" me even more. I continue maintain a part-time hospital based practice as a CNM to "keep my hands in it" (I'm finishing a night shift as I type this...things are peaceful at the moment). To address the gender issue...does it exist? Sure. Has it been a huge barrier for me? No. Even tonight, a muslim woman asked if she could have a woman perform her lady partsl exam. Of course. Are there midwives who think what we/they do is women's work? Yep. And that's ok. Bottom line? We all have a place. It's more about how you carry yourself and your demeanor with the women you care for. I maintain that a man in midwifery aint gonna last long if he aint got what it takes. I'll even go to what some might call the arrogant place and say that we've got to go the EXTRA mile because of our gender. You have picked an excellent program. I have worked with and have hired Vandy grads...and they're well prepared. A little "stuck" on their school...LOL...but excellent nurse-midwives! I also think you are INCREDIBLY wise to do the dual degree (CNM/FNP). I myself am planning to do a post-Master's FNP program. With all of the retail pharmacy based clinics popping up all over the country (they all use primarily FNP's) as well as many FQHC's, public health clinics, Planned Parenthood's, private practices, etc, etc, etc. You're doing it right. Further...this will be a great marketing tool for a potential employer. Not ONLY are you a CNM, but also a primary care provider who can manage women's primary care needs as well...CACHING! It sounds like you've thought things through. If the loans are out of control, consider working in an underserved area that does loan repayment. I had a Vandy grad midwife that I hired back in '99 into my practice do that...she's still in that practice...loans all paid 'cuz it was an underserved area and our clinic site was part of the department of public health. All the best to you. Feel free to contact me off list: [email protected] Darryn, CNM in Chicago

Zack, I've been a nurse-midwife since 1994 and I've enjoyed a fruitful and rewarding career ever since. I've delivered over 1,000 babies, have touched the lives of many, have worked many a night, weekend, and holiday, but have also been paid pretty decently for the work I've done as well. Don't let anyone stand in your way. I was you back in the 80's. I was fascinated with pregnancy and birth. I knew I wanted to be a nurse and care for pregnant/birthing women. I became a nurse in 1990 and started my nurse-midwifery program in 1992 finishing in 1994. I now teach nursing full-time and practice as a CNM very part-time (am finishing a shift as I type...things are "peaceful" tonight). The advice of others is wise...do the best you can in school to get in the best undergraduate program you can. Take as much science and math as you're able. Learn to write, speak, and critically think well. Research your nursing school options. Take things one step at a time. This CAN and WILL happen if you want it to! Feel free to contact me off forum if you'd like: [email protected] All the best to you, Darryn in Chicago, Nurse of 20 years, Midwife of 16!