Destined2sing

Good morning, I am starting my first primary care position June 6th (also my birthday...lucky me), and I could really use some help. I have been working as an RN in a Mom & Baby (with level II NICU) unit for the past 5 years, and have also worked for a period of time in a Level III NICU. I obtained my MSN from the University of Cincinnati as a WHNP (my opinion of UC is best left to another thread). I FINALLY (YAY! ) was offered a position as a NP this past February, with a start date as listed above. All I can say is that it took a LONG time to find a job, and my background in Women's Health was far from helpful. Since passing my NCC boards, and while looking for a job, I continued to work on my Mom & Baby floor as a Staff RN. Those of you that have experience in this area likely know how much 'care' patients typically need, so it has not exactly been the greatest way to keep my skills and knowledge up. Since it has been a while since I graduated from my MSN (9/09) I am really feeling nervous about starting this new job. My primary concern is that they are hiring me to actually do Family Practice care. Initially I will be working in the main clinic, and seeing regular patients, but eventually they want me to work in the walk-in clinic/urgent care. The clinic is actually a Federally Qualified Health Center (FQHC), and the vast majority of patients are heavily under serviced, and there is a rather wide variety of acuity levels and complexity. Currently the facility is transitioning away from mostly locum tenens providers. On staff currently will be 4 physicians (MDs and DOs), 2 NPs (an FNP and myself, however the CEO is looking to add a 3rd NP), and your various support staff (2-3 RNs, several LPNs, and other ancillary staff). When I met with the CEO, along with my husband, we were both really impressed with what the direction of the facility was, as well as the overall facility and equipment. The CEO is an extremely ambitious individual, but also is VERY demanding. I know that he is really a very understanding and accommodating man, but he does really expect his PCPs to perform at a high level (what CEO should NOT expect that). He recently let go a Physician Assistant from his staff because the PA was just not working independently enough. Apparently the PA had been at the clinic, and this was their first job as a PA, for around 3-4 months (I believe). The Medical Director felt that the PA was asking them too many questions, I got the feeling that the PA wanted to clarify every Dx or treatment decision before doing anything. It apparently was so bad that it was causing the other PCPs to get behind in their patient care duties. So I am really worried about being too much of a burden. Above and beyond all of this, the CEO is really hoping that I can come into the clinic, and within a short period of time begin to work on revising the Policies and Procedures for the NPs and Nursing staff. I did a large amount of this at my current employer because I was the chair of our practice council. In addition to this, he is hoping that I can develop into a strong leadership and mentorship role for the NP and Nursing staff, again because I did a lot of this at my current employer. I know that this seems like a HUGE amount (or at least to me) of things to expect from an inexperienced WHNP. I attribute a great deal of this to how well the CEO, Medical Director, my husband, and I hit it off together during the day we spent there. I am very proud that the CEO has this much confidence in my abilities, and I really just do NOT want to let him (or myself) down. I have been talking to my PCP about what she did when she first established her practice. She told me that she really used the book The Resident's Guide to Ambulatory Care as a quick reference for anything she needed to brush up on. On her suggestion I purchased the book, and I must admit that it really looks like it will be a huge help for me. The facility, currently, does not have any services such as DynaMed, but they are looking into something for the future. Are there any suggestions that you experienced NPs might have for me? Any books, journals, subscription services, computer/pda/iphone programs, or the like that you felt were a HUGE help to you? I am worried, also, about looking stupid in front of my patients. The scenario that kind of worries me is with something like medications. If I am going to a Rx a med that I am not really familiar with I plan on looking it up to make 100% sure that it is the best treatment option for the patient. I really do NOT want to pull out a Drug Reference guide or PDR in front of a patient. Did anyone else have this kind of fear? I really could use some help to calm my nerves down a bit. Susie B.

I ended up needing to delay my NCC exam (initially scheduled Monday) because of a family issue that came up. Still, when I was asked about my status at work today I told them that, just like before, I have my MSN as a Women's Health Nurse Practitioner, but have not been board certified as of yet. I was URGED by my facility to have my name badge changed from "Jane Doe MSN, RN" to "Jane Doe MNS, RN, WHNP." I am EXTREMELY hesitant to do this, as I do not feel that this is appropriate. When I addressed this concern they said it would be different if the badge would say "Jane Doe MSN, RN, WHNP-BC," as the latter implies the board certification, but since the former does not include the "-BC" it would be perfectly acceptable. I think this has a LOT to do with the fact that they are trying to add as many credentials to the staff name badges as possible, as apparently the more letters you have behind a name the better your staff is right? Any thoughts on this? Cliff notes: Employer wants me to add WHNP to my name badge, even though I am not board certified yet. They claim it is ok since I am not adding WHNP-BC to my badge. So is it ok for a individual that has graduated from a Master's Degree program for Nurse Practitioner to use the credentials WITHOUT the added "-BC?" Thanks for your input all! Also, to me, even if it is technically okay, it seems just really shady, misleading, or unethical to do this...

Hey all, Let me start with a little bit about me for background. I have been working in health care for about 10 years now. Early on my experience was as a CNA and Nursing extern. I have been an RN for 5 years now. My experience has overwhelmingly been as a Post-partum nurse, but I have had experience in a level 3 NICU (and my current facility has a level 2 nursery). My L&D experience is minimal, because my facility typically does not do any overlap between L&D and Mom/Baby. What I have experienced is mostly just standard nursing care of the L&D moms when the unit is under staffed. There are specific care actions that I am not allowed to perform, but conversely the L&D nurses that float up to our floor cannot take babies or mom's with certain medical issues. I have gone from having my ADN to getting my BSN and eventually having my MSN completed last year. I received my MSN as a Women's Health Care Nurse Practitioner, but unfortunately I did not pass my first certification exam last December (number of silly reasons on my part), and I am taking the exam this coming Monday. I have been fighting for more duties or tasks at my current employer (where I have been for the last 6 years), but there have been barriers placed in my way. My feelings are that it is a matter of floor political structure, but the reality is that I am sure there is more to it than that. An example is that I had been asking for a long period of time to be trained as a "charge nurse" on our floor, which is a duty that is just rotated depending on who is working that night. The reality is our "charge nurses" are really only responsible for assignments and canceling/calling in nursing staff dependent on floor census. While being told over and over that they were going to set me up for training, it was only about 6 months ago that they followed through. This has been the status with pretty much ANY advancement like opportunities available to our floor. About 8 months ago we had a change in management, and the nursing staffs immediate manager is an individual that has been a nurse for about 3 years longer than I have, and only has her ADN. She has ONLY Mom/Baby experience as well. I applied for the position, but was told that I did not have the supervisory experience needed (which I can understand), but was told that there was likely a position opening up shortly that would be an Assistant Nurse Manager. I was told that I should try to get some supervisory experience in, and they pushed me to take on a number of Chair and Co-Chair positions on various committees. Well, the position eventually came up, I applied again, and once again was told I did not have the experience needed. The reality though, and I am certain of this, is that the manager had already planned to give the position to a close friend of hers, and the application process was a formality. That may sound bitter and angry, but this is one case where I am certain of it, considering that there were a number of other people that applied for the position that had significant experience, training, and a long history of positive evals (of which the "friend" obviously had no where NEAR the qualifications that these other individuals did). Well, to make things more annoying for me, we cannot access our work emails at home, and the new manager decided we needed a Nurse educator for our floor. She sent out an email that pretty much said the first person to respond to this with a desire for the position gets it. I was not at work that day, so I did not find out until the following day. Surprisingly the position went to another 'friend' of the manager. This is one I AM bitter about, as the individual that received the position had only had her ADN and RN for a year, and was someone I was preceptor for during their new nurse orientation (which had only ended about 3 months prior). I have come to realize that I have absolutely NO chance for any job advancement working with this current hospital, and specifically this current floor management. Since that point I have been applying for numerous jobs that are not floor nursing positions (Management, Assistant Management, Nursing Education, Patient education, and so forth). My reasoning for this is that I am looking for a position that will be more commensurate with my education and experiences. I have had a number of applications that have resulted in interviews and several follow up interviews. In the end each place has passed on me for various reasons, but frequently it has something to do with experience or concerns about how my age will be received in a position of authority (I am 28). The last position, which the Nurse manager for the hospital said she felt I was more than qualified for the position, but wanted me to interview with another individual. This was because she had limited Women's health experience, and wanted this other individual to assess my knowledge of the field. The follow up interview was ANYTHING BUT THAT. The woman interviewing me was apparently a Nurse Manager for Women's health at another facility, and she only asked about why I had so little experience in L&D, why I did not have my RNC, why I did not have my NRP instructor license (mind you, the only certification required for the position was RN and BSN). She asked me nothing that would assess my knowledge of Women's health, and seemed to feel that time in the position was the only thing that mattered. Well, I she ultimately said that she could not advocate me as a candidate for the position, and suggested that I spend another 5-10 years as an RN before considering a management or education position, and that was even after I get my WHCNP certification:uhoh3:. I was really upset about this interview, and how it did not turn out like I was told. To make matters more infuriating I found out that the person that interviewed me (the Women's Health Nurse Manager) was two years older than me, but had been a nurse for 2 years LESS than I have been. I was just ****** that she lectured me about needing experience, when she in fact had LESS than I did... So I guess I am really torn right now as to just what to do with my career at this point. WHNP jobs are few and far between right now in this area, and what are there get applications from FNPs, ANPs, and WHNPs. I realize that I should have listened to my hubby and done an FNP position, but too late now. Should I stay at my current employer? Look for another floor RN position in Mom/Baby? Try to find another floor RN position in some other area of nursing? Any suggestions would be HUGELY appreciated! Thanks

Hey all, I could use a little encouragement, as I am taking the NCC WHNP exam on Monday the 26th. Unfortunately this is going to be my second attempt at this exam. I took the NCC exam in December of 2009, having finished my MSN in September of 2009. I did terrible on the first attempt, and it was primarily my fault for not being prepared for it. Of course, I have discovered that the program I went to for my WHNP MSN had not updated any of their power points or data since 2006, and a significant amount of information was outdated at the time I took the exam. So, I have been utilizing the Fitzgerald online seminar program to review. I also purchased the practice exam that NCC suggest through another company. I am really just nervous because I am not the best health care certification test taker. I know the material, and I can use it in real life practice, but applying the knowledge to the test world is not easy for me. This of course has not been improving to some extent, as I am moving further away from the academic mindset and back into the practitioner mindset. Any tips, advice, or encouragement would be greatly appreciated!