singleye

Just wondering how many patients you see average a week in large academic centers? The APPs in my hospital sees about 20+ a week. They have been here 4-5 years and their schedule is never full. I have worked in my workplace just over one year and is struggling to find my niche and source of patients. Some Dr. thinks that APPs are only there to see pts when the Dr has no openings. Some pts love their drs that they have seen for years and do not want to see me. I can see new pts too but I'm still nervous about seeing all types o new pts and I need an attending to staff for new pts. Different attendings have different preferred specialty and they don't want to staff everything. So after one year, I still has only about 20 pts a week on my schedule, less or more pending on the week. I guess I shouldn't complain but I'm so worried about not seeing enough patients. Any thoughts?

Layoffs: Two hospital system in my area is laying off people due to low censes. Our area is not the covid 19 hot spot. One is laying off 1000 of their 6000 employees. The other large system is asking employees to take personal time off. Has lay off occur in your health system? Freedom: just a rant So we can't reinforce the social distancing rule or locking down your state because people have freedom in this country, but you can seize medical equipments and call for drafting of healthcare professionals to work in your state! What a joke!

I started in a specialty NP clinic 2.5 months ago in an academic center. Our pt volume is also way down even with tele medicine visit options. Our MAs and RNs are taking low censes but no one had talked to the APPs yet. We are still waiting for the covid 19 surge and the hospital side talked about matching staff in the clinic to work in the hospital side when the surge occurs. I am technically still in training and does not have patients of my own. I am thinking about taking a personal leave because of the low patient volume and because I really don't want to go back to work as a RN on the covid 19 floor.

I graduated in August, passed my boards mid Oct, and got an offer from my dream job late Oct. I still can't believe it! Here are my refections and some tips, hopefully it'll be helpful to you. Boards One word: LEIK I didn't take review classes. Had listened to APEA videos, but LEIK is the best. Predictor tests: I got 65% and 69% on APEA and 75% on official predictor test. Jobs I applied all the jobs nearby (within 1 hour drive), maybe 30-40 total, more and further in past two months because I'm just fed up and wants it to be over with. Got 2 interviews and 1 offer. I think it helps to go through the process less painful if you compare job hunting to dating. If you don't give up, everyone will find someone eventually. You spread out the net wide first. Don't get too emotionally involved early on ? Timeline: two jobs I interviewed with, I got a call for interview the day after submission. was offered the job exactly 7 days after the interview. Interview One interview went very well. Longer than scheduled, very casual, felt the connection. The other interview were very short, casual, but the interviewer is not interested in me as a person at all. I think I got the job because of my coverletter, resume, and some luck. I still don't believe that I got the job! Reflections/ tips: Get your coverletter, resume looked over by career professionals. Sample coverletters help but your coverletter should be about YOU. Passing the boards is way easier than finding a good job. It's easier to find a job in the system you are currently working at, at least your first job. Good luck!

I graduated in August and will take my boards in Oct. I like my current hospital and wishes to find a job here. I sent my application to 3 different job listing starting mid July but didn't even get an interview yet. I was told it's all about networking but I only worked in this hospital for two years. I did my specialty rotation with the hospitalist but they currently don't have any openings. Now I am getting anxious and wants to apply anywhere else too. How long it took you to find your first NP job? Where did you find the job? Thanks.

I transfered to my current unit for about a year. It's a great unit: my boss is excellent, my coworkers are nice, and the job is easy. However, I feel that recently I felt bothered a lot at work, I need help to keep my inner peace! The major prob. is with a couple of charge nurses. They are young, cocky, and dangerous in my opinion. An example: One time I have to change the chest tube canister, I had everything set up, but forgot whether I have to clamp the chest tube or not before I switch the canister. I asked the charge nurse, she hesitated for a second, then she said "no". So I changed the canister without clamping the chest tube. I found on the manufacturer's website later on that you do need to clamp the chest tube before changing the canister. Glad the pt had a pigtail and no harm was done, but I was upset. You don't need to know everything but don't pretend that you do! My trust in you could have put patient safety and my license in danger! The same charge nurse kept Cardizem at lowest rate without titrating it up because " the pt's HR was 150s one hour ago and now she is 130s, I don't want to bring it done too fast." What??? It's frequent that our charge nurses have to call other unit to ask what type of blood tubing to use. one time one charge nurse proudly states " SVT and V-tach are pretty much the same thing", the other time the charge nurse titrated a drip up and down without documenting any changes in the MAR... These charge nurses are the ones that frequently tell me what to do with my patients... In addition to the lack of clinical experiences, our charge nurses are very privileged. We are a very small unit and the charge sometimes have to be in staffing. They always have the easiest one or two pt assignment but they will NOT help or selectively help since they "are in staffing". I don't have prob. with the two charge nurses personally and I don't ever want to be in charge, but I feel that it's starting to really bother me I need some input to keep my inner peace and keep me sane till my year is up here.

I want to thank everyone for the comments. I guess I am still grieving... I apologize for offending anyone, I did not mean to. many of the nurses I consider as mentor have ASN and they are the best nurses I have known, I wish I will have half of their wisdom one day. However, I stand where I was with my first preceptor. She said it's my orientation and she is there to support me but she just would not give me more than one patient despite how well I do with my only one pt. Would I meet their expectations if I had not "wasted" my 1st six weeks orientation? probably. In addition, I do buy a tea or coffee or a piece of fruit for my preceptors when I mean "showering them with small gifts", I really appreciate them after my first preceptor experiences. I think it's appropriate, sorry for confusing you guys :) I really like ICU, however, I realized that I didn't have much time to think and learn for the past 18 weeks since I was so absorbed in completing tasks. I don't know what I want to do with my NP, that's part of the reason why I took this new job. Now my experiences led me back to cardiology, maybe it's meant to be. I love cardiology. Should I work at step-down and try CCU/CTU later? I'm not sure... anyway, thanks.

Four months ago I left my beloved med-surg job in a small community hospital for a dream ICU job in a large academic center. My fascination with the ICU job started 3 years ago when my goal was CRNA school. I entered NP school a year ago after realizing that I enjoy the interaction with patients more than machines and drips. I have a lot on my plate, a new baby, a toddler, part-time school, full-time work. However, I still made the leap for the new dream ICU job without hesitation. Call me crazy, I thought I can do it all. My first preceptor was a control freak. With an associate degree and a little over a year experience, she made me feel intimidated and stupid every day during my first 6 weeks orientation and only gave me 1 step down patient even after the boss spoke to her. I caught up with my 2nd preceptor. I really like my 2nd and 3rd preceptor. I showered them with coffee and little gifts because I really appreciate them. I had 18 weeks orientation and I thought I may just need maybe a week or two to be ready but my boss insisted that I don't have critical thinking skills and the foundation to be in ICU. Thinking back, I think those words are the words of my 3rd preceptor (gosh I really like her and I thought that she is my friend). The doctors I worked with at the small hospital told me that I can probably do some consults for them (since I had so many questions for why and how to treat pts) and my coworkers said I am a good nurse. What you mean I don't have critical thinking skills and foundation to be in ICU? I didn't do well with my first sick sick patient assignment but I did well with the next few (independently took care of two ICU pts). It's easy for my preceptor to criticize without moving a finger. Can she do a perfect job? For a week or two, I was upset and hard on myself. I was offered another position in the cardiac observational unit. They are actually excited that I will be there. I also am able to transfer to the new cardiac step-down unit in the summer. Thanks for reading. I guess it is what it is. I tried my best and I still don't know why I insisted to go to ICU and what exactly this experience will benefit my career in the future. but things work out certain ways for a reason and I'm sure one day I will find out.

Thanks both! What's your intake for 1.5 hours (one way) commute to work? I live in a small town, way more options and much better rate if I travel to a bigger city 1.5 hours away. rotating shifts though. thanks again.

I am considering going with a traveling agency but surprisingly they offer $10 less since I am a local candidate, plus it's all night shifts. I worked at my local hospital for six years and left 6 months ago (on good terms) for a dream icu job. Unfortunately the ICU job didn't work out. Since I've two young children, traveling too far is not a good option for me. I'm wondering whether traveling agencies always offer lower rates for local candidates or it's agency specific? thanks.

I'm at 16 weeks orientation and just had my first sick patient assignment at week 14. My orientation went well till then. I was told that I am not functioning at the level that I should and I need to re-evaluate my fitness for ICU. I have worked on Med-surg for 6 years and I loved my job. After some soul searching, I found out that here are my problems. 1. I don't have a system or a routine, my first 6 weeks didn't go well (preceptor prob.) My mistakes (missed urine OP for 3 hours, clamped EVD) are prob. related to my lack of a routine. 2. to compensate for the lack of a system, I focused on tasks instead of the big picture (which will help me with my priority setting) 3. I have a lot of other responsibilities, so I didn't set time to process and think. I know I am capable and am usually good at critical thinking. I want to clear my mind and try to make this work. but my mind and emotions are like riding roller coasters. I am not sure whether realizing my problems is too late to correct them. Any seasoned nurses here can shed some light? thanks.

Thanks everyone so far for the comments. I have wonderful management and they kept someone for 20 weeks but I realized that they think I might not be a good fit for ICU. This is what happened. The attending dr. went to talk to my manager because I missed to collect 3 hour urine output for a pt who has low urine output overnight and the doctor found that I clamped the EVD ( my other pt had V-tach, I must have forgot to unclamp it before I went to check the other pt. He happened to found out about it right after). Also I got a incident report for a infiltrated IV. I'm not sure why I was not thinking. Maybe I'm taking on too much (school and work and new baby) and the stress dulls my mind. They set clear goals for me: recognize VS changes, make sure meds and labs are on time, follow formula for AM rounds. I need to make sure I need to make these daily goals, take care pts independently and make no more mistakes. Mostly I need to clear my mind and think!

I'm at week 16 orientation and I was told that I am expected to function at a higher level. I do feel that I'm chasing my tail all day with one sick ICU pt (not very unstable) and one step down pt assignment. I'm not sure whether anyone can give me any advices. background: I've been a RNx3 yrs+LPNx3 yrs on med-surg step-down at a small hospital (loved my job). now on week 16 orientation in a level I university hospital ICU. My first 6 weeks didn't go well, controlling mentor, only had 1 step down pt. caught up with 2nd mentor, doing fine with two stable vented pts but never had sicker assignment till now. Pt had increased ICP, shivering protocol, on precedex, fentanyl gtt, has ventric, GCS 211. My boss and preceptors are trying to help me but I don't know what I did wrong that I'm not getting it. I'm not annal, not an organized, OCD, detail oriented person. Does it mean I can't have a career in ICU? I am so lost now, please help!

Any seasoned ICU nurse mind sharing your daily routine? I feel that I can barely keep up with the charting every day ( week13 orientation, 3 years small hospital med-surg step-down experiences). Anyone mind taking a look at my plan for the day and gives me some advices? appreciated! 7-7:30 getting report, bedside hand-offs. 7:30-8:00 head to toe assessment, may pass 8am meds too (already doing bedside hand-offs, might well do head to toe assessment too) 8:00-9:00 read Kardex, notes, labs, etc. chart the head to toe assessment. 9:00-10:00 pass meds for 9a, 10a. 10:00-11:00 morning rounds, turn pt, catch up 1100 assessment and chart for noon assessment. 1200 noon meds, turn pt, maybe lunch. 1300 meds for 1400, maybe lunch 1500 head to toe assessment for 4pm, meds, charting for 4pm. 1600 meds, bath pt. 1700 meds, get pt back in bed, etc. 1800 meds, prep for report, turn pt. 1900 report.

because I have one stable near step down pt. I caught up with everything including charting, read MD notes a couple of times and truly has nothing else to do for my pt till next VS. I even walked around helping my coworkers a few times.

Thanks for the comments! I appreciate it. My prob. is that I think I can take on more than one step down pt but my preceptor does not allow the increased responsibility and learning opportunity. I did voiced my concern with her first and it didn't solve my problem. Another problem is that she always lecture and criticize me in front of everyone. I have felt stupid and incompetent since day 1 with her. Like purplegal suggested,I think I may not say anything to my boss because there are only 2 days left with this preceptor. The only reason I am considering it is that I hate to waste another week of orientation with 1 step down pt. In the next two days with her, should I even at least suggest a sicker pt assignment with my preceptor or just take whatever pt she suggests in order to keep a happy ending? Another new grad started the same time with me is taking 2 pts, taking and giving reports, calling dr. and putting notes in because of a more lenient preceptor. This make me feel behind even more. Anyone knows what is expected for a new icu nurse six weeks into orientation?

i've worked in med-surg/ step down for 3 years, just got my new dream job in ICU. my preceptor has 2 years' experiences in the ICU. She is very passionate about teaching and has gone out of her way to show me things many times but she micromanages everything. 4 weeks into my orientation, I still assumes a supportive role and we were told by our boss to let me step up and take at least one pt on my own. I was given one pt (almost step-down) status on my own for a week and I did fairly well. I felt bored so I asked her to give me her pt too (stable, on vents and pressor). I told her I'm not going to touch the pressor since she has been working on it. My preceptor agrees but I can tell she was bothered by my request to take two. I'm not sure whether she doesn't trust my ability or wants perfect control. Anyway, everything went well for 4 hours then I failed to pay attention to pt's MAP (dropped to 50s from 60s) and I was lectured in front of everyone if I want to take two pts I should not have done that. I didn't say anything but I want to say that you are titrating drips, you should have overseen me instead of spending the time chatting in the breakroom. She wants me to only take one pts from now on. Luckily I'm switching to another shift after two more days with her. My question is should I bring this up to the boss (not in a negative way?) My only concern is I felt that I can take two (with supervision and help) and I don't want to waste 2 days (a week)of my orientation with one step down pt and feel bored. Also with my future preceptor, should I step out of my comfort zone and take a little bit more? I am not sure why my preceptor is so ticked off by me doing that. Thanks so much.

I started clinical at a long term care facility last week, I took care of a 84 year old pt for two days. He requires full ADL. He's still very sharp. he told us about stories of his life and he's so nice to us students. on his bed table are pics of his three daughters and grandchildren, they are decent looking ppl but none of them have ever visited him. I found an unopened card from his friends in his draw and read it to him. He has tears in his eyes. when i asked whether his daughters visit often, he said no. I'm sad and mad about his daughters, do they just put their parent in a nursing home and never remeber about him? are they so busy that they can't find any time to visit? This makes me really mad. maybe I'm just too ideal and sentimental.

hello, I'm seven weeks into a LPN program and we started clinical last week. Disappointingly, we're actually doing CNA work there (such as bathing pts, taking vital signs), anyone knows whether we'll be allowed to do more complicated tasks such as wound care, inserting catheter, etc as students? thanks. is it ok to ask nurses about it?