CCRNDiva

I have to admit that I've asked what I thought were pertinent questions (such as how well do your nurses and docs work together, what are the weekend requirements, why do you have open positions etc.) and have been misled by the unit director. I did not find out all of this until working my first night of orientation on the unit. I was told by the director that the vacancies were due to nurses finishing grad school and the unit going up 7 beds. Imagine my shock to find out that the overwhelming majority of nurses left due to being unhappy with how the unit was ran. Several nurses had even left while in orientation or within a couple of months of finishing orientation. At least 6 RNs have left or put in their notice since I started there 2 1/2 months ago (none of those for job promotions or finishing school, lol). This is a repeat Magnet facility, by the way!! I don't know how I could have avoided this situation. I asked around before taking a job here and heard nothing but good things. I didn't find the dirt until I was already working there. Many directors and managers know how to hide the dirt. They are good at selling their units and making it seem like they have the best place to work. I thought I had found the holy grail of nursing care until I actually worked a night on the unit. So sometimes you won't know until you actually work there.

I just asked one of my instructors about this and she had not heard of it. I am anxious to see how it turns out. It seems like there should be some time of credentialing or certification to validate the ENP programs out here.

Yes, I am currently enrolled in an ACNP program. I am looking to supplement my program with a fellowship after graduation though.

It is a very frustrating situation and I don't understand why the PTB and program directors are not listening. For you and your fellow students to have complained about the same deficiencies we, as current students, are complaining about is insane. I have entire courses individually dedicated to health care ethics, role socialization, health care finance, health care policy, research, theory, epidemiology yet the body systems are covered in one class each.

SFDRN, I have to agree with you. After a year of full time course work, I'm finally into my specialty courses, (ACNP w/ critical care focus). I thought I would finally get into the meat and potatoes of my major. Surprise, I have 3 presentations and a paper that will account for half of my grade for a diagnostics course. Like you, these papers/presentations are meant to prepare for my comprehensive exam, which is, aha, just another paper!! I am lucky to get a full lecture (3 hours) devoted to each body system, while some are lumped together in one lecture but I've had entire lectures dedicated to quantitative research or how to develop a PICO question and an entire course dedicated to various nursing theories. Something is wrong here!!! I understand that this is how it has been done, but it is time for a change. We were told during orientation that they want us to publish. I understand that improves the reputation of their program but I want to take care of patients, critically ill patients, for that matter. I feel like I need another pharmacology course (and my course was taught by an awesome instructor who is both a PharmD and an ACNP) and I could use courses dedicated to the pulmonary and neuro systems. I had to take a cardiovascular course as an elective to expand my knowledge of the cardiovascular system. You would think the DNP would address these deficiencies, but sadly, it does not. I doubt my future patients are going to care that I had to master writing papers to complete my program or that I've been published in a peer-reviewed journal. I think they would like to know that I have a firm understanding of their disease process. I don't know how a direct entry student could master the clinical content in my program. We are frequently told "I'm not going to elaborate on this, you guys should understand this from you current practice." Which is probably why my program insists upon practice as an RN prior to clinicals. We have several students, however, who have less than 3 yrs of practice and they struggle at times. I stalk Medscape daily to try to supplement my learning. I ask the docs to explain what I don't understand when I'm at work. I'm also looking into supplementing my clinical time next year and applying to a fellowship after graduation. I'm not trying to bash my program, (its a top 50 program), I just feel that the format for NP education needs revamping and tacking on additional research, transitional research, EBP, policy, and finance courses and calling it a practice doctorate is not going to cut.

Don't pay it any mind. I received so much encouragement from the docs I worked with when applying to NP programs. Several offered to write letters of recommendation for me, while others offered to train me. Maybe they were all lying to my face while deriding me behind my back, but I seriously doubt it. As the above poster mentioned, most of these forums are populated by med students and residents who have not yet learned the value of a good nurse. As a matter of fact, I've experienced the most arrogant attitudes when working with residents since working at an academic facility. I was not prepared for that, as the overwhelming majority of the attendings and board certified docs I've had the pleasure to work with valued my contribution and input. I try to avoid those forums at all cost. You should do the same :)

May have been a blessing in disguise. I have not heard anything positive about Northwestern lately (and that includes current and former employees). I've also heard that it is not the most nurturing environment for new nurses with orientation reportedly lasting less than 2 weeks and poor staffing ratios. I had always considered NW to be my dream facility but have since realized that its true what they say, "all that glitters isn't gold", lol. Please remember that interviews serve as a time for you to interview the facility too. Ask about the average tenure of the nurses, the number of open positions and the number of new grads on the unit you're interviewing with. An overabundance of open positions and new grads lets you know that the experienced nurses have left the building (usually a bad sign). Try not to be swayed by US News and World Reports rankings and magnet status. I've found that these top ranking, magnet facilities are struggling with issues that many community and regional hospitals have resolved years ago. You can get some solid nursing experience in community and regional hospitals. Please don't count them out of your job search. Good luck!!

A lot of it depends upon the facility you would work in and their magnet aspirations. Some places require their nursing leadership to have a BSN or a MSN while others will accept an ADN with a bachelors or masters degree in the healthcare field. For instance, I have two former colleagues who were recently promoted to unit director positions as ADNs with bachelors degrees in healthcare administration (one has not yet completed her degree). Unit directors at my current facility, however, are required to hold a MSN or obtain one within 2 years of securing the position. My current facility is a magnet facility. According to the new Magnet guidelines, by 2013, 100% of nurse managers must hold either a bachelors or graduate degree in nursing at the time of application. So a lot would depend upon the hospitals magnet aspirations. My previous facility is not pursuing magnet status so they are willing to promote nurses with experience and degrees in other fields. My advice would be to complete the ADN, work as a RN and decide if you want a career that involves direct patient care or management and what type of facility you would like to work in. There is no sense in wasting time and money pursuing another degreee without knowing what you want to do. I worked as a charge RN for several years prior to obtaining my BSN and that was enough for me to know that I did not want a career in management. Your current degrees along with an ADN may qualify you for a leadership position in an ambulatory care center or hospital without an additional degree. If you find that you would like to become an advanced practice nurse, several universities will accept you into their program with your current degrees (you would most likely have to complete some transitional courses like nursing theory, community nursing and research). Good luck in journey!!

I feel for you. This is why I like my patients truly sick and dang near dead.

Different assignments/locations pay different rates. I was quoted a take home of just under $1200/wk for a position in Ft. Wayne, IN that included housing stipend, but that area is also notorious for low nursing pay. Higher paying areas tend to pay higher wages.

Loyola University Chicago and the University of Maryland have additional course work in critical care included in their ACNP programs. You can choose to focus on either critical or emergency care at Loyola. Both programs include both online and in-person course work. They're both affiliated with academic medical centers and provide clinical rotations for their students. U of Maryland also has post-graduate fellowship programs in trauma and critical care for NPs at their medical center. Good luck in your journey!!

St. Lukes in PA has an Emergency/Trauma NP fellowship. University of Maryland also has a trauma fellowship. Both programs look phenomenal to me and I plan on applying to both after graduation. A former colleague of mine completed some clinical time for his ACNP program at U of Maryland and he was very impressed. He would have jumped at the chance to complete a fellowship there but family obligations prevented him from doing so. He is currently a trauma coordinator and told me that completing such a fellowship would allow me to "write my own ticket" thereafter. Good luck in your journey!!

As long as the MD is willing to teach and nurture you as a novice, I would take the job over holding out for something else. A bird in the hand is better than 2 in the bush, as they say! I think your plan is sound; you could always supplement this experience with volunteer work. I think that any experience is often considered better than none.

I think you have to keep in mind where you want to practice and the laws in that state. For instance, PAs were given prescriptive authority in IN in 2008, while NPs had prescriptive authority here for years. Plus our state schools are just now starting PA programs while they've had NP programs for years. The majority of the local docs in my area prefer NPs while the CT surgeons prefer PAs. I had considered becoming a PA when I started nursing school my kids' pediatrician and others told me my job prospects would be slim if I chose to stay in this area.

I would love to attend an event like that!!

Congratulations!!!

If you can afford to take an unpaid residency/internship, then why not? I would also take the time network with the surgeons you work with on a daily basis. Let them know you're an ACNP and looking for a position. Some physicians are not aware of the ACNP role and how ACNP training is ideal for working in the inpatient or surgical domains. I think you're really going to have to sell yourself and what you have to offer. Offer to train with them for a few months on a trial basis. Also, I don't know how close you are to Methodist Hospital but they have a couple of NP fellowships, one in transplant and one in neuroscience, and they give preference to those who are willing to sign a 2 yr contract after the completion of the fellowship. Good luck!!

I would not look to a hospital to protect my license. I can't tell you how many time I was given a telemetry RN (I've had to refuse med/surg RNs) to fill a shortage in the ICU while working as an ICU charge RN. I can't tell you how many times we were expected to make due with an inadequate number of RNs for the number of patients we had. It is our responsibility to protect our licenses and careers. The hospital will be the first to hang you out to dry when it comes down to them or you. I'm not trying to be negative, just trying to provide some insight into how things work within a hospital.

Juan, thank you so much for taking the time to research the information you posted. I think your advice is well warranted. Unfortunately, we live in a litigious society where we have to be careful not to put our careers at risk. The healthcare arena is becoming increasingly specialized, even physicians are required to obtain additional training to enter additional specialties.

TraumaRUs, that is exactly what one of my coworkers told me when I asked when she was taking her certification exam! She doesn't know if she will get her certification either and she will make so much less as a new CNS compared to her RN pay with 20+ yrs of experience. As a matter of fact, several RNs in my facility have left management positions to return to the bedside for better pay and less responsibility, lol!

It was a 7 credit hour semester long course taught by a chemist with a PhD. The course was brutal and was known as the "weed out" course in our program. In fact, all of my science courses were taught by non-nurses with PhDs except for my undergrad pharmacology course.

A friend of mine is currently enrolled in a DNP program where she is required to secure her own preceptors. She has spent many hours cold-calling practices within her state to secure preceptors. She has to drive several hours to complete her clinical hours but she considers herself lucky as many of her classmates have had to drop out for the semester due to the inability to secure preceptors. A former colleague complained that his preceptors were unsure what they were supposed to teach him. He along with the intensivists I spoke with encouraged me to attend a program affiliated with a medical center that would also arrange my clinicals. I'm glad I took their advice.

I'm currently working in Chicago and I've noticed a significant number of advanced practice RNs remain or return to the bedside due to pay. It is not uncommon for bedside RNs with 10+ years of experience to make 6 figures (not including overtime) here. Oddly, NPs and CNS' often start at much lower salaries in this area.

Greygooseuria, your proposal looks an awful lot like the program I completed for nursing school (this was an ADN program). I got credit for the AP Chemistry completed in high school and had to complete A & P, Organic/Inorganic biochemistry, microbiology, nutrition, statistics and pharmacology. I didn't have to complete physics though. I think course content depends upon the program attended.

never mind