agrayRN

I have a recommendation - I really liked a book called Bradley's Neurology in Clinical Practice. It has a lot of good info in it. If you're able to access Up to Date, that's fantastic - I access it routinely on a daily basis. Once you actually join your practice and have access to CME funds, subscribe to Continuum, which is a really good resource.

I work in neuro, and I just heard that in my state they are about to legalize CBD prescribing for Dravet Syndrome and Lennox-Gastaux Syndrome - those two diagnoses only. It also is apparently going to be a Schedule I drug. We actually don't have any pediatrics in our practice currently, so until they aporive it for something else, this won't apply to us, anyway. Not that I would be prescribing it, being that it's Schedule I. Funny, considering you can get it anywhere. I get asked about CBD almost daily. I have patients that use marijuana for seizures and MS. One of them bakes it into brownies. If they are smoking it, I always tell them to stop. If they are going to do it (which of course I can't recommend), they should at least make it a little safer and consume it. Smoking it is so bad for you, I could never recommend that. I'm not entirely sure I could recommend marijuana in general.

I'm not sure if you're primary care (I'm assuming yes), but I'm in neurology. It's expected that we won't cover everything, but I frequently will get questions about labs that were done that don't apply to my area. If they specifically ask me about it, I will tell them. If not, I leave it to the others, because I don't know that they haven't already been informed and I'd be bringing up something they don't want to discuss. If, during the conversation, I discover they haven't heard about it, I usually decide on a case by case basis. You'll do the same. It won't be the same for every patient. Don't be too hard on yourself. That's easy for me to say, because if it were me, I'd be feeling the same way you do now. :-) But as someone else said, just use it as a learning experience. That's how we get to be better providers.

Wow. I'm assuming that since she is being tested, she is taking these routinely for chronic pain. I think before assuming anything, I would have a conversation with her (after checking INSPECT). Explain that her urine test results show that she's not taking her Norcos, and that she is taking some type of benzodiazepine. Try to get her side of the story. Obviously something fishy is going on, though, so you would have to stop prescribing the Norco. It's sad that these things happen, but it seems to happen more and more frequently. It happens a lot in my area. I work in a neuro practice now, so thankfully I don't deal with it much anymore. I can't imagine working in pain management.

That con should be a deal-breaker. She may be an excellent physician, but there is no excuse for that type of behavior. I really just don't understand how an organization could keep someone that does those things just because they are "money makers", or are the best in their field. Who cares if they treat people badly? If they are good at what they do and bring in money, they're a keeper. I have seen it before, and I can't stand it. If they are going to treat people that way, why on earth did they go into the medical field? Anyway, I digress. Happiness and job satisfaction are more important than money, and I think you would find that out if you were to take the job and work there for a period of time. There will be better jobs out there for you. Your self-esteem and self-worth are more valuable. I'm sure you're a fantastic RN, and I have a feeling that she would have you feeling down on yourself in no time.

Just to give my personal opinion - I think I would take the boards now. Once you pass the exam, you don't ever have to take it again. You'll get it out of the way, and won't have to worry about it next year - one less thing to stress about. In regards to the 1000 practice hours within 5 years, that translates to 200 hours per year, which you could easily do even if you don't practice as an FNP for a year. If you work, say 36 hours per week, you'll work 144 hours in just a month. All details aside, it's really a personal choice. But just think of how good it will feel if you've passed the exam already and you don't have to worry about it when next year rolls around. :)

I wanted to provide a little feedback on this topic from personal experience. I graduated in May from an online-only AGNP program, and while I really enjoyed it, I have to say that I would not recommend it to students that do not have any prior nursing background (e.g. do not have an ASN or BSN with at least a few years of experience behind them). I did the BSN to MSN track. I thought the content was great, but there are some things that you just need to learn in person if you are at the very beginning of your journey. My 10 years of nursing experience was very helpful, and I personally don't know that I would have done as well without it. I certainly would not feel as confident. We were able to choose our own clinical rotations in this program, which I believe can work well, if you have the ability to choose well for yourself. I also had a leg up in that way, because I have been with my organization for 8 years as an RN, and knew many of the providers well enough to choose preceptors easily. For someone who does not have that benefit, it would be much more difficult. So, long story short, I believe some of these programs (I can really only go by mine) are a good option for people that work full-time and would otherwise be unable to become NPs, which is why I went that route. The university near me that did the option that was previously mentioned by someone, the one that had on-site courses a couple times per week and the rest of it online (another good option), only offered FNP. The online-only AGNP program was the best option for me. Hopefully this provides a little insight!

This is really so helpful to me, I so appreciate it! I really haven't found many neuro NPs. I don't know any in my area. There is one in my office right now, but she is retiring in October. She isn't a traditional neuro NP, either, she sees a lot of kids for psych issues and ADHD and actually has her own panel of patients for that. I'm adult-gero, so I won't be seeing any of those. She does see some rechecks, but...she's a bit of an odd bird. :-) She's a very nice person and very experienced, though, so she could definitely give me some pointers. It is so great to get some advice from others in the same boat as I, though.

Wow, only 2 weeks? I would be seriously stressing about that! But if you did it, I'm sure it's doable! I will initially have 60 minute appointments. I'll probably start out with half days, is my guess, so maybe 4 patients? I'm just going by what I've seen other NPs in my organization do in the past. Ultimately though, she said we would discuss it when it's time to actually do it. I don't think they are going to have me do new patients starting out, though. I think I'm only doing rechecks. I guess I should probably ask about that! :-)

Great, thanks for the response! The neurologists I will be working with seem very nice, and I know one of them well already, as I work closely with her in my current position. I officially start on August 8, and the plan is to have me shadow for 60-90 days. Exactly how long with each neurologist, I'm not entirely sure. A couple of the neurologists' notes are a challenge to follow, so that should be interesting. The diagnoses you mentioned are the ones I thought I might see most frequently. Since I originally posted, I discussed my schedule, and I'll be in office every day with a half day on Thursday. The end goal is to have appointments in 20 and 40 minute increments. If you don't mind my asking, how long are your appointments?

Hi everyone! I was hoping to get some input. I graduated about a month ago and will be starting in an outpatient neurology practice as an AGNP in late August to early September. Are there any outpatient neurology NPs here that could give me advice on how a typical day might look for me? In my current position, I have experience in dementia, memory loss, and Parkinson's disease, but I'm taking it upon myself to brush up on other neurological conditions prior to starting. I have actually been reading a neurology textbook in an attempt to get some insight on disease processes and treatments, and have gotten a few other textbooks, as well. I will be shadowing each of my collaborating physicians prior to seeing patients (there are five) to determine each of their personal preferences on patient care. Any advice would be appreciated. I do have 10 years nursing experience behind me, but that is a lot different than being an NP. I am nervous, naturally. Thanks!

I graduated from NP school about a month ago and will soon be transitioning to neurology. But in my current position, I have done a lot of palliative care nursing, and a lot of referrals to our organization's palliative care program. It is very rewarding. Improving a patient's quality of life means the world to them and their family, and the education you can provide will take a lot of stress off of caregivers. Based on what you have described, you enjoy the interactions with the patients in your current position, but not so much the other things that come along with it. I think changing to the one that is being offered to you will give you the best of both worlds. I think you'll really enjoy it.

I had a lot of anxiety when I started out in the hospital. It didn't end up being the right fit for me, either. I made the change to ambulatory care, and have been there for 8 years. It was a pay cut at the beginning, but it was the best decision I ever made. But it was the best decision for me. You need to do what is best for you, and only you can know that. If it turns out this CM position is it, that's great! If not, you'll find your fit. You got into nursing to help people and you still will. We all do in various ways, and we all make a difference. Don't listen to anyone but yourself when it comes to decisions about your own life, because in the end, you are living it. If you love what you do every day, it's not really work.

I really admire you for doing that for your patients. It shows how much you truly care about them. I have social anxiety, so something like that would be really intimidating for someone with my personality. It's a closeness with patients that I would love to be able to experience as a nurse - it would just be a bit too awkward for me to do that with someone I don't know well. But that's how Jesus intended for us to interact with people - with love. :) Actually, your post made me immediately think about how Jesus would wash his disciples' feet. I really think you are doing a great thing, and I'm sure your patients appreciate it, too.

If you're seeing the doctor just to establish that first time, what you have already provided is great. If you're seeing him or her not only to establish, but for a particular reason, it's great when the patient brings any pertinent records with them, such as hospital records, imaging, etc. The docs in our office like to know certain pieces of information such as your last mammogram result, last colonoscopy, last pap, immunizations, etc. If possible, they'd also like the results of these, so if you have those in your possession, feel free to take those to the appointment as well. Taking in your typed medical history, family history and med list really does help us out and saves both the staff and the patient time that would have been spent asking all those questions. :)

I would say that it could be an entry level position, but it's not something I would want to take on without the proper background and knowledge. Depending on where you work, they ask a LOT of you. The rely on you to give treatment orders, and at our hospital, some of the physicians actually ask the wound care nurse for advice. I recently turned down a position for wound nurse, because it was just too much. I say that because I haven't done wound care for over 4 years, and I just don't have the knowledge. The previous wound care nurse had already left, so I wouldn't have gotten great training. I definitely can't order treatments, because I wouldn't know which treatment to order. I didn't have what it takes, and I knew my limitations. If you know a lot about wound care already and are willing to research treatment options, etc, then it is definitely for you! I just wouldn't have been what they needed in the amount of time they needed it (ASAP). I have always thought wounds are fascinating, too. :) But I don't regret turning it down.

Definitely not! It's so sad that there is a stigma against people with anxiety and depression at your workplace. It's just something that some people have to deal with on a daily basis. Some people just can't cope with it as well as others, I am one of them. I take Buspar twice daily and Xanax prn. It doesn't change who I am, it just helps me work more effectively. I'm sure it's the same way with you. So they don't need to know!

That is an amazing story. I know exactly what you mean - God has a plan for us, and everything happens in His time. You were definitely a blessing to them - it sounds like hospice nursing might be in His plan for you, too...but He obviously has something in store for you in oncology as well. I love that we can always know that we are at a place in our lives for a reason - if something seems to be taking forever to happen, like being offered a job, it means He has something far better in store for us. I accepted a new position recently within the same company for which I am employed, and because of our current staffing situation at the office, I'm unable to transition into my new position for at least another month. Including mine and another girl's positions (we both got the same position), there will be 5 open positions at our clinic. I was really disappointed when I found out about this, but your story just reminded me that this is happening for a reason. God isn't ready for me to be finished with my current position - I must still have unfinished business there. In the meantime, He is teaching me patience, something I really need to learn. Thanks so much for sharing!

I suffer from anxiety, as well, but it's something I've dealt with pretty much all my life. I've always been an emotional person and a worrier. I work in an office setting, not in a hospital, and I still have anxiety. I noticed that I interact better with patients and am able to deliver education, etc. when I am not anxious. When I'm anxious, I just can't get the message across very well, my mind goes blank. So I finally decided I would see my doctor to try some medication. I am now on Buspar twice daily regularly, and I take a low dose of Xanax when needed. The Buspar has really helped me - I still have feelings of anxiety occasionally, but not as much as I used to. Before the Buspar, I would have anxiety for no reason at all. I just got tired of feeling that way, and realized that there was something I could do about it. I know medication is not right for everyone, some people really don't like to be on it, and I totally respect that. But it has definitely helped me a lot. I have realized, though, that a job with a lot of stress is definitely not right for me. I tried working LTAC before I went to the office setting...let's just say, that did not go well at all. I called in sick several times because I was so anxious and worried about how my day was going to go, that I would actually become nauseated and vomit. The outpatient setting is definitely where I belong, and I really enjoy it. But I think all fields of nursing have their own stresses. I also have been coping well because I do a lot of praying. I feel like I have come a long way with my anxiety, with help from God and the medication. If you think your job might be causing your anxiety, maybe it's time you think about what really makes you happy. Life is too short to allow your job to cause you to feel this way. Maybe it's time for a change. If you really love your job and you don't want to change, there are also other ways of coping with the anxiety. Hope this helps!

I so agree! I love getting calls to my line, when I don't even know the call is from an external source. The phone will usually ring twice when it is external, once when internal. But if an internal source forwards the call, it just rings once. So I answer the phone informally, thinking it's a co-worker, and it turns out to be a patient. Ugh! And when patients just drop into the office thinking they should be helped ASAP....

I wish I could say there is a way to prevent it, but I don't think there is. If the MD would adhere to the policy, then it might work. But as long as the MD will fill it on short notice, the patient will know this and will continue their behavior. It happens all the time in our office - people are like, "I'll be taking my last dose today" or "I have to have these today because I am flying out tonight." I'm just like seriously?

I work at an Internal Medicine office. When I applied, I didn't have any experience in a clinic, either. I had come from LTC and LTAC. I finally got an interview, and after that, I never heard from the person who had interviewed me. I didn't get the position for which I had applied. About a month or two later, the person who had interviewed me called me out of the blue, asking if I wanted to interview for a position in Internal Medicine. She had remembered me from the previous interview and thought I would be perfect for it. Turns out she was right for not hiring me for the previous job, which was triage - NOT my favorite. So don't give up - keep applying and you're bound to find something like I did. :) It's a really great environment to work in - with great hours, too! I won't say there's no stress, it's just a different kind of stress. You shouldn't give up on something that you think will make you happy. Life is too short!

You didn't do anything wrong. Sometimes when people are depressed and anxious about something, they act a little bit irrational. They tend to lash out at those around them. I do agree that you will face these situations in nursing, but a lot of times, the anger they are demonstrating isn't really directed toward you at all. The anxiety the patient was feeling caused her to act according to her emotions instead of rational thought. I know I am definitely guilty of this sometimes, too (my poor husband). But you will learn how to identify these situations. It all comes with time. :) I think that if you truly care about people, nursing is still for you. I am also a highly sensitive person (polite, quiet, and reserved like you), and when patients act angrily toward me, I have learned not to take it personally most of the time. You will still have that occasional time where you feel offended, but it gets better and better as you go along. :) Hope this helps!

If there was no induration, or an upraised area of skin (not under), it was most likely a local reaction to the tuberculin. If I see redness, I usually run my finger over the area. If it's completely flat, it's negative. If there is a lump underneath the skin, it's still most likely a local reaction of inflammation. Hope this helps!