MattyIrie

Just got done with a week of shadowing with an FM doc. After 30 years she had had enough with insurance companies and stopped accepting them. The practice was amazing, 30 minutes with each patient, saw ~15 to 20/day depending, she even did home visits for a few. She admits that income is much lower than in the insurance model but patient and provider satisfaction are through the roof! Have any NP's managed to successfully start a practice similar to this?

the hard truth (s) I've learned are 1. there is never enough time or staff, ever. 2. hospitals do not care about their people or patients beyond the extent that it increases revenue. You are a number and a dollar sign. the "patient first" loving and caring picture they paint is utter BS. the money made in this industry is off the backs of every one of us and goes straight into the pockets of elite and upper admin.

You know it did look a LOT like a hospital parking structure :) . But hey, employees have to park right?

I did! It worked out to about 50/month. Try finding that rent anywhere else in the city haha! On days off I would take bus and cruise up and down the coast, big sur, Yosemite, Tahoe, you name it! Had a blast. Overall management has been awesome at both hospitals. The key people to inform are unit manager, AOD (esp if using showers off your unit) and security so they don't hassle you at midnight.

Hey all, As many know the new tax bill has a huge chance of being passed, as this is going to change almost everything tax wise, anyone know if reimbursement for traveling from tax home will change? I've only read 1 article saying they are doing away with most reimbursements for lodging, meals etc... If passed, the bill will take effect Jan 1 2018. Any thoughts? This should be discussed. Tax Reform Proposals Will Influence Staffing Agency Reimbursement Policies | The Staffing Stream

I've done two assignments in a vanagon. First assignment I posted up top floor of a parking garage in SF and had a killer City view. Second assignment i was in farther out parking lot. Never any issues and showered either in OR, cathlab or breakdown showers after work.. never an issue. As bed has said, don't say anything about it. When you get to the assignment (floor of your unit) just talk with the manager and work stuff out. No big deal..

Wife and I submitted snail mail applications August 18th. Licenses posted October 25th. Out of state with fingerprint cards. That's without any hangups. The time frames posted on the BON website are accurate. Any further questions on bay area, we are figuring it all out now...

Hey travelers, My wife and I are going to be traveling starting in Feb and continuing for approximately 2yrs or so before settling down to start a family. We currently own a subaru wagon with 150k miles and no major issues (yet) which is paid off and moderately well maintained. We are a bit tired of it and being outdoorsy people are kind of wanting a more capable vehicle for the mountains (climbing and camping and such) while we travel. The other side of us wants to be fiscally responsible and keep wringing out the benefit of a paid off car that will do OK and avoid buying a 30k+ truck just to put a load of miles on it right away. Any advice from experienced travelers? Would it be easy to pay off the truck quickly? Btw it's tacoma 4x4 or bust.

Afternoon Travelers, I began speaking to about 3 travel nursing companies a few months ago just getting the ball rolling so i can be prepared to travel in january of 2017. After initial contact they have advised to submit the basic stuff so i can be ready in their system when it comes closer to travel date. I am now recontacting these recruiters to update them and just hear their voices after a few months and EVERY ONE has moved on leaving me to establish rapport with another person. Is this common? every company i have been dealing with has been reputable within the travel nursing realm. any comments or advice?

This man was a carpentero, while meaning little to society…. Meant everything to his wife and family, he contributed significantly to the reality known by them, daughters, sons following in his footsteps. This man helped move this city and possibly others, forward, in his way, with his craft. This became evident when we told his family that despite everything within our power… he died. I had the fortune of being this man's nurse, his human face to this foreign, transient environment known as medicine to us, hospital to him. One of the few areas in his life where control would be impossible…. His wife, a loving, supportive partner had left for a break, in good hands she presumed, a man with a mild complaint of chest pain… This man who showed no signs of distress throughout his stay was having a non-STEMI…. Cardiology was slated to see him but, per usual, made no rush of the matter as NSTEMI's are stable and can wait for a cath…”. I should use that line next time I'm telling a family they've just lost everything, the next time a spouse goes for a casual lunch with their family to decompress and doesn't think of saying that last good bye…. Levantate! she said… vamonos!...." to the corpse that lay before her and her weeping, crushed family… as she stroked his hair... and kissed him... speechless, I offer a futile apology Lo Siento mucho Senora”, and step out of the room that was a flurry of activity just minutes ago to compose myself, call my wife..in tears I tell her I love her and know that I have other patients that have needs as well, and if not tended to may very well experience this same tragic fate…. Thank you nurses and support staff…….I've been a nurse 3 years... I think I'm starting to get it.

If you are looking for a change then ER is a great direction. Do not go into it thinking it will be any type of chaos. This will cause you to panic and freak out with largely stable patients and make emergencies out nothing. Acting this way will cause you to rush, make mistakes, fumble more and ultimately be slower in your response to the real "emergencies" as people call them. You will have a semi steep learning curve in the beginning but you also have your team of (hopefully) stronger ED nurses to check in with. I personally love ED nursing and will be involved with it for the rest of my career. But if there is ANYTHING I can say, its this: "There are no emergencies in the ER." I'll use an example to explain: 25 y/o male comes in post stab to the chest in PEA arrest CPR in progress. Many staff will begin running around, yelling bogus orders and a general air of panic will begin to descend...almost inevitably to some degree in most ED's (especially teaching centers). This WILL create a slower response to management than slowing down..acting purposefully and realizing you DO have time to treat this patient, discuss a plan of action, preassemble needed supplies like blood or a thoracotomy tray and internal paddles, chest tube and airway kit.... Etc. So DONT act emergently but rather purposefully. You should do ED! :) you won't regret it!

I'd go ED and here is why: for FNP no other unit will give you the exposure ED will. Most condition across all life spans, even better if the hospital runs out of beds and you hold those pts for multiple shifts, then you are forced to be ED, ICU, med-surg, Tele (heck...even OB)nurse. And with level 1 trauma cases you get good Ortho and neuro experience. For acute care it would be good as well if you don't know what specialty you want. I would not choose ANY ccu that doesn't have a progressive heart program in the hospital. Basic caths get old quick and those pts aren't often sick post PCI. Mow a GOOD ccu is different... those are often the most complex ICU pts you'll see, bad valves, CABG, cardiogenic shock, post arrest... these people get sick but you'll only deal with that... not ideal for fnp but great for acnp working in cardiology....... go ED, and move units in a year if necessary. and if this is an academic facility? Even better.

That's the funny thing about healthcare that I have noticed so far. Previous work experience is valid...to a point; previous work in healthcare...pulls much more weight. In talking with unit directors, at least where I am located, extracurricular activities don't really matter that much either (SNA, student govt, local bake sales...). By having previous healthcare experience employers are seeing that you KNOW what you are getting yourself into and are much more confident that you wont bail within 6 months. A word about CNA classes that blind sides many: These classes are COMPETITIVE. Where else can you take a semester long or shorter course(mine was 3 40hr weeks) and be almost guaranteed a job somewhere? They often have many hoops one needs to jump thru in order to filter the masses so a word of advice is GET STARTED EARLY! get your standard immunization regimen and AHA BLS for the healthcare provider out of the way now. Be extremely proactive and satisfy the pre-enrollment requirements as early as possible. Classes will fill up in minutes or be a wait list type of deal.

I am currently in a BSN program in the southwest and I will be graduating with the following experience: -3 years as a CNA/PCT with 1 yr LTC and 2 yr Telemetry/ICU experience -AHA BLS Instructor teaching classes at both area hospitals -2 years as an EMT in a busy 911 system -2 years volunteer work with technical rescue team and a volunteer fire department I would say cover all of your bases by getting both paid and volunteer work. The more you can do to place yourself above the rest the better! Becoming a CNA/EMT is the best move I could have made before entering nursing school and something I would recommend to everyone.

I know how you feel, my instructor asked me today "How are you?" and i happily replied "well, I have increased anxiety, increased stress, im short tempered and snapping at everything, I sleep poorly when i can...and you?" that ended the conversation. yea feeling stupid is the best thing ever and i am only in the first semester of nursing school proper (2 yrs pre-reqs). GOD GIVE ME A HARD SCIENCE I CAN DEAL WITH! these arguable, grey area NCLEX questions make me want to scream!!!

SO! Like many (I hope) I am really struggling with my performance in nursing school. I entered with a strong 4.0 after challenging pre-reqs. As of now I am averaging 80-88% on my exams in fundamentals, doing well in my health assessment course and decent in Pharmacology. So the original goal was to graduate with a well preserved GPA that would set me up to continue my education at a better school later down the road. WELL I am pretty much a C student (nursing school grading scale) which is producing some serious anxiety as i am struggling to let go of because no matter how i study or what i study (i scored higher on the test i studied the least for...go figure) it doesn't make much of a difference. Was i lucky that day or not? while i have no doubt that i will graduate nursing school (as i get better at the old NCLEX question and find my groove studying and get into a topic that interests me...fundamentals DOESNT), i DO have doubts about passing with a decently preserved GPA (3.5+). So concerning the Masters/DNP route (advanced clinical nursing practice is the goal), how important is a strong GPA? Does everyone pretty much except that nursing school is hard therefore not placing as much of an emphasis on GPA? More on Clinical experience? these exams are frustrating because of the spread of questions, miss 4 and your A is shot, miss 12 and you fail. any words of encouragement?

right now i am feeling as though there is an imbalance in the instruction but i could be totally misguided. I havent even had my first exam yet but we have these "clicker" questions during class and i am not doing as well as i would like to be doing. I am wondering if there is a difference that exists now between NCLEX style questioning and NCLEX style teaching and understanding (as in no NCLEX style teaching). By that i mean that material is taught the way it has always been taught, here are the facts, this is what it is, like the different methods and formats of charting for example. Its awesome that i now can memorize all of these different methods, formats and acronyms, but that is far from adequate if i expect to apply them in the NCLEX fashion. this is where i am stuck, finding strategies to attain that higher level of understanding.

Greetings!! So i am a very new nursing student that is just now getting familiar with the "NCLEX style question" and i am intimidated as many students seem to be. I am a "pro" at attaining the lowest level of understanding (memorization) with material thanks to the pre-reqs but i am feeling very lost about how to effectively study the material in a way that allows me to gain the complete understanding necessary to be successful at this style of question. SO, any tips on study strategies, question strategies, online resources for tools that help to guide the nursing student in the successful study of the material....etc. It just seems that material that is not that challenging is being applied in ways that make it pretty challenging.

Ok here goes, ive got quite alot to think about. i am currently in last semester of pre-req's for CCNE accredited BSN program with 3.68 GPA (all sciences are 4.0). 50/50 chance of being accepted, will know in october of 2011 as application has been made. I also have a friend that is devoting more time and effort into trying to convince me to become a medic. He has devoted more time and effort to this with no apparent personal benefit other than he thinks i have what it takes to make an excellent medic. he himself is a good medic (advancement/respect within his ambulance service, ccemt-p cert...etc). the end goal for me is to embody the skills that make me as useful as possible in a rural health setting. so practice good medicine and be a huge asset to a rural hospital. a swiss army knife so to speak and good at it. i want both RN/EMT-P knowledge as they are apples and oranges. emergent care (medic) and longer-term (RN). OK, so the reason medic route is attractive at this time is because i am being offered (100%) a job at a busy ambulance service (not thru fire dept) right after EMT-B certification. he'll get me in which isnt easy here. also, total immersion in the learning thru medic school by being paired with the best medics at the service, consults with his dad who is leading thoracic surgeon in state...etc. many tools at my disposal to be the best i can be in critical care. Nursing school doesnt come with these benefits (different area of work pretty much outside friends scope as he is a medic). pretty much me going thru school like everyone else with all the job uncertainty and mostly book learning and test passing. the reason nursing is so attractive right now is because ive spent 12 g's of my own money on pre-req's and am a HESI test away from a complete, fairly strong (not strongest) application to a decent nursing program. if i go medic, i will bridge to RN/BSN thru excelsior afterwards anyways. if i go RN i will complete my paramedic training so i can be good on that side of the coin as well. though all of it will be without these extra learning opportunities being offered now. mainly because the guy wont be around forever (another source of mistrust i guess). well? what say you? this one seems over my head a bit. i am registered for an EMT-B class in the fall which carries clinical hours on ambulance and in ER.

Afternoon CNA's, i am currently a CNA in LTC and due to other things in my life i end up working PRN at a few different facilities in different parts of New Mexico while in school. One thing i have noticed is the pressure to chart during orientation. now, i see the benefit of being accustomed to a facilities charting procedures and format for CNA's but alot of the time (every time in my experience) the new CNA is left to do the charting alone. I am not comfortable with this for many reasons. the first is that i didnt provide care to all of the patients (residents in LTC) i am asked to chart for. another big reason (predicated on the first) is that i (like most i hope) cannot attach name to face for at least the first week or so which makes it difficult to remember who was who and what was what. my questions are, have you noticed this as well? and if so, how do you handle this situation? thanks!

The best thing to do in your case would probably be to find a school where you can re-take pre-req's w/o a penalty for a higher grade. Reason being that i havent seen any programs that will accept anything below a 2.5 and most BSN programs are bumping to 3.0 min GPA. i would stay away from private schools if at all possible. there is just something that doesnt look good about paying tons of money for guaranteed acceptance into those schools. dont give up though, nursing has GOT to be one of the most STRESSFUL degrees to get but it pays off in the end with the quality of work, occupational variability and flexability. also there are plenty of schools that allow you to retake pre-reqs for a better grade. The rule I am operating under while in pre-req purgatory is anything under an A is unacceptable/unthinkable and i will study and commit myself to a class as much as needed to achieve that. Another thought as i am writing this is to also maybe choose a school that weighs other factors besides GPA alone. For instance alot of schools will consider some type of standardized entrance exam score or interview processes, work/volunteer experience etc... heck even ANOTHER (farout) option might be to go the EMS route to RN licensure. there does exist a bridge program from paramedic to RN through Excelsior college online or something like that (GOOOOOGLE). Kinda round-a-bout but hey, gotta do what you gotta do right? can you tell ive got a "plan b"? haha