NeuroNP

I'm working on a presentation covering basic neurocritical care topics. It's aimed at the ICU nurse/NP who works someplace where there isn't dedicated neurocritical care coverage. It's been my experience that a lot of neuro is alien and maybe even a bit frightening to people who don't do it full time (that was certainly my experience before I started in neurocritical care!). I know that there are a lot of specialties like this (CT surgery comes to mind) but most of those are fairly well isolated. That is, if you work in a place that doesn't do CT surgery, you aren't likely to have to deal with CT surgery. Neuro is a little different, however. Not infrequently, patient's in non neuro ICUs will have strokes or minor head trauma. Hospitals without round the clock neuro coverage (never mind dedicated neuro ICUs and neurointensivists) will still often admit acute strokes to their ICUs. So, for those of you out there who don't do neurocritical care, what topics would you like to see in a basic talk like this? Would this even be something you'd find helpful? Thanks!

That's kind of my thoughts as well.

They require a certain number within the past x years, which I meet because I'm a new NP.

I'll keep my ACLS, PALS went by the wayside a few years ago, I don't see kids. Do you still practice Emergency? (traumaRUs...) the certifications I'm talking about are in areas where I'm not currently practicing. I was wondering if keeping them was worth the cost just to look good on a CV in case I go back to those areas at some point.

I'm a new ACNP practicing in neurocritical care. I've got a CCRN, CSC (cardiac surgery certification) and CEN (certified emergency nurse) as well. My CSC is up for renewal at the end of this year. Is it worth maintaining these certifications (I'm still eligible for all of them) now that I'm an NP? I don't currently practice in emergency or cardiac surgery, but I have interests in both those areas and would consider going back to them in the future. I easily qualify for renewal with my CEs, but just don't know if it's worth the cost. Thanks, bryan

I'm an ACNP student and I'd like to set up an away rotation someplace. This wouldn't be for another year or so, but I'm starting to think about these things. My main interests in doing this would be a) to get a perspective outside of where I currently live/work and b) to possibly get some exposure/training someplace that is really excellent/cutting edge/uses ACNPs really effectively. My primary interests are either trauma or cardiothoracic surgery with the critical care aspects of both being more interesting to me than the floor/clinic. I'm a part-time student and work a regular job and have a wife and two small kids, so I'd be looking for something that would allow the flexibility of a shorter stay away from home (I'd be more than willing to work extra long day/extra days/week to make up for a shorter stay). Anyone work at a place/know of a place that would be somewhere to really consider? A third benefit to this would be in possibly making contacts for future jobs after graduation. My family and I would possibly be interested in moving when I'm done with school. So, anyplace near the coast or in a good area for raising a family would be a plus (but not necessary if it's a good teaching/learning environment!). Thanks!

I'm wanting to take the CSC exam, but I'd really like to take a practice exam first. I've been working in CTICU for three years, before that worked in CCU and ER. Got both CCRN and CEN certification and I'm in grad school for ACNP. I feel like I should be able to do this, but I'd really like a dry run before committing. Anyone know of a good place to get practice tests/questions? Thanks!

Several of us who have gone back to school to become NPs have encountered a lot of animosity from some fellow nurses. We get remarks like, "You think you're better than us?" The other night at work, several of the nurses were complaining that they didn't think they should have to take orders from NPs because, "they're just nurses like me, they're not doctors." Recently one of our nurses had surgery and proclaimed that she didn't want, "some NURSE" (i.e. CRNA) doing her anesthesia, she demanded a doctor. I was coming here to post this and ask if any of you had encountered that same type of attitude, but then I see yet another post demeaning the DNP and read some of the comments and see that it's no better. I'm in a DNP program and I'm proud to be. I don't think that I'm any better than an MSN prepared NP. You may think that it's all fluff (and there is some of that, but from talking to my MSN friends, no more than in most MSN programs) but I'm proud of the education that I'm receiving and I have no doubt that I'll be a great nurse practitioner when I'm done. I think it's funny, I can't think of any other profession where obtaining more education is looked down on like it is in nursing. For the record, I don't plan on calling myself "doctor" for fear of confusing patients. I don't feel that I'm any "better" than an MSN prepared NP or that an MSN is a "joke." I just think it's very telling that in our profession, any attempt to better yourself is looked down on. If you don't want to become an APN, don't. We need good nurses at the bedside. If you have an MSN and don't want to get a DNP, don't. But can we all please stop slamming people who do make that choice? I want to do research and to teach as well as practice clinically, I realize that I can do that with an MSN, but I felt like the DNP would better prepare me for that. If you don't feel that way, that's your right. If you don't want to teach or be involved in research, that's fine too. Until we can all respect the choices each of us makes and the contributions we can all make, our profession is never going to advance. Ahh...that feels better. I'll get of my soapbox now. Bring on the flames...

OK, I've got an interview! I'm really getting excited about this. I think it'd be a great experience. The recruiter I talked to said that this is kind of a fluke, there are never any openings in this unit (I've never seen one posted before). I guess that's good, must mean staff turnover is low. What sort of things should I be doing to prepare for an interview? Anything in particular that I should read up on? Any questions that I should ask?Thanks!

OK, I've got an interview! I'm really getting excited about this. I think it'd be a great experience. The recruiter I talked to said that this is kind of a fluke, there are never any openings in this unit (I've never seen one posted before). I guess that's good, must mean staff turnover is low. What sort of things should I be doing to prepare for an interview? Anything in particular that I should read up on? Any questions that I should ask?Thanks!

OK, this is kind of broad...I'm a CEN/CCRN who has worked in Medical/Surgical/Cardiac/Cardiothoracic ICUs and the ED, I'm in nurse practitioner school and trying to get a job at the university for tuition benefits. I started looking at the various ICU openings and there was one in the Burn ICU. I've never even really thought about burn before, but it caught my eye and kind of intrigued me, so I applied. From what I understand, it's a small unit that does get a fair amount of overflow from other ICUs due to the fact that it's not a major burn center. I'm not really sure what I might be getting myself into! :-). I've worked with burn patients in the ED (I worked in this same hospital's ED a number of years ago) and I've seen some really bad burns. What is "life" like as a Burn ICU nurse? (told you it'd be broad!)I'm working on my DNP and looking at sepsis and shock for my research. I would guess you deal with that a lot in a Burn ICU? What else could I expect (if I even gt the job, I've just applied at this point)?Thanks!

OK, this is kind of broad...I'm a CEN/CCRN who has worked in Medical/Surgical/Cardiac/Cardiothoracic ICUs and the ED, I'm in nurse practitioner school and trying to get a job at the university for tuition benefits. I started looking at the various ICU openings and there was one in the Burn ICU. I've never even really thought about burn before, but it caught my eye and kind of intrigued me, so I applied. From what I understand, it's a small unit that does get a fair amount of overflow from other ICUs due to the fact that it's not a major burn center. I'm not really sure what I might be getting myself into! :-). I've worked with burn patients in the ED (I worked in this same hospital's ED a number of years ago) and I've seen some really bad burns. What is "life" like as a Burn ICU nurse? (told you it'd be broad!)I'm working on my DNP and looking at sepsis and shock for my research. I would guess you deal with that a lot in a Burn ICU? What else could I expect (if I even gt the job, I've just applied at this point)?Thanks!

Thanks for the responses so far. I'm only talking about routine assessments. Codes, events, etc, I would chart to the minute. And I'm only talking about on paper. For computer, I'd let it time it. I (almost) always chart as I go (unless I'm crazy busy and have to go back and chart after the fact). My only question is, do I need to be anal enough to time those routine assessments to the minute? Drs orders, etc I always chart to the minute.

We still use paper charting in our ICU. We document assessments q4 and there is some debate over how those should be timed on the flowsheet. For example, do you need to document that the assessment was done at 2005, 0015, and 0358 or is 2000, 0000, and 0400 sufficient? Most of our nurses do the latter, but some have said at a previous hospital they had a charting class that said the former was correct because in chart, an attorney could say, "so you were in the room at PRECISELY 2000, 0000, and 0400?" and could use that to show that you were sloppy about record keeping. Seems a bit far fetched to me, but who knows? Opinions anyone? Hopefully, we'll be using computer charting soon and this will be a moot point. Thanks!

I'm in the ACNP program at University of Kentucky. I work full-time in a Cardiothoracic ICU and some prn work in the ER. I'm a part-time student in a DNP program. I'm married with a three year old son and a daughter on the way! My wife stays home with our kid(s), so for me the stress comes more from the finances than the time (although there's not much of that either!). My family is really great about giving me the time I need to do school. So far, it's not that bad, but then I have a BA where I went to school FT and worked FT, then went back to nursing school FT while working FT and my son was born halfway through that, then I finished my BSN FT while working FT, so maybe I'm just numb to it all! I want to go into Critical Care, particularly cardiothoracic although I'm interested in the ER as well. I'm trying to figure out what I'm going to do my capstone project on! We've got time, but the earlier you decide, the better as a lot of papers you write for other classes can be geared towards your capstone and save you work in the long run. Right now I'm thinking about doing something with POC testing (like the iStat) in the ICU. I'm interested in new technologies. Did a study several years ago involving Computerized Provider Order Entry and patient safety. I'd love to do something with that, but where I am currently doesn't use a system like that and so I don't think that would be possible. Bryan

Update: I went to the website listed on the card and searched for jobs. There were NONE listed in the entire state! I don't know why you'd send out a card like that without having jobs posted on the website. There was no other contact information listed on the card. I'm wondering if that's not a bad sign... Anyway, things are starting to pick back up a little and I've been able to get some additional prn work, so for now, it's all ok. I looked on the actual VA site to see if there were positions listed, but there was nothing in critical care (my specialty, plus I've heard that the ICU is the only decent place to work in the local VA, supposedly the med-surg and tele floors are horrible).

I've never done any kind of agency work before, so I don't really know how this works. We're having a real slump at work the past couple of months and not getting any overtime (in fact, some weeks I know of people who are having to use PTO to get their regular hours) due to low census. Some people say, "this happens every year, it'll turn around" but it's never been quite this bad. I don't have the option of relocating right now and there aren't many openings at other hospitals. My wife is a stay at home mom and we're getting ready to have a second baby. I really NEED that OT! :-) I got a post card in the mail today from an agency looking for nurses to work at the local VA. I'm a surgical (specifically CT surgical) ICU and ER nurse and I've heard that the local VA's ICU is actually pretty nice (unlike the rest of the hospital) so I thought maybe some per diem agency work might be a good solution. But, I'm a little leery to jump into it without knowing much about how it works. Can anyone fill me in on the details? How does this work? What can I expect? I don't want to get myself locked into a bad situation. Any advice would be greatly appreciated! Thanks! Bryan

I'm a CVICU nurse in school to become an ACNP. Next summer will be my last one without classes and it just hit me it might be a good time to try a travel assignment. I've got a wife (stay at home mom) and two small kids (both under 4) so if I went anywhere, I'd want to be able to take them with me. The reasons I'd like to try it are the money and experience. Our hospital gets slow in the summer and opportunities for OT dwindle. It'd be nice to get some extra $$. I'd love to go someplace really great to get some experience (we don't do transplants, and only a few VADs/ECMO). I'd even be ok if I wouldn't get to take those patients as a traveller, it'd be great to just get the exposure to it/ It'd be nice to get some time at a "name" hospital to put on a CV. I hope to go into CTICU as an NP in a few years when I'm done with school. If not a "name" place, it'd be nice to go someplace fun with the family, an extended vacation. (Or both?) Is this possible? I don't know much about travelling except what most nurses know, the hearsay. Also, how does it work if you've got a job? I don't want to quit my job to go away for the summer and not have one to come back to. I need insurance and stuff (more for the family than for me). Can someone fill me in? Thanks!

Thanks for all the replies so far. Several of the places mentioned are places I'd already been looking at, but it's nice to hear from people who know first hand!

I'm currently working on my DNP for ACNP and I'm interested in working in critical care upon graduation (particularly trauma or other surgical critical care). My wife and I have talked and decided that we will most likely be interested in relocating our family after graduation. We would like to live in the South (because of the weather) and I'd ideally like the opportunity to work in a surgical ICU (trauma, Cardiothoracic, or general surgical) and also be able to participate in some sort of academic/research activities. This could be something formal (i.e. teaching in an NP program) or informal (i.e. precepting NP students or working somewhere where there is a post-graduate fellowship for NPs). Research could also be formal or informal (I'd like the chance to contribute to scholarly work, but it doesn't necessarily need to be big-time research). Clinical is the most important role and I'd be willing to sacrifice academic/research for a great clinical situation and a nice place to live. Can anyone recommend good places? Cities/metro regions to live in that have a good ACNP market, or specific hospitals/systems/universities? Thanks!

Anyone know much about these certifications offered by AACN? Are they worth it? I'm eligible to sit for both. It doesn't look like many people have these certifications. Anyone know of good study materials? I used Gaspararis's CDs to study for the CCRN and learned/reinforced a lot. If there is something good out there for CMC/CSC, I'd be interested even if I didn't decided to take the exams. Thanks!

I borrowed that book, but the CD was missing. I thought the book was way too detailed and it actually scared the life out of me. I thought, I'm NEVER going to pass this test! But I might look into getting it if the CD is good. I thought the book was a great reference text, just way too detailed to study from. Hard to sort out what you actually need to know for the test. I'd love to know all of that, but...

I am an ENA member. You're right, if you're going to take the CEN, it doesn't make any sense NOT to be a member. I joined recently along with several people from work and so we got a group discount. Joining if you're taking the CEN is basically taking the CEN and getting a membership for a year for free.

Any good recommendations? Like I said, I've got a book with a website (haven't really looked at it yet) so I don't really want to spend a lot of extra $$. I've already registered to take the test (need to schedule a date) so I have to take it by July anyway.

Anyone know of a good place to get CEN practice questions/test? I've got a book (Pass CEN) that has some, so I don't really want to pay for more, but it'd be great if there were some more out there. I find that I do best by doing lots of practice questions. Not only does it help cement my understanding, but it bolsters my confidence when I start getting a lot correct! Starting NP school in the fall (I'm also planning to take the CCRN this summer!!) and I'd really like to have this under my belt before then! Thanks, Bryan