OnwardEver

Yes, I received an email to check my application decision.

I just found out I wasn't oferred admission to the program I applied to at UNC. It's a huge relief finding out and being able to move on and focus on my choice among the more highly ranked programs I was accepted to. Because of the time element I made my deposit at another program months ago. UNC would have been the most affordable choice and I would have foregone my deposit if I had gotten in, but for a bit more tuition I will be starting at a more highly ranked and regarded program this fall. I am happy to have all the information I need to move forward from this application cycle. I'm hoping the rest of you will too.

That's crazy, redshirt09. Apparently you never came off the wait list last year? I appreciate how heavy the applicant pool is and the efforts of the admissions team devoted to making the decisions and hope we find out sooner in April than later. Good luck to everyone that applied.

I'm waiting to hear too. Problem is I've already received admission offers from two other top schools and they want deposits within 15-30 days. UNC is closest to where I am living now and as an in-state student would be the best choice financially and it is still among the top ranked schools but with my current lease ending in two months (and having already had to give two months notice to avoid an automatic lease renewal) and needing to move away from NC to go to school at either of the two institutions I have been accepted at, it makes the waiting very difficult. Where I will live and how much tuition will be (a difference of $35k+ overall) is riding on an admissions decision that may come in April (or even May!).

Thank you both for the advice. From my rotations in nursing school and experiences across the various specialties I have worked in I feel the PMHNP would be a great direction to go in for me. Nursing colleagues have told me I have a way with and seem to be a "whisperer" of sorts with the PMH patients I've had the opportunity to work with. That said, I agree with you and understand it's not the same as having locked down unit experience. I'm aware that psychiatric mental health nursing is a very different kind of nursing, just like any specialty priorities and goals and how you practice changes to meet the needs of the population you are working with. In addition, as far as I understand, PMHNPs work in a variety of settings, some locked down in-patient and others outpatient, etc. I appreciate the feedback regarding USA's program!

I find myself more and more interested in pursuing an advanced practice Psychiatric Mental Health Nurse Practitioner post-master's certificate or DNP degree. I'm a North Carolina resident with 8 years of nursing experience ranging from med-surg to home health and critical care looking at affordable in-state and online out-of-state programs. While I already have a good idea what NC has to offer, I'm curious about hybrid or online programs at schools like Frontier, U or Ark, U of Missouri Kansas City, etc. I have read mixed reviews about programs through U of Southern Alabama. I'm hoping for a program that is authorized to provide education to North Carolinians as well as one that strikes a balance between quality education, reputation, and affordability. What programs do you think might be a good fit and what are the pros and cons of going for a low residency hybrid/online program vs. a traditional sit down especially when considering out of state offerings and clinical placements in or near-state?

My favorite part of receiving report from the ED is when the nurse that is giving me report has never even assessed the patient. So I ask of the ED nurse sending me a patient that was given Lasix 80 mg IV when was the last time the patient voided or does the patient have a urinary catheter and either way what has the UOP been. What are heart and lung sounds like? Any shortness of breath? What IV fluid and rate are you running and through what IV catheter size? Yes, I could look at the chart and from the few responses I've scanned in response to the OP it is plausible that it would save the OP or like-minded ED nurse's time, but have you laid eyes on and put a larger picture together of the patient you are caring for, what you or the person before you was doing for the patient and why, and then transferring all of what you know and don't know about the patient into my care? It's possible, as others have mentioned, that I have several catastrophes that I have had to delegate to another nurse or two and a larger patient group that I can't transfer out or ignore to take report from you or risk angering the Gods of patient flow or worse yet be written up for "refusing to take report" especially on shift change when I may or may not have completely received report on all my other patients. It is possible I want a complete picture of what is coming and what I need to do to prepare and what I need to get done that hasn't been that you would be in the best position to tell me as the nurse that is currently providing care to the patient. After all if I were down in the ED providing care for that patient myself then report wouldn't even be necessary but it so happens I'm not. Not to mention before you've given me report you're already up with the patient in a gurney even though you've been told the room either hasn't been cleaned or is being cleaned. Why haven't you looked at bed status in the system before wheeling your patient up to me? There is no question that it is faster and more accurate for you to look at any number of things in the system that would enable you to cooperate with me and not be at odds in providing high quality, seamless attitude free care to the patient. So--why don't *you*? As others have said both the ED nurse and floor or unit nurses are under pressure and trying to do less with more. What makes you think thorough communication and a safe, informed patient transfer isn't in the best interest of everyone including you, the floor nurse, and the patient?

I agree with mvm2 and others in that just because we are a males in the nursing profession it doesn't exempt us from performing medically necessary procedures on patients of the opposite sex. There will be shifts when all the nursing staff, from the charge nurse down, are male. You aren't going to allow a bladder to sit full of urine and cause the patient distress and harm by neglecting to place the urinary catheter. If you are unsuccessful after earnest attempts then get help, even if it's from another nurse that happens to be male. The only way you can grow and reach your potential in your career and in this field is by repetition and experience. Diverting or delegation of a task based on gender doesn't help you learn, it just allows you to deny your need for practice and mastery of an important and necessary skill. Some patients will prefer for modesty to have a nurse, doctor, or other applicable healthcare professional of the same gender provide certain types of personal care, but then that would be the patient's preference, not the provider of that care deciding for the patient without even giving them the option or approaching them about it. You owe it to yourself and the patient to attempt the procedure provided the patient agrees and continue to grow and promote your mastery of that skill no matter the patient's gender.

I have gotten a similar PTSD-like aftershock of alarms and beeps just like you, OP. I agree with others in that it often happened after a particularly stressful shift especially if staffing was short and census was high. This happened quite a bit on an oncology floor which was my first job as a new grad and I worked with patients that were s/p chemo and radiation or at the end of life. Eventually the sounds die out but it is a bit unsettling especially when you're trying to go to sleep and they persist in haunting you. What's even better is when you start to dream about work and you wake up in the middle of the night (or day, depending on your shift) terrified and haunted by what's happened at work. Thankfully I've been able to leave most of the intense "stuff" at work and no longer perseverate on what I might have missed or what the outcomes were. I haven't had a work dream in a long time and only occasionally do I hear the call bells and tele alarms after I've left work. It helps that I have a lengthy commute that serves as a buffer. I agree that some white noise or even some soothing music like piano or whatever helps you relax maybe even a bike ride or job on the treadmill--some kind of buffer--is helpful. The better you become over time at putting work "on the shelf" I imagine the easier it gets to ward off the phantom noises after work. It might also help to have adequate staffing or address root causes for the stress. I'm glad I'm not the only one that has experienced this. You're not alone, OP.

Berkshire1995 (tried to PM this but got a message that your PM inbox was full) and any others who might have an opinion or thoughts/feedback to add, I'm interested in obtaining my FNP as a post-master's. I am about to graduate with a master's in community health nursing with an educator role emphasis. I saw your post about online NP programs and wanted to inquire further about Frontier as a program. I have advanced patho and pharm and assessment I've taken as part of my master's program and would be looking to take the FNP role courses. Is it hard to find preceptors? I'd be interested in working on the east coast. Would I have any trouble if I wanted to work outside of Kentucky where the Frontier program is based? I've tried looking for approved programs for New York state for example and I don't see any. I've seen some mention that some hospitals and states won't approve/license or hire you if you do a non-approved program. How did you feel about the program? Was the faculty supportive? Did you feel well prepared for the AANP/ANCC exam and entry into practice when you graduated? I don't want to feel like I'm being weeded out. I'd like faculty that bring the best out in me and help me reach my potential which I believe is great. I want to be challenged and stimulated intellectually and master skills. I'm weighing the online vs. "brick and mortar" classroom programs. There is also the possibility of completing a DNP online or in the classroom but I don't think I'm interested in taking all that on. I just want to do a post-master's FNP. What are your thoughts and advice? I appreciate any feedback or response--anything you can speak to.

Igunbor, you started out asking why become a nurse if you won't find a job once you graduate and then you shifted to "the problem of oversaturation of nurses in the nursing field" when you received a response that stated it depends on where you are looking. I think it's clear that there are areas of saturation, especially in cities that have several nursing programs and one or a few smaller hospitals that can't possibly hire all the students that choose to stay where they graduate due to economics or other factors. The suggestion seems to be that if you're willing to travel elsewhere where there is a pocket of jobs and need for RNs you may be able to secure a position. Often, once you get your experience, you can come back and go for a position that requires it. Not all places have a glut of nursing programs and realize that once nurses that have been working for 30+ years retire and the baby boomer generation itself retires, needs will increase due in part to the vacancies left by retired nurses and the increase in the demand for skilled nursing care due to an increase in the population requiring care. So the problem is much more than "oversaturation". The projections for shortage and needs in nursing involve changes in populations and are different depending on where you go. In a more competitive market you must set yourself apart and network. In the end, though, if nursing is what you want to do then don't you owe it to yourself to pursue it and fight for the job you want rather than sit around trying to find reasons NOT to? If it's really what you want...

bump: Any other thoughts or advice from anyone regarding this topic? Will also search the forums for more. Thanks.

Thanks, rgbrn. I'm not clear about the isolated negatives I've read about UNC-CH. It sounds like Duke, Vandy, and ETSU all have strong programs in the area but I'd like to be further east closer to Duke and UNC-CH and, on gorgeous days off, the shore/beach OBX, etc. though it's nice to know ETSU has a strong faculty practice network. That's a big advantage. Do you know of anyone that has gone to UNC-CH for either undergrad or grad nursing and what their experiences were?

Bump: does anyone have any advice on east coast FNP programs? I'm sure this is the way I want to go but still on the fence regarding UNC-CH. Would appreciate advice and welcome any feedback if I'm going about my request the wrong way. Thanks.

I agree, stand up for the residents and do what is right but also look out for yourself--whether you walk or not. Walking doesn't mean you can't contact the state like the poster above says and let them know what's going on at this place. I'm very sorry to hear what you're going through too but you're not the only one. Things can get very nasty when you bring concerns to management.

Why waste your time with employment attorneys when you know this is going to be a contentious work situation? As long as that DON is in, you will be the target of fury and disapproval no matter what you do. Start collecting the names of co-workers and your peer nurses for references and find a bigger and better opportunity for yourself.

Hi BostonSN, I think it's prudent to say in your cover letter that you will follow up in a certain amount of time, say 2 weeks. It is a very competitive job market and following up and showing interest may distinguish you from the rest of the pack. A handwritten thank you to the HR contact you spoke with over the phone might also be helpful. Anything you can do to stand out in a professional and positive way will be good. In other words, if you can follow up and show interest by navigating the interviewing process in this way--with handwritten thank you notes, etc.--you end up standing out and showing your interest without coming off overly aggressive/aggravating. Definitely network and use what connections you can to find out when positions open up and be the first to get your resume in. If you have family or friends at the hospital, use them as resources to help get you in. Scour the HR sites for positions and apply the first day particular positions become available. Give yourself all the advantages you can.

Your perspective is appreciated, juan de la cruz. You're right, when evaluating the quality of FNP programs one definitely has to proportionately weigh the quality of partnering community-based practices and associated providers. However, it's also been my experience that a majority of practices are part of a larger hospital system in order to garner greater Medicare reimbursement--the strength in numbers negotiation approach, greater ability to bill and receive the highest reimbursement possible for each visit and procedure. Is it the same on the west coast? I find it curious that there hasn't been a stronger response from the nurses on the site re: east coast programs... I know the "nursing shortage" has slowed and we are all holding on to our nursing jobs and competing more fiercely for spots in nursing programs but if anything I'd think more people would be talking about this and ensuring a sound investment when enrolling in a program, whether located in the midwest, east, or west. I'd love to go to the west coast and have seen that UCSF ranks at the top according to U.S. News but I'm limited due to family commitments from going to SF. The opportunities to be exposed to and provide care for vulnerable populations sounds great.

Thanks for letting me know about your experience at UMich bearasara94. I'm trying to look at schools where the winter is milder than up here near Canada. While I've seen where UNC Chapel Hill and UMD Baltimore rank, I wonder if the programs and their reputations match up and what people's experiences have been recently. To give my post some context, I should add that posts I've read at The Student Doctor Network by "ChillyRN" have made me think twice about UNC-CH: Seeking serious advice re: MSN/FNP vs. DNP | Clinicians [ RN / NP / PA ] | Student Doctor Network. That a local hospital gave UNC-CH an unsatisfactory rating and would not host their students and that a graduate of the program "felt very underprepared", at least according to that series of posts in 2008--see linked thread, is a big concern to me. Perhaps I should also post on studentdoctor.net but I'd rather frame my inquiry around and receive responses from nursing/nurses.... I'm very interested in hearing more from anyone who knows about or has attended/is attending a school (or schools) in the NC or MD/DC area. Does what I've read about UNC-CH's FNP program still hold true? What do I really need to know about Duke, UMD Baltimore, and JHU before considering them for my post-master's FNP?

I'm considering graduate programs in North Carolina and Maryland areas to continue my nursing education as a post-master's FNP and possibly go on for a PhD to explore teaching and research. I'm interested in the reputations of programs that rank high on U.S. News & World Report including UNC Chapel Hill (and Greensboro), UMD Baltimore, JHU, Duke, and Vanderbilt. While I'm leaning toward UNC Chapel Hill, I've read posts about the program's reputation being such that some hospitals are not interested in working with its NP students. Are there other schools with grad programs to consider in these areas that didn't make the U.S. News cut but have a great reputation and are respected as producing quality advanced practice nurses?

I am trying to network to find a preceptor this semester (now through May). If anyone knows of any resources in the upstate NY area or has any leads on NPs/PAs/MDs in Family Health/Primary Care I'd really appreciate hearing from you. I've looked at free clinics in the area but the clinic hours there are limited to 4-8 hours weekly and ideally I'd like to do at least 16 clinical hours a week. Solid providers at convenient care centers or walk in clinics would be great, especially because of the extended hours into the evenings. I would try calling providers directly but from what I've seen and heard one generally doesn't get past the front office staff. Any leads or advice/support would be greatly appreciated. I'm located near the southern tier and will travel throughout the area to Binghamton, Scranton, Syracuse, Auburn, Cortland, Ithaca, Elmira, Corning, Sayre, Bath, Oneonta, Cooperstown, Albany, possibly even Rochester or NYC/NJ, etc. for a preceptor interested in working with me. Thanks.

Here's my sheet, adapted from others I liked here on the site: MyBrain.doc

Because the patient doesn't appear to have COPD I agree, I don't think it's so much about the risk of knocking out respiratory drive as it is about the day nurse wanting to know if you tried to titrate down to see if the patient responded well and was able to keep his sats up with less help from the oxygen. I just did a Google search to see what the literature has to say about oxygen therapy in oxygen-naive patients but there isn't much that isn't specifically about COPD. Generally, I don't think it's a great idea to maintain higher flow rates of oxygen over the long term (and here we're talking days and weeks); you want to wean down to discourage the body from developing a dependence/tolerance of sorts. While you could have done a trial with 3.5 liters or less overnight, I don't believe not doing it would have caused any harm (and here we're speaking hypothetically/generally as there's no way to know for certain if this would actually be the case without access to the big picture and all the information about this specific case). Having worked night shift for years, I would also venture to guess that the day nurse's disposition has to do with the classic dynamic present between day and night shift (and I'm not trying to start a flame war between day and night shift folks but sharing something I believe has held true in my own personal experience): nurses coming on days assume night shift does nothing and this entitles them to feel superior and ask questions like "Why didn't you drop the oxygen back down to 3.5 liters if he was satting at 95%?" Next time you're on with a similar situation on nights, and given the opportunity and time, you can titrate down as ordered by the physician and see how your patient tolerates it and you'll have an answer for the smarty pants day nurse. :)

AG-RN, I don't have any recommendations to give as far as online bachelors programs for nursing, but I should note I saw a Jacksonville degree on the wall of someone practicing at a high level in a nursing organization recently. I would Google and search here on allnurses, there's got to be a thread ranking or discussing the online courses. Have you decided between a BS or MS program? Good luck!

I have the opportunity to buy Amelie Hollier's Adult and Family NP Certification Questions book at a reduced price. I've looked at the scant reviews on Amazon and saw Hollier's book looks at obscure questions where Fitzgerald and Leik may have more of the central concepts. Any thoughts? Just wondering if Hollier's book is a good value or if I'd be better off looking elsewhere. Anybody have experience with this book and passing their boards? Any comparisons with other books and success in passing the NP certification exam? Thanks in advance for any help fellow students, recent grads, and NPs.