ZenLover

I have an entire career in healthcare before coming to the bedside or getting my RN. I was given some level of credit for this. I am not sure what to entirely expect of myself or my career as I begin a new position soon, but I KNOW there isn't going to be a big battle to "get me out of bedside thinking" because with my previous experience...well, my views and how I approach my current job is much different than most nurses I work with that have ONLY worked as nurses. My journey took the route it did for my own personal reasons, but it provided me a well rounded look at the profession and healthcare that is VERY rare in my opinion because no one would actively choose the route I did. Some of the jobs I have worked were for survival and just simply getting a foot in. I have worked all over the trenches and learned respect for everyone's point of view. They have their point of view for a reason and to disrespect real life experience for academic or choosing a blank slate over one that has had SOME kind of experience is very odd to me. Not all experience is the same, some is useful, some can be a hinderance, but I find that to be very individual. I have worked with medical students who are working as scribes in the ER or as EMTs, and they are given some level of credit for the understanding these jobs give to them in their own journey. A few rules I think would be valuable to follow after reading through all of this is 1) Don't be quick to judge without having appropriate conversation with whom you think you are debating. You don't know what they know and don't know what they don't know. Period. 2) Don't take criticism from someone you would not take advice from. Not every statement deserves or has earned a reply. 3) If someone has a difficult time communicating (spelling or grammar format) first find out if English is their first language. Being brave enough to debate in a language that is not your primary deserves it's own level of respect. Not every great idea is presented in a great way, however if you are trying to argue in an intelligent way...spellcheck and Google are your friend. That is all I have to say and good luck to everyone on their journeys. May we all manage to make more connections than creating disconnect.

First, I don't know if you intended the tone here to be condescending, but it is. Second, I made it clear my experience is in the ICU. Of course you never asked what kind but after the past 2 years alone I was definitely part of the conversation. I often facilitate and advocate for families that are afraid of stating how they feel. I don't know what kind of nurses you work with or what your experience is, but it sounds limited and horrible. Depending on RN experience and location, it often is just as good, if not better than most residencies. If you want someone who just jumped into a NP position and tried to avoid the bedside because it is hard as hell, I don't even know what to say to that. The ED I work in depends on the experienced RNs to enhance the experience of Residents and we are absolutely engaged in their training. Also, I made it clear my experience expands well beyond. I know all about billing, coding, politics, how the pharmacy runs and the difficulties several different departments face when trying to accomplish their jobs because I have previously worked with them. If you can't understand the position your team member plays and the limitations involved, you can't be a good team member yourself. RNs are a HUGE part of the team. If you are implying that RNs have a difficult time mastering a condescending, holier than thou attitude....I think you have nailed it. It is damn near impossible to be at the bedside for 5+ years and dream that you are above anyone. If you are having a hard time understanding where someone is coming from and how to transition their thinking, that says more about you than about them.

I am currently working on an offer that does give me credit for previous nursing and my hourly rate / salary will also be above average. I am a brand new NP starting a Critical Care Neuro position. My experience is ICU and Rapid Response Team. I understand I will be in a completely different role. That isn't even taking into account the learning curve with Neuro alone. Now I won't be performing procedures and will be basically doing the "admin" side of medicine to take pressure off the docs, but I'll still be rounding in the ICU. I have worked in healthcare my entire life. I have worked in several different positions and on the business side. It ALL counts. To have a complete understanding of how the entire system works, the challenges in it as it has changed over the years, I have experience that you can't get in a classroom and the team I am joining very much appreciates what I bring to the table. If you are joining a team that can't appreciate what you have done and what you are bringing in, you are joining the wrong team. Always negotiate. A bedside nurse of 2 years in a critical care environment and no other experience in healthcare is just beginning to see the tip of an iceberg. Anyone who thinks a 9 year nurse (with all other things equal) is just as valuable as a 2 year nurse doesn't know what they are talking about. You aren't even understanding the complexities of ethics and end of life discussion in 2 years - you are just getting your feet wet, just my opinion.

Thank you for your positive feedback. It took a pandemic for me to finally just "put" myself out there.

My most recent experiences sound so much like what you have already heard. Being a critical care nurse in a pandemic has not been easy. But what is easy? What in life is ever easy? Falling down, but not getting back up. Failing to show up, but not the conversation as to why when you are confronted. What starts out feeling easy rarely ends up that way, if you see your own story through. That is what I am doing now, seeing my story through and owning what I am. I am a mother to a special needs child, a wife to first responder and a critical care nurse. I work in a small community general medicine ICU and a large level 1 Trauma Center Emergency Room. My story is not just about the pandemic. My story is about surviving trauma from an early age, navigating life with a broken foundation, being a woman in a misogynistic society, often lost in narratives and at the end of the day not just surviving but figuring out my place in helping you survive situations that seem impossible. Why? Because I was born for it, built for it and created into it. My most recent poignant moment of the pandemic was taking care of a middle-aged man who looked a lot like my own husband. He was sick with COVID and this was far enough into the pandemic that I was experiencing emotional exhaustion. The respirator I had to wear was giving me panic attacks by the end of my shift. In the last few hours of my recent shifts during this time, each time I had to put the mask on and pull it off, I would just feel so incredibly irritated and angry. I didn't recognize these as a panic attack at first. I had to describe it to someone else and they retorted "oh yeah, a panic attack". Life is funny that way. Often when you are the one drowning you are the last one to realize it. This gentleman I was caring for was on several drips, ventilated, heavily sedated, and had been on our unit for a few weeks. A lot of us caring for him would walk by his room with our heads down because as the days and hours ticked by, we felt he was less likely to ever come back to us. No one thought he would really make it out and if he did, he would most likely be in a vegetative state. I was in a dark and jaded place. I felt like death gently going through the motions of caring for him and patiently waiting for his body to finally say it couldn't go on. I knew deep down that I should not be feeling this way and that I needed to dig deep to fight it off. On the one hand, it felt so right to give in to this peaceful feeling of letting go and letting nature take a celestial course, but on the other hand, I knew the family could not be there. They were depending on me to fight to the bitter end and if I did not do just that, I was betraying a trust and a need that they had in me that was and is sacred. Deep down I knew that the last thing to ever go should be hope and that hope should go with you to your own end. You don't lose hope, no matter what. You hang on to it like it's the only thing your soul will ever have left long after your bones have turned to dust. On one particular day caring for him I had to schedule a zoom visit for his daughter. I was told she was 22 and wanted to speak to him. He was ventilated, sedated and being supported with bedside continuous dialysis which required me to be in the room every hour. Scheduling this visit would be easy, which hour do you want because I will obviously be available. I was hanging on to hope for this guy, but I was also semi-checked out emotionally. To protect myself and keep my head straight I had to check out. I had vital signs to constantly watch, drips titrating and the continuous dialysis to contend with. COVID makes your blood clot and he was doing a lot of that. If I didn't watch the speed of the dialysis and configure the amount of fluid going in and out every hour correctly, he would clot faster, resulting in less treatment and possibly die faster. I had to be stone cold, concentrated and on point. You can't cry every moment, the emotion can both inspire you and distract you. However, survival is name of the game for you and the patient so stay with me on that point. The hour came for the zoom meeting and first, her mother came on and explained to me that the daughter has High Functioning Autism. I choked a little and I felt a crack develop in my emotional wall. My daughter, Marcella, has High Functioning Autism and she is only 10. All throughout this pandemic I have felt compelled to be there for my community, but at what cost? What if I make my children sick? What if I get sick and my children no longer have a mother? My son and daughter's education is suffering and I am not there for them because I am needed where? Do we have an IEP meeting this month or ever again? My husband has been dealing with riots and my family receiving death threats because of what he does for a living. I have spent months fighting for others' lives and worried about my own and those closest to me...constantly. Being at work, staying busy, focusing on others...it has helped me survive. But suddenly now are my two worlds colliding? Then his daughter came on the screen and I heard her voice as clear as a beautiful silvery bell. She immediately started to beg. "Please don't leave me, daddy.” "You can't leave me.” "I'll take care of you.” "Come back home to me and I will hold you.” "I can take care of you daddy.” "I promise I can.” People with autism, when they are upset, will often speak repetitively. She could not stop begging and all I could do was picture my husband and child in this situation. It was surreal and mind blowing. I am not exaggerating when I say I dropped to my knees and begged God/Universe/Life to pick me back up. I had previously turned off my emotions so I could do my job and then in this moment of everything hitting home, I just had every emotion possible slam me in the gut. I managed to pick myself back up. That is what I do. That is what I have always done. There is no other way. There is no other choice. Move forward or don't move at all. I took care of him and waged one of my biggest battles for him. A week or so later I was able to speak to him after he was removed off the ventilator, he was recovering well and I had the privilege of sending him out to rehab. He did survive. I don't subscribe to a specific religion and I won't put this experience in that kind of context. However, The God / Life Force of our Universe taught me a lesson both through this man and his daughter that I will carry with me forever and it will be my own personal turning point in having worked through this pandemic. It will be yet another medal I wear on my chest as a survivor of trauma. I, myself, am currently experiencing a different journey than I feel most do or ever have. All through the pandemic I worked in the ICU, provided coverage when needed in the ER and continue to work even now as needed. Through all of this, I also managed to graduate with my Masters in Nursing from the University of Virginia from the Family Nurse Practitioner program. As of July 2021, I am officially a Board-Certified Family Nurse Practitioner. I have moments when I am very proud and then I have moments when I feel like it is about as valuable as toilet paper in the current state of Healthcare. I am "just a nurse". I will never be a doctor. I am told I should not pretend to be like one or have any ideas that I will ever know as much as one. Right now, people argue that I am both overpaid and undervalued by almost all of leadership. None of my sacrifice, loyalty, efforts, or hard work to make myself the best possible healthcare provider means much of anything to anyone as my position becomes part of a political argument over money and power. I have, many times, meant the world to the patients I have touched and that is why I do what I do. Politics, money and power be damned because none of that ever inspired me or created me. I am a nurse because I aid people in navigating life's most treacherous waters. I do this because I have spent my own life navigating the waters and I know how. Our healthcare system is imploding in areas and I am here to help people survive it. I can do that because I am the Queen of Dysfunction. A lot of nurses are. If you really get to know a nurse and ask them about their history of what led them to the bedside you would be surprised the number of people that have survived trauma and now are bent on helping you survive yours. Right now, everyone questions me on why I think I can be a Nurse Practitioner. They tell me "You have no experience as a Nurse Practitioner". They tell me how hard it will be to transition from being "just a nurse" to a Nurse Practitioner. They ask me "Why do you want to do it?” No one wants to really give me a chance. This is why I am struggling with seeing my story through now. I have heard "NO" so many times in my life it would make your head spin. My answer to "no" has always been a loud and proud response of who I am and where I come from. I am a grown woman now, but I started out riding my tricycle in the middle of a Miami downtown expressway at 2 am with a dirty diaper because my mother was not able to pay attention due to drug addiction. It was the mid to late 70's and the beginning of the cocaine scene. Before the age of 10 I was so neglected and left with so little oversite I was electrocuted, run over by a car, almost shot my own head off with a revolver left for me to find, lost more times than I can count, and beaten at the hands of those who were supposed to care for me. Both my parents gave me away when I was 3 years of age to a family member who quickly grew tired of me. Did you know raising a traumatized child can be challenging? My father never believed he was MY father so he raised my sister, but gave me away to his sister and I became the family charity case. I was the lost daughter of a whore who was lucky to have a roof over her head and food on a table. I was told most of my grade school years that I was "retarded" and something was wrong with me. I grew up fast. I grew up strong and I grew up wild. The worst thing that ever happened to me though was being stranded in the desert with my father who was suffering from blackouts due to his alcoholism. He was working out in White Sands on the Stealth Bomber. When I finally made it out few believed me or my experience. I did everything all the after school T.V. programs said you were supposed to do. I told a trusted friend. I told a school guidance counselor. I told my church pastor. In turn, I was told I was "histrionic", "depressed", "dramatic" and worst of all, just simply a liar. The few that did believe me responded with "it happens to a lot of women and if you are smart you will shut up about it because no one can help you and you are making yourself a target". I heard stories from women about how grandpa, dad, brother, or cousin did this or that. At the end of the day, I had to figure my own way, the same as the women I came from. I almost failed out of school entirely and my high school guidance counselor told me I was not college material. I went to Summer school to get out early because I could no longer stand the environment. I was an outcast and lost. I would be lost in an emotional desert for a long time. So that is where I began, but here I am now. An undergraduate nursing degree from Virginia Commonwealth University and a graduate degree from the University of Virginia both with honors and a boatload of student loans. I received a little scholarship money and people obviously gave me chances along the way. I have done a lot of hiding of my story however and presenting to people what I thought they wanted to see. There were never any free passes and no one ever paid my way, but I got it done. I survived, found my place and discovered my calling so that I could be useful to my own community. I also have an incredible husband and two of the most beautiful children one could want. I grew up in a roach-infested trailer on the wrong side of the tracks in South Carolina, but now I live in a beautiful house and I work at jobs that I am extremely proud of. Granted, I don't connect well to a lot of my neighbors because I don't quite "get them" and they don't quite "get me". I will always be a little "dark" and "street" for the monogrammed crowd. But it is a dream life compared to what I started with and a miracle if you really think about it, but I try not to over think it because that little girl on the tricycle is always afraid it could change and she will always be with me. She is willing to get out there and ride them streets, but she will never trust that you or those streets are safe. I have had interesting careers over the years. I have worked as a safety watch for a GE welder during a Nuclear Reactor head replacement. I have worked as a contractor at Capital One because my database skills rock. I am not just a "nurse" or a "survivor". I am a THRIVER. This is my story and my tale about how the Phoenix can rise from the worst kind of ashes. How then, can anyone, anywhere in this world, tell me that something is too hard for me. Excuse me? I don't believe you know me, let's try that introduction again. Shall we? I have worked in healthcare for over 20 years. I have worked mostly on the business side, but heavily supporting clinical as a pharmacy tech, billing and coding, business office management, and medical transcription. Basically, anything that allowed me to help others and pay my bills. Let me also share that as a Pharmacy Tech I worked for a pharmacy benefit management company. During my time with them, I found myself hiding under my desk from an active shooter and was forgotten by my employer during the evacuation of the building. They were "kind" enough to make me employee of the quarter afterward. Yep...I attract that kind of drama. The trauma didn't end with childhood. So many stories and so little time. But I survived it and I am here. I know how broken the system is. I know what my experiences have made me. I know how to work with broken and I am not under the disillusionment that I will be the person to change it all. I can be the person caring for you or your loved one that knows critically, academically and intimately how to get you through it, however. How important is that to you? It means my life. Saving others gives my life meaning and it gives me what I have been through true meaning. In healing others, I have been able to actively heal myself. In doing this I show my children how to navigate life and help others. The benefits never stop as long as I don't. I have to do it. I don't have a choice. And no, absolutely none of it is too hard. What may be too hard for others is that I no longer hide my truth or who I am. I am not your average suburban soccer mom. I am not one of the 2.5 kids from an average military family. I am an anomaly. I am a Phoenix and you, my dearest love, have just met one. Should you ever REALLY need me and hopefully you don't, I am here for you and I will get you through.

What amazes me are the number of employees anywhere acting like this vaccine is the first mandate ever. Umm...TB testing, even outside of healthcare. And if you had a positive result you had to do chest x-rays with months of meds that have a lot more side effects than this vaccine and STILL DO. But any way. Everyone is entitled to their opinion, but if you get on social media and advertise you are a Registered Nurse and then give out health advice you are asking for it, even long before now. You don't know who you are interacting with, if they are being honest and if you are just generally stating stuff you better be able to back it up as not being YOUR words. Even as a MSN prepared nurse you are limited on giving recommendations for any diagnosis. I am friends with many doctors I work with and they don't say squat on line...FOR A REASON and they have a much larger scope than we. I have also noticed than there a lot of people calling themselves nurses that are not and that can come with its own set of charges if you give out advice as if you are, someone takes it and then is harmed. Give advice at your own risk and if you share your opinion on COVID or the Vaccine I would say don't state your opinion along with your licensure status unless you are sharing your organizations views along with their permission to do so. I had an argument online with a nurse telling people to take Ivermectin and please don't get me restarted on that....but reminded her she is a nurse and her advice was outside of her scope as well as being actively debunked by large University Health Systems all over the US. The only thing one has to do is screen shot her recommendations and send it in to her board...if she was even a nurse, because on line who knows.

I work in the ICU and with COVID we see a lot more of this than ever before because many of our patients are unvaccinated and come from families that didn't really believe COVID was real. As a result we have been screamed at, one patient's family ran up and down hallways screaming we were killing everyone for the Govt agenda. Death is stressful. Pandemic is stressful. People get into these emotional binds and then lose it because they have no control. Acknowledge the lack of control. Then acknowledge what you can give them control of. Let them tell how they feel about that. This is team effort and they have to feel they are a part of it. The lack of education in healthcare is tough. Most of these people have had providers telling them and their loved one that they are doing "okay" for decades and then the 11th hour comes as a surprise. It is often hard for us to imagine the deficit in knowledge because we live this life....but people outside of healthcare know NOTHING and often worse than knowing nothing they think they know and it is all wrong. You are essentially watching the blind be blinded by the truth/light at a hard time. When you understand that and understand the response you will probably get that can be NORMAL you will better understand what your boundaries should be with them as well. Don't call the police unless you have NO OTHER choice, it is not a good move to be vindictive and most officers won't appreciate responding to that kind of call. There is a time and a place, but you should be able to recognize an emergency and remove yourself long before getting to that place if you truly are listening to them and not just expecting people to hear you. Good luck! xoxo

I don't know if this will work for you but I know what your talking about because I work in a hospital and that thick Zinc is hard to deal with once pasted on. I remember though when my son was a baby he managed to get Strep in his gut and it gave him the worst diarrhea and excoriation I ever saw....bleeding and all. Warm water with baking soda in a spray bottle was what I used and I swear as soon as I sprayed it on him it must have put the fire out because he would quit crying and it cleaned remarkably well. I am guessing because the stool was so acidic and the baking soda being a base neutralized it. It was about a 50/50 mix, maybe less, I didn't scientifically measure. But if the problem is managing the ointment and diarrhea that might do the trick. You could probably talk to the local pharmacy about it too since it is a little of a compounding thing. Good luck and happy healing!

https://onlinelibrary.wiley.com/doi/10.1111/1742-6723.13537 Not that it was necessarily Ivermectin, but this link looking at the potential toxicity of different treatments at home for COVID might be useful to you right now. Problem is that I am not sure people will be forthcoming with exactly what they did or did not do, especially with their kids. There will be denial and fear of repercussions to deal with as well.

I saw something similar in a grown man that came into our ED and up to our ICU. His pH was 7.02 and it was metabolic acidosis, not respiratory driven. They were thinking it was because he had taken a new prescription of Metformin....but no way it was that without overdose so quickly. But what you describe sounds like a similar presentation to this man. He did report having had diarrhea for a few days before, but his kidneys were failing and he was very average to small framed. The metformin had been started as aggressive measures for "pre-diabetes" at low daily dose. Nothing that one would expect that kind of severe reaction. He had no prior known medical history and his previous labs should healthy kidneys that were now failing fast. My fear is Ivermectin, especially the over the counter animal version. It can cause severe diarrhea and I am afraid people are so terrified of COVID they are trying to self medicate inappropriately. Despite intubating him and starting emergent dialysis which quickly turned into CRRT we lost him. Still waiting on toxicology labs to understand how and why. Now I'm afraid it isn't just COVID we are fighting, but the fear, the misinformation and the myriad of ways people can harm themselves and their loved ones.

I, personally, would avoid "talking at her". She obviously doesn't like it and you are getting frustrated = not working for either of you. Most miscommunication is not bad intent, is bad understanding. Quit trying to educate her and educate yourself. Ask her why she feels the way she does and keep drilling down until you understand her AND empathize. If you manage this it will make you a better spouse, better NP and better educator. Remove all judgement and assumptions. Don't go in asking questions full of emotional response. Try to remove yourself and look at it from a 3rd party perspective. Also....it doesn't take a specific education level to encourage others to avoid illicit drug use. Biggest problem with it is that street level pharmacists don't compound with quality products or measure with their customers in mind, even outside of all the long term known side effects and bad coping outcomes. My 10 year old who is on the spectrum knows how to say NO and why. So I would be interested in knowing why she thinks the way she does? Does she not want you to chase your patient off? Does she feel like you tell her what to do and it pisses her off and so she is trying to tell you not to piss off others? Her emotional perception of you may not be entirely accurate, but it sounds like you need the education from her to find out if you want to make head way. Just my humble opinion.

I worked on the business side. Credentialing is time consuming, not necessarily expensive. I am not saying you need to argue or even seek him out on the conversation. Professionally I would ignore the comment and do my job to the best of my ability. However, if he approaches you again you need to figure out how you will calmly, professionally but with a great amount of confidence, state that you know what he has said is not true. I would, personally, add that in the future he may want to think about contracts if that is his concern but since one does not exist for you, you have nothing but professional courtesy to work with and in light of his statements that is running out quickly. Figure out how to use this situation to stand up for yourself in a professional manner....guaranteed it won't be the last time you'll need to and the practice won't hurt you.

Okay, so ya'll are probably like why did you hop on here, you should be celebrating. Seriously, I have to tell you though that after reading all the posts about how I passed the boards I needed to help save ya'll some money. 1) Keep some of your books from school and re-read them. I kept a physical examination, Essentials of primary care and Essentials of pediatrics because I figured I would need these for reference in practice anyway, maybe. Some people say they don't look at their books ever again. But, I like books. I like the pages and touching, I don't learn everything from listening or on-line. That is me. But don't buy a bunch of new books that are basically condensed versions of these. A good review course will help you narrow content. 2) All I did was the Fitzgerald review, just that one. I figured out pretty quick that almost ALL the companies that market for reviews tell you to take this freebie or cheap test that isn't anything like the board, poorly worded and extremely difficult so that when you fail it you will be convinced that you NEED their review. It's a marketing ploy that we all fall into because we have to pass. Find one good review that your friends have used or you think uses an approach that fits your learning and stick with that. 3) Take the test quickly after graduating, just like the NCLEX. If you decide to take your time, then take it but study a little every day to really get info into your long-term memory. This Board is way too much info to cram. Slow and steady. I do not think you will do well just taking test after test unless you really read the rationale and then open up those books you should have kept to dive deep into the pathophysiology or pharmacology/pharmacokinetics of WHY. if you understand the basis of why, you will be able to answer any question that manipulates around the topic. Study drug classes and know some of the most common, but don't memorize all the drugs, you want to focus on pharmacology/pharmacokinetics and understanding the class will help you do that. 4) Just like NCLEX, know safety first. Know what the current national initiatives are around mortality and high healthcare costs. This will be what you need to know because as soon as you are in practice you will be evaluated on your ability drive practice outcomes that will meet with these initiatives and it will always be this way, so plan on your continuing education to be centered around them too. Good luck and don't break the bank buying multiple reviews and especially books....you should have some you already dropped dime on in school!

Are there any NP / FNPs or the like that work in home healthcare? I am potentially looking at being hired (within the hospital system I currently work in) as a new grad FNP in home health. Basically (5) 8 hour days a week seeing 8-10 patients a day. My background is general medicine ICU in a very small community hospital so I see a lot of these patients during illness and exacerbation crisis. I feel my team will support the transition and it will "feed" into the palliative / hospice care that I feel passionate about helping being navigate well before need and during need. I am one of the crazies that loves complex care and advocating for those that are either difficult to advocate for or can't do it themselves. I sit for my boards in a few weeks and am currently doing review for that while working PRN. I'll be prepared. But, what I would also like to know are some thoughts and experiences from some others in this line of work. Challenges to training, what I need to prepare myself for after boards...what additional training would be helpful. My team would potentially help me with that, but I am an over achiever, aim to impress and want to do my homework on this! ?

Thank you for sharing! It is very much appreciated.