sarena33

Hi all, I am a family nurse practitioner with 2 years of NP experience. Prior to that, I was a bedside RN for 12 years. My experience is mostly cardiac or med/surg step down. I did a lot of travel nursing in my 12 years as well. I'm currently planning ot move to New Orleans from Chicago to be with my fiance. I'm applying for NP primary care jobs and I think I'm close to getting an offer. Unfortunately even if I get a job offer now, I won't start working until October due the length of time it takes to get credentialed. The time off sounds great, but we're planning a wedding and I need cash. I was thinking of applying for a travel nursing position in Louisiana to do in the meantime. I think I remember the travel agencies requiring recent job experience in the last 2 years or less. May of 2022 was the last time I worked as a bedside RN. Does anyone know of any agencies who would let me work as an travel nurse even though my recent experience is primary care NP work?

I don't have children and have never had to deal with the childcare aspect of things, so I apologize if any of my ideas don't make sense for you. If I were in this position, I think I would find a way to create a relationship with the nursing staff at a hospital or nursing home. You could apply to be a unit secretary, patient transport, telemetry technician, or nurse's aid. A position that allows you to have bedside experience is probably best, but you may need to work your way towards that. Another idea is to obtain a volunteer position at a hospital. Volunteer jobs usually allow you to choose your schedule. Find a way to slowly boost your resume and work your way up the chain to be working under a nursing manager Once you prove yourself with that staff, have a conversation with the manager about what it would take for them to give you a chance working as an RN. Maybe they would require you to complete a refresher course, but maybe they would give you paid leave to complete it or in the very least, promise you a job once it is complete. Of course this is all hypothetical and I'm just throwing ideas out there, but if being a nurse is what you want to do, I suggest you do anything in your power to work towards that goal. Even if it takes small baby steps, if you set your mind to it, you can do it! Do you have any friends from nursing school you could reach out to? Sometimes networking with who you know makes all the difference. Your old classmates may be working in settings that are desperate for staff and could put in a good word for you at their workplace, even if it's just to start off as a nurse's aid. Becoming a nurse opens up the door for so many opportunities. Being a single mother, I'm sure you want the best for you and your son, so I don't think you should give up. You've already put in a lot of time and money into this career, you just need to get a little creative to accomplish your goal. I know you can do it!

I agree that "walk in only" is not unethical or considered fraudulent. It's frustrating and decreases continuity of care, thus poor quality of care. Bringing someone in quarterly to reduce ED visits makes sense for a lot of patients depending on their age, co-morbidities, medical hx, and medications. But I have 25 year old patients who are required to come in every three months for their topical acne medication that they've been on for years, absolutely ridiculous. I've also seen 20 year old women get pregnant because they weren't able to get back to the clinic every 3 months for their birth control. Withholding someone's contraceptive is unethical, especially if they're taking a method that is completely medically appropriate and safe for them to take. The birth control issue was one that I fought and won, now the clinic allows 1 year refills for BC because of me, but that was not the case for many years before me. I am about 99% sure that that the owner (who is not a physician or a provider) does not require the quarterly follow up to reduce ED visits, but instead to create higher volume of patient visits on a daily basis for more money. My name is not on any charts that are tied to the unnecessary ultrasound ORDERS, it's my supervising physician that does all of that. However, the patients do come to me asking why the test was done and I tell them the honest truth. I also document in my note. "patient asks about abdominal US that was completed on xx/xx/xx. Unsure why test was completed and do not see a medical indication documented in the patient's chart...etc." I suppose I should talk to a lawyer about the best way to maneuver that documentation. Due to personal circumstances I probably will not report anything until after my contract here is over and I've secured a new job. In the meantime, I should talk to a lawyer about what to do until then. Thank you for your thoughts.

Thank you for your response. The thought has crossed my mind on multiple occasions. Is there any benefit to reporting sooner rather than later? I don't want to burn any bridges and not have the option of asking them for a letter of recommendation when I apply for new jobs. If I call this number several months after leaving that job, can I still report the fraud? Any idea what type of "proof" or documentation I will need, if any? Thanks again.

Thank you for your response. I have definitely thought about attempting to get out of the contract. My concerns are that I'll burn bridges and not have their support in future job applications. Right now, I know the two physicians would write a good letter of recommendation to future employers. But, if I hired a lawyer and attempted to get out of the contract early, especially with claims of fraud, I'm not sure they would. ? Also, most job postings that I'm seeing require 2 or 3 years of experience, so I feel like it would benefit me to just put my head down and finish the contract. I don't want to "settle" again when it comes to finding a job.

I am submitting this post as a means to get some things off my chest, as well as simultaneously get some insight and advice from other NPs in primary care. I am currently 18 months in to my 24 month contract at my first primary care NP job. I graduated with my FNP degree in the fall of 2021, passed boards in the Spring of 2022, and began my current contract in June of 2022. I have been a nurse for 13 years and prior to my current job, I worked as an RN in various ICU/PCU settings, mostly cardiology. The clinic is a small, privately owned practice owned by 2 MDs and one pharmacist. The pharmacist being the main owner/manager. The company consists of 3 clinics, all of which have a pharmacy attached. I float between 2 of the 3 clinics. In addition to seeing patients of all ages for their primary care needs, we also see patients for urgent care needs. This happens, because the clinics are WALK-IN only. I do not have my own panel of patients. If I see a patient and request that they follow up, they don't make an appointment for that, they just come back in the requested timeframe and see whoever is working that day. This in and of itself causes a lot of issues, but it's the least of my worries. There are several rules, or "policies" that the pharmacist owner upholds that I do not agree with (including the walk-in model for primary care pts). He will not take anyone's clinical knowledge, critical thinking, education, or experience into consideration when discussing these rules. One rule is that all patients have a urine dipstick done for every visit, does not matter why they are there. Then, if there are any abnormalities on this UA (despite the patient's subjective complaints/symptoms, chronic conditions or lack therof), a urine PCR is sent to the lab, and this order is submitted by a medical assistant with the supervising physican's signature. This leads to some patients getting treated for asymptomatic bacteriuria (which is very rarely indicated) by some of the other providers that I work with. While the order does not have my name on it, the clinical note, which does have my name and signature on it, shows "urine pcr" in the plan. Another rule is that we are not allowed, under any circumstance, to prescribed medications for more that 90 days. Not allowed to give any refills, doesn't matter what the medication is, what it's for, how stable the patient is, how well tolerated the medication is, or how long the patient has been on the medication. He wants them coming in for a visit with the provider every 3 months no matter what. I will get a text from him if I give a refill past the 90 days telling me that I am not allowed to do that. This leads to many patients running out of medications, having very high BP or poorly controlled HLD and returning when they're able, usually well past the 3 month mark. I realize that this is appropriate in certain situations, but not EVERY medication needs follow up every 3 months. Something else that goes on is that there are 2 ultrasound techs, who work for an outside company, that hang out in the clinic throughout the day. They will wait for patients to arrive, look at their charts and their chief complaint, pluck them from the waiting room, and perform different ultrasound tests on them without a proper provider's order or real indication. I've had to interpret echocardiograms, abdominal US, thyroid US for patients who were told "this is what we do on all the patients." There is never a realistic indication for doing the test. They also call patients from home and tell them to come in for these tests. This leaves the patient's scared and confused. When I asked my bosses, why this was being done, they stated, "this helps keep food on the table for the ultrasound technicians." In my opinion, this is insurance fraud.... Patients also have to return to the clinic for a full visit with the provider in order to get blood test's interpreted and addressed, we are not allowed to call them and tell them anything over the phone, even if it's something harmful or dangerous such as an STD. Granted, most of the time I do not have the resources or time to check results (don't have an inbox) or call because of the walk-in model. I see a very large volume of patients over time, and a lot of patients each day (30-35 pts per day). But sometimes I come across something concerning, I am not allowed to call and inform them of their results or the plan moving forward. I realize that the reasons for all of these "polices" is for business or financial reasons, but I guess this is what upsets me the most. I was taught to be a COST-EFFECTIVE provider, which I take very seriously. Performing unnecessary tests is NOT cost-effective. The population we serve are uninsured, or on medicare/medicaid, many are non-english speaking patients with low income/education levels and limited transportation. I went into this field to help these people, but don't feel I can do this in my current position. I am wondering if anyone else has experienced anything similar with management. I feel stuck, because my contract doesn't end for 6 more months, but I also feel like my license could be at risk. When I've voiced that specific concern to my bosses, they say that they will cover the costs of any court cases or lawsuits, if it happens. I am shocked an appalled by this answer. My contract requires that I pay back A LOT of money if I break it prior to the 2 year mark. I feel very burnt out and not even 2 years into this role. I really do love what I'm doing, but feel as though I can not practice to the best of my ability in my current situation. IF any one can relate or has any advice or insight, I would greatly appreciate it. Also wondering if these things are standard in similar clinics. Thank you for reading my extremely long-winded post.

I am in the exact same boat as you. I make REALLY good money working in the bay area as a travel nurse, I just graduated from NP school and I'm now looking for an NP job. The only difference for me is that I moved to California to be a travel nurse and I'm bored and lonely because I don't know anyone here. Something that I'm not sure you've thought about is the fact that legally, you can't continue to be a travel nurse in the same region for longer than a year. So technically, after one year of working in that city/region, you'd have to move. You could try to get away with not doing that, but if you ever got audited you'd likely get in trouble with the IRS. So, basically what I'm saying is that, the travel RN thing is not sustainable unless you want to keep moving around every year. I need to live in a place where I can put down some roots. I don't enjoy worrying about a new job/finding a new place to live every 3 months (or even every year). For me, I'd prefer to take the pay cut (and receive better benefits as a previous post noted), and have better quality of life, live in one one location. I also feel like I will enjoy the work I do as an FNP more than what I do as an RN, but that's just me. I'm excited for a new career path. Just some things to think about!! Good luck!

Hello all, I have recently been contacted by a manager in a Cardiac Progressive Care Unit for a 3 month travel contract. The unit sounds exactly like the last unit I was working at in London, England. Similar setup, patient to nurse ratio, patient population, a lot of CHF, same type of drips etc. The only thing is that they have a lot of LVAD patients. I have never cared for an LVAD patient. Because I've been a cardiac nurse for 5 years, I completely understand the concept and I have been educating myself on post-op care for LVAD patients and have even watched some videos. My question is, do you think I will be okay to care for these patients (with the general support of my co-workers, manager said it's a very supportive environment) after having no hands on experience caring for them? Also, even if I had cared for these patients in the past, chances are, considering I've been working in England for 3 years, that the manufacturing company would be different. So I'd need training anyway because of that, am I right?? Also, any advice on where I can get the most up to date resources on LVADs? Thanks.

Hello all, I am a US nurse who has been in the process of getting my UK nursing license for the past 2 years. Finally, I have moved to London and am currently taking the ONP. Since the ONP I'm taking is a month long online class, I am having trouble meeting people who are going through the same thing. Once i start working, I anticipate meeting a lot of nurses but for the next month and a half, I don't think I will. Just wondering if there is anyone in London going through the situation!

Thanks! Okay, that makes me feel better. It's 2 years and i plan on taking the onp ASAP! BTW have you been working with Continental??? How is it?

I ahve a question. When you receive your decision letter from the NMC does it have a PIN number on it? I received a letter from the NMC and it states "I am writing to give my assessment of your application for registration as a nurse with the NMC. Then it goes on to say that all of the nurses who apply have to complete the ONP. It does not give a PIN number. ALso, attached is a "Declaration of Good Health and Good Character in support of an application for admission to a Part of the NMC's Professional Register." I assume that this means I can go ahead and take the ONP? Do I get my PIN number after that? If anyone can answer my questions let me know!

Newshark, I have a question about the 3 months of supervised practice that you say you're not required to do, but all other overseas nurses are. Continental informed me that I won't have to do the supervised practice either because I had already sent all of the info for the second pack before the changes were made. Is this the case for you too, or is it because you're staying in London right now? Did they tell you why the changes don't apply to you? I'm just nervous that I'm going to get my decision letter and then they're going to tell me that I do have to go through the supervised practice. :/

I had a feeling I'd get some comments about leaving my email. I've contemplated the risks, I can always block a sender, or if worse comes to worst, I'll delete my gmail account and make a new one. I completely agree that the forum format of the site is very beneficial. Because of that reason, most of my questions about travel nursing, cardiac nursing, and nursing in general are already answered. Therefore, I don't need to start new topics in order to get my questions answered. It is because of that reason that I haven't started the required 15 topics to be able to utilize the Private Message aspect of this site despite having been a part of the allnurses community for almost 2 years. I only put my email address because I've had people private message me with great advice and questions and I've not been able to respond, it's not a good feeling. As for the "pervs" that could potentially email me...I think i'll be okay. Thanks for your concern and all of the other great advice. I will certainly take it all into consideration :)

Hello all, I am currently a nurse in the suberbs of Chicago working for the past year and a half on a cardiac/tele floor. I've been a nurse for a total of 2 1/2 years. I'm 25 years old, single, no kids, living with my parents.. so basically I have no ties to keep me home and nothing to lose. I've been reading all of the horror stories on here and it has me slightly discouraged. One question I have is, what is the quality/type of housing usually? Is it normally in an extended stay hotel or in a small condo/apartment type? If it is in a hotel, does this work out okay or is it pretty inconvenient?? As far as finding a trustworthy and reliable agency and recruiter, I have no idea where to begin. I have been looking at travelnursecentral.com which posts the "top agencies in 2012." Does anyone know if this is a reliable website to take advice from? I've also been looking at the posts on here, but I can never tell which are the legitimate posts by actual nurses who have worked with the agencies or just recruiters trying to get more clients. Any info would be helpful. At the moment I can't respond to PM's so if you want to send me a PM either leave your email address or just email me directly [email protected] THANKS

I am currently an RN on a telemetry floor at Northwest Community Hospital in Arlington Heights. For the most part I love my job but, financially the hospital is going through some issues. I'm thinking it's time to move on and look for a more stable place to work. In 2012 the hospital had 2 rounds of lay offs. Nurses, PCT's, administrators were included in this lay off. Until then I had never heard of a nurse getting layed off. Just wondering, where are the good places to work in Chicago? I'd like to move closer to the city.