Noodle411

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I highly recommend this course: https://npreviews.com/ Helped me pass after failing x1 (previously used Leik, Fitzgerald, and another review book).

I can only guess that you took the ANCC *acute* care NP exam since you also mentioned having taken the AACN exam. Since you mentioned having difficulty with "professional role and core competencies" portions, I might recommend taking Sarah Michelle NP Reviews https://npreviews.com/faq/. Her courses are meant for PRIMARY NPs taking the ANCC or the AANP, but professional roles and core competencies, I believe are the same across the board for all NPs (I could be wrong). I did fail my initial attempt for primary care NP with the ANCC exam; however, Sarah Michelle's course was REALLY helpful to me and I passed the 2nd time with time to spare! Something to consider. [As an aside, prior to SM's course, I had bought the Leik book, the ANCC's review book, and bought Fitzgerald's course, and still failed the initial exam.] Wishing you the best.

Hello, I am considering self employment as well, which led me to Justin Allan's courses page. This is the link. https://elitenp.com/products/ Hope it helps you figure out what business might best suit both of your skill sets. Wishing you both the best!

I empathize with you. I also failed my first attempt. Sarah Michelle's course helped me pass the board exam. I was able to pass my exam far earlier than the allotted time. The questions seemed easier the 2nd time around, too. https://npreviews.com/ Hope it helps you, too. Wishing you all the best!

https://www.sage.edu/admission/apply/international/ https://grad-catalog.sage.edu/nursing/nursing-ms I don't know if this will be helpful to you, but I know my NP school accepted international students and I'm certain there are others in the US that do so as well. Best of luck.

I am an NP who is also a mil. spouse. I did look into this a while back, but for different reasons. I don't want to bore you, so I'll get straight to the resources that you may find beneficial in the following links to ThriveAP and USA Jobs (you can enter a country name and see what pops up). Another thought is to do telehealth. Check with the state you're currently licensed in and see if you can do telehealth for patients that live in your state regardless of where you physically are. If you work for a company or organization, they may allow you to continue employment by doing telehealth. If you go down this path, some things to consider are: having a reliable work computer with all the EMR & encryptions for HIPAA, reliable internet connection, time zones of where you are vs. your patients, and eval&treat for mainly routine stuff and medical management. Doximity apps allows you to make free calls and/or virtual visits. If you work for a company, there may be an option for you to log on to a designated work PC that is physically in the office but you can use remotely (ex: "GoToMyPC") so that if any of the components needs to be serviced or updated, you don't have to mess with it. https://thriveap.com/blog/nurse-practitioners-international-scene https://thriveap.com/blog/3-ways-work-internationally-nurse-practitioner https://www.usajobs.gov/

I gave one of my preceptors a 3-in-1 charging cable that has a USB-C, a Lightning plug for iPhones, and a micro USB so that she can charge both her Android phone and her iPhone at the same time (as she had borrowed mine a few times). For another preceptor, I ordered from Dunkin Donuts a pot of coffee and a variety of donuts for National NP Week. For health-conscious recipients, food options might be more difficult. I think people might appreciate assorted coffees (like K-cups) or assorted herbal TEAS. When I'm lazy and I don't know what to get someone, I often resort to an Amazon gift card, which so far, many people respond positively to. A nice smelling candle might be nice, too. Hope that helps.

Yes, there are certainly limitations to not being able to do a physical exam on a patient and patients need to be made aware of this as well when making their appointment for telemedicine/telehealth/televisit. Since I do not work with pediatric population, I can only speculate that if you were to work as an NP in Pediatric Primary Care, telehealth visits would be mostly talking to the parent, and some with the patient (depending on the child's age). Virtual video would be likely your main mode of telehealth visit since they likely are comfortable with using their smartphones and video-chatting. Non-urgent problems would likely be the most appropriate type for telemedicine visits... routine/common ailments, medication management, and health promotion. Speaking as an Adult NP working in a privately MD-owned gastroenterology office, my experience in telemedicine has been this: Most patients have already been "seen" by their PCP and are referred to our specialty office for further evaluation. Telephone vs. "Virtual Video" conversations done in our office primarily due to having more elderly patients (also less likely to deal with tech issues or tech-knowledge deficits). Primarily, the conversation goes much like an intake chart, minus the Objective findings: Chief Complaint, OLDCARTS, Assessment/Impression/Differential Diagnosis, and Plan. The plan usually involves additional diagnostics such as imaging, labwork, endoscopy procedures, a prescription or a recommendation for alleviating current discomfort (example: May consider 1/2 dose of OTC Imodium BID PRN for diarrhea), and next follow-up. For the imaging and labwork, we usually send scripts to their choice of imaging office (or hospital) or lab (ex: LabCorp, HealthQuest). When the results become available, we review them and discuss next steps with the patient. For established patients for follow-up, the conversation is not that much different than if they were in the office. "How are you feeling today compared to... since you started...". The plan changes and you adjust accordingly. For example, "Per shared medical decision-making with patient, patient agreeable to trying... If his/her symptoms do not improve, I would consider increasing medication X to BID, or this XYZ diagnostic, or refer to specialty surgery for further evaluation." Challenges with televisits: Calls dropping (if you or they are using a cell phone). Patients don't pick up the phone (because you're calling from a blocked number or secondary office line that is not recognized by their cell phone). They talk longer than the time you allotted for the appointment (which also happens with in-person visits). Another challenge with using the telephone: Needing to get creative with your wording so that patients can better describe their problem. Example: Me-If I were to ask you to point to where in your body your pain is, where would you point to? Patients-Directly underneath my right ribs, the part of my stomach above my left hip bone, in the bottom of my throat between my collar bones. Hope this was helpful. Best of luck in your future endeavors.

Hi Nichole, Since your original post was in January, I am wondering what your experience ended up being (now that it's been nearly 10 months later). I am curious because I find myself in a similarly specific position -- I graduated in May 2020 (AGNP) and currently I have two job offers - one in GI and one in Hospice. I am currently leaning towards the GI office and am told that as a new grad NP, I would likely start off doing a lot of colonoscopy screening consultations for those who have recently turned 50 and the advice I got was to brush up initially on the most common GI diseases and build from there. Would you please post your recent experience in GI (if you accepted the position)? Are you feeling more comfortable now that some time has passed? Looking forward to reading your post.

Speaking as a newly graduated adult health NP, here's my experience and what I learned: As an NP student, I also thought that I would need special RN experience that would help prepare me for the NP role. However, I learned (and was told by faculty) this was not true because my NP training in Adult Gero NP (and similarly for those pursuing FNP) would be in PRIMARY CARE (like the experience you would have going to your own Primary Care Provider's office). The only exception to the above that I can think of is if you wanted to train to be an Acute Care NP, then perhaps the experience of being an ER/ICU nurse would be helpful to you in the NP role. Your duration (regardless of type) as an RN is important to the NP Program because this means that you have been exposed to a variety of population, disease processes, lab findings, treatments, medications, and people-skills -- these are the skills that will be helpful to have as a foundation. Additionally, as a future primary care NP, your RN experience will remind you where your patients will end up if their disease gets worse or when they have an acute episode. Quick discussion: From my understanding, many primary care NP-trained professionals (such as FNPs and Adult health NPs) do not end up doing what they were trained for (primary care). Many end up working in a specialty (example: cardiology office, neurology office, hospitalist, etc.). That being said, if for example, you wanted to be an FNP to be a cardiology NP, then your RN experience in telemetry may help obtain a job in cardiology as a new grad NP. Advice: Maintain your connections for future recall when it comes time to get your first job. In your FNP program, towards the end, you will have opportunities to practice and hone your FNP skills in a variety of precepted clinical rotations -- these are truly instrumental experiences that will be helpful to you in your future role as a Nurse Practitioner. In these clinical rotations, you will have opportunities to examine, order diagnostic testing if needed, diagnose, treat, evaluate, and of course, do preventive screening, etc. The main goal is to keep patients as healthy as possible so that they can be happy and living their best life and keep them out of the hospital. Hope you found this post helpful. Wishing you the best in your future endeavors.

According to the American Nurse's Association (ANA), "Many nurses mistakenly believe they are covered by their employer's liability insurance — until a licensing board complaint or lawsuit is filed and they find that no one is advocating for their interests." Also, "a complaint or suit can be filed even if you did nothing wrong, and an investment in liability insurance will protect your future and the future of your family." I've been had personal liability insurance since I was a student nurse. As a working RN, I continue to have personal liability insurance as I don't exactly know what my employer's coverages are. It is my understanding and belief that an employer's coverage and their attorney will only watch out for the employer's best interest and not my own. I read an article that mentioned that certain circumstances could occur -- an employer could sue the nurse to get back money paid if negligence occurred and that if a hospital goes bankrupt, money might not be available for legal services. (Knock on wood) I haven't had anything occur, but if it does, then I feel better having the insurance. I've used both NSO and Mercer Proliability. Those two seem to be the most recommended by nurses and professional organizations.

From 2014-2016, I worked in state correctional facility, in the Long-Term Care units run by Corizon, a contracted company. I worked strictly per diem and worked a variety of shifts. Since I'm not sure how they do things in other facilities, so I can only share my experience. What I learned based on my experience: Correctional nursing is nursing with the added emphasis of safety -- yours and the correctional officers (COs) FIRST. So, a person may initially experience ethical conflicts with how patient care is delivered. There were no curtains for privacy. When delivering care, general room lights must be on and the door must remain open. There were times when staff was required to have a second person (another nurse, CAN, or CO) to be in the room for various reasons, ex: the patient might be Keep-Lock (they had behavior issues, so a privilege is taken away), or you have to provide care on their groin parts (so you can't be accused of being inappropriate). Inmates are considered a vulnerable population, so they must be protected. There may be times when it is deemed by a CO that a security/safety issue is at hand, and you need to stop whatever you're doing and leave the room, and you and your staff need to leave the room regardless of any medically necessary issues that you deem more important. The other thing about security is that there are no cell phones allowed in the prison. Everyone leaves their phone in their car for the duration of their shift as it's not allowed for anyone, not even the correctional officers. When I first started, I had forgotten twice to leave my phone in my car, so I had to trudge all the way back to my car and leave it there. Staff were given a telephone code for their own use only, so we can call out to the pharmacy, lab, or the NP/MD. Staff were allowed to make personal phone calls under the assumption that we won't abuse the privilege. Also, staff should always have ID on their person, otherwise, they’d have to get someone from their unit to come get them and escort them to their unit. Staff are transferred/passed a set of keys to use when they arrive (usually after report), and they surrender them to someone else before they leave the building. Many doors are locked, including the nurse’s station. Tip: Do not lose your keys, otherwise, the entire prison goes into a Lockdown where no one can come in or leave until the keys have been found - it can be nerve-wracking. I lost my keys once, but luckily a colleague had found it right away. They waited for me to realize that my keys were lost, waited for me to panic, then returned my keys to me, saying, "Now you'll never lose them again." My orientation was one week-long, which involved a good chunk being dedicated to Security Training -- keeping yourself and your co-workers safe while delivering patient care. There was also a training on Prison Rape Elimination. Then, the other half of the orientation was on medication safety, skills refresher, getting signed off on clinical skills. We were also given a tour of the facility. Security training is done once a year. Because of security, there was no electronic documentation system as they do in most other facilities. I don’t know if that is still the case since it’s been a few years. We used paper flow sheets for a lot of things - assessments, med admin, treatment admin (a lot of initialing). We also handwrote progress notes for those: under hospice care, under Keep-Lock, under contact precautions, who have something new going on. One thing to note: Because of the litigious nature of patients and their families, keeping good documentation was highly stressed. There might be 3 pieces of paper that you would have to complete for a person who had a fall. Relating to patients: There tends to be a lot of manipulative behavior among patients, as you can imagine. So, the best approach is to always be aware of your surroundings, use assertive body language and facial expressions. Be kind, do the job, BUT don't be overly-nice either (don't do them any favors of any kind -- if it's not medically necessary or a professional duty, don't do it). Your colleagues may warn you that you're "too nice," but don't let that dissuade you - if you're not compromising your professional ethics, you should be fine. Just be mindful of your security. You might hear stories of how an inmate manipulated a staff to do certain things for them (favors) - started as a benign request, then it would get progressively worse. Just remember: FIRM, FAIR, and CONSISTENT. Relating to colleagues: Please and thank yous go a long way in my experience. Many of my colleagues felt under-appreciated, seems to me. And many of them thanked me for thanking them after a long shift. It goes without saying that it's important to not disclose any personal information about yourself to the patients, but in my experience, it's also important to be vague about your personal life with your colleagues. Some staff have mistakenly disclosed personal information to a patient about their colleagues. Inmates have phone access to the outside world, so it's best to keep your personal life outside the prison walls entirely, just my advice since it has happened to me that someone disclosed my info to a patient and I was very upset about it. Ultimately, nothing came of it, but the potential outcomes can be scary. Lunch – the facility had a cafeteria, which they referred to as the “officer's mess hall,” but it was only open during School Hours, and closed on School Holidays -- I can't explain it. There were vending machines outside the unit, but who wants to eat that crap. Best advice is to bring lunch and drinks. We were lucky to have a nice break room with a full-size fridge, a microwave, a toaster oven, water cooler. Good to bring food, drinks, and extra protein bars or whatever in case you get mandated. It's rare, but it did happen for me. I hope this has been helpful. I took the time to write this because there were stuff that I wish I had known before-hand. It wasn’t a bad place to work, but just be wary. Best of luck in your future endeavors.

Hi Flor, I worked in corrections as my first job as a new grad RN; worked for there for 2.5 years in long-term care units of a max B facility. I applied for a hospice position in a hospital - emailed my cover letter and resume. In spite of my having only had corrections experience, they hired me because I had experience with working with the elderly, patients with cancer, had end-of-life experience care in corrections, and my current supervisors in corrections provided letters of recommendation. I did not know anybody working at that hospital. One thing that my interviewers told me was that I had expressed a strong passion for hospice, which helped in their decision-making. Hope you found this post helpful. Best of luck to you in your future endeavors.

I'm replying based on my own experience when I was a new grad. I would say 2-3 months prior to the time you expect that you are able to work... Graduate, pass NCLEX, and get professional liability insurance. Hope that's helpful. Wishing you all the best in your new career.