pluckyduck

Hi all, I'm a primary care NP (FNP) working in a small satellite emergency department for a larger health system. I've been working in ER for 10 months and was an ER RN at a level one trauma center prior to my current role. I'm interested in doing the ENP exam offered by the AANP once I meet the criteria. Has anyone done it, and did they find it enhanced their opportunities in terms of salary, benefits, better job opportunities? Thanks in advance!

Hi, I went to school in Ontario. There are 9 schools in Ontario that offer primary care NP programs at the Master’s level. Primary care in Ontario is equivalent to “family/FNP” in the US. A consortium of nine Ontario universities currently offers the program: Lakehead, York, McMaster, Ottawa, Laurentian, Western, Windsor, Queens and Ryerson. (http://NP-education.ca/) They are all accredited and recognized by AANP and ANCC. If you write your US board, CNO in Ontario will allow you to apply for your license by endorsement, so you only have to write one exam. If you write the Canadian NP exam, you’ll still have to write either the ANCC or AANP exam should you choose to practice in the US. The biggest pro to going to school in Canada was that my school found all my placements for me based on my learning needs and program requirements, which was invaluable. I have worked with many US colleagues in FNP programs (especially online ones) that have not been able to graduate as they can’t find someone to take them for a a placement. Drawbacks to going to school in Canada include you may have to go farther for a specialty program. In Ontario, the only Adult and Pediatric NP programs are offered at university of Toronto. McGill is the only school in the country (I believe) that offers a psych NP certification. This is a link to a list of accredited nursing programs in Canada. https://www.casn.ca/casn-members/ Good luck!

I did my master’s & FNP in Canada, where I’m originally from, at the same school I did my BSN at. My student loan was $18K Canadian. Part of the reason I chose to go back in Canada even though I live in the US is because the tuition was better and the program was structured in that they found my placements for me. My school was recognized by AANP and ANCC as an accredited institution and I only had to write one board exam in the US, which was recognized in Canada. It was a win win for my situation.

My employer mandates it, unless there is a medical exemption/documentation (and it usually has to be pretty legit—like anaphylaxis, for example). Otherwise, if you’re not immunized by December 1 you’ll be terminated. I get my flu shot every year regardless. My husband and father are diabetic and I would hate to get sick and give them the flu. I also made sure they received their pneumococcal vaccines due to their diabetic risk. Plus, this year of all years, it’s another tool in our belt to help minimize the flu on top of the ongoing pandemic.

We use EPIC at work and we only call report to the unit when patient is going to step down or ICU, and then the RN brings them up on a monitor with a tech. Otherwise, our department has a quick text template that we use as a free text note that looks like this: Chief complaint, current signs/symptoms, mental status, precautions, ambulatory status, outstanding orders, current infusions, code sepsis y/n, other info (why they’re being admitted, IV access, other pertinent info), my contact name and number. So the floor nurse can pull it up quickly.

I placed EKG leads on an elderly lady in triage once. She came in for syncope. I put the stickers on and could not get the leads to pick up. I used two different machines and rebooted the damn thing and finally asked he tech for troubleshooting help. My elderly lady was wearing nude pantyhose and the stickers were on top of the pantyhose. We all had a good laugh. ?

We have high turnover in the ED because we hire new grads and after a couple years, they want to go to ICU to do CRNA, or they want to travel nurse. We are always short staffed and I’m getting tired. If I didn’t have a year left of school, I’d probably be checking to see what’s out there. That said, I have really excellent management who accommodate my school schedule and are super flexible and that’s one of the best perks of my job. It’s a rarity, I know.

I worked in the OR of a level one trauma center/teaching hospital for 3.5 years after I graduated nursing school. Never did a day of OR in clinicals but wanted full time work, and they paid for my training and certification, and gave me an extensive orientation for 5-6 months (I was very fortunate). I loved the OR and did neurosurgery, ENT, and dental primarily but scrubbed and circulated in all areas, except scrubbing in cardiothoracic. I worked in Ontario, Canada and we did not have scrub techs. Then, I relocated to Michigan when my now husband finished college at the time, and applied to a level one trauma center/teaching facility here. I actually interviewed for the OR and the ER on the same day in the facility. I always had an interest in ER and thought since I was relocating, now was as good a time as any to jump ship. I also had the vague idea of going back and doing my FNP so I figured ER would give me a nice knowledge base going back to school. When I transitioned to ER, I had a 14 week orientation and many of the "skills" I was worried about losing came back quickly, and my educator was kind enough to offer to shadow me for a shift and just spent 12 hours doing IV starts and lab draws. It was a different mindset for sure - controlled chaos in the OR verses "poop hitting the fan" chaos in the ED but I have enjoyed both and thought both were very valuable in different ways. Of note, I was the first OR nurse my ER had hired in over ten years and the manager warned me it would be difficult. I, like an idiot, said "challenge accepted," and never looked back. You can leave the OR if you want later on, there will probably be a learning curve (but that's expected switching into any specialty). Don't turn down an opportunity you might enjoy because of other people's opinions. If I had a dollar for every time I heard "OR is not like regular nursing" I'd be able to retire. Keep up with continuing education opportunities and follow ER related nursing updates and best practice guidelines if you choose to transition out down the line. Good luck to you!!

As a NP student, thanks for helping us learn. This is cool of you to do, especially donating back to PP. ??

I volunteer with an animal rescue group. I also went back to school for my master’s. this is an expensive way to “pass the time” though. ? If you like learning, look into studying for the specialization you work in—example, CCRN, CEN.

So a RPN in Canada would be an LPN (licensed practical nurse) in the US equivalent wise. The ADN is an associates diploma program but it is for RNs only —it’s an alternative to the BSN here because of the cost and time required to obtain a BSN, many RNs have their ADN. So the ADN is NOT for RPNs. Your friend can work as a LPN here though. She would have to write the NCLEX-PN though for practical nurses. For both of you, you can’t work in a California until you have a minimum one year working in another state first—as a foreign nurse, they will not issue a license by examination (if you have to write the nclex, which it sounds like you do). You need to be licensed in another state and work for a bit, as you need to have a SSN to apply for license by endorsement in California. Like user Juan de la Cruz said above, California and New York have really specific extra requirements that make it challenging to get licensure there. My friend travel nurses and he had his Michigan license first for a few years and worked before he was issued a California license and could go out there. He spent the last two years working on his NY license and just received it a few months ago as he was planning to go out there after his California contract ended. I would recommend picking another state first. Michigan had a high concentration of Canadian RNs due to the influx of BSN educated RNs coming from southwestern Ontario looking for work when there are minimal jobs open here. Best of luck to you!

I can answer this because I am a Canadian working in the US. I’ve been working here for the last 4 years. The NCLEX-RN is the same test whether written in Canada or the US but you need to look at the individual licensing requirements for the state you’re interested in practicing. I am assuming you already have a license to practice in a province in Canada. You should apply for the license for the state you intend to practice in first. You can find this information by googling “state nursing license application”. For example, this is the site for Michigan: https://www.michigan.gov/lara/0,4601,7-154-89334_72600_72603_27529_27542---,00.html Read through everything with a fine tooth comb. It is a lengthy process and if you make mistakes it will cost money and time. Once you have the license for the state, then you to start the VisaScreen process through CGFNS international. http://www.cgfns.org/services/certification/visascreen-visa-credentials-assessment/ They are a third party agency that verifies your credentials including education and licensure and once your visa screen is issued, then you can start applying for jobs in the states. The visa screen has to be renewed every 5 years for the duration of the time you work in the US. This process takes about 9-12 months. Once you have a visa screen and a license, then you can apply for work. An employer will not even look at you if you don’t have the visa screen as it does the preliminary work for your employer and US customs and immigration. Once you have offer of employment, you will get a letter from your employer and an immigration firm that you take to a port of entry (border crossing between the US and Canada) and you present it with a passport, your licenses, your degree and a bunch of other paperwork. Then they will briefly interview you and issue you your I-94 which is your TN VISA under NAFTA. This has to be renewed every 3 years and it is directly tied to your employer. If you lose your job, your visa is no longer valid. If you change jobs you need to apply for a new visa sponsored through the new employer. This entire process will take at least a year. I knew when my husband was finishing college I was going to be relocating to the the US so I started it about 16 months prior to moving. It will also cost about -$500 for the visa screen with associated fees required for paperwork verification and each states licensing fees vary. If you don’t have a passport, you need to do that as well and that’s $160. Hope this helps!

I was assaulted for the same reason—patient discharged from ED, had no place to go. So he punched me in the side of the head and he got an admission to a psych facility and 4 points. You better believe I pressed charges. I went with our department security who drove me to the precinct to file a report immediately after I was medically evaluated. I spent the better part of a year going to court repeatedly and he eventually got 30 days in jail as a misdemeanour assault charge (which is crap but I digress). We all need to be filing reports and pressing criminal charges because if we don’t hold people accountable for this behaviour and continue to “accept it” as part of nursing it will never change. It’s not too late. And if you don’t have the support of management behind you, then you need to start looking for another job. You don’t want to work for that kind of environment.

All the major medical systems in southeastern Michigan are tobacco free and employees are subject to urine drug testing as a condition of their hire. If there’s nicotine present, they won’t be hired. If they drug test you at random, and they find nicotine, they’ll fire you on the spot. It doesn’t deter people from smoking though. *shrug*

Agree with the previous advice—I work days 6a-6p in the ED and when I do 3 in a row, I’m tired the first day off. But if you’re feeling exhausted, maybe you should see your PCP for a thyroid check, make sure this isn’t a symptom of something more insidious going on. Try and space out the shifts if you can. It might help. Or consider if they offer a different midday shift—can you switch to that? I was less tired working afternoons 2p-2a then I am working nights or days.