celle507

Hi everyone, has anyone ever left in the middle of the school year? I live 1 hr away from the school district I work in which was fine when my son was in daycare (just dropped him off close to where I work). He has now started kindergarten in my home school district and because I work so far, I have to leave him in an after school program as well. This is making him and me both miserable for the past two weeks and I want to quit my job (I’m only 0.5 FTE but 2.5 days is a lot)! He is having a hard time adjusting to kinder and I feel so sad I am not there for him Has anyone ever left the school year (we are on a teachers contract ... I have yet to see what the ramifications are for leaving early) ...

I entered school nursing two years ago with a large district working 2 days per week. We do not do any patient care, due to having one school for one day, we essentially only do screenings, IEPs, staff trainings, immunization, follow up on kinder requirements like physicals and dental exams. i also work two days per week at a hospice agency doing admissions and visits just to keep my skills up. Anyway, I just had a baby and need to get rid of one of my jobs. I like school nursing but I honestly don't know if this will be around in 10-20 years due to budget cuts and also I don't see any students (the other nurses in the school district are very strict that we should not be doing first aid and they want us all to be consistent about it). I like the fact that there is a pension due to being part of the teachers inion but honestly not sure if this will be viable when I retire (I'm only in my thirties) and if I give us hospice, not sure how school nursing can transition into another specialty as I don't do any patient care at all. What do you all think about the future of school nursing ??

Is anyone here a hospice NP? I am a fairly new grad FNP but worked Admissions in Hospice as an RN for 3 years prior to becoming a nurse practitioner. I just got offered a position as a hospice NP but am having second thoughts about it. The position is for mostly doing face to face visits. My question is: how do you typically get paid for this? Per hour or per visit? They said the prior NP would see about 4-5 face to face visits per day which sounds like a lot considering chart review, notes, travel time, etc. What is a reasonable expectation for this, not taking into account travel time? Also is it too routine just seeing face to face visits? Do you ever get called for symptom management visits or complex admissions? Thanks for any advice you can provide! The other position I applied for and got was for a school nurse position (district nurse). I know, they are two completely different specialties but part of me also just wanted to be a nurse again without all the responsibilities of a NP and to do more public health programs. However, another part of me wants to practice to the top of my education. I'm just not sure if I have enough knowledge to do such an independent position in hospice

Just wondering what you all are using in your units-- What do you do in your unit to prevent tunneled catheter infections? What do you use to clean the site (Ex-Sept, chloraprep, etc.)? Anyone using antibiotic locks? antibiotic ointments? biopatches? If you are using chloraprep and antibiotic ointments, anybody seeing a lot of skin irritation? Are you using occlusive dressings, transparent dressings? We have had a lot of infections in our unit so we are using chloraprep, antibiotic ointment, AND antibiotic locks (gentamicin/citrate). BUT, it seems like a lot of patients are developing skin irritation from the ointments. I am really interested in this topic. And if someone has an exit site infection (with negative blood cx), how are the providers treating it? vancomycin 1 g x 1 dose or vancomycin 500 mg x 3-5 doses. It seems there is no standard treatment protocol and everyone treats differently. Anybody have any suggestions what work the best (aside from strict aseptic technique of course)? Thank you for your replies!

Hi, I am a new FNP. I have a large number of patients with diabetes and am looking for a good resource to help me manage/titrate oral antihypoglycemics as well as learning how to start/titrate insulin. Also does anyone have any good resources on how to manage ESRD patients on dialysis (best practices for managing hypertension, access infections, etc.)? I have already bought and read Handbook of Dialysis and read the KDOQI guidelines but am still yearning for more information. Thank you for any advice!

I am new to dialysis nursing and I had a question about this patient I had. Typically it seems that patients will have higher heart rate during dialysis due to fluid being removed. I have a patient whose heart rate goes down to 48, 46 during dialysis. Completely asymptomatic. Her baseline (pre and post) is in the 50s as she is on metoprolol 100 mg BID. It has been like this for about 3-4 months now consistently. Her blood pressure is great with no episodes of SBP Is this typical for patients on beta blockers?

I just want to thank everyone for replying. I guess the sample here is a little skewed most people here are either practicing NPs or want to be NPs. It is comforting to hear that most new grads have doubts about their ability to practice as an NP... I hope it gets better but I am so terrified of making a mistake! I could probably be a little more choosy in my applications and make sure that there are other mid-levels in the group and they have experience with new grad NPs before applying. The places I have interviewed so far are either 1) practices with only MDs [or only one NP] or 2) individual MD practices looking to expand , both sites which intimidate me greatly! Also, I went to a normal NP school with in-class lectures and plenty of clinical hours where they arranged it for me and I've been a nurse for 5 years already. thank you again for all the replies.

I am wondering if anyone here has finished NP school but decided not to practice as an NP... I have just finished an FNP program at a top-rated school. During the FNP program, I just felt like I did not love what I was doing and always felt like I didn't know enough. While my classmates seemed so confident, I always felt uneasy and anxious. I have been on multiple interviews now (women's health, primary care offices, specialty clinics i.e. pain, dialysis) and I can't imagine myself working on my own and seeing my own patients. I know that there is some on the job training involved but the clinics all seem to expect their NPs (even new grad ones) to know what they are doing. I have also interviewed for an RN position and have been offered the job - it's a Clinic RN Case Manager position which is what I was doing previous to NP school. I know I can do it and I would feel comfortable doing it... I want to take it but I also feel like such a failure accepting the RN job! has anyone else completed the NP program and decided not to practice voluntarily (not because they couldn't find a job)? Thanks for any insight, experiences anyone can share

hi traumaRUs, Thank you for replying. I read your previous posts and hoped you would reply and give more information! I haven't had my interview yet but am trying to gather information so I know how to negotiate. So you have your own set of patients that you follow? I was told that I was basically there to assist with the 4 provider visits that Medicare requires each month for dialysis patients and I would be put on the dialysis rounding schedule. I assumed that meant I would be working under direct supervision of physician and not have my own set of patients. Do you think 240 patients/week is reasonable (approx 48 patients/day?)? Do you feel like the patients are too complex for someone like me (a new FNP grad with only med/surg experience) to handle? I am most nervous about that. I know chronic kidney patients are extremely challenging and I hope that I will be able to take care of their needs. FNP programs really emphasize primary care rather than specialty care. Thanks again for your reply and any other tips or info that you can suggest.

I am a new grad FNP (RN for 4 years in med/surg and home hospice) and have an interview with a nephrology practice next week. The practice is 5 MDs and this would be their first time hiring a mid-level provider. I have always been interested in nephrology but I have never worked in a dialysis clinic and have had no NP clinical experience in nephrology. My questions are: 1. How much training should I expect? This position would primarily be rounding on dialysis patients with potential to do clinic if I wanted. 2. What are your daily duties? How independent are you in adjusting meds, etc. since you are really just working under the supervision of the docs. Any advice or recommendations on other issues I should be thinking about would be much appreciated. Thank you!

In my opinion, a nurse can be both a public health and community health nurse... For me, a public health nurse is someone who looks at the health of communities. So, TB screenings, infectious disease investigations, mammograms, health education to schools, etc. to make sure that the community is healthy. In essence, the community is your client and you are trying to prevent illness. A community health nurse is a nurse who works out in the community (i.e. NOT an institution such as a hospital or nursing home). So, a home health nurse, a HIV case manager, a clinic nurse, etc. However, the person is still your client. So you are still doing direct care tasks such as vital signs, wound care, case management and more tasks that are helping people who are already sick. To me, that is the difference between public health nursing and community health nursing althogh the two very, very often overlap.. I hope that helps!

Hi, I am undecided about taking a clinic nurse position and hoping you guys could help me! The job is in a county internal medicine clinic. There are I think 4-6 physicians and 4 MAs currently and this is the first time they are hiring an RN for the clinic. From the questions in the interview, it seemed like a lot of managing the flow of the clinic and managing the Medical Assistants versus actually doing hands-on tasks like VS, EKGs, etc. (because obviously the MA's can do that easily). Some of the questions I remember them asking me were "How would you feel disciplining an MA," "would you feel comfortable firing someone," etc. I am just wondering if anyone here has a clinic nurse job like the one in this clinic. And if so, what exactly do you do all day? I'm sure the RN is also responsible for sharing the workload of the MA's such as triage, managing labs, calling insurances, etc. but how much of your time is spent doing managing and how much is spent doing other tasks and specifically what tasks do you do? It doesn't sound like the clinic has nurse visits either. Also how much autonomy do you then have? I want a job where I know what I am doing without taking too many orders from physicians. If so, should I not take a clinic nurse job?

hi! i am another person who has not found her niche in nursing yet. i have tried nursing home, hospital, and psych hospital and to all of these, i could not stay in any job for more than 5 months FULL-TIME. I got burnt out too quickly doing the same things, seeing the same patients, and hating the politics of the floor. However, I think I found the perfect solution to anyone who dislikes nursing - Work two part-time or per diem jobs (or a part-time job and a per diem job). Now, I work two per diem jobs (one in a sub-acute facility, and one on a med/surg floor) and I can tolerate nursing so much better. I can schedule my own hours and because the two facilities are short-staffed, I find I have more than enough hours and then I just pay out of pocket for my own benefits. but, if you can find a place to give you benefits at 0.6 or something, that's great too. Working part-time or per diem is great because I am friendly to my co-workers but I don't have to get involved in politics (either with co-workers or patient's families) because I'm not around enough! Also, just to comment on the workload of nursing homes, it is INSANE! I strongly believe that nursing homes need to be unionized. Take your 30 minute break and if you have to stay over finishing your work, then stay over and get paid the OT, and tell your DON (hopefully she's your advocate) that the workload is too much. If all the nurses keep staying overtime, and saying the same thing, they'll wake up and realize that with the money they spend on OT, they might as well hire an extra nurse for the floor (yeah, like they'll ever do that huh?)

I do think that being a nurse will give you an edge over other candidates for the position but I don't think you need to be a nurse. I attended the Lamaze International training course and our instructor wasn't a nurse. And half the class attending weren't nurses. I also worked for the Comprehensive Perinatal Services Program (CPSP) and most of the educators weren't nurses (although less pay than being a nurse)! Like the other posters said, if you become a doula, certified lactation specialist, or certified childhood educator, that can also open up the same career path for you. I would definitely recommend pursuing your masters degree -such as the MPH in Health Education or also being a nutritionist would also help in your career goals (I don't know though if that's an option for a masters degree). The career prospects are a little murkier if you are not a nurse (I mean, it's not like there are jobs for those positions advertised everywhere like nursing is) but they do exist! They just require a little bit more networking and research about organizations.

Hi, I graduated from BC's DE program and had the same concerns about the time frame as others on this post. However, I ended up choosing it because it was the least amount of credits (and thus least amount of money) than other schools. Also, it's possible to do the NP portion part-time (which is what I did and gained experience as an RN). Overall, the program is well-respected and I know several of my classmates who are actually working as NP's after graduation (without ever working as nurses first). If you guys have any questions, feel free to ask!

I am just wondering if anybody can recommend any good, independent health insurance plans. I finally decided the perfect schedule for me is working two per diem jobs but the only problem is what health insurance to use (I can't use my husband's). Any recommendations for cheap but comprehensive health plans? Thanks in advance!

I was a new grad 2 years ago looking for jobs in NJ (graduated from out-of-state school) and heard from recruiters from Capitol Health (in Trenton- they were the fastest), St. Peters, and Centrastate (in Freehold). Have you tried those? I did not hear at all from RWJUH (either New Brunswick or Hamilton one) but heard they didn't hire new grads.

If your interests are in public health, I would look into public health jobs or health eduator-type jobs and remain per diem at the hospital just to keep your hospital skills. I also went into nursing because I wanted to help people and found that nursing in a hospital overlooked some of the bigger picture issues I wanted to work with (lack of health insurance, lack of primary care, etc.). I ended up working in a homeless clinic for 2 years (which I loved but I still felt like I wasn't doing enough macro-level stuff by just passing out meds, doing wound care, etc. but I liked the environment since you dealt with people who are so directly affected by all these larger issues in healthcare). Now, I am working at a migrant health clinic doing more program planning and program implementation but I'm doing more paperwork than patient interaction. And I miss the patient interaction! I still work per diem at the hospital b/c 1) people give me more respect when I say I still work in a hospital and they see me more as a "nurse" and 2) just in case, I'll always have my hospital skills. Honestly, I HATE working in the hospital. But, one weekend is a month is tolerable. I would definitely start looking for other jobs that you will like more but stay per diem at the hospital.

i am fairly young (26) and received my MS in community health nursing in May. After graduation, I accepted a job as a program director in an adult day health center and have been working there since August- I have two years of nursing experience in a community health setting. BUt, I don't like being a manager. I dislike having to write policies, procedures, and dealing with paper all day. I can't get anyone to follow me. I dislike being the manager of people and being the regulator - making sure people are not coming in late, taking long lunches, taking advantage of me, etc. What made this job harder is that nobody trained me to do it. Previous management had quit so I sort of had to train myself on what my daily duties are and what the rules and regulations of adult day healh centers are so I still feel like I'm floundering a little. The only other manager in this center is someone who is also new (hired a month before me), and has no adult day health or management experience. I guess my question is ... are there some people who just weren't meant to be managers/leaders? Would it look bad for me to quit this job after 4 months and apply to just be a staff nurse somewhere else?? Would that make me look like a job hopper? Any advice/comments/suggestions would be much appreciated!!

I guess you need to ask yourself what you want to do. Do you want to be involved in policy, research, program planning, etc. (more macro-level type jobs) in the health industry? If so, with an MPH and an RN, you have an edge over others who only have an MPH. When you plan programs and think about budgets, you understand what it's like to be "in the trenches" and the people who are directly affected by the decisions you make will be grateful. BUT, if you don't see yourself in the health industry at all, I wouldn't continue with the RN. If you've always wanted to be working with unions or teaching or whatever, then this degree will just take you farther from what you really want to do.

hi, thank you all for your replies. i didn't think acute rehab was really med/surg. i guess i was hoping it was considered acute enough so that if later on, i want to go and work on a med/surg floor or in a critical care unit or whatever, i wouldn't have to go in as a "new grad" again but as someone with acute care experience with the requisite 1-2 years experience. it seems like i would have a harder time in the future marketing myself as someone with hospital experience (rather than rehab experience) than someone who worked on a med/surg floor. i would rather just work on a med/surg floor but i placed my application to all the area hospitals and none gave me a call back except for this acute rehab unit.

hi, I am considering taking a position on an acute rehab unit located in a hospital. However, the reason I want to work in a hospital is because I want that "med/surg" experience (have 2 years community health experience but no hospital will hire me since i don't have acute care exp.)... is an acute rehab unit considered med/surg? or would 2 years of working on this floor still not count as acute care experience? thanks for any replies!!

Is it possible to enter med-surg after 2 years of doing community health nursing (respite care and outpatient clinic)? I started off in a hospital after graduation and quit after orientation, but now want to go back to a hospital. i applied to all the area hospitals (even those almost 2 hrs away) but nobody has given me a call back! would it be awkward for me to call the NM at the hospital I quit 1.5 years ago and ask for a job there again? Do you think they would hire me back even though it would mean having to re-train me again?

hi, just wanted to give my input on your decision. i am currently enrolled at a direct-entry program (finished the rn portion, now working as a nurse and doing my ms portion part-time). if you want to save money, i would DEFINITELY recommend state schools. another way would be to enroll in an accelerated BSN program, and then apply to your masters afterward. this way, you have your bsn and can start working as a nurse and pay off your masters tuition slowly. i was stupid and went to a private school for the master's entry program and will be paying loans until i'm 80. for nursing, it is not worth it to go to yale or columbia over umass boston, unless you are getting a lot of scholarships. if you really know you don't want to be a nurse at all, then go to a masters entry program. i know some of my classmates went on to work as an np right away, even without any rn experience. good luck in your decision

Hi, I am a relatively new nurse (5 months med/surg experience) and didn't particularly like med/surg so I decided to try psych nursing since I've always had an interest in psych anyway. However, the unit that I was placed (adolescent) is very, very short-staffed (which is one of the reasons they put me on there). During the interview, they told me that there would always be two nurses working there but there is hardly any nurses here so usually, only one nurse is on with 4 mental health associates. I've only been orienting for a week, but every day, there is an issue of staffing (who will be on tonight?, who can we get? who do we need to float from other units to work?) and there is no consistent staff for the kids since it's usually staff from other units who are floated to our unit. I am a new nurse so I DON'T want to be put in the position where I am responsible for the entire floor, esp. in the event of emergencies (3 restraints last night!). The nurse manager promised me that I would not have to work on my own and they would always float another nurse over. However, I am not sure this is the best place to start off my psych career ... the place seems very disorganized, very short-staffed, the kids do not seem to have many activities, and the staff who do work there seem to let the kids run wild. Now, are all psych places like this or is this perhaps due to the fact that it is run by a for-profit company?? Should I look for another psych job elsewhere or stay in this place but maybe on another unit? This unit has had a mass exodus of nurses, and MHA's in the past few months and they are trying to regroup and restaff so I feel bad for leaving but at the same time, I feel like I can't work under these conditions... any advice? I also hate to leave another job so quickly... I am thinking maybe transferring to an adult unit since *maybe* the adults will be easier to work with than these adolescents ... is that true? I also feel like I haven't developed a good rapport with adolescents... sheesh, I couldn't even connect with adolescents when I was one, nevermind now that I am ten years older than them! :)