lifelong

You raise a great question. My graduate NP program included the use/benefits etc., but the program did not include individual training (landmarks, anatomy) or return demonstration. But found in my ICU practice we used it enough my collaborating MDs wanted me using it for therapeutics only. I had to go to a specific training (local medical school and SCCM class) and then have my docs demonstrate and observe me perform 7 of them before they would check me off. Then I added those to my SCA, DOP & credentials at the hospital. But every program is different...yours might have included it. My program had skills days specific to suturing, lines, intubation, para and thora but not bronchos. Hope this helps. Tracey

I have been an NP in a community ICU and loved the position, however the model and collaborating MDs have changed and I am moving into an oppty to enhance a vascular center that focuses on vascular diseases (CEAs, renal artery stenosis, PAD, PVD, uterine embo, etc). The infrastructure has been such as clerical support, space, doctors invested as is hospital. The space in the hospital and will support both inpatients and outpatients. There is a vascular lab (duplex studies etc) and interventional radiology (stenting etc) plus ORs. The center is new and currently doesnt have an advanced practice person directing or leading. I am coming from an ICU environment where I have thrived for a few years...but excited about starting something and moving it forward, studies and beginning to specialize. My questions have to do with staying general such as in the ICU versus specializing, pros/cons. Also if there is anyone out there who already specializes in vascular diseases/surgery etc. I will have nothing to do with vascular access (central lines etc.) so my area of focus is primarily treating vascular diseases. Anyone out there with thoughts or experience starting a specialized business unit as an NP/CNS/PA-C? Or experience in vascular surgery? Any help would be great. Tracey

Hi there, I am an ACNP who works in an ICU and manages patients on and off vents. I manage vent settings, monitor ABGs, place central and arterial lines, intubate, place chest tubes and perform thoracentesis. I preround, round with the attending and give my plan of care. Sometimes the attending wants to manage things differently, that's ok; I am new in the role and learning a ton! I manage the vent but also everything else. So I don't want to give the illusion I am pulmonary only. I manage cardiac, nutrition, ABD, everything...but pulmonology is part of it. My attendings are anesthesiologists so I tend to be heavily focused on cardio-respiratory. I did have a job offer from a pulmonologist to work in both the hospital performing H&Ps for new pulmonology consults and follow-up patients in the office. He also had a sleep study that I would have helped with as well. There were likely other things with that position, that I dont recall. I didn't take that position...it didn't feel right with the person. But I remember the position sounded pretty cool. I think the decision between ACNP and FNP is if you want inpatient or outpatient environment and the patient population you want to work with. Not saying either one is 100% set in stone. But it may help you if you can make that determination. I think the oppty is there for either and upon graduation there should probably be work to be found. However, if you want to go the MD route...thats an option to consider well. I am 43 yo...couldn't recoup the financial debt. Plus I honestly love being a nurse. These are hard decisions my friend. How about shadowing both an FNP and ACNP around to get a feel then find someone in your area in pulmonary. It may help you. If you live in Cincinnati PM me...you could follow me. Tracey

Nope, I am not in a combined role. I think there is just confusion. So far, I have just pushed back saying..."you really don’t want to pay me for data collection" or which one of my patient care responsibilities do you want me to lessen?" So far it’s working. I do want to be a team player but don’t want to get pulled into that stuff. I mean it takes me all day to get through all my clinical stuff. Either because I am new or because I carry up to 18 ICU patients (along with attending). Either way, I just don’t have the time or brain power. I just wanted to know if I were missing something. I have yet to meet an ACNP in a non-combined role to do data collection and I wanted to be sure. Thanks for all the replies.

Thats alright...yesterday I reminded the them that patient care was foremost in my mind, QA wasn't and that I wasn't willing to step into the data collection role because it wasn't study related. I also mentioned that objectively, I wasn't sure I was the person to fit the bill. I mean, would I objectively be able to QA stuff I do or services I provide? Honestly, I think they forget really what I do and perhaps blend the lines with other roles. I didn't get any nasty grams and think I nipped it. I just wanted to see if I was missing something. Thanks! Tracey

Hi again, I am a new ACNP in a brand new hospital. Love the position...but recently my boss the CNO has begun including me in meetings and some QA stuff. Don't make most of the meetings and have shared why with her and she is cool with it (I am usually in patient related stuff). But I have received a data form to fill out. Like am in charge of collecting data for certain data points. I guess I have been given the Code/RRT monthly QA. I remember her asking to look at a policy (which I did), but don't recall agreeing to performing monthly QA monitors. Nor do I have any idea about developing improvement plans which I would think would need to be rolled out and monitored and reported as well. Where I need help is how to wordsmith not wanting to do these, not really having the time to do these and already putting in way too many hours since I am salaried. She is very reasonable, I don't want to sound as a whiner (?sp)....but I am too involved in patient care to really being able to do these timely without doing them on my time. Thoughts?

Thanks guys! You helped me realize this is just a phase...normal phase I must travel through. I spoke with my instructor and she also mentioned it usually takes 5 yrs before one is very comfortable. She said it comes with time, that I knew I was just hoping to provide value quicker. I appreciate your thoughts. Tracey

Hi there, I thought I would check in with you and tell you how things are going. They are going fabulous; I am learning a ton yet feel so inadequate. I am literally saturated everyday to the point where my noodle is filled to the brim. Is that how it is the first year? Remember, I just started in the ACNP role a few months ago, graduated in November and the brand new hospital openned its doors May this year. The MDs are happy and from their perspective I am doing great....my perspective is I am DEAD weight! I don't know if it's because there are various diagnoses, or that I am learning why I am doing things versus what to do or what. It's just unnerving. I love what I am doing but don't feel I am adding value. I am curious as to the transition timing & experience of you experienced advanced practice folks (what did you go through). My preceptors are Intensivists and I am the first NP in the hospital. The hospital leadership are thrilled with me and what I have been doing. So it's not that angle...its more to do with the transition side. My question to you guys is...is this how it is the first year? Any thoughts? Tracey

You ask very good questions. I will give you my thoughts, but others may be able to shed more light. It sounds like you have wonderful well-rounded experience, all which will help you no matter what track you decide to go. I honestly believe since the ACNP is focused primarily in critical care/ICU settings, having ICU experience will only enhance your learning and allow you to have some comfort during your clinical time. Having said that I am certain with your vast experience, you will likely do well either way. Graduate school is hard enough...always trying to keep ahead, if there's any way to keep things easy for you, then do it. For me, I was an ICU nurse; I didn't make any job changes (other than going weekend option) during my program...just to keep sane. As far as the different tracks...I am no expert, but I always kept the two separated solely on what the titles were. FNP focuses on the lifespan of the person, from cradle to grave. So in my mind the focus is on primary care for the entire life span. I believe the clinicals are also focused on primary care. The ACNP focus is solely on acute phases of specific age groups (neonatal, pediatric and adult). Here the clinicals and focus is on deep penetration on the acute phases of disease management within that age group. Thats how I kept them separted in my mind. I am not certain I hit the nail on the head, but hope that helps a little. Tracey

I remember graduating this past November (2008) and being offered an NP position in an inpatient rehab unit. I was doing my final clinical rotation in an ICU and we referred many patients to rehab (some in-house/others SNFs, etc.). Anyway, the inpatient rehab unit had 30 beds, self contained and the position had a hospitalist feel to it. I would work with up to 3 MDs as they rotated every month, and it was a M-F position. I would round on patients, participate in weekly multidisciplinary rounds. Pay was 88K, good benes/perks, etc (I live in Ohio). I didn't take it because Rehab is not my thing, but I think there is clearly a need for NPs in the rehab environment. Hope this helps. Tracey

Hi there, I am employed by the hospital. I have an office I share with my collaborating MD (who has his own practice...anesthesia). In Ohio I think the climate is such that the conservatism wouldn't gain me many referrals...but after I get some more experience I may give it a try. Setting up my own practice is something I would eventually want to do and technically could do legally in my state. I would just have to consider all options. I was approached about doing pre-admission testing for patients. I did one, kind of liked it but not sure right now it’s the best fit. It's a little slower pace, but had an office feel to it. I would probably bridge this before setting up anything on my own to give me a better feel for billings, office setup etc. I graduated this past November, so I have a ton of learning to go through. So right now the 1:1 time with the Intensivist is my golden to me. I hope this has been helpful. Tracey

Wow, I have both a MS from a college of nursing within a university setting and an MSN from a different university setting. Both highly regarded both with medical schools onsite. I received my MSN in 1992, and had the requirement of a master's thesis. My MS waved my research requirement because of that and now requires others receiving the MS degree to have a research project that could be done in a group format. Today the MSN offers both options. Although the thesis was extremely painful (and I think they fooled with my head just because), I found it beneficial in my ability to apply research. However, when I ask many healthcare professionals...my degree orders is MS, MSN. From the professional ranking the MS is more scientifically grounded (and I did have 3 more graduate science courses) and thus has more weight. Personally, I am not sure I buy that notion. Heck, sometimes I question why I did both, but here I am. I think I muddied the water even more. Tracey

You know after rereading your question, I focused on questions you could ask...not what might be asked of you, sorry! Questions they may ask you might be focused on your newness and the type of support you may need, which to them may mean who needs to be available, how will you bill, how to staff you (time slots/MA support, etc.), do you room your own patients. They may give you scenarios and ask you to problem solve, I am not sure. My guess they are trying to figure out the value you bring to them. You could emphasize your keen assessments skills, ability to work with people, trouble shooting experience as an RN. I hope this helps. Good luck! Tracey

Congratulations on the interview, wow, you must be excited. I am coming from an ACNP perspective so please take that into consideration. But some questions that come to mind after reading your listing are: Typical conditions/diagnosis you might be expected to manage (will you only see call ins or have an appt book), number of patients to see/day, appt time slots for new pt vs. f/u How are no shows/cancellations managed? Who would be collaborating MD and are they available, esp. since you are just starting out. How are referrals managed? Direct billing Is all equipment there that might be needed? Have they worked with NPs before, what's their experience with them, why is there an opening? Is there an MA assigned? Are there other NPs there or are you the first (this may bring up additional?s especially if they aren't used to NPs) I think the biggest thing for you to come away with in the interview is if this is a place where you feel is a good fit for you. Knowing jobs might be tight...but you need to have the support you feel you need in the beginning of your career. Does the position feel right, are the people you intermingle with appropriate or from another planet, etc?? ****other things that eventually need to be talked through, probably not at first interview though**** Hours/times/weekends/evenings/call etc Insurance, DEA fees, etc. Benefits I hope this helps. Tracey

Hey there, I am an ACNP and graduated in November. I work in the ICU and love it. As an ACNP I work primarily in the hospital but can work outside the hospital if the patients I would see are a follow up from an acute episode. For me, I would only work external if part of my time would be spent seeing patients in the hosp as well. I can care for patients 16 yrs of age or older (that might be state practice act specific...not sure), anyone younger is out of my scope. I am not prepared to take care of OB patients but can do a gyn exam if need be but if I wanted to subspecialize then I would need to head back to school and pick up an FNP or ANP. If an OB patient has a hypertensive crisis, I may see them in the ICU, but rest assured, the OB would be heavily consulted. ACNP's focus is in the acute phase of disease processes and now a days that lends itself to a hospital environment. I think it comes down to what you want and like to do. Critical care is in my blood, always has been, thought about CRNA and it was not for me (didn't like the grey walls and stationary workbench). With my delineation of privileges, I intubate, place lines, perform therapeutic bronchs, perform LPs if needed, round on patients, and write orders. I do not float swans but place the introducer. This is what I like to do. So I went with the ACNP route. When I graduated, I thought I would end up with a hospitalist team, but there wasn't an opening. However, I did end up with an Intensivist team and thats where I am. If I can help your further please let me know. Tracey