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zmansc ASN, RN

Emergency
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zmansc is a ASN, RN and specializes in Emergency.

zmansc's Latest Activity

  1. zmansc

    Not Hiring New Grads in ER's

    Personally, I went straight into the ED. Many have argued that new grads should not go directly to specialty areas, and my hospital has even made this change recently. I think it's wrong, but I'm already in so I'm not going to argue that point with our admin. I will say some of the best ED nurses I've met never worked the floors, and the same for some of the best ICU nurses, and other specialty areas. When I was graduating there were a few large hospitals in bigger cities that had new grad programs (I don't recall the term they used, probably a residency), where the new grads who were selected had both a didactic program and worked a certain number of shifts in the specialty area of their choosing. If it hadn't been so far, or my local hospital hadn't offered me the job they did, I would have gone that route. Since my local community access hospital did offer me the ED position when I graduated, I took it, and I'm not dissatisfied with the results of that at all. IF ED is your goal, you can certainly learn all you need to there. I stepped up to a larger ED two years after I started (PRN only) because I wanted to learn some things that I thought we didn't do... Turns out, there wasn't alot to learn that I hadn't done here, just more volume divided by more nurses. I will say that I strongly suggest against making up your mind of what specialty you wish to spend then rest of your career in too early. You are very new to nursing, and there is alot you could do. If you have interest in one specialty (ED) then by all means put it at the top of your list, I did, and I'm glad I did. I now work as a float though. I still get to play in the ED when they need me there, other days I play in the ICU, or wherever they need me. You may find that you have multiple interests as you learn more about the various areas. As you gain experience in an area or two, you may find other areas that peak your interest. I only say this because you are the only one who can determine the best path for you. The great thing about nursing is if you don't like what your doing, there are many other areas for you to go and find a better fit, a better job. Good Luck!
  2. zmansc

    67 Medications Every New ER Nurse Must Master!

    https://allnurses.com/emergency-nursing/medications-in-the-990012.html Seems more in that vein. I haven't looked at both to reconcile the differences, but the much more organized list is to my way of thinking much easier to grasp, especially for new to the ED nurses. I like your idea of posts on each med, or category of meds to delve into more detail, good idea!
  3. zmansc

    11am-11pm ER nurse help!

    At our facility the traffic picks up around 10a, so the 10-10 and 11-11 shifts were very hard to fill, as you came in and had to hit the ground running. The 7a-7p shift nurses usually had time to stock the rooms, check the crash carts, and ease into the day a bit more. Also, it was very difficult to see the crew you had been working with leave and a new crew come on while you still had 3 or 4 hours on your shift. On the good side, as some have mentioned is sleeping in a bit later, and if you like to be busy, you will not be disappointed! I also felt like I could be a part of both the day shift crews and night shift crews I worked with. I didn't mind it so much (I was 10a-10p), but traditionally they are harder shifts to fill.
  4. zmansc

    67 Medications Every New ER Nurse Must Master!

    I'd say a fair portion of this list either isn't used at all, or is so rarely used that only a very cursory knowledge is necessary and listing all of the medications as if they are all of equal value is somewhat misleading. I do think this list and the many other lists of meds to be aware of are all good starting points for new nurses to the ED setting however. From an educational standpoint, I think it would be easier for new ED nurses to gain a working knowledge of this list if they were presented in an easier to grasp format, for example by drug categories. Just my $.02 (adjusted for inflation of course). I am curious to poll the ED nurses here on use of romazicon at their facility. I have never seen it used at my facility. Every provider I talk to feels the potential side effects out weigh the potential benefit. Is it used at your facility? How frequently? What is the criteria where the docs decide it is worth the potential side effects? How often does it induce seizures?
  5. zmansc

    Can I work in a hospital as a FNP?

    An FNP can work anywhere that is within their state's scope of practice law (with caveat below). So, by that, the question to you would be, what does your state's scope of practice law say in regards to this? The caveat to this is: does your local hospital, or the hospitals within your region, hire FNPs? If so to do what role? Within the scope that your state allows, facilities can choose whomever they wish to hire. Either by having formal limitations, or informal ones. They often consider insurance reimbursement limitations in your state in making these decisions. My own state's SOP law is very vague on this, basically saying that if you are trained to perform the work, you can do it. Thus there are ERs in my state that are fully staffed by NPs. I'm only partially familiar with them, so I can't say how they determine if the provider is trained to treat all of the patient population that is/will come into the ED. I also know of several EDs in other states that are staffed by NPs exclusively. All of these hospitals that I know of are rural hospitals, and at the very least the vast majority of the NPs are trained as FNPs (I don't have the credentials of all the providers here). My own local community hospital has two providers, one MD 24x7 and one NP/PA 12x7. The mix of NP to PA has varied over the years. All of the NPs are FNPs as the facility wants them to be able to see all patients. One ACNP was considered mainly because she had many years of experience in our ED. Officially, our ED policy states that the NP/PA take levels 3-5 pt only unless the physician is overloaded and directs them to take 1&2s. Unofficially almost all the providers split the patients on a provider available basis. Level 1&2 probably get a physician 75-80% of the time. Also, our provider group has protocols for the providers to become checked off on skills (for physician provider as well as NP/PA, many of the physician providers are not board certified although they are working on improving that ratio), so that is how the group and facility meet the "trained" aspect of the SOP. My own facility has toyed with the idea of, and hired both NPs & PAs for the hospitalist group, but they have never stuck. I think the main issue has been the distribution of work, basically the physicians have only given the grunt work to the NP/PA. In the cases I know of the NP has been an FNP, again for the reason of all age groups. I think this will improve over time, and at some point there will be FNPs hired into the group that will stick. I know of several FNP Hospitalists in many states, so I have to believe we will figure out how to make it work at some point. The medical director of our ICU has expressed interest in hiring FNPs to staff the ICU. At this point it is a proposal, so I don't know where that will end up. Again there will be issues of putting the proper training and checkoff procedures in place to meet the SOP. Personally, if I was to try to make a career in any of these settings, I would consider going back and getting my ACNP.
  6. zmansc

    Frontier Nursing Uni. Class 136

    First, good luck to all of you! Second, as someone who was where you are now a while back, your best bet for your own health is to find something else to occupy your time. The admissions folks work very hard to try to meet their projected dates, but sometimes application pools are larger or someone on the committee is unavailable for unseen reasons, or whatever and the dates have to be pushed back. They will notify you guys by email (unless that has changed) as soon as the list is finalized, and no amount of checking your emails will change when that happens (believe me I have personal experience on that one, hitting refresh over and over again didn't help). I don't have anything to do with the admissions process, and I have had discussions with some of the administration of the school about what it's like and how they might improve the process from a prospective students perspective, but for whatever logistical reason, it hasn't materially improved. The good part of that (in my opinion), is that they truly do spend a significant amount of time reviewing all of your application and pick a diverse student body. It is worth the wait, even if one needs an occasional ativan to cope! j/k
  7. zmansc

    CNM vs WHNP

    I'm not sure who your question is targeted towards. I have not found any additional information as it was merely a curiosity and I don't feel like reading my state's scope of practice for specialties I don't plan on getting. From my understanding the scope of practice for WHNP & CNM have high overlap, with CNM being more broad (delivery), but that's at a very high level, I'm not sure how each state sees it in detail, not to mention how the insurance companies and facilities in my area would see it. We don't have any WHNPs here, we have two CNM/FNP, as this combination allows them to take care of a much broader spectrum of patients. In fact, I would say the FNPs outnumber the WHNP in my cohort by about 20:1. I think people tend to be going either FNP or CNM, but I'm sure there are more accurate census numbers somewhere for the different specialties. Since you have very specific interests (VA Women's Health Clinic or Women's Clinics in general), I would suggest talking to practitioners in those clinics and asking which path they believe would be most helpful and what would be the practical differences in your practice between a WHNP, CNM, & WHNP/CNM.
  8. zmansc

    ED techs to start IVs?

    The statement was "IV starts are simply a monkey task", not "IV therapy is simply a monkey task". Don't confuse the overall job (IV Therapy) with doing a task (IV Start). There are many tasks we have given to techs which are just part of a further job. Yes, the tech can clean up the patient, but the nurse still needs to assess the patient for skin breakdown, etc. A good tech might tell you, "when I was doing xxx, I saw yyy", but it's still your job to assess the patient. You the nurse need to give clear instructions to the tech on any restrictions in how/where/when they place the IV, but the task of placement is very much a task that can be delegated to a trained, competent tech. Also, your assumption that the tech is going to be too lazy to walk around to the other side of the patient if the other side is the proper place for placement of the IV, or that the tech will not use proper technique to prevent infection and do a good job of placing IVs is quite condescending and rude to the high quality techs who place IVs at my ED. These folks are trained to do a job, and take great pride in doing it well. The techs I work with who place IVs are some of the best at placing IVs I've seen. They place them per what information the nurse gives them and if they are confused by the orders and what they see, they will go get clarification. It also helps when they are around and we need an IV in an emergent situation, like a code, because we can give them that task and move on to doing another task ourselves confident that the task will be accomplished quickly and correctly.
  9. I certainly hope not. Both as a RN and a future NP, I would disagree that the provider orders it, the RN gives it blindly, and I'm hoping you didn't mean it that way. I'm sure you advocate for your patient when you feel the provider's order is not correct, just as the rest of us do. Both the provider and the RN must treat the patient as the patient presents, not a number on a pain scale. That includes the patients history, assessment, exam, labs, and other tests. What often confuses new grads is that they have been taught over and over if the patient says 6, pain is a 6, and in the real world, that's not the case for many reasons, one being that the pain scale is a very subjective scale that has poor inter-rater reliability. I live in a very rural area, we have alot of ranchers who haven't seen anyone medical since they were born, if then. When they play with power tools, they get hurt. Invariably they come to the ER with some nice big trauma, usually against their will. Now these guys, all believe they must be tough guys and when asked about pain answer: "It don't hurt much." If you push them for a number they will answer 2 or 3, all with a grimace on their face, clenched fists, veins popping from their necks, diaphoretic, etc. Do we assume their pain is a 2 and go on my merry way without treating it? Of course not, the number is no where near as reliable as our assessment of the patient is. It's no different for the patient who is eating chips, sipping a coke, playing on their cell phone, yet complaining of 11/10 abd pain. Do I treat based on a number, or a whole picture? I think this is what most of us try to do. Sometimes we get too jaded and don't treat pain we should, and sometimes we get played and treat non-existent pain. Another part of this that is always fun is the documentation. I don't know about your systems, but ours is terrible about treating pain. We have a screen we have to fill out, it takes a number and selecting an action from a drop down list. So, I have on occasion gotten the nasty email, you had a patient with a 10/10 pain and you didn't treat it?!?!?! My response is typically, did you read the nurses note made at the same time? That note will say something to the effect of "pt reports 10/10 abd pain, exam shows....provider notified". With the description of what indicates the patients pain is not requiring treatment at this time. The desk nurses who review charts for a living still didn't like this because it messed up their numbers, but I successfully argued that if they didn't like it change how they want me to document the pain assessment as I wasn't going to lie on the medical record so that their numbers looked better.
  10. zmansc

    Best school to attend for WHCNP?

    Frontier Nursing University is a very reputable school with a WHCNP program that I would suggest you consider.
  11. zmansc

    Frontier University as FNP

    I'm in FNU's FNP program. Yes, you have to identify the clinical sites and preceptors you wish to work with. From my experience and that of my classmates, I can tell you it is something that is much easier if you put a little time into it early. It's basic networking 101, you first must establish relationships with folks you want something from (NPs mainly, but all providers really), then you ask them for that something (to precept you or help you find someone who could precept you). Once you have identified preceptors who are willing to precept you, FNU's credentialling office will take over and verify their qualifications, and your regional faculty member will help you by coordinating the entire process. You don't have to do anything related to paperwork or contracts, etc., just identify the individuals and the facility they work at. Personally, I started networking with providers about 6-12 months before I was accepted into the program, as I knew I would need their assistance at some point (if not precepting, then hiring). I have been inundated with offers to precept me, many of the offers I had to turn down as they were specialist, or I just cannot have that many hours with non NP preceptors. It really didn't take that much time, at first, I simply introduced myself to providers I came into contact with at work. If you don't have anything else in common with the provider, discuss the NP profession with them. Ask about NPs in their practice/specialty, how they utilize NPs in their practice, etc. Try to have an intelligent conversation with them and make them remember you, it really doesn't take much. Some might offer to have you shadow or meet staff, always a good sign and something to take them up on. Then once they consider you a colleague and have at least a modicum of emotional investment in you, you can ask them if they know of someone who would be able to precept you, this step is probably best left until your in your program. Within six months, I didn't have to go out of my way to network, I've met several providers who have become friends, I'm invited to their social gatherings, etc. and my network grew exponentially. FNU also provides assistance in several ways, they have a database of past facilities and past preceptors who have taken FNU students, and they have a (much smaller) list of those who have not worked out in the past to avoid. They also have a very active and extensive alumni network that is generally very willing to either precept or help you identify preceptors, it's a very good resource for students who are going to FNU. I personally, tried to not rely on these resources and only have them as backups in case I needed them. I do know of several cohorts who had some difficulties, the most common issues were by far the student who had not prepared for their clinicals and all they wanted to do was send out form letters asking folks to precept them. Form letters in this case is equal to junk mail, and we all know how well we receive and respond to junk mail so expecting busy providers to put you at the top of their list via junk mail is a very risky approach. I can think of two other cases where cohorts had difficulty, in both cases it was related to their required anteparnum contacts (yes, FNU has a whole list of the number of patient contacts needed in each population for FNP students). Both students lived in very rural areas, and were unable to secure the services of the only OB in their area. In one case, she found a CNM who worked in the next nearest town, about three hours away, and coordinated a couple two day trips to her town/office to get in the appropriate visits. In the other case, her regional faculty member helped her find a very busy clinic that would be able to get her visits in a city a few hours away in one week. So both students had to travel some, but were able to stay on schedule for their graduation. These were the worst cases I have heard of from my personal contacts. Although FNU does not advertise that they will help you with your clinical placement, rest assured they are not there to fail you, they will do whatever they can to help once they know you have done everything in your power and exhausted your resources, but you must show them you are not just being lazy and wanting them to do your work for you. As for seriousness of an online degree, I have not found that to be an issue in regards to FNU. I believe perception of the degree is more based on reputation of the institution than the delivery mechanism of the didactic lessons. From my limited experience, I have never heard anything negative about FNU, their alumni, or the quality of the education provided. If anything, I think it is more rigorous than most B&M courses I've taken. If you want the easiest way out, don't pick FNU! Exams are proctored, and they expect you to put in the time to know your ****. Clinicals are monitored closely, and compared to other online universities where friends have gone, they are more picky about your preceptors and monitor them more closely. In fact the biggest complaint I hear from preceptors is how much paperwork and extra time they have to do to appease the FNU regional faculty compared to those from other universities they have had students from. In conclusion, if I had it to do over again, I would select FNU in a heartbeat, it was the right choice for me, and I have no fears of having difficulty finding a position because of it's reputation, in fact, I believe it's reputation (or that of it's alumni) will greatly help me come time to interview. I do believe that different programs are targeted towards different audiences, and you should research how FNU's mission matches up with your mission/goals. Sorry for the long response and hope that helps.
  12. I know several nurses and providers who go overboard on the pain seeker paranoia, and conversely I know several who are at the opposite end of the spectrum as well. Contrary to nursing school, in the real world pain is what the patient says it is but.... When the patient says they have 15/10 pain but they have no signs of pain, no etiology that would be causing this massive pain, etc., the nurses suspicions get aroused. Are we perfect? Nope, never gonna be, it's a subjective finding with high inter-rater variability, always will be. So, can it be improved? Absolutely. We as ED nurses must be (and most are) careful to not become too jaded about pain med seekers, yet to also not be too fast to feed the pain med seeker with supplies of narcotics. When the patient comes back to the ER for the fifth time during your shift, your probably giving pain meds out too easily (true story, we had to have the rest of the providers talk to that provider), when someone crashes their motorcycle or has other trauma with obvious etiology of pain and you tell them, "um, can't give you nothing until we do a UDS", or "I have two tylenol po for your pain", probably not treating their pain. Incidentally, anyone using Tylenol IV to reduce/eliminate the need for narcotics in certain cases? If your ED isn't using it, it seems to be very good in alot of situations and if the provider is reluctant to give more opioids to a patient or to even give any opioids, then it's something you can advocate for your patient.
  13. I'd suggest starting on the beach, with a cold one in hand. You've just been through a grind, recharge your batteries, give yourself a break, and get ready to hit the ground running in a couple of months when the job starts. Oh, and congratulations!
  14. zmansc

    Article on Nurse Practitioners

    OP - By spreading these links you promote the websites that host them and thus indirectly promote their propaganda/smear campaign.
  15. zmansc

    online F.N.P. programs??

    Frontier expects you to find your preceptors. They work with you in coordinating the clinicals, and are very hands on in monitoring your clinical progress. They have many tools including a database of previous preceptors and facilities for you to use when finding preceptors, but you should expect to do much of the leg work in finding preceptors. I believe most online programs also expect you to find preceptors in your area as they seldom have a local presence with the providers in your community. It is mostly a logistics issue, if your school is in Hyden, KY and you are in Biloxi, MS they are unlikely to know providers who have a good demeanor towards students and are willing to take them. FNU does provide honorarium for your preceptors, so that sometimes gives you a slight lead against students in other online programs, and my experience there has been exceptional. But if finding your preceptors is a deal breaker, it would not be the school for you. Good luck!
  16. zmansc

    FNP in a pending acreditation University

    For the kind of money I'm spending on my education both in the actual funds I spend and in the lost revenue from not being able to work those hours, I would not want to risk that investment on if they are going to gain accreditation. There really are so many good programs available, that I would not risk it.