MurseJJ

I would definitely recommend joining the American Association of Neuroscience Nurses. They have an annual conference (next one is in March 2019 in Denver, CO), and they also have an annual stroke conference (coming up in August in Louisville, KY). When you join you also get a subscription to the Journal of Neuroscience Nursing. The American Board of Neuroscience Nursing has two certifications for neuro RNs: CNRN (certified neuroscience RN) and SCRN (stroke certified RN). I have the SCRN. Studying for the certification exam definitely expanded my knowledge base (especially related to neuroanatomy and pathophysiology), and has helped me better understand the rationale for various interventions, stroke presentations, etc. I think studying for either the CNRN or SCRN would be a great way to become a better neuro nurse. Hope that helps

Even if you do CNS you could always apply for positions that are related to the CNS competencies but may not specifically be titled CNS (i.e. quality and safety specialist, professional development, even management). Especially if you aren't interested in direct patient care. But i agree with you and MGMR, I go through this dilemma all the time. Although NP is interesting to me, I'm much more interested in being a "nurse specialist" and "nurse expert", and working with nurses and leaders (and being a clinical leader). I'd like to maintain some contact with the clinical setting and practice, though I'd be fine with less of that than being at the bedside or as an NP. At the moment I'll be starting an MSN in leadership in the Fall (luckily reimbursed by the job), and will decide after that what to do (may do a CNS DNP or possibly a PhD program, who knows, haha).

Typically an assistant nurse manager position is something you could look into first. Perhaps look into that.

I work at NYP/Columbia. Yes, we do work 13 shifts (all 12 hour shifts), however I will say that the salary is about $20K more than Stony Brook (I was hired at Stony just before I got hired at NYP a little over a year and a half ago, as a new grad).

It's interesting, I work with a nurse that has around 8 years experience, all on our unit, has two masters, two certifications, presents at conferences, chairs a hospital committee, clinical ladder, and is a permanent charge and preceptor, and she has no desire to leave the bedside and go into leadership or anything else. She likes her 3 12s and the flexibility that offers. She just did the last level of the clinical ladder, and is happy with that (the ladder is specifically stated to be for those that want to advance in nursing but remain at the bedside, and it does offer pretty substantial pay raises). We also have nurses that have been on the unit for 18+ years, some as permanent charges, others taking patients, and i really don't know how they do it.

May be helpful to get a letter of recommendation from a nurse.

Saw this article on Twitter, thought I'd share here: Independent Practice: Both Nurse Practitioners and Physicians Should Be Outraged.

Agreed. Our inpatient neurology NPs do 3 12s.

That sounds hard. You could basically double your salary as a new grad, let alone as an experienced RN, at various hospitals in the city (Mt Sinai, NYU, NYP, etc), even LI (St. Francis, Northwell).

I prefer "advanced practice provider" or "APP". There are many in-person NP programs around the country. Here in NYC we have Columbia, NYU, Pace, LIU Brooklyn, and CUNY Hunter, in addition to a number of others in the metro area. Good luck!

Recently I passed the ABNN Stroke Certified Registered Nurse (SCRN) exam. When I was preparing, I searched for info on the exam, how others prepared, etc., but didn't find too much out there. So I'll briefly share my experience in the hope that others will find it helpful. I have a year's experience on a neuro step-down unit, and studied about a month. The resources I used were: -Comprehensive Review For Stroke Nursing: this is the review book from AANN. It is very detailed, there are some charts but it's mostly text. Looking back, this book has a lot of info that wasn't on my exam, however the details do help in understanding. -Fast Facts for Stroke Care Nursing: this is a quick small review book that covers the essentials to know about caring for stroke patients. It covers a lot of what is on the exam, so I went thru it after I did the Comprehensive Review. It includes a lot of tips that are helpful, and helps you make sense of the details from the Comprehensive Review. -Stroke Chapters in Clinical Practice of Neurological and Neurosurgical Nursing: I looked thru the cerebrovascular anatomy (definitely need to know this), ischemic, ICH, aneurysm, and AVM chapters. Doesn't cover everything on the exam, but good overviews, and has a good chart on stroke syndrome symptoms by vessel, which you need to know. -Stroke Certification Study Guide for Nurses: Q&A Review: this is by the same author as Fast Facts. It's a 300 question review book, covering each section of the SCRN exam, and the number of questions in each section is based on the percentages from the exam blueprint. Good practice, and great rationales. -SCRN Practice Test: I also bought the 75 question practice test from AANN. The only downside to these questions is there are no rationales. Also, once you submit, you can go back and review the questions, but you can't do them all over again (you'll only see your answer choice, as well as the correct one if you got it wrong). If you can get these used or from the library, I'd definitely recommend each resource if you like to study on your own. I personally don't like to sit in review classes, however you may find that useful if that's your style. As far as the test, it was pretty straightforward. I didn't feel like they were trying to trick you, and I didn't have that uncertain feeling like I had during the NCLEX. If you reviewed with these resources, and reflect on your evidence-based clinical experience, it's honestly pretty easy and straightforward. There were maybe 2-3 questions out of the 170 that I just didn't remember ever covering (like a random medication I never heard of), and the ones I figured I got wrong still sounded vaguely familiar. You're allowed to bring a basic calculator, and the only calculation you might have to do would be related to tPA dosage. Hope that helps, and good luck

Hey just letting you know, I took the SCRN earlier today and I passed! I'll post a separate thread on what I used and what I thought (when I searched there wasn't too much info on it so hopefully I can help others) on the weekend after I recover haha.

Agreed. I also work on a neurosurg stepdown, and we get neurology patients as well. A psych background will definitely not go to waste in neuro, even in the neuro ICU (I actually have a coworker on my unit that was a psych RN for years then came to our unit, and she's great). She recently did an inservice on managing psychiatric presentations and therapeutic communication on the unit). I'm actually doing research on post-stroke depression, a major stroke complication, and have looked into the psychiatric implications of neuroscience diseases. There's a lot there. And yes, with neuro, many either love it or hate it. Many times when I say I work in neuro, I get the s visceral, "why would you do that?" look/reaction, haha. If you're interested in the brain, neuro-trauma ICU can be fascinating. Presumably in addition to the usual ICU interventions, you'll also have brain-related monitors (brain tissue oxygenation, definitely ICP monitors, cerebral microdialysis, cerebral blood flow monitors, EEG, transcranial dopplers, etc). Think about it, you're basically expanding your knowledge related to caring for patients with brain disorders and diseases. Good luck!

I agree. While the roles of bedside RN and NP are different (just like the roles of bedside RN and physician are different), there is also some overlap, and I agree that there is a connectedness between the two roles. For example, as a clinical RN, one is hopefully: -performing physical assessments and correlating findings with normal and abnormal findings related to disease states -interpreting laboratory test data and correlating with presentation, disease states, and interventions -understanding indications, contraindications, etc related to pharmacological interventions -understanding common indications and contraindications for radiologic and other diagnostic studies and their relevance to your area The NP of course will add a deeper understanding of pathophysiology and pharmacology, as well as the diagnostic perspective of being a provider to all of that and more, however it is clear that the clinical RN, functioning at the "top of his/her license" should be more than a task-manager/order-fulfiller (as we are often perceived as being).

A colleague works both as an RN on our neuro step-down and as a neuro NP at a different hospital (at least for now).

Hi I'm from the NYC area. Usage of CNSs in NYC really depends on the location. At my hospital (I work at NYP/Columbia), there aren't too many (maybe 4 or 5 max). Sloan Kettering employees a lot more (I've heard over 30). Really depends on the hospital. Also, in NJ a CNS has prescriptive privileges, while in NY they do not (if that matters to you). Also, in NYC, CUNY Hunter College has an on-site Adult CNS program, I've heard good things about it, and students from there regularly do clinical rotations at my hospital (the CNSs we have are in medicine (med/surg and the MICUs), cardiology, cardiothoracic stepdown and ICU, and oncology...definitely a lot of other specialties without a CNS, so there could be potential to create a role there). Hope that helps!

Curious to know your thoughts on this. Recently I've been reading about Britt Hermes, former naturopath turned critic of CAM. This also led me into learning more about functional medicine and integrative medicine. Sounds interesting (though not really sold on it yet). Would love to hear your thoughts as an NP training in it. Seems as if the naturopaths, functional medicine, and integrative medicine practitioners all seem to emphasize finding the "root cause" of illness, but don't conventional providers do so as well (the alternative providers seem to think that conventional providers only treat "symptoms", not the actual cause, and I think this is a caricature). And yeah, it does seem like the alternative providers have very long appointments, I wonder if that's actually sustainable financially. Curiously, all of this reading has led me to become very interested in going down the primary care/specialty practice NP route, when up to this point I've been thinking I'll be inpatient (as a CNS or perhaps ACNP) forever, haha. Thanks for sharing any insight.

Perhaps also post this in the New York Nursing forum to get more responses. I'm not an NP (RN at NYP), but I do know that NPs are able to have their own panel of patients in New York. Also, I would check this link out for more about collaboration in NYS (link). An NP with more than 3600 hours of NP experience is not required to have written practice protocols. It's still not fully independent practice, but close.

BTW, a coworker got an email from ABNN saying that starting January 1, the requirement for CNRN will now be 1 year experience (instead of required 2 years), and SCRN will also be 1 year (instead of recommended 2 years).

CTICU/HVICU sounds interesting (but I've always had an interest in cardiac and neuro and not really general medical or surgical units, including ICUs). A consideration could be what you plan to do as an ACNP, as many positions in specialties ask for RN experience in that specialty for new grads (so if you want to be a heart failure or electrophysiology NP, new grad positions may ask for 1-2 years RN experience in cardiac nursing). Of course, you can always move to another ICU in the future, so you aren't really "stuck" in whatever you choose, especially if your interests evolve. So for now, I'd go with the unit that has a more interesting patient population for your personal interests. Good luck!

I'm taking it very soon! I'll let you know!

It depends on the hospital, with city/state public hospitals typically paying less. I was hired at Stony Brook first, and their salary was 75K with night differential for new grads. I was grateful for the opportunity but decided to hold out for a position at NYP/Columbia, where I worked as a nursing attendant. The salary for new grads was 96K with night diff (6K) when I started almost a year ago. After a year that goes up to 100K (with night diff). You then can get differentials for experience (starting at 2 years), MSN/doctorate, certification, charge/preceptor, and clinical ladder. You also get paid for council/committee meetings and training you go to, get continuing education days for conferences, etc. From what I understand, NYU, Mount Sinai, and Sloan Kettering pay similarly to NYP/Columbia (not too sure about Cornell, though I'm sure it's similar as well), with Sloan having the highest starting. I believe the city public hospitals are closer in pay to Stony Brook, slightly less (their salaries are online, when I looked a year ago I believe I saw around 69K starting without differential). In LI, St. Francis and Northwell aren't too much lower than the private city hospitals, at least in the mid 80s starting.

The admission process for NCC? When I applied it was based on your GPA in four pre-reqs (English I, A&P I, Psych I, and I believe stats was the last one), as well as a standardized test, the TEAS. They also gave preference for living in Nassau County. They then rank you by the GPA and TEAS score, and go down from the top until the class is full. The website has the latest information on the admissions process you should check out: http://www.ncc.edu/programsandcourses/academic_departments/nursing/routes_for_admission.shtml It looks like they only base the GPA on grades from courses that directly apply to the program if you're coming in with prior college credits. If you did well in those courses, and do well on the TEAS (there are review books), you should be competitive. Good luck!

Nassau Community College is also great. I did some pre-reqs there and was admitted, but ended up going elsewhere. Also, just FYI, if you plan on working in a hospital in the NYC metro area, the vast majority of hospitals either strongly prefer or require a BSN. When I went to an info session for NCC's program, I asked how job placement is for the graduates. The dean said that some work in long term care, while others go directly into an RN-BSN program because that's what's needed to be hired in the hospitals (there are exceptions of course). NCC does have linkage programs with other institutions for the BSN, and I'm assuming SCC does as well, so plan on going into your BSN right after the program to maximize your opportunities. I was set on going to NCC 3 years ago, mostly for the savings and also the easy commute since I don't live too far. It was the first school I was admitted to. However after that info session and really thinking about it once I had all of my options, I ended up going to a BSN program. No regrets. Good luck!