ritit123

As a second year Primary care NP student with and 4 years of experience as an RN in acute rehab I decided to go back to school when I felt confident in my skills and understanding of the patient population I was working with. I would say it also depends on where you want to work after you graduate. My ICU experienced counter parts who decided to go for primary care at times struggle because they lack the experience working with patients in an out patient setting and by experience I mean the timeline of events and plan of care which happens in outpatient setting. I, on the other hand would probably struggle in the acute care track as I know little about that setting. All in all, I can recall wanting to be an NP about 2 years into my career but felt that I had more to learn. As some folks above mentioned, it's not so much the details of medical facts but the experience of seeing the "big picture", taking on leadership roles and working independently.

Can you tell me about your experience after you graduated? Also, I have one recommendation coming from a faculty member but am having trouble coming up a with a good second recommendation. Its been too long for any of the NGOs where I volunteered. I was thinking either my preceptor or the lead instructor of a yoga teacher training/ healthy life style program I am completing who has known me for many years. My essay tone will be trending toward applying my knowledge in medicine and yoga/ meditation to preventative medicine especially for people who don't have access to such resources.

In my program, the first clinical rotation you are expected to take on 6-8patients/ day and do complete/ focused SOAP notes. You are expected to do a full assessment and try your best on differential diagnosis and plan of care.

I think its really important to discuss different roles within the heath care setting. As a bedside nurse I often find my self feeling resentful toward PA/NP who would come strolling in with their differential diagnosis, etc. Then, when I became an NP student, everything changed. The benefit of MD's, PA's, NP's and RN's/LPN's as well an nursing assistant/ techs having a different education model is evident in the success of a multi- disciplinary team. To be able to focus in on a pertinent diagnosis all the while maintaining the integrity of your field i.e holistic care approach of nursing, the 1:1 time spend with pt. by CNA's is crucial in effective practice.

You and other reliers have clarified it pretty well. Basically, an NP can do everything that an MD can do with a focus on health promotion and disease prevention. If you went to see an NP she would not only prescribe you medication or diagnostic procedures but ( hopefully) have a heart to heart discussion about life style, psychosocial issues, etc. An RN can only assess, report and make "nursing diagnoses"which do not rely on the process of differential diagnosis.

Look up AENT, it funded 1/2 of my tuition and gave me a $1200 monthly stipend with no commitments!

I certainly agree with you on the effect the organization of the program has on my own confidence. While my sites are picked by my school, I find the instructors hardly on par and interested in my education. I go to a brick and mortar school meanwhile 3 of my 4 classes are online which means its all up to me to study which is fine except some of the professors do not actually have a clue about how much time their assignments actually take. One of my professors finally got a clue and withdrew some assignments from the syllabus ( I think he was having a hard time staying on top of grading them too). The one didactic class was my only hope for some real experience with a professor. Instead, the lady just reads right off the power points which are endless and she never has time to finish them. They only good lecture I got all semester was a guest instructor who went through case studies which was very informative. I study on my own and am not part of a group study which tends to be competitive and kind of weird but I have yet to see or hear an inspirational lecture that is both interesting and informative. It is what it is, I'm hoping to get some good preceptors who will help me understand how all this nonsense is actually applied.

I guess each faculty is different but when I get an order to collect a urine sample I clarify if they want a clean catch or a straight cath. If a doc ordered a sample on an incontinent patient I would get a cath order right away but i guess that goes back to the person who got the order being responsible for getting the sample

I have struggled with the same issue. While I have been able to grow professionally at my currency job the stress leaves me so burnt out that I am unable to explore other part time opportunities or classes. I am going to graduate school this fall and I will DEFINITELY be leaving my job and taking in something less intense, I was thinking home care hospice but I will stay per diem to keep my skills up. My advice, every place has something new for you to learn so explore the possibilities.

I'm sorry about your situation but do you think going around and getting a cath sample would have made the whole thing easier? I would never attempt to get a clean catch from an incontinent patient. With all that said, no shift should take responsibility for getting all the samples, in fact, at my facility if you received the order you get the sample.

Any advice? Anything we can do to prepare ahead of time? What about books and other helpful resources.

I also just found out I got in

Basically the foley is removed and the patient is given opportunity to void on their own. Depending on you facility protocol or the MD orders you either bladder scan after voiding and straight cath if residual ( what's left in the bladder) is over a certain amount, say 400ml or you straight cath every 8 or 12 hours if patient does not void an adequate amount in that time frame. You will need to keep strict I&O in that case and regularly assess the bladder for distention. The goal is to "teach" the bladder to recognize when it's full and empty itself after being deconditioned by a catheter which simply drained a continuous stream of urine. At first it may need your help to "empty" itself via straight cath but hopefully after a day or so it will regain it's function. As the patient voids more frequently and in larger amounts you might only need to cath once a day but it's very important to measure what they are putting in and make sure most of it is coming out. Remember, the golden rule is that at basic kidney function the human body produces 30 ml of urine per hour. Good luck!

Anyone have a good technique for taking a BP on someone who the machine doesn't read and manually you can hardly hear anything, even the arrow doesn't jump clearly. I have tried as well as APRN and charge nurse. I'm pushing lasix on this pt q8h and frequent bp's are really becoming a problem

That's good to hear. One of my schools actually states that they recommend full time for continuity. Are they implying something?

I've been mulling this question over in my head as my NP school application deadline is approaching. As much as I love school I might feel overwhelmed especially since I might be starting a family sooner then I thought and keeping my job as an RN. If I apply part time will the school see me as less serious about my commitment?

I am also interested in this. My plan is to get a yoga certification which I will have in June and then offer my services to the yoga studio that I am a part of and where I will be getting my certification. I have seen some job posting with sigma insurance for this position. I think health coaching can be a lucrative option not only for insurance companies but also hospitals if it can be proven to reduce re admission rates.

I did, sorry about that.

In hopes of shedding light on this argument I will tell two opposing stories that demonstrate the importance of the nurse to patient relationship in terms of hospice. Though I work on a sub acute rehab floor as a skilled nursing facility I always have one bed that is a hospice case. A while back I took care of a fairly young woman dying from lung cancer from second hand smoke of her husband. She was a Jamaican woman who had been a very proud and strong woman and was now a fragile skinny little thing with a non healing hip fracture since the cancer went to her bone and a son with whom she had an up in the air relationship but which I know was important to her. Though she had no other symptoms from the cancer besides a broken hip and weight loss she had a slew of chronic problems. Per POA request ( who was an RN) patient was on all meds plus insulin. From the first day I saw the misery in the woman's face when she had to swallow a med. I'm talking 15-30 minutes if holding the small pill in her hand while I pleaded with her to take her stool softer. When I came to check her sugar she had every excuse in the book why she wasn't available right now. She would play with her sheets, rub her back, message her scalp.....anything to avoid a finger prick or even the tiny dose of morphine I would bring her after hearing her wail with pain when repositioning. The straw that broke the camels back was when the POA wanted vancyclovir for an exacerbation of herpes. I stepped in I verbalized to the team that as comfort is my patients greatest concern and she being so miserable taking anything by mouth why don't we hold off the horse pills. In fact, I did not give the patient regular doses of morphine until she was almost non verbal. I did so then because I knew she was dehydrated and uncomfortable. I knew she didn't like morphine because it made her loopy. When her son came to see her from prison I was glad that she was alert and able to speak with him. A few days after he left she declined greatly and finally passed. Some time after this I had another patient who was an end stage kidney patient who was actually doing very well off all her meds for a few months. She was completely independent with her ADL's and pretty much just lived on my floor like it was her apartment. After some time though her ckd symptoms began to flair up, mainly an uncomfortable itch. The gist I got from her POA was that he couldn't wait to get on with his life and was waiting for her to pass. He asked me if I can start her on a morphine drip to relieve the discomfort. I KNEW that is not what my patient wanted. Yes she was uncomfortable but she loved to knit and volunteer with the recreation department during activities. Over the course of a few weeks I, the hospice nurse as well as the pharmacist worked on a series of med adjustments to alleviate her symptoms. The importance of listening and observing your patients is detrimental to creating a personalized care plan even for hospice patients . .

Hi. I would consider myself a lazy person who likes to get things done so this is how I studied for the NCLEX. After trying to go over material for a few days I became over whelmed and gave up. So, I went to the book store and did practice tests on individual sections ie respiratory, gi, L&D etc. If I scored above 75 I moved on if not I would read the explanations and keep testing until I received above 75. The last few days I did mixed tests until I got 75. I never studied more than 3 hours a day and only spent about a week studying total. I'm no genius but I do love efficiency. Passed the NCLEX the first time in the minimum amount of questions.

I love Evernote as well. It syncs to all my devices which means I can use my phone to review notes but also works well with different mediums, text, audio and visual media.

Yoga is not an exercise, it is life style. As a yogi for a number of years I have found that my physical practice (on the mat) directly translates into my life. Yoga is about movement, breath and state of mind. I would recommend that you research yoga centers/studios in your area. As a novice I would avoid gyms as these institutions tend to view yoga as an exercise and avoid the spiritual/mental aspect of it. Some of the challenges that you will face during your practice is difficulty focusing on one thing for a long time, muscle fatigue or discomfort and issues with self esteem (I'm not good at this, the person in front of me is so much better). Yet, through out my years I have learned that this is called "friction" and this friction is what creates fire with in you. Every time I hold that pose a little longer than comfortable or clear my mind despite my life trying to interfere with my meditation I feel like I have grown as a person. In your personal and professional life yoga will not only reward you with a strong body immune to the hardships of daily life especially nursing but also will train your mind to approach the "friction" of life with the same calmness you will on your mat. To avoid injuries and get started not the right foot I would recommend taking classes at the yoga studio near you. When you feel comfortable you can practice yoga at home or anywhere else. Good luck!

Ever since I became a nurse I have had less and less time to help out with the family business which at times requires travel. I am still undecided which branch of nursing I want to settle in but flexibility is key. Right now my schedule if pretty rigid unless I go above and beyond to please my scheduler with extra shifts which makes me burn out quickly. Any ideas which branches of nursing are more flexible then others?

Just as a side note, I think it's unfortunate that if someone engaged in a little pot smoking once a week they are doomed for the drug test but you can go out every week end and blow lines of who knows what and the next week pass a drug test no problem.

4 admissions, 3 days of working ca2]-,