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On a serious note I did work for an organization that allowed the Managers and Assistant Manager to do 4 10 hour shifts a week. One of you had to be there M-F and if you were off a day and something came up you had to be available. They knew we were putting in way too many hours and even on your "day off" you were still checking email and working on projects from home most of the time. It was nice though.

I used to work for HCA. They will say "sure, 12 hours M-F"...ok. Can you do weekends and holidays as well? By the way here are 3 more departments you can manage. haha kind of kidding.

We just started doing triannual coaching rather than monthly rounding and annual evaluations. Goal focused. More meaningful in my opinion.

We have recently changed our policy on this. We now triage patients before they are registered. If they classify as a level 2 or sometimes 3 we bring them immediately back. Also, if they present with something we cannot treat it is the expectation the provider does a quick assessment to make sure they are capable of self transport. However, currently we aren't charging them for the visit if we are just asking questions and calling for transport or sending them to the ED by private vehicle. We felt it was risky to send them without the provider actually looking at them first. So far this hasn't delayed any patients from getting appropriate care or generated unnecessary billing. We probably could still bill since we are doing an assessment on them but it doesn't seem like the right thing to do since we have no intention of treating.

I transitioned from inpatient management to outpatient management about 6 months ago. I had never worked outpatient a day in my career but it was a good opportunity. I think the most important thing to consider for a bedside nurse is its not always an "easy" job. Offices are more fast paced than you would expect when you are seeing 3-4 patients across every 15-30 minutes depending on the level of visit. However, if you get behind its not like inpatient. The worst that happens is the wait time increases and you get out late or miss lunch. Getting behind in the inpatient world could have bigger consequences. Its just a different way of thinking and different types of "busy". I enjoy both worlds but it is nice that I don't typically have to wake up to 3AM phone calls about staffing and bed crunches. Definitely some perks.

Just for follow up. I checked with my state board. There are no specific rules in my state that differentiate between what an NP does vs. a physician. As long as they are trained and competent they may provide the same service. Billing for services I still need to look into.

that is a good point. It really does depend on the region. When I was working at an academic medical center many director level had DNP or were working on it...mainly because it was free to employees and academic medical centers often have better support around student employees. Its less important at smaller regional medical centers. Most of the director levels have a MSN where I am currently working. I don't know of any with DNP but most also have MHA or MBA. More education is never a bad way to go. I think you just have to look at what you want to do. I don't see a DNP advancing my career with my current experience but someone with 20+ years looking for a CNO position may have different opinions.

thank you for your feedback. We typically only staff with LPN and QMA which limits some of our ability to do more advanced procedures in the clinic. I have been in urgent care for a short time, most of my background is inpatient so this is a new world for me.

I think it depends what you are wanting to do in your career. I would like my options to be open outside of nursing if I ever choose to go that route. An MSN can be a business degree but the entire curriculum is around nursing. In combination with an MBA it can give you a leg up if wanting to apply for a position like COO or some sort of other operational leadership position. Having a nursing background I find is always helpful. I don't know what I want to do in my career but I do believe an MBA gives me more options than a DNP.

I am fairly new to the urgent care world. Do you currently work urgent care? If so, what certifications do you require? (example ACLS, NIH stroke, etc.)

I graduated with an MSN about 4 years after my BSN. It has opened a lot of doors for me professionally that I don't believe I would have been able to pursue if I hadn't completed the MSN. At least not so early in my career. The MSN program can be as valuable as you make it. In general I found the MSN program to be pretty easy. If you wanted to skate by, most of the programs are online so its not difficult to do but if you want to learn something, do the readings and take the assignments seriously. Now I personally do not have any motivation to go back for a DNP. I am going to pursue an MBA soon.

Hey all - I manage a small wound care center. Currently our staffing is all physician based and are looking at supplementing with a nurse practitioner or PA. Does anyone currently practice as an NP in a wound care specialty center? What credentials do you have and are you able to practice independently and do everything thing the MDs do in your clinic? I figure a NP would be more likely if you can find someone with the WON experience.

Congratulations on advancing your career! I got into management after being a bedside nurse for about a year. My first role was an assistant nurse manager and I had the privilege of working alongside the bedside nurses about 75% of my shifts while spending about 25% on other stuff...usually education or management related. I think this is a great first step for those who are interested in leadership. Don't let others discourage you because you only have 5 years of experience. Leadership is more than experience. I would take a 5 year RN who has great leadership qualities as a manager over a 25 year RN who does not. Experience certainly helps but I have managed units that I have had no experience in...its certainly easier if you do but its doable in today's environment of nursing management. I would caution you against taking a job as a manager because you feel you are "doing nothing" with your degree. You want to make sure you are entering an environment that is supportive of your growth. I have worked at magnet hospitals in the past who have groomed new leaders into great leaders. I currently work at an organization that does not do this and is hard on new leaders. Fortunately I have the experience as a leader that I can be successful but you don't want to get yourself into that situation as a new leader. Be sure to ask questions about how the organization supports new leaders. They already know you are green because they have your resume. No reason to try to make up for that in an interview. They chose to interview you! Good luck!

You are quick to judge those of us who do work very hard and are stressed. Do I work the floor? not usually. No I do not like working the floor. When I do it prevents me from getting my other work done. I mostly do not like it because I do not feel as helpful as someone who works in that role every day so I would prefer to find someone who does so the other staff do not have to pick up my slack. It sounds like if your depiction of your leadership is true it is some bad apples. I cover 4 different units and have nearly 100 employees... if you think that I am "lazy" because I am a manager you can come see what I do every day. You may want to see how the shoe fits before you rush to judgment.

Is it personal or work related?