Xlorgguss

Are your concerns the patients not being on telemetry, the frequency of vitals, or the patient to nurse ratio? In my stepdown floor we have fluctuating ratios meaning that certain criteria determine the nursing to patient ratio. As far as patients on telemetry we do have the odd patient that is not on telemetry, but those patients are usually from a different service and overflow from other floors. As far as vitals, q4 is our standard. Additionally I don't really see a difference between IMU/PCU/Stepdown, aside from "true stepdown" patients being a nurse to patient ratio of 1:3. Each floor is likely different in their criteria for that though.

I appreciate such a thoughtful response. While there is part of me that thinks I could enjoy the role of a provider, as you pointed out- thats not where my passions really are. I personally feel that the role of CNS's are more important now more than ever. I have to admit that the uncertainty of the future for CNS's is my major cause for concern with going with that specific degree.

While I completely agree about not going the NP route unless you want to specifically be a provider, the program that offers the CNS role has nearly the exact same education as the NP role with the exception of 3 1 credit courses and 100 hours of clinical. It begs the question, if you are going for all of that, why not just go the NP route just for the security and just as an "in case". When I spoke with one of my instructors she recommended going the FNP route. I'm really just torn between the different roles. Being a provider might be something I'd like to do, but at this point I'm unsure.

I have definitely started to branch out farther than my immediate role as a bedside nurse. I am a preceptor, have joined a committee, and have been working with our educator or revamping our orientation process and am working on starting an online education drive to make resources readily available. I am also likely going to be tapped in the next few months to orient to charge responsibilities. One issue that I have found is that many of our staff do not follow current protocols either because there isn't an updated one or it is extremely difficult for us to find it. Now this is obviously a bigger problem than just our floor as it is voiced as a concern on nearly every other floor. I know that I enjoy teaching, enjoy being a problem fixer, and constantly evaluating what we do well and what should be adjusted. By no means am I trying to rush into anything, I am trying to do the exact opposite. I am trying to identify which degree will allow me to pursue those passions. My gut tells me nursing education, however those roles are sometimes not defined well varying on unit to unit. As I previously stated I love the idea of being a CNS, but that role has all but disappeared in my area. There is a program, but there is literally only a seven credit difference between the CNS degree and an NP. Undoubtedly going the NP route is much more flexible in the sense that I could always go the provider route. And by no means am I looking to have an answer here and now, I am just trying to be mindful of all of the options that I have in front of me, and be open to other options that I have not considered. Perhaps a EdD?

Oh that's awesome! It is unfortunate that the role of CNS has all but vanished. I really don't know where our CNS's go honestly. Many of my instructors from nursing schools were CNS's and many of them (at least three) were going on to pursue their NP. I think I would enjoy being an NP sure, but the primary role as an NP is not to educate nursing staff- its a provider role. Our favorite APP's at work are the ones who we go to with questions and they explain and teach us in the few extra minutes that they have. So much emphasis is being placed in being Evidence Based Practice, and I do think that most nurses are inquisitive and have plenty of questions. However there often isn't time to devote to answering clinical questions or it can be very overwhelming for nurses seeking to answer their "why" questions. Its often much easier to just "do what is ordered" instead of actually sitting down to figure out if what we are actually doing is helping, hurting, or useless. The role of nursing has changed so much over its history and continues to evolve. I'm just looking for the role that will best prepare me to continue my passions.

I do agree that with more time the answer will become more apparent. I am finishing my BSN and I just started by third of four semesters so I will graduate in the Spring. Perhaps its the nature of nursing these days, but as a profession we are constantly asked where we are off to next in our career. Now whether that is a good thing or bad thing is debatable. The reality is that I am in my late 20's. I have plenty of time to continue to develop as a nurse as I finish my BSN and further as I continue the 2-3 years as I advance through Graduate school. I don't think there is any harm with being aware of what aspects I like in nursing and continue to foster those. Perhaps I'm passionate about supporting new nurses because I was (and to some degree still am) a new nurse. We read every day how nurses are burnt out and frustrated in their careers. I would love to be able to support nurses transition into their roles and continue to support them in practice. I personally went through a new grad residency program that I found very helpful, but those programs are limited and very competitive. In my class that I attended today we talked about how 20-30% of nurses who enter practice leave completely within a year. I love the nursing profession and I would love to be an agent of change and support for the profession. I'm just not sure the exact route that it will take to get me there.

Hi all! As as the title suggests I am having a difficult time determining what step I would like to take in my career, and what education I should pursue. I have been a bedside nurse for a bit over a year working in cardiac surgery. I love the patient population and I enjoy being a bedside nurse, but I know that it is not my end all be all. I have long considered becoming an NP specifically AGACNP with the intention of going the intensivist route. I still like the idea of it, however I equally find myself passionate about supporting bedside nurses. I enjoy teaching, I enjoy looking at problems and trying to fix them, and I enjoy constantly learning. I have considered other options besides an NP. One thought I had was going into Nursing Education. I enjoy supporting the floor and think that role would be awesome. I could see myself working to develop better orientations for new staff and working to improve policies, procedures, and the ability for nurses to access that information easily. Another thought would be to go the route of a CNS. Unfortunately that role has all but disappeared in my area and it's so unfortunate. I don't see myself enjoying a management role either. I spoke with one of my instructors (I am finishing my BSN) and she recommended getting my FNP. However I don't really see myself ever working with kids or in woman's health. Additionally I'm not sure if I would enjoy working for a university as a professor, but it would be something I would be open to. With all that in mind, where would be your best guess at which degree I should go for next? I am fortunate that NP, Nursing education, and CNS are all degrees that are immediately available to me in my current location.

While I do agree that PA and NP is definitely more flexible in the sense of being able to switch specialties at will, I dont think that doing perfusion would be boring. Its definitely a growing field especially with further advances in ECMO as we are seeing it in all age ranges. When I looked into it, it doesnt seem like there is an overwhelming amount of programs in the United States, so it seems like a pretty secure job and many hospitals dont do off-pump bypass. I think that from a quality of life standpoint, perfusion seems like a nice role. They are compensated well (comparable to PA or NP) without the stress of managing multiple patients. I am by no means suggesting there jobs aren't stressful, but Id imagine its a different stress. Additionally, if you can get behind the OR hours it seems like a nice regular schedule.

Most programs are masters level. They have varied entrance requirements but most require a bachelors degree and most of your basic sciences including chemistry, physics, A&P, math, etc. it seems similar to PA or MD prerequisites honestly. Quick google search and you will find a list of all of the perfusion programs. It does seem like an awesome profession and it's personally appealing to me. Seems like a great salary, reasonable hours, and although not really advanced practice in the sense of nursing, it does seem like nursing (especially thise with ECMO experience) would progress nicely

Okay so now having been a nurse a bit over a year I think I have a good idea of what's warranted. I'll go with new grads first because I feel like it's probably the easiest. Personally I don't feel like there should really be monetary incentives for new grads to work at a given place. For instance I have heard of new grads getting tablets, expensive earphones etc while current employees got nothing. Experienced nurses that are new hires to organizations are getting sign on bonuses by current staff get nothing. I think that as a new grad what is most attractive to a hospital is a strong residency program that offers meaningful and practical education. It's nice to rotate through different floors to decide where you like before making a commitment to a specific floor. I have seen some organizations do that and I think it's beneficial so new graduates get a feel for the type of nursing they like instead of just taking any job and jumping at the sight of a better opportunity. If you can make an informed decision first and get a feel for the floor you are more likely to stay. Now as far as retention for current staff that's a tough one. I echo what others have said and ensuring safe and reasonable staffing is likely the most important. Aside from that adding incentives to taking charge, incentive to precepting new staff and have that staff successfully come off of orientation. These incentives would more than likely be monetary. But there is a sense of reward in having successfully trained a new graduate or staff and actually be compensated for it. Other things to look at might be uniform policy. Additionally, compensation for becoming certified. Also a clinical ladder for nursing advancement that engages staff is also important. Ideally a blend of compensations for engaging staff and supporting their own advancement would be the way to go. Money isn't always the answer, but tied with engaging and empowering your staff and I think you'll have staff that are happy to be at work and stay at work.

I have no intention on skipping out on ICU experience as that was what I wanted to start my nursing career with anyways. Personally I chose stepdown to start my career because I liked the patient population and our Cardiac ICU did not offer the support I was expecting as a new graduate (indications for different pressors, understanding different hemodynamics, etc). They had a steep orientation of being able to recover open hearts independently around week 8 whether or not you were an experienced RN or not. I have heard of some institutions having staff learn to recover open hearts after a year, but it seems like our ICU is not that case. As such I decided to do stepdown to get a good fostered education and environment while I went back for my BSN. I have hit my one year mark as a nurse, I have a year left of my BSN, and I am currently studying for certifications. This thread was in no way intended to argue whether ICU experience is necessary for AGACNP programs or whether I was looking to circumvent that experience for "easier" Stepdown experience. I was simply looking to seek out programs to compile a list to look into for the future. In reality I am likely 1.5-2.5 years away from starting a program which gives me time to start my ICU experience in addition to the time while in school part time.

I have now looked through a good 15 or so programs (some being USA World News ranked) and have yet to see a program that required ICU employment. Undoubtedly it is helpful but "critical care" is poorly defined in my opinion. Patients that are routinely taken care of in some larger institutions stepdown floors would often be considered ICU criteria for other institutions.

I have some experience with Vents, however in general respiratory takes ownership of most of the vent stuff in my facility. I know the basic nursing considerations. Likewise I have some experience with arterial lines. I am not entirely sure what specialty I would like but I work CardioThoracic now and I really like this patient population. Our CTICU just recently (within last few months) started doing CRRT and to my knowledge doesn't do rotoprone therapy. I do have some experience with putting chest tubes at bedside as well as cardioversion at the bedside (but that is uncommon). I would like to get specific ICU experience but that might wait until I relocate for school. I am looking at working while doing school part time so assuming I start working in an ICU after relocating for school that would give me a good two years of experience while completing my Masters. I'm honestly not concerned about my experience because I know that it will come with time and continued experience. Currently I am looking to compile a list of schools to look into applying to.

I currently have a year of experience in Cardiac Surgery Stepdown. I have considered jumping to ICU but I have wanted to finish getting my certifications and am trying to decide which kind of ICU I would like to go for (Cardiac, Surgical, Medical, Trauma, etc). The programs that I have looked into haven't had the stipulation of requiring ICU experience per se. I know that Vanderbilt specifically does not as brother does the programs located immediately around me.

Hi all! i am finishing up my last two semesters of my BSN and am looking to apply for graduate school in the year or so following graduation. I am interested in AGACNP programs, and was wondering if anyone could offer insight into more traditional programs as opposed to purely online coursework. I have completed online courses before, but I struggle with retention when I don't have the opportunity to put the content into context. Unfortunately many programs have gone to all online which does not necessarily meet my learning style. I am fine with online lectures, but I like a physical class component to reinforce the material. For my Associates degree my program used the concept of a flipped classroom which I enjoyed. You did the lectures on your own time at home online and class time was spent going trough case studies and other activities to cement the material. I was wondering if off hand anyone knows of programs like this or what would be my best bet for finding out what I need. Would anyone happen to have recommendations for schools? I really don't have any issue relocating so long as I get what I need out of my education. Vanderbilt's Intensivist program is very appealing to me, as it seems very traditional education-wise. Any recommendations? Thanks!