Uroboros

Apologies no one has responded to your common question. I'll crack the ice as simply as possible. First, I'd suggest you do your research regarding where you want to live and practice as FNP may not be the way to go if jobs are unavailable. From experience I would also recommend multi-certification to cover you in a time of APRN credential amalgamation. For example I have post-masters certs in adult acute care, family, and occupational health, with PhD in progress. The ACNP has afforded me numerous hospital based positions during my career. FNP, along with the occ med cert, has provided options for community care, whereby I have practiced in urgent care, DOT, and rural clinics. I plan to use my PhD to finish my career teaching and lobbying for future APRNs in my state. I currently co-manage a high volume urgent care that went urban pre-hospital COVID triage and collection center overnight. We are also adjunct to a large teaching system where I am among academic faculty. We work off 40 hour weeks, with varying day flex shifts. Teaching hours vary with class size and enrollment, along with online options. Pay is all contractual, but I'm 50 and debt free so it's been good to me. Best advice I can give you is think in terms of liability. Always ask yourself if called to court, does my cert cover me for this, no matter what. For hospital jobs, you'll have to have some form of acute care training to be fully covered. That's a hot debate that's getting hotter as jobs become more competitive between acute care and family APRNs, which is partly why I got both. Nevertheless, we work in an equal opportunity environment for litigation, it's simply a matter of what personal risk you are will to take. Really wish you the best. Hope you get some more good feedback than my rant here. Godspeed.

You do realize we are all anonymous here for good reason?Truly, just a friendly warning.

There's a quote here from the end of my posting, followed by an editorial that has little if anything to do with the citation? Respectfully, rather than an ongoing litany of emotions run rampant, can you relate your ideas to the Matthew Effect or Pareto Lines in current economics that I did mention? Given your financial concerns this would provide an objective thought process and discussion. Espousing derivations regarding health effects from merely two months of mandated social isolation is echoing more personal concern, and understandably, rather than evidence based community medicine. If anything the consumerism behaviors are more apparent during social lockdowns, since Amazon recorded an all time high in sales some 75 billion, yes billion, with 60% of that in America alone. Hardly an economic crisis wouldn't you say? So our system is hardly in the financial dire straits just based on Amazon, eBay, and general auto sales alone. An idea the "world will starve is our system fails" is hardly the case. Made in America is an idea that died in the 60's, along with the steel and coal industries. This is finally beginning to effect big oil. Simply put, America is a consumer nation, and supplies little if anything apart from financial support to international economies. Read up on The Club of Rome, a social justice league from the 70's that broadcasted similar fears of world starvation and over population by the year 2000. They included the likes of Rockefellers, Morgenthau, and some 75 of the supposedly most brilliant philanthropists, scientists, and economists of the time. Obviously they were all quite wrong, and did not accurately account for epochs of technology advances since then. It's quite self evident that America needs to, and is reopening. Any base or lay person would agree. Tension between my nursing optimism and pessimism often gets the best of me, but hope remains as the thinking gate keepers to healthcare we use hints and hedges from our history, rather than fall prey to current anxiety and fear which simply are byproducts of the unknown. And it's just that we should argue the most against, while protecting at risk populations. The idea that these people groups should simply fend for themselves with hygienic methodology such as face masks and hand washing is a bit preposterous. After all, without severely diluting the issue, failure to adhere to those menial tasks is what leads to pandemic events. Exposure therapy is well proven in clinical psychology, but should hardly be the technique applied to a novel virus, with however varying mortality rates. Would any right minded parent think to throw their child into the dark unknown, simply to overcome the fear faster? Continuing to predicate our derivations in archetypical comparison traps by citing influenza trends or Great Depression similarities is misleading ideology. Keep in mind, COVID did in a few months what those historic issues took years to inflict. Look I'm not here to deflate anyone's position in the interest of pretention, and we all have the sovereign right to opinion. And were this issue a simple arithmetic equation there would be no discussion to be had either. Yet I do believe the APRN is in a unique role of separating good empiric science from existential fodder for ourselves, family, communities, if not now more than ever. Appreciate your efforts in fighting the good fight.

We stand at the precipice of this issue, especially those of us on the front lines of COVID testing and treatment, as I wind down my day at a high volume urban COVID center. Comparing this to the seasonal flu is rather spurious and grossly misunderstanding the clear difference. However, in four short months, coming this October, when our friendly regular flu is here we will see the two in action together. Personally and professionally I fear for the worst. Common flu statistic left out is some 40 million catch it in America even with decades of vaccine and treatment. Now imagine that same 40 million this fall with COVID still lingering, with no vaccine, and little to any proven treatment. IMO the most serious blind variable which remains a real wild card are pediatrics. We are just now seeing cases of SIRS nearly one month post COVID in this age group. I'm surprised there is so little mention of the some 150 pediatric cases in NY alone under current review for this syndrome. During peak strep, myco, RSV, and influenza, which are all well on the way, what grim statistics will we be debating concerning our children this fall concerning COVID? People seem to easily turn a blind eye to literally dump truck loads of adults dying in these novel times, calling it a hoax or conspiracy. But when kids are affected even the hardest, most apathetic among us capriciously sing a more sobering tune. I'm not virtue signaling here, and I haven't wore my pink hat in a while. And I'm also no economist but I do have a business degree as well. There's something called the Pareto Rule that really applies here, meaning nothing is 1/1 in financial principle, and most causes come from the smallest means. Helps to put all this into better perspective, since after all we closed the economy, hence we can reopen it. Businesses can bounce back, or be reborn. The people who have died from COVID do not have that luxury. And no one would agree we can put a price tag on the life of one single child. Godspeed sincerely to all.

Nothing has copyrights here my friend. Glad it helped.

Checkout some of the solid literature on "cytokine storm", which follows criteria many APP's were following before we had COVID PCR testing. The labs you mention are some of the precursors. In our testing center we have a similar protocol developed for patients with negative PCR's. And we have developed our own IgM IgG IgA antibody testing pending community approval. Think about how many patients we commonly diagnose with influenza every season who have negative tests as well. COVID I suspect will eventually fall into a similar practice. Not true at all we only accept explicit POC testing for anything. Consider viral loading, which limits the sensitivity of these tests, however specific it may be remains a real mystery as many things still are with COVID. Of course the day may come when computers are able to collect quantifying data and simply spit out the corresponding ICD-10. But for now we tarry not in the art.

ACNP, FNP here with PhD in works. Other convoluted alphabet soup credentials I won't mention but you get the point. I was actually accepted to CRNA school along with several NP programs many years ago, and made the obvious choice. Don't regret it a bit after 16 years of everything from ER to admin, academia, and nearly everything in between. Both are rewarding, I simply saw more diversity for career growth going the NP route. Think always in terms of liability, and CRNA's work with high risk and typically well understand this, as I'm certain the OP knows. As an APRN we should always be asking ourselves, whether it's placing a chest tube or removing a splinter, if called to court or before the ever benevolent BON, "does my certification support it?" It's really that simple. Doesn't matter what the supervising or collaborating (cough cough) physician approves, what the other NPs are doing, or hospital policy even. It's our responsibility, one and only, when answering the call. My program was classroom and just begun to use some online course work. It's hard enough in court for physicians, who receive the very best healthcare training. I can't imagine defending myself with most of the fully online degrees that are flooding the APRN field now. Seriously, I'm not personally knocking anyone's education or training. In fact I teach some online coursework. It's a point of liability. And on the job training holds little water in court as well, ask any med-mal lawyer. I went to a top ten school, cost a pretty penny that we just paid off. We had no hospital rounding during the FNP coursework, and my FNP exam had no hospital or acute care question material. Vice versa my ACNP training had no primary care or family medicine rounds, and the exam material was critical care based, more akin to the CCRN. Point is you can take unnecessary risk that your friends will happily report you for, and the lawyers are always waiting for soft targets. My best advice do both, you'll be covered essentially wherever you go. After all CRNA curriculum is far more challenging. You'll do well regardless. Best wishes.

see: Basic Terms of Service #2. special attention to subheading: Foul Language/ Profanity Oh and thread derailment of your own thread. ?

There's a real flaw in our worldview if all we see is something that leads to more nihilism. The OP sounds more like a much needed decompression session, and these cyber-social platforms are okay for that at risk. I mean after all, were it not for the anonymity of the conversation nurses would be reporting each other in droves. My empathy is hopefully apparent, and I say without sincerely pandering, anyone who feels their occupation is toxic to mind, body, and soul should immediately find something else to do. Nursing or not. It's self evident as nurses we work with people arguably full of life, not inanimate products. If we see our job as worthless, that will invariably bleed over into our value assigned to other people. This poses a grave danger to the well being of the general public, your family and friends, mine, and not to mention risks personal suit, litigation, or even criminal charges. Now as a social Newtonian I'm guilty of spending too much time outside the box thinking sometimes. But as mentioned, nursing makes an excellent Spring board career into other fields. Maybe getting out of any patient care situations to avoid the worst case scenarios, and seek solutions to levy real change through aggressive lobbyist opportunities, or academia even, molding the young minds of tomorrow? It's an understatement to say it's certainly challenging, and should be. A lot of passion in the OP, which is good. When there's careless apathy little hope typically remains. Best wishes.

This is another old debate, as evident by the dated article. Seems difficult for medics to make the transition from field to hospital practice, and understandably since the two are very different. In my experience the successful ones were simply tired of those long 24-48 hour shifts and really ready for something different, or working those last few years for drop pay maximizing. It's really more of a personality issue, and less of a true practice paradigm trap. As the OP states, medics work under their medical director's protocols. And those do not matter in a hospital, since every facility has it's own profundity in volumes of policies, procedure guidelines, and job descriptions. That's why even physicians and APC's have to request and be approved for privileges, since they all differ between hospitals, clinic systems, even departments. As an ER supervisor for several years at a very busy southwest intercity level one teaching facility I encountered this personnel issue quite a lot. That culture had more to do with medics and fire employees, who were typically older men, taking orders from young female RN's. Certainly not implying that's the issue here, but it sounds along the same personal lines, and again less of a real practice issue.

Unfortunately there is not a "typical salary". And really I'm not attempting to stir business semantics. Sure anyone can go to salary.com, Google anything, or curbside gossip approach. But it all boils down to bargaining power, everything is contractual, and everything is negotiable. I mean everything from your pay to parking spot should be considered and in writing. Any NP who wants to be treated like a professional, and most of all paid like one, has to present their case. And too often we see the good hearts of nursing professionals or new grads taken advantage of in these cases. Transitioning from the thinking of bedside nursing into the APRN realm requires being in the business of yourself for a change, as opposed to the constant patient advocate. One of our academic failings is key in this area, since little time is spent teaching even minimal contractual standards in most NP program curriculum. Most take the harder route through experiential knowledge like your friend. Maybe instead of bursting you friend's bubble try asking questions. Such as how the figures were determined? Is that merely the base with RVU's? Bonus possibilities? May be more to the story. But in the end, if there's a bubble to burst, means they are happy with the pay, and that's all that matters really. But I can personally say, I haven't made a figure that low since back when red leather was in style.

Yes! Hitchen's razor! Rare to see any post-modern quotes, ironically in a post-modern world.

Student loans are the worst. They are government owned, and you cannot default or even chapter 11. And good luck trying to prove "undue hardship" with the land of the free to get out of one. Students are given very little guidance on this critical issue. Seriously, with a few FAFSA screen computer clicks you're eligible for nearly 100k. Of course everyone in healthcare thinks they will be rich so this is chump change to pay back. Or the loan repayment options look enticing, but are insanely competitive and appear to good to be true because they are. Take it from someone with a lot of credentials, who just payed off their loans finally. Don't do it. Not a single dollar. You'll pay enough to the government in taxes during your long and successful career. Check out Dave Ramsey's take on these. He's old and opinionated, reminds me of my mean uncle in many ways, but helped my spouse and I alot on this matter. Wish you the best.

Nursing was my second career choice. I was attempting to be a free lance writer but quickly realized this was not going to pay the bills. After completing a CNA program that only took several weeks I then completed an ADN program. This was many years ago so the tuition was cheap and I paid it all out of pocket with a few writing scholarships. I've since gone on to a word salad of credentials, but all started with CNA to ADN as an initial springboard. Definitely the most timely and least expensive route. If you see yourself pursuing more BSN is the standard, but for bedside nursing or middle management even,ADN typically meets the minimum required. Wish you well.

Philosophy is just fascinating, if you think about it, pun intended. Interests me your archetypal choice of ISTJ, and practice in ICU where every bell and whistle exists non-stop. As a reductionist myself, I did not appreciate the hyperstimulus environment either, but continue to enjoy challenges of acute care only if moonlighting. When considering grad school years ago I asked myself the same question. But if you're thinking CRNA will be any less stressful think again my friend. Since anesthesia holds the highest risks, and these APRNs are always near top of the list for BNE discipline and litigation. I'm sure you've looked at CRNA tuition as well. Mostly that, along with the idea of still doing shift work took me down the NP track. As an NP with multiple specialty certs, and finishing a PhD, I continue to teach and run a growing practice. The diversity I found and immediate return on my more reasonable education investment has been with little regret. May I simply suggest consider your career over the long term, and maintain a series of short term and long term goals. Compare your goals to your job market and location. Give yourself room to grow into whatever career path you choose. Because the only thing that stays the same is everything changes, including our personality types or subtypes over time. Check out living Stoicism in an Epicurean society. I've played in some literature on this, your ISTJ post brought a lot of that material to mind. Best wishes on your journey.

Disclaimer; I am biased in the direction of education. OP says they completed the first half of NP school? That would mean an MSN would be nearly complete. My best advice, finish that, an MBA, or better both. With a little hands on experience and those credentials admin jobs galore. And I speak from experience as well. Best of luck.

Entertaining as most conspiracy theories are, but easily debunked with good fact and logic as already mentioned. I think there's easier and safer ways to spread chem trails personally. How about lacing the McRib with some next time we bring it back?

The authors of this BMJ article, published in 2015, have written a recent response to their work in light of the COVID-19 pandemic. article. https://bmjopen.bmj.com/content/5/4/e006577.responses#covid-19-shortages-of-masks-and-the-use-of-cloth-masks-as-a-last-resort Current CDC statement hopefully most here are aware of; https://www.CDC.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html I'm going to go out on a limb here and keep trusting the empirical data. However many entertaining ideas, especially the COVID positive-negative color system.

First I applaud your efforts for personal and professional endeavors beyond the bedside. Nursing offers more room for growth in these areas than most careers. Of course it comes down to the individual, and a short read across social platforms like these gives a clear illustration of the huge number of nurses who feel unsatisfied, burned out, unfulfilled, or stuck as you say. My best advice is do your homework. Where do you want to live and practice? What is that job market like? Where do you envision your career in 5 year increments? Physician training upstages APRN training in many areas, most of all I would say "being in the business of yourself". Have a business plan for yourself. View yourself and your career as just that, a business. Closely examine the state you want to work in along with the respective BNE. Many states also list the types of APRN in each county, and when compared with current jobs in those areas give you something quantifiable. I have three post masters certs. One of them is an ACNPC-AG, comparative to your AGACNP mention, which is simply a rearrangement of the word soup that encompasses the APRN world. That cert has honestly afforded me the most job opportunities of the three. I also have an MBA and held various admin positions before settling back into practice, just in time for crisis COVID. Like you, I've heard my entire 25 year career how hard jobs would be to find based on personal experiences. The most unreliable form of knowledge is experiential, because it's personal, emotional, too often diametric, and that's mostly what you will find here. Happy to help you with any business specifics, freely PM me. Best wishes.

Now I'm fairly uninformed on Canadian employment law, but I do believe the idea of "at-will" does not exist there, as mentioned initially by NunNurseCat in Florida and the state law there. This is fairly common in the US, especially in the southern states. Which is part of why I think we see weaker nursing lobbying in the regions. Just my lay perspective. My best advice is to know the employment law, and I think it differs from province to province in Canada. But from what little I've read the legislation is highly in favor of the individual employee, since some 90% of the system is regulated by protective labor associations. Good nursing conscience is a given, but when combined with soundly informed judgement, now that's someone to be reckoned with. Wish you the best.

First, it's quite admirable or even noble you even have the presence of mind to consider ongoing social isolation beyond our present day to day circumstances, but maintain a healthy self awareness of the lasting health effects of that even. My spouse and I currently work in high volume COVID testing centers as well. In fact my site was the first one in a very large urban county and part of a chain of the initial drive through options state wide. We continue to relentlessly test daily, especially now that rapid antibody testing available, with walk in and drive through options lining the street it seems. My spouse works in a free standing ED part of the same system, where like you, there is confirmed critical COVID daily. Needless to say, we have installed an airlock adjacent to our Tesla powerwall in the garage, or so it seems. We have not physically visited our extended family in months, nor plan to, until the data is more clear. But we are wearing out some ZOOM meetings, with the occasional amusing hacks. We were off nursing websites like this for years as well, but recently rejoined to cyber-social in some down time. Point is you find a way to stay connected. Really the decision is yours to make. Just like we are taking it week to week with extreme caution. Do what's best for your family, because that's all that matters. You'll get a profundity of recommendations and additional personal experiences to follow. But in the end, decision is yours and yours alone. But I sincerely empathize with your position, and commend your efforts to be as informed as possible. Trust facts, trust data, trust patterns, least of all trust people.

The hierarchical de facto system of governing these threads continues to make the best power point material for my courses. I mean seriously, you cannot make this kind of whimsical stuff up. I recently revisited T. S Elliot's "The Cocktail Party", and what a masterpiece. "It will do you no harm to find yourself ridiculous. Resign yourself to be the fool you are... ...We must always take risks. That is our destiny...” ― T.S. Eliot, The Cocktail Party- Without sounding too capricious I say take a risk, draw your morning labs, go test yourself or someone else for COVID today even, but I'd also suggest wearing a mask, with or without eye contact.

Making an existential experience out of every discussion seems to be a real reoccurring trend here. My comment was directed to provoke some legal-ethical thoughts beyond the surface ideas of charity gifting or free lunch. Truly, it was not intended to make you feel guilty about your free McChicken and fries, so for that I apologize. However, have you ever known anyone who took a little too much of anything? While a major overdose may be the first witness account we acquire, the perilous journey to those disasters begin with very minute, insidious, what we convince ourselves to be "gifts" along the way. I'm going to show my age here, but there's an old 1930's business adage, "there is no free lunch", I'd be interested to hear your take on that in relation to this thread. Cheers.

That's a great point, as does nearly every alphabet soup of business associations, because they are all founded on loose ethics? Why don't you share specifically with us which code you are referring to? Although, quoting even the ANA won't save anyone in front of their respective BON if there is conflict with practice wording in that state. What state do you work in? Does your BON say anything about nurse gifting?

It's interesting that the AMA gives physicians clear guidance on this. See Code of Ethics Provision 1.2.8. Although it pertains more to influential gifts on service, I'd suggest we take a hard look. To my knowledge the states I've practiced in as an RN or APRN do not have practice acts that address the issue as clear. It's all smiles and for a good cause until lawyers get involved.