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Hi! I was accepted into the post master's FNP program! Have you received any more info from the school of nursing yet?

Hi, I was recently accepted into Duke's post masters FNP program and wanted to see if anyone was willing to share recent experience with their FNP program. I'm in the Bay Area and I'm mostly worried about finding clinical placements. They say that they place you but they also ask you to network and reach out to your own contacts so it seems a bit murky. Anyone have recent experience with their clinical placement process, especially in northern CA? thanks!

Where are you at now? Was it worth leaving a specialty you otherwise liked?

I've been on the night shift for about two years now and am still having a lot of trouble with it. It seems like no matter how much I sleep, if I am awake before around 1 to 2pm I feel like absolute crap. For example, yesterday I went to sleep around 10am (late because I went out to breakfast with my coworkers after a shift), slept til 3pm, took a 45 minute nap around 6pm, went to sleep at 1am and slept til 8am, and now it's 10:30am and I am exhausted and about to go back to sleep to get ready for my shift tonight. This seems like a ridiculous amount to sleep in a small amount of time and yet I still feel like crap and tired. Basically all my night shift coworkers seem to be awake and about during the day, do things during the weekend, etc. I can't really do anything with my life anymore or be an active member of society and it's really depressing as I am a very social person and I prefer to be out doing things. I feel it's straining my relationship with my fiance who works normal hours -- I just feel very disconnected from him at times. I have a hard time looking forward to vacations or time off because I know I'll either be exhausted and in a fog or asleep half the day. What do I do?! There's a wait ahead of me to go to days at my job and only one person has been moved in the year I've been there. I love my specialty (ED) and the sad thing is that I want to try ICU in the future but I know that just means more years of this. I love acute care and want to spend my career in the hospital so I know that means nights. No real way out I guess, I just feel stuck and hopeless a lot of the time (some days are better than others) and wondering what anyone did in this situation. Thanks in advance.

Hi all, I am considering taking a new ED job and am looking for your opinions. I have been working in a large, busy Level I ED for about 16 months, but have only been off orientation for 4.5 months. By the time I start this new job I am looking at I would hopefully have around 6 months off orientation. The ED I am looking at stated their orientation is 4-6 shifts and "longer if needed." (I am not sure how much longer). This seems super short to me! Would it not be a smart move to take it? I feel I am just getting comfortable now as an ED nurse and while I have improved a lot in so many ways since coming off orientation, there is so much I am still not comfortable with (for example, I have never given TPA and the new facility said they give it all the time). How long is orientation typically for an ED nurse with experience?

I am an ED RN with about a year of experience (first job). I am a good test-taker and pretty academically inclined so I would like to start studying for the CEN. I plan to use Sheehy's, Mark Boswell and the ENA study guide. Before I spend $60 on the ENA study guide, I was wondering if anyone has used it recently? I noticed it was published in 2009 and I heard the test was just changed in July. I just wanted to make sure it was still relevant before I purchased it. Any other good resource recommendations would also be appreciated! Thanks.

Thanks! I did find a job, in an ED, coming up on one year :) Hope HHC is treating you well!

Thanks for the advice everyone, I appreciate it. I am managing the same number of patients as the other orientees -- we officially cap at 8, but staffing has improved a lot since I started and I haven't had more than 5-6 patients at once in a long time. On that particular day I had the septic patient and 3-4 others. Unfortunately in my facility we don't delegate IV starts, so I have to do all my own IVs. I do however need to improve at delegating as I try to do as much as I can myself and delegating more would probably help me to be less overwhelmed. I have worked primarily with the one preceptor, but I have had days here and there with other nurses. I haven't had any negative feedback from anyone else except for one nurse who told me I need a "sense of urgency" after I hesitated before drawing up Zofran and hanging fluids on a vomiting patient. It wasn't that I was intentionally moving slowly, I just feel that it still takes me a minute to "know what to do" in a given situation and isn't automatic yet. The rest of the feedback I have gotten from other nurses has been positive or neutral, leading me to believe I am more or less in line with the other new grads. But none of the other nurses know me as well or have worked with me nearly as much as my main preceptor. I am working with a different nurse this coming Sunday, and have worked with her a number of times as well in the pediatric section of our ED. I plan to ask her for some feedback about how she thinks I am doing so that I can have another perspective. I am only working one more week with my main preceptor and then am switching to a different shift and a different nurse, so I am hoping that may also improve things. Thank you all again, makes me feel a bit better. I feel that my preceptor expects me to be as good of a nurse as she is at this point and I just don't know if that is realistic. To me, I believe I will continue learning even after orientation is over and that I won't be "fully formed" by the time I come off but safe to practice on my own. Not sure if that is realistic.

I am 6 months into my new grad orientation in a big, busy ED and I feel I am falling behind the rest of my peers I was hired with. I am wondering if I should try and stick it out or if at this point realize that maybe ED is not for me. ED is all I ever wanted while in school and at first I felt orientation was going well, my preceptor was happy with me. Recently some things have happened and she now feels I am unsafe and not ready to be on my own (which I am supposed to be in a short three more months or so). I feel that I get caught up in trying to manage all the details (is the urine sent to the lab? did I give this med? is the chart together for admission?) that I miss the big picture, so I am trying now to focus on my patient more globally. My preceptor has a lot of criticisms of me -- she has told me I am too slow, I don't cluster care well, I don't anticipate, I wait for orders instead of completing things first. It is true that I can be forgetful and scattered but I feel I have improved a lot since I started orientation, I still have a lot of room for improvement in that regard. I always start IVs and draw labs before a provider has seen the pt, I am starting now to try and always bring fluids and if I can, the meds I think the patient may need. I am slow to react to what is happening in front of me -- if someone's BP is going down I don't always have an automatic reaction of hanging fluids like I see more experienced nurses do. I know that is what the patient needs but somehow it is not automatic yet. My preceptor is particularly concerned because we had a patient who was in for a septic workup the other day. The pt was nonverbal at baseline so it was hard to assess mental status, but was awake, spontaneous eye opening, etc. BP was around 140/70 and HR was around 112. Pt had a fever of 100.6. So right there he obviously qualified for septic criteria. I started a line and hung fluids, but then when the antibiotic was ordered I hung it as a piggyback on the already running fluids. She was very mad when she found out the pt had been there a long time and had not received all the ordered fluids. I definitely feel I made a mistake, and was in the mindset of "ok, I hung fluids, check that off" rather than stepping back and looking at the bigger picture. I honestly didn't realize, and I guess this is dumb of me, that fluids are even more important than abx in sepsis. I understand now that they are and I understand why, after my preceptor explaining to me. She and my educator are upset because we have had many septic patients before and feel I should be able to handle them with ease. It is true that we have had many septic patients but I felt I was handling the patient the same as before, and we have almost never started 2 lines on septic pts. The following day I had another septic workup and this one I made sure to start 2 lines, infused fluids through one and abx through another, but the pt pulled out one IV line and when I went to start another my preceptor said not to worry about it for now because the pt was stable. I am honestly confused as to why the first patient was not stable but the second one was (I guess lack of fever/tachycardia? But I am not sure what led her to that judgement call). My preceptor has told me that I am going to drown when I am on my own. I honestly don't know what to do because I am working as hard as I can, trying to keep up, I research things I don't understand of my own volition at home, and I am trying to be as good of a nurse as I can be at this point. I am feeling very discouraged and wondering if at this point it's time to start looking for another, perhaps less high-acuity job. Should I "get it" by 6 months? I feel my preceptor expects me to be more or less perfect by this point and I am just not there yet. Thank you in advance for any advice.

Sorry, I don't feel comfortable saying where I work but it is a Level I, not in the heart of the city but in the NYC metro region. This may be why the ratios are lower than a lot of Manhattan hospitals.

I'm an ED nurse in NYC and we max at 8.

Hi all, I am a new graduate RN (since May) and have been working in a high-volume Level I academic ED setting, where we have tons of residents, attendings and a few NPs and PAs. I haven't been on the floor for long so I am not yet 100% clear on the role of the PAs and NPs, although I have been told they do not just work the fast-track that is where I see most of them so far and I have never seen them in the "critical" section. I absolutely love the ED and love my job, despite the fact that it is very stressful, and since beginning to work as a nurse I have become pretty sure that one day I will want to advance and be the person creating a differential diagnosis and ruling out most likely causes. I never really understood the MD role in school but now that I work closely with them and see what they do their job seems very interesting. It's something I never ever considered either before of during nursing school. I haven't 100% ruled out going to med school at some point but I feel I am too old (29) and going into that much debt terrifies me. It's also a very long time commitment and would probably require a lot of relocating and sacrifice from my boyfriend. I would much rather go to NP (or possibly PA) school, but my dilemma is that I think I want to stay in the ED, if not forever then at least for a long time. The RNs in my department who are going for their NP all seem to be interested in working outpatient and are very negative about the role of NPs in the hospital, referring to them as "perpetual residents" and other similar comments. I don't really see myself working in a clinic, I love the hospital setting. So, I have some questions for any NPs who work in the ED and what your role is. I am wondering: - What level ESIs do you see? Do you see only 4/5s? Or all acuities? - Does every patient who walks through your door have to be seen by an attending physician or are there some patients who are handled 100% independently by the PA/NP? - Are you happy with your scope in the ED? - What procedures do you do? I have heard that there are very few NPs/PAs who intubate, run codes, place central lines etc but I know there are "residency" programs that teach this so it must be done in some places? I don't care so much about being able to do procedures but I would like to be involved in the decision-making process for complex patients. - Do you work in a teaching or community hospital? Does scope of practice vary by setting and do you feel that NPs/PAs in community hospitals have more independence? - Are you certified as an ACNP or FNP? What kind of post-masters training did you get at your hospital? - What are your hours like? Do you work rotating shifts like MDs or strictly days/nights? - Is there anything a PA can do at your facility that an NP cannot, or vice versa? And any other general insight would be great. Sorry about the length of this post ... am very curious!

1.5 hours each way on the train (which is less stressful than driving IMO). It is my dream job and I live in a very competitive market! That said, I am looking to moving closer and buying a car next year. So far it is rough but worth it!

Second interview was very very laid back, I met with the director of the ED and she really just explained the fellowship to me and asked me if I had any questions. But I have to stress this is very very facility and unit dependent, as people I have met doing the fellowship in other units and hospitals all had different experiences. Some had panel interviews, some didn't, etc. "Phase 1" consists of lectures, simulation and some "clinical days." We have lecture maybe 2-3 days per week on average. After Phase 1 (which lasts about 12 weeks) we will be precepting, and won't have class days per se although we still have some classes occasionally, like ACLS.

It is paid, I am a current ED fellow. I don't really want to reveal salary but they pay competitively (plus every facility varies a bit). I am not in the MICU so I can't comment on that, but we are still in "phase 1" which consists of classroom time and some days on the floor. The first 2 1/2 months is a lot of work and feels like you are back in school, but not too overwhelming. So far I am very satisfied, but I have a long ways to go and don't have any experience with any of their ICUs. Good luck!

New York Graduated May 2015 Took NCLEX June 2015 Job offer July 2015 (but I started interviewing for it in April)

Can you do it through your school by any chance? At my school, we paid a clinic fee (separate from the health insurance fee) that qualified us for free care at the school-run clinic, and was included as part of our tuition. If you haven't tried that already you could contact your school and ask.

Thank you so much! I wasn't that worried about NCLEX til I got my ATT and scheduled my test date and it's like now I realized all the things I don't know... and it seems like basically everything! I will keep going, I really don't want to postpone since I want to get it over with ...

I am studying for my NCLEX and just signed up to take it next Wednesday, so around 10 days from now. I am wondering I should push my test date back and keep studying, or if my scores look ok. Here they are: Diagnostic: 61% QTrainer 1: 65% QTrainer 2: 74% QTrainer 3: 58% QTrainer 4: 58% QTrainer 5: 60% QTrainer 6: 58% Readiness: 64% I took the Kaplan course back in April because that was when my school offered it, and I'm sort of concerned that my scores have dropped since then (they were really high right after). I have done all of Qbank with an average of 62%, but that's after re-doing the ones I've gotten wrong. I usually got between 55-75% on Qbanks, with a few 50's here and there. What do you all think of my scores? Postpone or no? Thank you!

I am only a graduate and haven't yet started my first job, but I have met plenty of RNs who enjoy their jobs (for ex, my mother, who played a big part in convincing me to go back to school. Seriously, I have never spoken to anyone who loves their job as much as she does). Maybe your workplace just has low morale? Many of the jobs I have applied for offer a year-long training period, so yes I think you have should have a lot of support when you begin your first job. I have heard people say you learn more in your first month on the job than in all of nursing school, and I believe it. Not that I didn't learn a lot in school, but I think you truly learn when you are thrown in and have to begin to figure things out on your own (not that you shouldn't have lots of support). I don't know much about being an x-ray tech or sonographer, but I have heard they are less stressful, but I believe they also come with less options, less variety and fewer opportunities for career advancement. Good luck!

I have really wide feet and wear New Balance shoes in EE, I believe -- I don't know the exact name but if you go to the store, they should be able to tell you as they said nurses buy them (they are fluid resistant). They're extremely comfortable and I have a real problem finding shoes!

My favorite clinical rotation so far has been the current one, which is our preceptorship and I am in the ED, which I love and hope to work in. I haven't really hated any but OB and psych were not my favorite. Most of the clinicals I thought I would love, I didn't, and most that I thought I would hate I ended up enjoying (aside from the ER, which I had a lot of experience volunteering in and knew I would like). I don't have a car either and I am living off campus, which I won't lie, is difficult. There is a bus system but just be aware that coming from NYC it is NOTHING like the public transit there (for ex, the bus stops running here at 5pm on weekends). I have relied on my friends a lot throughout the program, so I think I have been lucky but it definitely would have been easier with a car and if I could go back in time I may have bought one for just the year. There are very frequent buses that run back and forth, but it can get expensive (around $70 round trip unless you buy a ticket months ahead), and it just depends on your schedule. I had 4 days weekends for half the fall so I went home a lot. It's not a big deal to get back to the city but it does take some time and money and I would not want to do it more than once a month, maaaybe twice.

Just to counter the other review.. I am in the BAT program and I am happy with it and believe I made the right decision in coming here! Maybe it's not perfect, but I don't think any 12 month program is, and I have found the faculty very supportive and am overall happy with my experience. Also, it is 12 months, not 15, unless they changed it!

I agree.. I am in upstate NY and lots of my classmates are getting jobs!

Thanks! I just spoke to my school and they said I should use the "expedited application" for NYS that they will post in March. They said that people who used the regular application for licensure last year had to wait even longer to get their ATT. Does anyone know about this expedited application for licensure?