Back2SchoolRN

ntbw, We must not be the only ones. Surely! On my first NP job in the Midwest, I interviewed with one collaborator and found out after I started that he was being pushed out and the jerk they hired in his place would now be my collaborator. He was from another country where women are much oppressed. He clearly had no desire to work with an NP, but couldn't pass up the money. He spent an average of 8 minutes with the patients on his unit, then went on to his private practice. (I and those other patients were side income for him). He required that I consult him over every little order, which I respected at first because I was so new. But he did not want to mentor, even a few minutes a week, and refused to be contacted by text or e-mail. He would accept only phone calls and they had to be under a minute or so. He would interrupt my brief background basis for my plan, with an order as though I were the floor RN calling for orders, exactly. Later, when I asked him about a particular situation, again he would bark, but "Yes, yes, Suzy!" (not my real name). Sometimes he did not listen to the entire planned order. Yet when he went on vacation, he left me covering his more acute patients AND mine, without a request, report, or verifying I could care for them safely. Even so, I did not talk him down except privately to a 2nd nurse who was at nearly the end of her NP program, and then only explaining this. I had trouble getting him to audit the required charts, too. I started auditing the EMR to check on the number and timing. That's when I caught him falsifying a supposed visit to me, in which he wrote he'd examined a patient and consulted with me in person, none of which had actually happened! I expected that he would have me pushed out if I complained to him, maybe set me up to reported to the BON. I knew the Board of Healing Arts/medicine would not do anything, so I could (I thought) only report the situation as discreetly as possible to my direct supervisor. I did so. After that, my job became hellish. There had been no clinical complaints, concerns about my judgment, disrespect to the MD, nothing. My nurse, that student NP, was taken away and I was given her duties. This was possibly due at least in part to saving money as they had just been taken over by a large corporation. But there was no warning and no explanation, or asking for my willingness. No orientation to her duties, either. I began to be graded on her non-NP paperwork duties, too, and required to make myself available with my door open for patient drop-ins, and to make my patient appt schedule subordinate to everyone else's on the multidisciplinary (psych PHP) team--even if that made me idle in the middle of the day and at work long after everyone else had left. Of course I started looking for a job after I saw this was real and permanent and escalating. I feared I would be set up to not just be fired but reported to the Board. Not to be sued, because they'd be sued, too---but disciplined by the Board for (God knows what!) I would not have done. It was past time already that I had the required number of practice hours to apply for permission from the BON and a DEA number, both required in my state to prescribe controlled substances. For weeks he'd said he would sign it, hadn't "gotten to it yet. I the meantime, I left by mutual agreement, and he refused to sign the document or even answer my e-mails. I gave up for fear more than 2 (brief, polite) e-mails and one text could be considered harrassment. That puts me on an equal footing with new grads without that much-desired DEA. Worse, actually, because how does that look, with less than a year on the first NP job, and a collaborator who refuses to acknowledge you worked under him for that long? It means someone else has to prescribe those meds for at least 6 months, and a collaborator actually has to collaborate. Without that, I can and have been credentialed to work at another job, but without the DEA, Now, shortly into my new job, when they lost the collaborator at my new job, they are having trouble finding one who will work with me without my having the DEA. Wil this cost me the job? Maybe. I negotiated a settlement for leaving that horrible job by mutual agreement, with a gag order. An employment attorney said there was nothing else I could do, and that I'd done well for myself, monetarily. Period. And so you see, physicians have another way to punish and control us or to get even for having to collaborate at all, with no consequences whatsoever. It should be a professional duty to sign a document required for future employment, or a necessary legal process for full practice because it is not a reference or recommendation. It takes 30 seconds, being just a signature. Like the person in Human Resouces who tells potential employers only your dates of employment there, it simply states that yes, you have worked that many hours, which, to the BON, qualifies for the application. So this is NP abuse, and yes, I think there must be others, and it needs to stop. BTW, To those who think nbtw is asking the MD to give her a glowing reference or to continue as her collaborator, she is not. She's asking for documentation that she worked there and there was no disi[plinary or clinical concern. I would like to know how it turned out for you, nbtw.

I totally get that you have limitations, and have a right to want acute care. Being willing to commute is great. And ultimately if your family situation just won't let you work nights, you do have to put them first. (BTW, Are you sure no one else can help? We nurses always think we can care best, even when actual licensed skill is not needed or permitted at home.) Don't go back to school til you do have some solid experience. I am older than you, and am back in school, but have tons of wide experience and some deep experience with an applicable certification or two....That means I will have a better chance of repaying the loans or even opportunities to work them off (even if I never got an NP job) because I am already hire-able in more advanced-experience-and-responsibility jobs. But here's the kicker: Most nurses are starting their careers at a younger age, and thus have the stamina and often the reduced home responsibilities that go with being younger. That's why medical doctor programs can abuse their interns--youth and only youth can survive the internship and residency, with extremely rare exceptions. You aren't that young, but you will be expected to work as if you were, in the beginning. School recruiters should have shared that, but seldom do. It's not that severe for nurses. (For med school, it has been 36 hour shifts with naps, and early-AM rounds with the residents and attendings; only now is that changing somewhat.) But it's bad enough. That's why it's not just a hazing or nurses-eating-their-young game that causes new nurses to put in their dues on night and rotating shifts before moving up to first bearable (and then, eventually, almost cushy) shifts. And though it's not so typical as it once was, nurses used to have to do general care for a year or two, before moving into specialty areas that had, say, 12 hour shifts x 3 with 40-hour pay. In the new market, you may have to start with nursing home care, then general acute care or outpatient care, then acute specialty or critical care. Or whatever is most needed right now, but unpopular. And when you move a step up in hours, pay, or choice of work, don't expect to step up in all 3 at once! Usually you will sacrifice something to move up a step in something you want more. Night shift to eves to days, yes. Acute care to CCU, yes, but not on days at first, and not much more pay that first year, because you're back to being a (CCU) trainee, especially if you're going to another facility! Always calculate what they are getting from you from your first shift, not what you think you have to give. If you need more experience or training to be fully functional, you are a TRAINEE. Consider what I had to do to get my experience: 1) I worked nightmarishly understaffed hospitals--like being the new charge RN (with much LPN experience) on an ortho unit of 48 patients, with another RN and/or 1 LPN, and a floating aide for only morning V/S and I/O's. (FL, early 1990's; don't know how they are now). Or, a very few years later, night shift acute medical charge (with all the attendant paperwork, etc., plus a full patient load of my own), some patients that should have been in ICU or at least step-down, 1 LPN (cuz the other called in sick) and one CNA for V/S and outputs. (When one of our patients went into status epilepticus, WE wheeled him down about 200 feet of hall to ICU so he could get IV Ativan, because they had standing order protocols there and we could not get an order fast enough. That left almost nobody on our unit for about 5 minutes in which anything could have happened. I quit very soon after.) I would never recommend allowing this kind of staffing now, but such abuses were common in always-short-staffed Florida nursing back then. In both jobs, I worked 12-hour nights, including every weekend. 2) I worked with AIDS patients back when it was a terrifying mystery, and nurses were dressed as if for nuclear warfare to care for them, and when their isolation linen and trays piled up in their rooms because most staff were afraid to discard them! (It was seen like Ebola is now.) That usually earned me the Hepatitis patient, with Hep A, B AND C and drug withdrawal, because they knew I would cope AND care. And because I was the float/bottom of the ladder. 4) I took rotating shifts, too many exhausting 12s in a row, floating when I didn't want to because I was the junior member on my shift. 5) I had some long commutes. Still do. 6) I did without benefits so I could go back to school, even basic health insurance at age 32, and supplemented my regular job with night shift home care in 3 different areas of care, so I could study while my patients napped. (It's a myth the really sick ones sleep for more than an hour or two.) 5) I purposely took on challenging new work, like hemodialysis, to learn and grow. 7) I did my share of nursing home jobs, and 48-75 beds to pass meds on was commonplace. Sometimes all I did between phones, wound care, falls, etc., until the shift was over was pass meds from one end of the hall to the other. When 1 pass ended the other was more than due to begin! ...and, yes, I graduated back when long-term care was seen as less prestigious than acute, and a place where you could get stuck if your acute skills faded....and yet my first job was still in a nursing home. So, if you are quite limited for legitimate reasons, BUT THE LIMITATIONS HAPPEN TO BE in areas where new nurses must go to gain experience (aka paying your dues), then not only is it tougher for you to get started at all, but far less likely that you will get quickly into the area you want (acute). Remember, as a trainee, you will be lucky to get ONE thing you want: shift, type of care, location, hours, etc. The one thing you have control over is your expectations. No one is going to give you a "get out of jail free" ticket because you are older; they will expect you to be as humble and ready to work the cr@p jobs in the beginning as any 20- year old. Refusing night shift and nursing homes and (whatever), even with your very good reasons, will get you passed by for new-grad jobs. For you it's not an entitlement issue, but for your coworkers it would be. I'm in NP school, and I speak as gently as I can, knowing I will be a trainee, too, in not too long. I will work less desirable first jobs than people young enough in some cases to be my child, and have to do it with a smile, even if I was formerly a day shift manager in my choice of specialties. (Those will help me move up faster later, and may widen my choices a bit, but the principle is the same.) Likewise, you have to do what you feel is safe for your license and your patients, but before you decide 48 is too many to bear, check what is typical for your area. Support staff and resources, and the type of nursing home are factors. There's a big difference between "I don't think this is safe!" and "That is way too many to care for." Expect to be very tired at the end of a nursing shift. (As a profession we need to make things better, but we are talking about your first job in the here and now.) Maybe you will move up, and find ways to staff such a facility better. That can be a back-door way to be ready--eventually-- to move up in acute care. Why? Because a nurse with some recent experience in Acute Care and years of high level long-term care managerial experience is more prepared for acute management in many ways than a nurse with a ton of acute care experience and little or no managerial, other than team leader or shift charge. (Been there!) Others are right in saying networking is important. Volunteering at health fairs to do V/S and weights might seem like a come-down, but you will meet others and can show a professional demeanor/dedication. Consider also asking local nursing managers what would make you employable. Yes, take a refresher! You need it; it will show willingness, and you will meet others who have been out of the market for a while, or out of acute care, who can share what they've discovered. Best Wishes on your hunt.

I think completion rate may be a better focus. Getting in is always easier than getting through! (Some things are federally monitored, and so schools that are not especially fair-minded may be ultra-careful in those observed areas, and less so where they are not. Graduation rates overall are monitored, and the demographic breakdown of admissions; I have no idea if the demographics of graduation rates at all types of degree-granting institutions are monitored at all academic degree levels and published by governmental authorities for those same demographics. It doesn't help me to know that a brick-and-mortar school X admits a proper ethnic mix of undergrads, when I am looking at an online graduate program completion rate in a very specific program. Would love to hear from those who do know.) Do older students get the same support as traditional ones? In schools, especially online aschools, where volume is the money maker for the school, are they graduating at the same rates? I have seen many happy posts by older ones who felt supported and well-treated and are SO glad they went back. But I've also seen posts on other sites about instructors seeming ultra-sensitive to any seeming challenge from an older student, or any sense that the student feels s/he already knows anything. I am referring to all levels and types of schools about that particular complaint. (One such site is named something like "rn reality" or "reality nurse". Those are the disappointed ones, yes--but the stories do remind me of things I have actually seen myself from LPN vocational school to on the job with new RNs, etc.) I've seen posts about older students being challenged to do more in some ways to see if they have the stamina to keep up, or are presumed to be out-dated dinosaurs in regards to technology, especially if they are not working in acute care when they apply--in school and on the job as a recent grad. Humility is already emphasized in any medical training, but I can see where an instructor or school might be tempted to challenge the humility of, say, a DNS at a hospital pursuing her mid-careerMSN or doctoral degree than a 24 yo nearly-new med-surg nurse working on the same one. And it would be normal for that younger nurse to blatantly hero-worship (rather than just admire and respect) a shining role-model instructor--and who doesn't love being the object of hero-worship? So I think that in general older nurses seem welcome and are well-treated and glad they went back--but it's not always a level playing field and not every school lives up to its advertising. (For that matter, how many schools have older nurses on their "welcome, prospective students!" page, as students?)

Might any of you be willing to share the general area you're describing, as in the Islands, Southwest, etc.? I don't think that would compromise our anonymity, but could go a long way in helping nurses and NPs gain traction in career planning and compensation as a profession. It's mutual empowerment. I don't understand the extreme reluctance (not yours; don't know why you as an individual weren't more specific, but in general) to provide that one level-higher information that would make so much more of what we share here actually USEFUL in a practical way. I don't think it's going to weaken us as mutual competitors, either. If someone is willing to move across country or change his/her choice of specialties based on what's hot (or not) in your area you know about, then they are in a minority of nurses. If they;re willing to go that far, more power to them, I say. At the same time, they are balancing out a possible glut of licenses in one area that is depressing the market there, so adjustments are win-win. There is a big shortage of PMHNPs in the Midwest, a psychiatrist friend told me, and he should know! I felt smug knowing I had already selected the "smart" choice, but it was my passion, not my pockets, that had chosen it years before I got to actually start.

Yes, and nothing like feeling you are giving substandard care to patients right out of the gates to make you feel even more accomplished and caring as a provider, hmmm? Not to mention the liability risks and reasonable fears associated with inadequate examining, thinking, and documentation time. Finally, where is the time you will need and want to build your knowledge and grow as a practitioner, if there's not a spare minute to read up, consult someone with more knowledge, dig deeper in the record, or just dwell on a tantalizing question for a little while? That's surely one of the more fulfilling and fun part of being challenged, or the "more mental stimulation" many nurses went to NP school to get. Stress and excitement must be balanced or you'll burn out fast! Outside the money and fairness issue (and yes, it sounds as though you are being looked at as a vending machine, not a provider who will be supported) consider your self-image, your confidence, your long-term growth, especially in those first few years where you are creating a foundation, and before the time when your (possibly upscaled) lifestyle may no longer accommodate the lower salary. Expect and demand a fair compensation package, but look out for your other needs and goals, too: Surely where you work and what you do can seriously enhance or decrease those opportunities. Just my thoughts as an experienced RN (and new NP student) who's taken on some challenges over the years.

Tasha, yes--devastated is the right word. I am working hard on moving on but it certainly makes me feel nurses are still "eating their young", especially as the school was not just firm in their "no", but actually unconcerned about the impact, and not at all encouraging even for me to keep going in spite of it.

Good point, Ella; I don't know. Usually when there are problems, each party blames it on someone else. AT&T blamed Examity, Examity blamed Blackboard, the school blamed me, I don't know where the technical issues actually lies, but I blame AT&T for lying, but the school for not taking responsibility for their part (missing information). But apparently, no matter what the problem was, I paid the price.

JustBeachy, I'm a little surprised to hear how harsh your tone seems to be toward Ashmi11. He or she is asking simple factual questions, and yet your answers suggest you think he or she is expecting the US to give her an unearned privilege of some kind. Business is business; if there were a company that wanted to sponsor him/her, however unlikely that might be, could you be happy for her or him? I could; I don't think we US-born nurses are in danger of losing our jobs in large numbers to individual nurses from other countries who seek to come here under their own initiative. There have been times when US entities did hire large-scale hiring of (underpaid) nurses from outside the US to avoid paying us adequately, but that's different. Many of those were extremely dedicated well-trained nurses, some from countries where the 4-year degree had been the point of entry into licensed nursing for many years before it was even discussed here. Those nurses weren't looking for an sneaky way in, nor were they under-qualified or lazy, even if they were taken advantage of in a way that undercut our efforts to gain respect and compensation. Aggressive competition with immigrant nurses seems as pointless as territorial battles between US nurses over such topics as, "Do we still have a place for LPNs in nursing?". The answer is yes, of course. Some of the best and brightest nurses I've ever worked with were LPNs. (That's what the Filipina BSN nurses hired in one of those episodes mentioned above said to me when I was working alongside them as an LPN, too.) Maybe I'm seeing coldness where it isn't meant, but, seeing that you feel strongly we should, "Never lose a chance of saying a kind word," I was just surprised not to hear more encouragement. It is good that you did explain that it isn't quick nor easy; just a little warmth could soften the blow, and doesn't cost a thing. I'm guessing "tq" means "thank you". To Ashmi11 I say: She's right that excellent English will be required. It's best to get your information directly from the US authorities who'd be issuing you the items you're hoping for--work Visa, nursing license, etc. That's the only way to get accurate unbiased, current and complete information. When you can make those calls or mailings comfortably, you'll know your English is ready. You might find what you're hoping for somewhere else, too, so keep an open mind. .

Oh, Ella! Thank you for sharing this publicly; people need to know. You are now the 3rd student I actually know from this school who had the same experience (of difficulty connecting with the outside proctoring service, "Examity"). The 2nd one could not connect, gave up after almost 90 minutes, then had to go to her job, work a shift, get another laptop, and with the professor sending cold e-mails, take the exam late that night, exhausted. She missed the passing grade of 80 by 1.5 points and was failed. Would she have passed if she'd been able to take the exam a little less tired and stressed? Maybe! She was doing fine in school until then. Examity TOLD HER directly that the problem was the interface with (the virtual classroom named) "BlackBoard" and Examity's requirements. Whether or not that is true, I was told by the head of IT--the director of IT--at the school that he was unaware the professor was using an outside proctoring service that way (meaning via BlackBoard, I suppose). He urged me to "Don't make any decisions about your future just yet; let me speak to her and get back to you!" and "What you are saying disturbs me." He never wrote me again, and when I e-mailed him a week later to ask why, I got no answer. It seemed clear, since he was so kind and open when we first e-mailed, that he had been told to keep quiet for legal reasons, or been told I was someone entirely different than I am, so he no longer believed what I'd said (?). That same week I got an e-mail from the school stating that I was requested to take part in an "anonymous survey" about school honesty and integrity practices, which asked (among other details) whether I felt there was any wrongdoing at the school, and if so, was I worried about reporting it for fear of retaliation? Geeeez, what a coincidence, eh?! Maybe. It is hard to know how much of the problem with Examity was employee incompetence, though anyone who has used online technical help can attest it happens. But the school has chosen to protect itself rather than its students by refusing to admit there WAS any problem, nor matter how costly to some. Admitting the service they provided--even if 3rd party--makes the school liable for any damage it caused. The obvious monetary incentive for taking on more students than you can handle, using 80% automated courses, then dumping some over minimal-to-zero cause, while of course keeping the lost tuition money, is a very bad situation for students. Charging the student about $800.00 for the privilege of leaving, as this school does, seems ripe for investigation. It is called, "return of Title IV funds", which sounds as though the government requires it. If it was illegal, they wouldn't do it, obviously. And it is mentioned in the fine print that you may be charged a fee by that name if you leave, even if involuntarily. I admit, since I've never flunked out of school and had no intention of leaving before completion, I barely noticed. If I did, I would have assumed it simply meant returning unused tuition, and that you still have to repay loans even if you don't graduate! Still, I have not heard of this before, and no other school I have spoken to recalls asking for such money when students leave. Maybe other readers can clarify their experiences. It seems to be a legal option schools have, as long as it's in the fine print. But is it okay, ethically speaking, if you can also dump the student rather too easily? This money is labeled as being "repaid" to the school, though it was not given to the student by the school--I double-checked on that. Nor was I told that the school donated it to the feds or any other entity on my behalf. Yet it must also be repaid, with interest, to the actual lender--the federal government! If you don't pay it immediately to the school, your transcripts will not be available, and so you will not be transferring anywhere else, either. If this is accepted practice, the laws need to change, I think. It is unethical, whether legal or not. And wayyyy too tempting! I thought, after reading the heavy emphasis (in the "MSN Handbook") on the "Advanced Physical Assessment" performance exam at the end of the last course before clinical, "I wonder if that somewhat subjective exam is the last opportunity to make sure the number of surviving students is as small as it needs to be?" If so, then those that make it that far can breathe much easier once they pass, as thereafter there is no incentive/pressure to let you go, other than deficiencies in your actual performance and ethical/professional behavior. I'm not saying I think they literally flunk people who actually take an exam and pass; I'm saying that many already-overworked professors probably don't appreciate taking on non-traditional students that mean extra work without extra teaching staff. Some (especially late-career ones who attended traditional programs) may have doubts about the attitudes or quality of online students that make them quicker to leap to negative conclusions. ...Some (especially the junior, lower-paid ones, like this professor?) may resent students who may be making more than academics do (which truly is ridiculously low pay for their education and responsibility, but not our fault!). Some, I have heard, already state on discussion boards for many disciplines that they expect us to be more opinionated and demanding (and in need of humbling) than traditional students in their 20s who haven't been DONs, etc. They may also be pressured to keep numbers to certain parameters at certain times. And if you've had basic psychology, you know what happens when "nice" people are made to do things that make them morally uneasy; they rationalize, even blaming the victim, mostly unconsciously. It's probably a lot easier to do so if you already resent their presence and never have to speak face-to-face with them about it. Regardless, each is responsible for her choices, and I think the response to the technology issue that cost me (in lost tuition, time off work for study, etc.) in the range of 15k, was very cold, distant, unfair and unwarranted. The more I hear (and there were allegedly as many as 5 others who were similarly affected, though most may have squeaked by as you did), the more I am appalled. I will say that this dynamic must certainly NOT be true of many of the teachers there, nor be the case at all schools, and I know all schools must make predictive guesses about enrollment, attrition, etc. and (I think) may have to meet retention/graduation ratios to stay accredited; this must be tough. This is not a blanket criticism of all online schools. Actually, I found several of the professors and staff to be kind enough and supportive enough, and 2 educators in particular seemed exceptional--dedicated, concerned, and very knowledgeable! I'm just saying that the extremely lucrative nature of these schools is a set-up for greed to override ethics, and professors who are coerced to participate may not look too closely at any unpleasant details like these, or just feel there is no choice. (Especially in a regional college--where else will they work, especially if they have, or are approaching, tenure status? Throw away a career for some probably-careless-and-now-whiny student who has to sit out a year, but will probably survive?) Either way, the students and nurses lose, and ultimately, the professors do, too, in several ways. I know that they can't be the only school besides for-profit vocational colleges that do this. I don't want to risk being sued for naming them, nor hurt those who work there--even that cold-hearted professor herself--and there seems to be no point. But by sharing where others can read, we are doing those who listen a service, and you are helping to show that it's not just one disgruntled person who has observed or experienced the behavior. A class-action suit might be appropriate, too, if any others completely missed the exam for technology reasons, and were given a "zero" as I was. However, I have other things to work on right now--including just dealing with the financial aftermath, and deciding what to do next and how. Thank you again for sharing what you experienced. I'm sorry to hear you are feeling let down, too; I hope the degree will make it all worthwhile in the end! I will be dumping U-Verse, too. And please keep me--us--posted on your progress.

Yes, and sometimes as the patient when told the same thing, it makes what may have above-and-beyond for that nurse in that situation less than what it really was. A more honest reply might be, "I'm doing my best to give you good care, Mr. Jones; I'm glad it shows...", or if you have really wanted to show compassion or support or caring, you could say, "I'm so glad; it's my job to take good care of you, and your right to expect it, but I am glad you can feel how much I--we--care about your well-being, too." I think that keeps it on a professional level but lets the person know that the caring they sensed was real, not just a mistaken interpretation of standard, rote behavior or professional courtesy. It can be life-changing to have someone care when it really, really, matters, especially it seems no one else does. I've felt that on both sides of the bedrails. :-)

I wonder what happens when you feel you are in an urgent medical situation yourself, and must get help for yourself, but not quite 911? It seems to me that, because even a 911 illness could happen to a caregiver nurse, any agency MUST be able to provide back-up, even if it is for a short time the DON of the agency. Surely that's true even if there is a family caregiver who is wiling and competent, because that person could get sick, too. (Speaking of getting your flu shot.....) I think if I were stuck in this nurse's shoes, I would surely document everything, and when I called the supervisor, not only work my way up the ladder, but give the agency a deadline, because frankly they are more likely to come through if they know they must, and how soon. I would also not share the nature of my illness, just that I was too unwell to perform my duties competently and needed relief for my patient's sake. Why open yourself up to questions about your sanity or mental stability, which could then raise doubts about anything you said or wrote or recall now? If you did have to go, you would surely want to document the hand-off to the Mom, including that she is comfortable with that and knows where to call if she needs more help. But I can tell you from close-up observation that, when it comes to a "he said--she said" at the BON, the party who reports the other first, especially if it is an agency/facility/employer, virtually always wins. Some agencies use this as a weapon of intimidation over their nurses, and so do some facilities that use agency staffing. Once you've been reported, anything you say about the reporting party only seems like retaliation, and not very credible. BTW, if you need to report something you see at a place where you are sent as an agency nurse, keep your mouth shut and do it in writing, or by calling the authorities directly first; otherwise you may find yourself set up/reported for something manufactured just for that very reason--to get the "first complainer" advantage. Keep in mind who will have custody of a paper record, and whether they can remove/replace and entire page of notes, if they are unethical enough to do so, in order to hide something. It has happened! Some agencies, and/or places with chronic inspection or licensure problems that also use agency staffing, are old hands at such tricks. Meanwhile, any serious complaint follows you everywhere, even if it is determined unfounded. You will notice, if you apply for reciprocal licenses in non-compact states (and some school and job applications), that you are asked not whether you've been found guilty, but whether you've been ACCUSED of neglect, abuse, etc. You will have space to write your story, but some damage is probably done, because we're inclined to believe there must have been something to it, aren't we? We assume the BON must have entertained the idea seriously, at least, after seeing the evidence, even if in the end you were judged innocent. Yet the BON field investigator must be groaning under stacks of cases like everyone else these days, and low-priority cases can sit for years before being investigated. I'm not sure what the solutions to these things are. But I do think legal self-protection classes for nurses should go beyond simple charting improvement. They should include looking out for yourself against other entities, like businesses, whose needs may conflict with yours. You don't see that in nursing journal articles, I think. There's a myth that if you do everything by the books, and document it all, you are safe. Also that if your heart's in the right place, and you didn't endanger your patient, and you document the patient's safety, you're probably basically okay. (Not necessarily. Not by any means.)

Yes, false alarms are bad, and so would someone ignoring "flu-like" symptoms when they did have risk factors, because they presume it's most likely the flu. Worst come to worst, if a national hysteria develops, it could be taking your life in your hands to be out in public, clearly febrile and coughing/shivering! And yet you would need to get out to get help, most likely, since as we know the flu can be fatal, too. Its a good year to get a flu shot, for sure.

Having been an online student, I ma getting the strong impression that, unless the school is online-only, or has had an online program for well over a decade, it may be the the professors have been forced to teach in the programs online. Those bring in massive money, but t is clear that some of those instructors have a very negative attitude toward the online students; maybe they buy into the idea that they are lazy, unmotivated, have low standards, whatever. Likely there are fewer instructors per student, too, so they are glad to see some drop out. All in all, the online student loses. I for one will now only choose one in my area, and which has had an online program for a lonnnnggggg time, or only online programs!

Wow; this goes beyond laziness; it's unethical. If you were caught, it would be justifiable to restrict or remove your license, that you would cheat in your training. Papers are not fun, but I'm guessing this is only the tip of the iceberg you're showing here. Shame on you. If your post could be traced, your school would be justified in booting you and your sister both out.

Well, I think you are right, and that's my point: Adding that other content defines the DNP role as population management, albeit from multiple angles. It says the clinical knowledge needed is much more limited than the need for political, managerial, administrative, legal, sociological, and similar types of knowledge, and that once you clear the MSN hurdle, it's all about the system. I realize that evaluating and applying evidence to practice on a national or world-wide scale does require some of that knowledge--a lot, in fact, to do it well, and make it be lasting change. And I am sure many long discussions or even arguments defined the generation of new evidence--pure research--as PhD territory. But there is so little emphasis on higher clinical expertise. "Who you gonna call, when nobody knows what to do?" That used to be the CNS, and should be the DNP, too, as the ultimate resource in his/her specialty area. Nurses do more than practice demi-medicine; they solve problems and puzzles when the patient has complex, multi-spheric emotional and physical needs, in a way that no other discipline does; I think it's what we do best. Large-scale advocacy is part of that, but doesn't replace it. And the new DNP doesn't seem to be receiving education that adds anything to that competence. It seems that some NPs don't agree that this is the way it should be; they see the value in the extra non-clinical knowledge, but don't want it to be the only focus, nor even the strongest. I'm so glad! And I can say there is a LOT more to be learned about health and personality psychology, cultural influences, genetics, toxicology, immunology, nutrition, medications, family dynamics, environmental illnesses, etc., some of which isn't even mentioned in NP school. For the most part, the last mention of some of those topics is ASN/ADN school, though some of it is basic enough that any first-line provider needs to know. Now that's sad: Nurses have traditionally led the way in holistic care, and I believe that we're dropping the ball by making the practice doctorate about everything BUT the individual, and in keeping the NP scope of actual clinical practice to extremely-limited medical practice. DNP's should know a lot more about the aspects of care that make nursing unique than a nurse at any lower practice level, and how best to offer that unique care. If we don't, then we may be advocates for our patients, but we're not adding any fresh knowledge or uniquely-nursing perspective into the "health care policy" discussion, either. Why not a deeper dive first into those topics that could improve practitioners' daily practice? We then might have a broader scope of ideas as to what should change than we do now, especially in our own practice, and facts to back them up. As for the BSN training, again I agree with you that the extra knowledge is very handy in understanding the "big picture", which helps, again, with running the show, guiding change, health advocacy, economics, etc. It helps the nurse understand where to find research and evaluate it, so it can be used, too--though I'd be curious to know how many actually use that part in managing care. Unfortunately, this just shows the old cliche is true--BSNs make easier managers, because they have additional administrative-prep and public health training. They are not more knowledgeable clinicians for being BSNs. That extra BSN or non-clinical MSN knowledge doesn't contribute much, if anything, to hands-on nursing. When it does, it requires pre-existing knowledge that many of the nurses working under them may have that the BSN/MSN may not. They are leaders, but not greater clinical experts. So it's sad that they CNS is going by the wayside, if the rumors are true. (Are they?) Why this desperation to distance higher practice as far as possible from the bedside? NOW "Who you gonna call?" You can't direct a Code Blue from the Boardroom. SOMEbody needs to be the recognized #1 expert clinical resource, and that should be the DNP, as an outgrowth from the junction of NP and CNS. Those are just my opinions, and they are not the only valid ones, of course.