np830

1) Hanging mutliple units of prbc and platelets without sending the patient into flash pulmonary edema. 2) removing running sutures from an open Whipple- heavenly.

Facility and state-dependent. If you ask me, I'd go for ACNP as onc patients I see are sick patients, not well patients coming in requiring BP med adjustment (unless, well, Avastin). ACNP will also open you up to onc ED and onc inpatient opportunities. This isn't to say you can't see onc patients as an ANP, but you may find that you're better trained going the other route.

I would assume your lawyer-husband also gets paid adequately to make his job ennui worth his while. Nurses are paid little, compared to other professions, and the myth is that we should be happy to accept this because it's our "calling."

Nope! And NP isn't much different. Nursing is a lot of responsibility with ultimately little control over outcomes thanks to administration.

It depends on your state, unfortunately. I've worked in MA in oncology and many ACNPs are hired outpatient, especially since those patients in the ambulatory care/infusion center are sicker than your usual outpatient. A lot of places are willing to hire PAs with no onc experience, including DFCI, so having the ACNP plus onc experience puts you ahead of them and FNPs, IMHO, as does having ONS certification (I assume you are an onc RN?). If you have no desire to do outpatient, don't do FNP.

I have come across this, and you're correct, it's not ideal. Good infection prevention practices and surveillance of fever/illness is key.

Hello. NP applying to PMHNP post-masters certificate programs, looking at University of Pittsburgh.. Does anyone have experience with clinicals at Pitt? Have you ever been told you needed to find your own preceptor??

Dude, blueball, or whatever your name is-- we all know NP education needs a ton of help. A LOT of us wish all online nursing classes would be outlawed and that there were a 2000-hr clinical minimum. But throwing your NP colleagues under the bus for things they can't control makes you look less like a proper "doctor" and more like something else.

It's low. I work heme/onc. But I also have RN experience as heme onc and 7.5 years of combined surg-onc and heme-onc NP experience. Do they give you CME money? I'd at least negotiate for more vacation. What type of patients? If you're seeing head and neck, that's a LOT of patients. Will you have physician adequate back up if you have no heme onc experience?

Yes, it's definitely something I'm seeing more of in the Mid-Atlantic. I'm also seeing more and more PAs being hired in Boston for what ACNPs could be doing, albeit at lower cost for what Boston pays their NPs.

Haha, yes, i understand many not seeing how one could go back to the bedside. I think I really am looking towards the post-masters AG-ACNP certificate... I wish that particular masters track would have been around when I was in grad school the first time í ½í¸£

Looking for some advice on a topic that doesn't seem to be mentioned much- I worked as an inpt RN (intermediate care) for 4 years before starting as an NP, certified as adult primary care. Have been outpt oncology NP for most of this. One thing that I increasingly regret is never having had critical care experience. It never made sense to transfer to an icu once I was deep into a full time NP program, but now that I look back, I just should have done it. I guess it could be that i want a break from my current position , or i need a new challenge, or I just miss the acuity. I think it's all 3. I'm not qualified to work inpatient as an NP with the ANP certification, so that's out. Have realized since graduation that i have no desire to work primary care. If I were to get an ACNP post-grad certificate, wouldn't it help to have ICU experience? (I seriously don't know how some schools take direct entry students and turn them into ACNPs...) Have any other NPs experienced this ambivalence a few years into their career? It's unsettling. And does anyone know if people can even get hired into an ICU after having not worked as an RN for 7 years? I know this is not a usual thing people do.

The job of nursing is hard enough without having to account for the cliques. There's been some great advice here about ignoring the bad apples and focusing on your patients, finding allies and nice people amongst the other staff where you work. I think if you decide to be a NNP, it's obviously a no-brainer to stay. (Where I live, NNPs are so high in demand, that's the route I'd go!) At any rate, be the best nurse you can. Although that will piss them off even more.

Sure, if they are willing to train you since we do not learn this in school obviously and it's a huge learning curve. Be careful about what the job is, as some may just want you following up to make sure patients are taking their extended IV antibiotics, which is mostly f/up with visiting nursing associations that the docs don't want to do. Some may train you to do HIV care or bread and butter joint infections. I doubt you'd be working up anything very strange as that goes to the fellows and seasoned docs. ID specialists are often the last specialists patients see when NO ONE else can figure cases out.

I found that it depends on where you live and how picky you are. The market is saturated with NPs here. I graduated from a reputable program in Boston and it took me what seemed like forever (3 months, which I suppose in hindsight wasn't that long, but when you have to pay rent it certainly felt like it) after passing my boards to get an offer. Lots of places only wanted experienced NPs. My current NP job is great and i got that through networking. Sometimes if you don't have the experience of great clinicals it can be tough to find good connections with which to network, but of course some people are just better at networking than others!

I graduated from a BSN program 7 years ago, my NP program 3 years ago. I grew up with a family member who was a retired CRNA, so I've known about the career and entertained it since I was in pre-school. I graduated from a very competitive BSN program, where the majority of the students chattered about being CRNAs, usually highlighting the amount of money that was to be made. Truth be told, my colleagues' apparent insincerity about the field was a big turn-off--my family member was a CRNA before they made big bucks--, but the real reason I never pursued my dream was because I just didn't think I was "smart enough" to get into a CRNA program. So, I filed the dream away, and decided to pursue advanced practice studies as a nurse practitioner, figuring it could make me "just as happy." Prior to becoming an NP I worked on an inpatient hematology unit at an academic medical center with very sick patients, many on the precipice of an ICU transfer. I loved that job, and would have made the transition to the hospital's MICU had personal circumstances not necessitated me moving across the country. I also have one year experience in a step-down telemetry unit. For the past 3 years I've been an NP for a busy (again, academic) surgical service-- major abdominal operations and the like. My job is to handle the less-severe sequelae of these operations in the outpatient setting, but also follow my patients when they are admitted. My conundrum is that deep down I miss the day-to-day high acuity level of the very ill patients (at the cancer center-- I don't miss the step-down... floor politics). And deep down, one of my greatest career regrets is never having been a critical care nurse. This is not to say that I didn't entertain it many, many times. I just thought "why bother transferring to a CC unit when I will be graduating from the MSN program in x months?; What if I get the CC experience to apply to anesthesia school and then ditch NP school, thus having wasted all those student loans?!" Meanwhile, my intellectual curiosity is not quenched and I am not fulfilled. I'm only 29. No kids. I can't imagine myself at age 50 never having worked in a critical setting as an RN. And I don't want to be this unhappy forever. It's weird how I am just realizing this now, but better now than age 90, I suppose. I have a lot of interaction with the OR staff, including CRNAs. I know what the job entails, and I believe that's what I'm meant to be doing (that little kid was right). My questions: 1) How the heck does one make the transition from NP to critical care RN? I'm prepared for the shift work, weekends, pay cut, stupid "nursing politics" that I get to avoid at my current position, etc., but would any nurse manager want to hire someone like me? One would think my experience and knowledge puts me at an advantage over a newly minted RN, correct? I would have great recommendations from the surgeons with whom I've worked, but due to politics, would that hold any water? 2) For the CRNAs/SRNAs: Did/Do you have any former NPs in your CRNA classes? Did they ever discuss their journey? Were you one yourself? 3) How did you "just do it"? I.E., nothing is guaranteed in life... Do you have any advice for taking a job in a critical care setting without the guarantee of admission to a CRNA program? (I apologize for the long post!)