Julia77

Thanks for sharing your thoughts. djmatte, I completely understand and respect the RN role, and yes, I have experience in ICU, although not in this specific type of unit. I have noticed that some RN's will willingly do certain tasks when asked by more senior NP colleagues and by attending physicians, and some of these same RNs will continue to Facebook on their phones and redirect me to do these identical tasks when I ask for assistance ('you can look up the number in that book over there" in response to a request to page a specialist for me) and ask me to solve problems that when I was in an ICU RN role, I would have solved myself. In past positions, I have assisted RN's with turning and positioning patients, so I could assess skin, and I know other providers did not do this, and then the expectation became that I would assist with full bed changes, even on days when short staffing was not an issue. I did address this by assisting until I was able to complete my assessment, and then excusing myself and telling the nurse I would get someone to come help them from the nurses' station, with the rest of the bed change. My perception is that I have previously been too friendly, too willing to help out, and this has somehow contributed to an expectation that I would help with nursing tasks, which ended up contributing to a time management issues for me. It is not the expectation of the employer that I assist with nursing tasks. I am not sure I have communicated the scenario and question here optimally, but if other NP's have had similar situations with insights about this type of scenario, I would appreciate hearing thoughts on successfully addressing this. Julia

While you are still at the job is there any way to get training? Can you get training from the other NP? Is he or she an ally? Can he or she provide insight or advice? ((())) Julia

I am starting as a new NP in a specialized ICU role. I am concerned that many of the nursing staff, having been on this unit for 15-20 years, are more knowledgeable in this specialized area of practice than I will be, yet I know I will be responsible to provide leadership within the department. Said nurses on unit are reputed to be a 'tough bunch'. In addition, I look younger than my age. Has anyone else had a similar experience? Any insights to share? Wanting to start on this unit without inadvertantly communicating to potential bullies that I am the soup du jour... I have been told that at times I appear to lack confidence and am too soft-spoken. I do not want this set of nurses to have idea that I will assist them or do nursing tasks that they would do for other providers when asked. (I do want nurses to get off Facebook to page a specialist for me, for example, and not tell me where to find the phone number). Thanks, Julia

Yes, absolutely, contact the CNO. They will send you a package that will explain everything, and when they are satisfied with your preparation and have the needed paperwork, you will take an open book jurisprudence exam, using the info on the CNO website, to reinforce Ontario specific practice issues. Each province is different.

How do you know what your state requires if you are new to the state? Thanks.

Jules, can you please be more explicit for those of us terrified and unexperienced with negotiating as to how your conversations go when the subject of payment comes up? Thanks, Julia

I think this may be a case of different locales using different language. Critical patients are quickly determined to be ICU patients in my ED. They are then identified as admit-no-bed ICU's. I have been responsible for these heavy, heavy patients in the ED, when in the actual ICU these patients would be with a 1:1 or 1:2 nurse patient ratio. The ICU cannot accept due to inadequate staffing, leading to longer term boarding of ICU patients in the ED. I have walked into an ED assignment with 3/5 patients designated as admit-no-bed-ICU. Of course, an ED patient may be simply critical and need significant care, but without an ICU designation. This said, I believe it is key to communicate clearly and assertively with the CN, with the manager, to advocate for patient well-being and safe practice, as mentioned earlier, even if the terminology may be different, or the situation can worsen. Julia

Oh, if you are applying to a competitive post baccalaureate program, do not do WGU

I believe Western Governors was relatively painless and easy (yes, required work and APA style) but I had an awesome mentor who helped me focus on key aspects of successful course completion. Would do again in a heartbeat. My regret is that I should have done my MSN from WGU and then done a post grad NP program, rather than another NP program from a different school. Julia

If you come in to this mess, you need to let CN know right away. You need to say that it is not a safe assignment before beginning, and I would let my manager know, also. When you are maxed you need to tell CN right away, and advise that you are 1:1 or 1:2 and need additional help. If this is brewing, charge needs to know you cannot accept more assignments due to safety concerns. Agree with above posts on documenting. You have a duty to care for patients you have accepted, but also try to make CN aware before another patient is put into your assignment. Julia

Can you frame your concerns based on patient care, and patient needs? What compromises in patient care or in team function happen because of these concerns? Julia

My ED went through a time when bags were discouraged. However, our nurse manager understood that newer nurses often felt more secure with their educational and other supplies available to them, and was understanding of this need. I would also be unhappy with this being enforced. Julia

Our local EDs have hired only NPs. I believe there are regional differences, though. Julia

Are all NP and PA charts reviewed, stamped and double billed by MDs?

I agree, that we are all professionally responsible to obtain the appropriate continuing education to maintain our licensure, however, the other educational requirements or opportunities our facilities offer, or require may differ from licensure requirements. I pm'd you on your question. Thanks for responding. Julia :)