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 :)

Do you break in the Doctors' Lounge? Are you welcomed to Journal Club? Are you invited to the same educational/CME opportunities that the physicians are? Do you have full digital access that staff physicians have to educational opportunities? Do you have provider parking? How do you feel you are treated in your workplace environment? What advice would you give a new NP who realizes its important to her to work in an environment in which the NP profession is respected, and supported in the role of diagnosing and prescribing? Are you required to attend staff nurse education nurses designed for RNs and LPNs? Is your boss the nurse manager? Have you been in a position in a backwards area when it comes to the NP role, where you've had to advocate for any of these things, and if yes, any insights to share? Thanks in advance, Julia For the record, I am not promoting the notion that NP education is equivalent in any way to physician education, however, I know in some places NPs are treated with more respect, and support and provided with continuing education opportunities, and I am determined to either help facilitate some changes where I am currently employed, find a position I am happier with elsewhere, and possibly negotiate some changes either in a current workplace or a future one. I would love to hear others' positive thoughts or experiences on this subject.

CONGRATULATIONS!!!!!!! :)

At my shop, if it's an adult that doesn't do anything then they get nothing but Strattera or Wellbutrin. PsychGuy, can you please explain what you mean by this comment? Thanks, Julia

"We are nurses and we need to continue to define ourselves differently from physicians." I am curious as to why you feel this is imperative? I believe the NP is taking an educational and professional step into the role of diagnosing and prescribing, period, and it is incumbent that we are optimally, clinically prepared. I do not believe that rehashing cultural competency, cultural competency and nursing theory is in the best interests of patients, providers, or our profession. Yes, we need to be culturally competent and have some nursing theory -- however, I have not felt that any of the focus on this in graduate NP school has been of any benefit to me, whatsoever. Yes, I am thankful to have the opportunity to advance my career and to diagnose and prescribe, but the focus of these fluffy courses is truly akin to jumping through hoops in terms of usefulness, has and does DETRACT from the beneficial aspects of the M:NP program. Julia

Thanks, I read up on your posts, and was hoping you would help with some information! Julia

I am interested in learning about the tax and legal implications of a nurse practitioner, living in a Canadian province, licensed in the US, to start a travel NP corporation with the said NP working for the corporation. Has anyone done this who can provide information on this? Professional liability? Does one need to go through the provincial College of Nurses to start a corporation? Can one start a plain, non-nursing corporation? If one works on a cruise ship, where and how does one obtain professional liability from and what Board of Nursing is the proper regulatory body? If one lives in a province, does this mean that one's corporation would need to be in the province rather than another state? Any insight or advice would be appreciated. Thanks! Julia

I am interested in your post, but curious what this means: I staff solo fory region. Thanks, Julia

Good luck on your exams! Can I ask for input on the best value for dollar in terms of multiple choice question bank for clinicals, exam prep, identifying weak areas and preparing for MCQ tests and final licensing exam? APEA seems really expensive...I have the Fitzgerald and Leik books, and the Fitzgerald app ($35) -- but want something more to put on my phone with rationales and tracking. Thanks! Julia

I am wanting to buy some QBANK access for my phone but am trying to figure out what the best deal is, length of time, quality of questions and explanations, etc. I have another year left of NP school to go and ongoing clinical exams. Advice please? Julia

Did you buy the bundle or the assessment or management? The Qbank looks pretty pricey from $79 per month for the one component, $129 per month for both components, and up to $299 per 6 months with both components. Can you use them on your mobile phone? Do they need internet continually, or can one download and use for the specified amount of time? Thanks, Julia