WrekDiver88

I have been working in critical care for six years, but am considering getting my PMHNP, and wondering what the best psych experience would be before applying to school? I got my first BS in psychology before going to nursing school, so it has always been an area of interest for me. I would most likely plan on working outpatient, or possibly some inpatient consults after school (I am sure this could change as I find an environment/niche I really enjoy). Would working inpatient or clinic be the best place to start for useful experience?

It might... I was actually in the same situation as you in that I wanted to go backpacking for >6 after I graduated. I ended up deciding to get my first job, worked a little over a year, then took the 6 months off to go backpacking. As the previous poster said, many hospitals will not even consider a new grad that graduated over six months ago, and after a year it will be near impossible. The other problem that you will run into, is most larger hospitals plan their new grad positions/residencies around the graduation dates, and if you miss this window it will make it more difficult. You might have a bit more flexibility in some community hospitals, or states with a larger shortage, but big academic hospitals are the best experience/teaching for new grads, and look the best on a resume. After you have a year of solid experience you should be fine taking off for some extended travel. I have a little over 2.5 years experience now, and I am getting ready to do another trip in July for 8-12 months. Just get that first year of solid experience, and then travel all you want. Plus you will have more money for a longer trip, or the option to do travel nursing if you want then also. Or, if you really want to travel now, make your priority passing the NCLEX and finding a job, then see if you can set a start date that will allow you a month or two off to travel before the start of your new job.

I do not know how the process works for getting a license as a Non-U.S. citizen, but for an American, once you are licensed in one state, it is easy to endorse to another. You would however have to pay the state you are endorsing to (Hawaii) for the license, so if money is your primary concern, try to get the license where you will be working. Once you are working here, $350 will be affordable though, as you will make that in a single shift. And, you are required to do continuing education to be able to renew your license, but you will not have to worry about that until a few years after you get your additional license. The states I have endorsed to have not required continuing eduction to endorse. Your employer will likely have classes you can take to meet that requirement, or you can do them online when that time comes.

It will depend on the type of MSN degree you get. An advanced practice program such as an NP, CRNA, or CNS from outside the U.S. will very likely not be recognized; while a general, education, or administration MSN degree does not grant an additional license beyond the BSN (RN) you have already obtained, so the board of nursing would not be concerned with it, the same as if you had done an MBA, or MPH for instance. The biggest problem you could potentially run into is U.S. schools' may not recognize it if you want to continue your education here. Employers may also have varying views of it as well, but I would guess most would recognize it, if for say you wanted to work in management that required an MSN, or it qualified you for a higher pay. It would be a safer bet to do your MSN in the U.S., but an MSN here will cost $10,000 - $60,000 per year vs. $200 - $1000 there.

Yes, I got an A in Chem and A & P so it mainly just the Pharm grade I am worried about. I honestly can't see how a C in Pharm could not be an issue, so I will definitely be retaking a class to replace it in the Spring. Thanks for the advice!

I just talked to someone a few nights ago who used to work on our unit, and who just finished CRNA school; they said the same thing. He thought better use of the time would be to work the overtime, and to join a practice council or committee at work (his school really like to see involvement). Thanks for the advice, and good luck with your applications!

Right now I have almost a year in the MICU, and 9 months in a Neuro Stepdown, all at a level I, university hospital. I probably won't apply for CRNA school for a few years, but am considering taking some graduate classes (or a graduate certificate) to make myself more competitive. I know some graduate level pharm and patho/physiology classes can only help, but I would rather continue working overtime instead of focusing on school, unless I need them to strengthen my application (at least to get into a somewhat competitive school, I would rather not live in North Dakota or something for 3 years). By the time I apply I will have at least 2 years ICU, and possibly 3 by the time I start. I actually have 2 degrees, the first a BS in Social Science, with a minor in Psych, and for nursing I did an accelerated BSN. My main concern is I got a couple of C grades in my BSN program, including a C in Pharm. Will the BSN GPA and the fact I got a C in Pharm be as big of a deal as I am worried about? What do you guys think? Overall GPA - 3.43 BSN GPA - 3.18 (w/ a couple of C's including Pharm) Science GPA - 3.91 First BS Degree - 3.56 Cum / 3.96 Upper Division (old classes brought down the overall) GRE - Not Taken Yet Certs - CCRN, TCAR, ACLS, etc.

I voted for UNMC in Omaha. I actually went to Creighton, but thought it was a horrible program, and no way I would even consider CU if I had to do it over again! Talking to other nurses students/nurses I met around the Old Market or in clinicals, I heard nothing but good things about UNMC however.

Your SICU takes adults, peds, and neonates? That is the first I have heard of anything like this; does your hospital not have a PICU? This is extremely uncommon, especially for a combined CCU since it is very rare for a child to have an MI, CHF, etc. And the medications/dosing/interventions/as well as physicians are so vastly different between the populations. Do you mind if I ask what hospital you work at?

Like Meanmaryjean said, you could get both certifications, but there isn't much point to it. The CCRN is not required to work as a nurse, it is just a test you can take to get a certification showing you have advanced knowledge in critical care (you can apply to take it after working as a nurse for about one year). And as far as ICU's go, there is the NICU (newborns), PICU (pediatrics), and a plethora of adult ICU's such as burn, trauma, cardiac, surgical, neuro, and medical. But, working critical care, you would never work with both adults and peds at the same time. The only exceptions I can think of would be if you worked in a very small rural hospital where the nurses were a catch all, the Emergency Department, or Post-Op. If you want to become a nurse, do it! Don't let you family talk you out of it. My family was also not supportive of me going to college, so I ended up getting a job as a plumber (student loans were not really available back then), and went back to school later in life. I can honestly say it was one of the best decisions I have ever made, and I love my job. With student loans automatic now, you will be able to do it without their help, though if they did help, or you lived at home while in school, it would make it easier. As far as what area to work in, I would just focus on getting through college for now, there is plenty of time to decide on a specialty later. During school you will do rotations through the various areas such as OB, Psych, Community Health, Peds, Critical Care, etc. which will give you a chance to see what you like. You can always change specialties also, so there is no reason you could not work both peds and adults at different points during your career if you wanted to.

No, if taken out of a 401k, it would be a low interest loan to yourself, that would need to be paid back to the 401k (within 5 years I believe). If taken out of traditional IRA, it is a penalty free withdrawal that does not ever need to be paid back, as long as you use it for qualified educational expenses (up to the COA per year). You only need to pay the income tax on the money (it was tax deferred when you put the money in the account), but if you are in school full time with no income, the tax credits for being in school should cover the tax owed on the withdrawal making it a tax (assuming you don't take a very large amount out in one year) and penalty free withdrawal you do not need to pay back. If you have a 401k at your current employer, you can usually roll it into a traditional IRA when you leave that job, which would allow you to use this tax advantage. I would call the advisor for any 401k(s) you have and ask about your options for a rollover.

I funded part of my ABSN with my IRA, and am planning on doing the same with grad school. I think with a 401k you can loan yourself the money, but it has to be paid back within 5 years or something to avoid the 10% early withdrawal penalty (at least that is the way it used to be I am pretty sure). With an IRA on the other hand, you can take the money out penalty free up to the COA of the school, as well as for some other uses such as 10k towards a first time home purchase. If eligible, what you can do is roll your 401k into an IRA (I did this with my 403b when I left my last job), then the money would be useable for school. Also, if you plan ahead, put extra money into an account you can roll into an IRA; an IRA itself has somewhat low caps per year, usually 5k at the max unless you are older, but based on income the tax deferred amount scales down, is why I am suggesting using an employer option, then rolling over when leaving. The biggest advantage to this (besides loan interest), is that you get the write off now, while you have income, lowering your taxes, and putting the money into the account tax free, then withdrawing it while you are in school with no income, and student credits, which will usually allowing a tax/penalty free withdrawal. Who doesn't like tax free money!

The most I have had was nine drips, plus the intermittent bags like antibiotics, albumin, boluses, K+, etc. Neo, Levo, Vaso, Hpp, Insulin, Fentanyl, Versed, Fluids, and a cardiac med (don't remember which one). Plus he had a temp pacer, IABP, and eventually CRRT. He coded twice the morning of the second day, and because of the IABP/CRRT and how unstable he was a 2:1 for awhile. Unfortunately he didn't make it. The most drips I have heard about was 15, it was a coworker who had the patient.

What Yammar said is all basically true. Some other things to consider is what you want to be doing at work. In the SICU you will get more invasive monitoring experience (art lines, CVP, possibly ICP, etc., though you will also get some of this in the in MICU), and in the MICU you will get more dialysis (HD and CRRT), and procedural experience (bronchoscopy, GI Scopes, Colonoscopy, etc.). You will also have to deal with quite a bit more death in the MICU, and possibly more codes. If you have future plans for moving into flight or CRNA school the SICU is probably a better choice because it relates more, otherwise just go with what appeals more to you. Also after a year in one unit, it should be fairly easy to apply you experience and transfer into a different ICU role pretty smoothly if you want to.

Which population do you have more of an interest in working with? I am in the critical care float pool where I work, and our SICU is a combined surgical, neuro, and trauma ICU. It is a great unit, and initially where I wanted to work, but I actually like the MICU more (something I would not have guessed before working there). Medical patients can be very complex, and very sick. A patient in septic shock will typically develop multi system organ failure, and the crashing pre-transplant patient will be in the MICU before transplant, and in the SICU after (unless it's cardiac). However many people don't like the MICU for some reasons I understand. Surgical patients have a somewhat expected course of care and recovery (which can be fast sometimes), and with medical patients you will see a lot of unusual things, and a lot of unknowns. In a large tertiary hospital you will learn a ton, and will deal with plenty of drips and intubated patients in either unit. I guess it depends on if you prefer medical or surgical patients.