mrsmsh42

Great advice, Nurse Beth. I've been a nurse for 10 years, and I'm a second career RN, too. I was a computer geek prior, and there were things in nursing that were hard for me to adjust to. In some ways, I cast another vote to try to stick it out for that first year, because that new grad year is pretty important. However, my best friend came to nursing six years after I'd started (also second career), and I was really worried about her mental health just getting through boards. She's insanely smart, and she would have panic attacks walking into the hospital. She found her place beautifully, however, being a home care RN. She loves it. Her patients love her. She's perfect for it and it is perfect for her. At no point in time during her nursing school experience did she learn about home care RNs and the important work they do. Fortunately, I did...and not only did I do a brief turn in home care (which I liked), I was able to nudge her to look into it. I did my turn on the floors, in ICU, as a dialysis acute care nurse (do not go there), and now I'm charge RN in a multispecialty medicine clinic. It's a different stress. Nobody dies on my any given Tuesday anymore. I loved the ICU, and I love the clinic now because it fits my life. Four 10s, no weekends, no holidays. I do have to respectfully disagree with feelix on the "inability to get those jobs." I have a heavy influence in who we hire in my clinic, and I have two RN openings. Would I look at an RN with six months on the floor and prior life experience? Hell, yes. RESOUNDING hell yes. The worst fit in my clinic was a flight nurse with 26 years experience....fantastic nurse....difficult adjustment to the different needs. I wouldn't expect a nurse with 6 months experience to triage a call from a complex patient the same way I will. My docs give me a lot of autonomy. But if a your previous life experience taught you to ask a lot of thoughtful questions, investigate solutions and think critically....and your heart is in the right place to help the patient get the best care possible....you would be a valuable member of my team. My team consists of experienced nurses, receptionists, business people, medical assistants with no bachelor's degree and no prior medical experience before starting in my clinic. Take heart. There is an entire world of nursing, and I don't know why we always insist that it has to start on "the floor." Good luck Michelle, RN

(Come to think of it, don't remember a lot about the CCRN, either. Less like a grand mal seizure, more like an absence seizure, that one.)

p.s. That was 2006, in case you're curious. I'm an RN, BSN, CCRN now and a charge nurse in a multispecialty medicine clinic.

No. I think of that entire year of my life (I did an accelerated program) as one long, big grand mal seizure. I know it happened. I know I divorced that year, too. I have papers to prove it, and have faint blurry images of question number #88 and # 151 of the NCLEX, and the panic attack in the bathroom after question #151. (The only person in my class of 88 nurses to get every. single. question.) But it's mostly like a blackout. And this long post-ictal state afterward. It's okay. Yes, it's worth it. I'm glad I did it. I'm equally glad that my only memory of it is a jumble of faint, blurry images. I don't try to hard to remember it. Doesn't help me.

Depending on how long ago you did your other bachelor's, some of those credits may transfer into a BSN program (mine did). It may be worth your while to do a few other classes to dramatically widen your choices of master's programs. Just a thought.

p.s. And it's a whole new ball of wax if you do procedures in your clinic. Any procedures. I work four days a week, and I work with another RN who works four days, too (Mondays she's without me; Fridays I'm without her.) We don't do many other procedures than burn care, but when the occasional thoracentesis comes up, I'm present for it. I have strict rules about me doing the wound vacs. My providers know to find me, and if it's Monday, to find the other RN. I'm never too busy to come "assist" my MAs for an EKG. The MAs don't touch foley catheters or central lines; I do it, and I make sure that I'm never "too busy" for those things. They come get me when we have patients coming from the prison, with police escort. They come get me when a patient reports being suicidal. I'm present for the 911 calls, the low blood sugars, the chest painers that get walked by an RN over to the ER. When pulmonary lab has a patient seize, there is an RN present. And there should be...and we actually have policies (or at least norms; we're building policies still) for all of that. We know who does what. Depending on what your clinic does, you should protect yourself and your MA colleagues with policies for all that stuff. To protect you and them.

I'm the Charge RN at my clinic, which is part of a large university system. That being said, there was a big gap in time with no nurses in clinic, and the charge nurse before me was present for only seven months. Basics that we are building: RN role descriptions and MA role descriptions, based on scope of practice in your state. Do you do wound care in your clinic? Who can do it? Who can pass meds and apply topicals? Who can triage patient calls? Who places orders? Who counts your Pyxis? I do weekly Pyxis counts, monthly pharmacy inspections for outdated meds. Yearly competencies on things like EKGs, new equipment, new policies. Refreshers on giving IM and SQ meds (and can your MAs give those meds...some clinics maybe yes, some no) Be very careful to find out WHO is ultimately responsible for your MAs, and how delegation works in your state/clinic. Even though I work in a state that allows physicians to delegate things to a medical assistant that no licensed CNA would dream of being able to do....as an employee of the university system I"m in, my MAs fall under my license. They know it, too, and my MAs are fabulous...they come and find me if they are asked to do something they're not sure if they "can" do. You need that delegation/accountability protocol, first and foremost. That's my suggestion.

I'm curious (and others among this audience may also be) as to why you'd choose the NP path, as opposed to social work counseling or another equally compatible path towards working in mental health. One of my providers is a psychiatric CNS with prescriptive authority (she has been grandfathered in...she's been doing this role for a long time.) There are many paths to doing clinical counseling work. A nurse, to probably a huge number of this audience's readers, is a very special and specific type of role. All of my NP providers were a nurse first, and then a provider. Each of them carries that "nurse first" sensibility to their patient care. It's different than what my MDs and DOs bring. Some of us (I'm among them) believe that skipping that nurse step to go straight to the advanced practice nurse role leaves a lot of "nurse" out of it. Whereas, going straight to an MSW, for example, feels like a different thing to a lot of us. I work with some fabulous social workers, caring clinical people whose work I highly respect. Do you want to be a nurse? Is that part of your dream job? Or does your dream job mean providing community mental health work/counseling? Those two things may be different. Is it prescriptive authority you want? That may be less exciting or appealing than you think it might be. I only ask because if you want to go to nurse practitioner school....you should want to also be a nurse. And I'm not sure that most straight-to-NP students are clear on that. For what it's worth, I'm a BSN. I am the charge nurse of my clinic, and I thought that the sane work schedule would give me time/breath so that I could do my master's. Now that I've worked with my NPs/CNSs, I've learned that it's in many ways, a totally different job. They are at heart, all nurses. But they're nurses tied to a pager, to long days, to liability insurance (again, be very clear if you want prescriptive authority) and more tied to a schedule than I am, and just more....tied ....all the way around than I may be comfortable with. We welcome more nurses. Please, come join us. Just consider whether you whether want to be a NURSE practitioner, or a practitioner. There's a lot of choices.

What a small world. I'm at the UCH pulmonology (and other specialties) clinic. I've been in my clinic for a year, after seven years of inpatient, mostly critical care...both days and nights. I re-upped my ACLS last year because "I didn't want to lose skills." Next time around, I don't think I'll bother. I'm changing skills. Sure, it's fun to analyze a 12 lead when I need to. But I love what I'm building. No nights, no holidays, no weekends. Say it again after me: no nights, no holidays, no weekends. Good luck. You and I may cross paths sometime.

Oh! In that case, I typically have four to seven providers per day. I misunderstood. :)

I know this is an older post, but I'm flabberghasted. I have FIFTY-TWO providers. I have TWO medical assistants and THREE nurses. We do fine. I don't know how your docs are affording eleven nurses. Sounds like a toxic environment to me. Come work for us. We're busy. (And our docs do not expect our staff to write their notes for them....how ridiculous and entitled of your providers....)

I know this conversation happened in June. It just caught my attention is all..."three providers to one nurse...can this be safe?" I have fifty-two providers. And they're grown ups. And I'm very busy, but sounds like your providers need some training.

WOW!, thank you for this, colleagues. I'm a clinic RN, and people don't know what I do, either. But it was really incredibly interesting to hear all of what you do. I am impressed and I salute you. Makes me think that I should write a post "What Clinic Nurses Do: Not Just Filing Our Nails in the Back Office to Ease Our Bon-Bon Feast" ? Really interesting thread.

I'm not sure what you mean by "floor nurse"....are you referring to Medical-Surgical Nursing? That *is* a specialty. It is a different specialty than ICU or OR or ER or peds or outpatient or ...etc etc etc. You can look into: https://www.amsn.org/

ICU nurses are frequently a tough-skinned crowd. ER nurses, too. You need a thick skin because you're surrounded by death and dying every single day. Med-surg just isn't like it. And when you as an RN are feeling that your patient is circling the drain, you need someone to pay attention to it NOW. I don't yell. A crisis actually makes me calmer. It makes me no less assertive. I had two nurses stare blankly at me one day, because I calmly said to them, "Could one of you get the crash cart, please?" When they didn't move, I said a little louder, "NOW, please." ...They literally shook their heads like in a cartoon. It didn't register at first because I said it calmly and I used 'please." That's how I am. I'm at a teaching hospital now, and working in a clinic. Residents do the first assessments on burns some days. I've been there six weeks in clinic, but I have a lot of experience before that. The residents will be talking to the patient, and the MDs still look at me when they say, "This looks like a third degree burn with some cellulitis..." They're looking for a slight nod of my head to agree with them. And when the residents don't know which wound care is appropriate, they'll say something like, "And I'll let (me) do the wound care for you." And I dress it, and teach the patient (and resident)...who usually observes, and needs only to see it once. Then the next visit, they take over. That's what you'll be able to do with time. In the ICU, it means during a code, you might toss out a suggestion for lidocaine....or it means that for a crazy patient, you say, "Doctor, would you like to start precedex now?" or "Have you thought about dopamine?" (when you have the bag already in your hand, and spiked...) ...instead of "Doctor, what do I do?' It takes time. The next time you're at a code, get into the middle of it. Don't watch on the sides. At the codes at my last ICU, anyone who said, "I haven't done compressions in awhile" got to jump on the chest. Don't ask if you can drop drugs...know your ACLS, and get the next bristojet ready to drop and nudge your way over to the iv access. You'll get there.