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traumaRUs MSN, APRN, CNS

Nephrology, Cardiology, ER, ICU
Member Innovator Expert Nurse
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traumaRUs has 27 years experience as a MSN, APRN, CNS and specializes in Nephrology, Cardiology, ER, ICU.

I have a total of 27+ years of nursing experience; including 10 years as an RN in a level one trauma center ED. Now, I'm an experienced (13+ years) nephrology APRN. In my spare time, I volunteer on my rural fire department as a licensed Pre-Hospital RN. I'm also a proud USN veteran. 

traumaRUs's Latest Activity

  1. traumaRUs

    Orthopedic Nursing

    Orthopedic Nursing is rooted in Victorian England. As a 9-year-old child, the specialty's matriarch, Dame Agnes Hunt, was crippled from septic arthritis of the hip (osteomyelitis). She overcame obstacles to become a Nurse and devoted her entire nursing career to improving the lives of crippled children. Work Environment Hospital acute units Hospital surgery units Outpatient surgical centers Oncology units (in -/out-patient bone cancer treatment) Orthopedic private practices Trauma units Rehabilitation hospitals Easter Seals organization (congenital defects, pediatric trauma) Early intervention clinics Long-term acute care rehab hospitals Home care Duties and Responsibilities Caring for patients who have orthopedic injuries or who are having or have had orthopedic surgery surgical assistant set broken bones apply casts and/or splints In-patient rounds and documentation Patient/family education Coordinate plan of care Pain management Interaction with orthopedic healthcare colleagues physicians and surgeons case managers physical therapists social workers Pre -/Intra -/post-operative care preparing for an orthopedic surgical procedure patient recovery from orthopedic surgery Counsel patients contemplating joint replacement Facilitate acute care for critically ill patients with multi-organ trauma and/or multiple fractures/trauma Assist with rehab bedside care coordinate care of physical and occupational therapists as well as ancillary personnel Home care assess the environment provide advice for safe transferring, bathing, cooking, overall living Professional Orthopedic Nursing Organization The National Association of Orthopaedic Nursing (NAON) is a nonprofit, volunteer-run organization. They sponsor conferences and define standards of practice and research guidelines for Nurses. It is an accredited provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation (ANCC - COA). Education Graduate from an accredited school of nursing that offers a Registered Nurse (RN) or Licensed Practical/Vocational Nurse (LPN/LVN) program LPN/LVN: Certificate, Diploma, or Degree RN: Associate Degree in Nursing (ADN), Diploma in Nursing, Bachelor of Science in Nursing (BSN) - Advanced Practice Nurses (NP, CNS, etc.) have at least an MSN or higher degree Successfully pass the NCLEX-RN or NCLEX-PN examination Current, unencumbered RN or LPN/LVN license in the U.S. state of practice Certifications The Orthopaedic Nurses Certification Board (ONCB) offers the ONC® certification, the ONP-C® certification, and the ONC-A™ Advanced Certification (by portfolio) examinations. ONC® Exam Eligibility (not all-inclusive) Candidates for the ONC examination are not required to have a BSN 2 years of full-time experience practicing as an RN Minimum of 1,000 hours work experience as an RN in orthopedic nursing practice within the past three years Current, unencumbered RN license in the U.S. or its possessions, OR hold a current, full and unrestricted license to practice as a first-level, general nurse in the country in which the candidate’s general nursing education was completed, and have educational equivalency established by outlined agencies (see site) ONP-C® Exam Eligibility (not all-inclusive) 3 years of full-time RN or APRN experience Master of Science in Nursing (MSN), or higher, from an accredited APRN nursing program as a Nurse Practitioner (NP) - NOTE: Candidates must have earned graduate degrees in the U.S. Minimum 2,000 hours of APRN experience within the past 3 years and presently be functioning as an NP who cares for patients with musculoskeletal conditions Current, unencumbered license as an RN in the U.S. or its possessions OR hold a current, full and unrestricted license to practice as a first-level, general nurse in the country in which the candidate’s general nursing education was completed, and meet the eligibility criteria for licensure as an RN in the U.S. in accordance with requirements of outlined agencies (see site) ONC-A™ (by portfolio) Eligibility (not all-inclusive) 3 years (full-time) RN experience Master of Science in Nursing (MSN), or higher, OR related discipline with direct involvement in musculoskeletal health (not available to Nurse Practitioners) Candidates whose graduate degrees were earned abroad are not eligible to apply for this certification Minimum 2500 hours work experience in musculoskeletal health since completing the graduate degree OR within the last 3 years if degree completion was more than 3 years ago Current, unencumbered RN license in the U.S. or its possessions Salary (2020) According to ZipRecruiter, the average annual salary for an Orthopedic RN in the U.S. is $96,259 a year with annual salaries as high as $144,000. The majority of Orthopedic RN salaries currently range between $69,500 to $120,500 across the U.S. According to salary.com, the average Orthopedic NP salary in the U.S. is $113,300 with the range falling between $105,800 and $120,500. Job Outlook Orthopedic nurses can fulfill many nursing roles in many varied environments. As healthcare continues to evolve, it will be very important for the Orthopedic Nurse to take advantage of continuing education (CE/CEU) opportunities as well as experience in a variety of orthopedic specialties. Choosing a Specialty but not sure which one is best for you? Download Nursing Specialties Guide!
  2. traumaRUs

    Endocrinology Nursing

    The Endocrinology Nurse (a sub-specialty of nursing) specializes in the care of patients who have endocrine disorders such as Diabetes Mellitus, Pituitary disorders, and Cushing's disease; working across the span of age groups. Endocrine Disorders (not all-inclusive) pediatric growth hormone deficits adrenal insufficiency thyroid abnormalities pituitary tumors thyroid abnormalities Work Environment Pediatric Endocrine Clinic Clients that have genetic disorders might start out in a peds specialty clinic. There, nurses will care for and educate patients and parents. Some of the diagnoses nurses include: growth hormone deficits childhood obesity osteogenesis imperfecta congenital adrenal hyperplasia precocious puberty diabetes Adult Endocrinology Clinic low testosterone diabetes hyper- or hypothyroidism adrenal insufficiency osteoporosis postmenopausal hormone replacement other bone and metabolic disorders Hospital In-patient Unit This will be for either adult or pediatrics. It is more common to have these patients on a medical-surgical or general medical floor. Ambulatory Clinic Work in research in the area of endocrinology continues to become more popular. In this job, the nurse might work in an office setting assembling and/or collecting data. Pharmaceutical Company These companies typically hire endocrinology nurses for specialized sales positions. Qualities of Endocrine Nurses Thirst for Knowledge Many endocrine disorders might be rare or not seen often, especially for nurses who work in more rural environments. These nurses might be left to their own devices to learn about these disorders. Some resources are found at the end of this article. Some of the more rare disorders might require a lit or internet search or perhaps networking with a colleague at a specialty research facility. Patient/Family Education Ability to convey complex educational concepts to patients and/or families on their learning level. As above, many of these disorders are fairly rare and many are very complex so it's important that the nurse is able to talk with patients and families of many backgrounds and intellects. Compassionate Many of these patients can feel isolated or alone. As an endocrinology nurse, you must be able to reassure the patient that a normal or near-normal lifestyle is possible either with or without modifications. Flexible Patients diagnosed with endocrine disorders can have the disorder as a co-morbid condition. This can result in highly-prioritized nursing care. Education / Licensure Graduate of an accredited nursing program ADN- or BSN-prepared education Current, unencumbered RN license in the state of practice Certification Currently, there is no specific certification for RNs or NPs that combines pediatrics and endocrinology. There are individual specialty options available such as becoming a Certified Diabetic Educator. Salary (2020) According to ZipRecruiter, the average salary for an Endocrinology Nurse in the U.S. is $99,371/year. Annual salaries are as high as $149,500 and as low as $23,000; the majority of salaries currently are between $89,000 (25th percentile) to $109,500 (75th percentile) across the U.S. Choosing a Specialty but not sure which one is best for you? Download Nursing Specialties Guide!
  3. The Certified Registered Nurse Anesthetist (CRNA) is an Advanced Practice Registered Nurse (APRN) who provides anesthesia to a wide variety of patients; from neonates to the geriatric population. Work Environment Most of the workday, CRNAs are in the operating room (OR) providing anesthesia to patients. There is a wide variety of OR settings. A CRNA can be in a level one trauma center with multiple ORs going many hours of the day. Or, a CRNA can be in a more rural environment where they might be the only anesthesia provider. Or, they could be active duty military deployed to some remote post providing emergent anesthesia in a war zone. Some other CRNAs work in research, pain management, office settings, and politics. With the advent of managed care on the horizon, opportunities are wide open for CRNAs to lobby on Capitol Hill. Other CRNAs teach and mentor. There are many opportunities for CRNAs. Some of the Steps Involved in Anesthesia Preoperative assessment which includes airway, need for consults/clearance from specialists, thoughts as to need for invasive monitoring Sedation, induction, advanced airway placement Maintenance of anesthesia to ensure patient safety Rapid Sequence Intubation (RSI) Extubation Postoperative visits to patients and families Qualifications CRNA school admission is very competitive. For most schools, a registered nurse will need at least one year (2 years preferred) of Intensive Care Unit (ICU) experience, along with solid letters of recommendation and an interview. Other qualifications might include specialty certifications such as Critical Care Registered Nurse (CCRN). Each school has its own nuances that go into the selection of CRNA candidates. Qualities All nurses need to be compassionate and caring. CRNAs need additional qualities (not all-inclusive): Affinity for "hard sciences" such as bio-Chemistry, physics, advanced pathophysiology and advanced cellular biology. (Each school has its own particular curriculum - this is just a general list). Confidence in their own ability to provide safe and cost-effective anesthesia. Ability to work with many different types of people, including attending physicians, nurses, techs and patients and families Must be able to explain complex medical concepts to patients and families in a way that they understand Professional Organizations The American Association of Nurse Anesthetists is the organization that represents CRNAs. This organization lobbies for CRNA specific legislation and develops policy, practice standards and guidelines. Education (not all-inclusive) Graduate from accredited Registered Nurse (RN) nursing program Successfully pass the NCLEX-RN Unencumbered, current RN license in U.S. state of practice Master's degree and more frequently, the Doctor of Nurse Anesthesia Practice (DNAP) or the Doctor of Nursing Practice (DNP). Certification As with other APRNs, the CRNA must successfully pass a certification test in order to use the title CRNA. The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is nationally recognized by the U.S. Department of Education (USDE) and the Council for Higher Education Accreditation (CHEA) as an accrediting agency for the “accreditation of institutions and programs of nurse anesthesia at the post-master’s certificate, master’s, or doctoral degree levels in the United States, and its territories, including programs offering distance education.” Graduates of a COA-accredited and approved school of anesthesia are eligible to sit for their National Certification Examination (NCE) through The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). Here is a list (2020) of the COA-accredited/recognized Nurse Anesthesia programs. Salaries (2020) A CRNA can expect a starting salary in the 6 figures. Payscale The average salary for a CRNA is $152,222. salary.com The average CRNA salary in the U.S. is $130,527 and ranges upwards of $234,778. ZipRecruiter Average CRNA Salary by State. Kathleen Piotrowski, DNP, CRNA, a nurse anesthesia specialty director and coordinator at the University of Arizona College of Nursing, describes what it's like to be a Certified Registered Nurse Anesthetist (CRNA).
  4. Hello traumaRUs! I want to thank you for your post and replies on NPs and nephrology. I really find them helpful and helped me decide on what specialty will I want to be in. I am a hemodialysis RN and will be finishing FNP school this month. The clinic that I'm trying to apply has 3 PAs, no NP. I am worried that they will not consider me because they don't have experience with an NP. In this case, I want to ask you how is your scope/billing in a dialysis center. I did some research about direct pay, incident to and split/shared but I want to hear from an nephrology NP themselves. Compared to PAs, we have a written agreement/Collaborative agreement with a physician, Do you round and see/bill a patient in dialysis without the physician or will there be a certain time that the physician is with you?

    Lastly, I noticed that the salary of nephrology NP is at the lower end, do you estimate your reimbursement so you can negotiate for annual salary? or you get reimbursed after you see your patients?


    All the best! - brooklynNP

    1. NRSKarenRN

      NRSKarenRN, BSN, RN

      Hello, Brooklyn03. 

      traumaRUs has been a great resource to AN members regarding Nephrology.  However, she's not been active on the site in 2020.

    2. brooklyn03

      brooklyn03, BSN, RN

      Thank you for your reply. I hope she's okay.

  5. Hi TraumaRUs! I have been reading a lot of your posts today, and you seem to be so knowledgeable in your field. I have accepted a position as a nephrology NP. I recently graduated in December, so this will be my first job as an NP. Could you please recommend an informative nephrology book to purchase and study before starting this job? I have downloaded all of the links you have posted, but would also like to have more of a comprehensive resource. If you know of any it would be greatly appreciated! 

  6. traumaRUs

    Camp Nursing

    Overview Camp Nursing sounds like an exciting and carefree way to spend the Summer! Camp nurses are responsible for the healthcare of children and teens while at camp, sometimes for days, weeks, or even months. Many children with chronic illnesses attend camps, sometimes specialized camps but often they are mainstreamed into regular camping sessions. Camp nurses interact on a daily basis with many non-healthcare providers. It is important to be able to easily get along with various members of the camp team. The campers are the customer, too, so keeping things fun and exciting for them is also something to consider. Benefits Often, salary is only part of the compensation package. One of the perks can be the ability to receive free tuition for the nurse's child to attend camp. There is also flexibility, travel, and enjoyment of the outdoors. Qualities Flexibility This is probably one of the top-rated qualities. Camp nurses must be flexible to handle a variety of campers, staff members, and parents. Ability to Multi-task Camp nurses are responsible for many campers who can become potential patients at a moment's notice. Many times, transferring ill and/or injured campers may take an extended amount of time in that the campsite may not be located near a health-care facility (hospital). Experienced Again, this is another important quality. Often Camp nurses are assessing and making decisions very quickly. Acute care experience with pediatric or adolescent patients can be invaluable. Psychiatric/Mental Health experience can be useful, too, as the Camp Nurse will be dealing with new campers who might be lonely or anxious. Roles / Duties Administrative duties: complete insurance forms pre-camp health assessments check medical supplies, re-order, check expiration dates disaster planning Communicable disease reporting as often occurs when in communal living situations, disease outbreaks can occur Assume risk management: liability concerns when caring for children with absent parents it is important to have individual liability insurance Sole healthcare provider on-site: What is the back-up plan? If more than one provider, how is on-call handled? Sick call responsibilities: Are protocols in place? Is off-site healthcare readily available? Medication administration: Are orders only received from licensed providers? Are parents writing out instructions? Communication with parents: Who makes the decision to call parents? Does it have to go through the camp administrator? Health appraisals: Who determines if an activity is safe for an individual camper? If a camper is involved in high adventure activities, are specific permissions obtained? CPR certified Wilderness/remote first aid training First Aid training Education Graduate from an accredited Licensed Practical/Vocational Nurse (LPN/LVN) or Registered Nurse (RN) nursing program LPN/LVN: certificate, diploma, degree RN: diploma, ADN, BSN, or higher degree Successfully pass the NCLEX-PN or NCLEX-RN Current, unencumbered LPN/LVN or RN license in U.S. state of practice Professional Organizations The American Camp Association (ACA) is, "a community of camp professionals who, for over 100 years, have joined together to share our knowledge and experience and to ensure the quality of camp programs". The Association of Camp Nursing (ACN) is, "a professional nursing organization working towards healthier camp communities by supporting the practice of camp nursing". Certifications American Red Cross 1 - American Red Cross: Wilderness and Remote First Aid Course This is very important for nurses who will be at a camp in remote areas. The course, "aligns with OSHA’s Best Practices for Workplace First Aid Training Programs". 2 - American Red Cross: Lifeguard Training It is also important to seek education in specialized water or watercraft activities. Many nurses have training as LifeGuards. This is very important for nurses who will be at a camp where there are water activities. 3 - American Red Cross: CPR Training In-person or blended learning CPR training. American Heart Association (AHA) American Heart Association (AHA): CPR and First Aid These courses provide the cognitive information needed for first aid, CPR, and AED training. Job Outlook This is usually a seasonal job and most often during the Summer months when individuals are on break from school. That said, camp tuition can best be described as economy-driven. For most families, camp tuition is a luxury item versus a must-have. So, in times of a strong economy, it is reasonable to assume there will be more campers while in tight times, fewer families have the needed extra money. Salary (2020) According to ZipRecruiter, the annual salary is $74,500 and ranges between $37,500 and $53,000 depending on experience and location.
  7. traumaRUs

    What's the least saturated specialty in APRN?

    Hmm...do you mean FNP, ACNP or do you mean pediatrics, family practice, dermatology? Can you clarify a bit?
  8. traumaRUs

    NP vs FNP

    Moved to advanced practice forum
  9. traumaRUs

    Why Nurses Should Join the Gig Economy Right Now

    You should make your time count. Totally agree. However the reality of life is that most of will work a long time. Why not do something you enjoy? With decreasing pensions and 401k’s and the fact that you do t want to outlive your retirement options are always a good idea to consider. that’s all this is - an option
  10. traumaRUs

    Happy Veterans Day 2019

    I just wanted to wish all my fellow military veterans a wonderful, peaceful day. This is a day to honor all veterans and active-duty military. Many businesses honor us with discounts today. However, more importantly, is our country recognizing our commitment and sacrifices. So many veterans have returned from military service disabled either physically or mentally. allnurses.com salutes our veterans! Veteran's Discounts Thank you for your service to our great country!
  11. traumaRUs

    Most important thing to look for in training/school

    Moved to SRNA forum
  12. traumaRUs

    RN. BSN

    We are going to need some more info - what kind of experience do you currently have? You need to choose a specialty in order to decide on NP track?? FNP, ANP, ACNP??? Moved to student NP
  13. traumaRUs

    What should I do?

    Moved to student NP forum - congrats
  14. traumaRUs

    To retake chemistry for CRNA school?

    Moved to SRNA forum.
  15. traumaRUs

    RN --> CRNA or Law School?

    IMHO life is too short to do something you aren't passionate about. What do you LIKE to do? Have you shadowed or talked with any RN, JDs? That might be a starting point.
  16. traumaRUs

    Post-interview update

    Great - first hurdle done. I would be leery of the Friday call - sounds like it could really eat into your weekend unless there is a "night call" MD. In our practice our "call" ends at 5pm when the "night call" MD comes on.