PiperLambie

I applied AGACNP with three years ED/CVICU experience, and was not offered admission. Congratulations to those who will start the next phase of their education this fall.

Nashville local here also waiting for some news. Could be a little later than today- we had rapid Winter weather come through overnight and jam up the roads, so unless the sender of decision emails is working remotely it's tough to know if they were able to make it into work or not today.

I'm guessing that "immediately call ED to floor report and let transport take them" is not what we're going for in this thread??

ED nurse here. Easiest report I've ever given was just the other day: Had a patient with TONS of stuff to be done after hospitalist finally got to my patient after about five hours of waiting. As I watched the admission orders roll in at 18:20- MRI with, additional serial blood work, 5000 home meds to be reconciled, VTE prophylaxis, needs a full brief change, etc. I strongly consider treating my computer like its the copier from Office Space, while muttering like I'm Joe Pesci's double in Home Alone. About 18:30 dialysis sudenly rolls in and takes him away "It's cool, we'll change him during dialysis". Welp. Glad I didn't take out my computer terminal... 18:35 bed drops. Damn, this nurse isn't gonna answer the phone for me, but she does. I report to her like it's the 90's and I've gotta call home collect for a ride because I don't have a quarter: "I know you're prepping for shift change, but this guy just went to dialysis and all charting is up to speed, He's stable, just needs an MRI form as dialysis is changing into a gown and pharmacy interns will get the med rec, I'll make notes for your relief to see about 21:30 when he gets to your unit, have a good night!"

I started in an ED with no prior intern/externships or medical experience, straight out of nursing school. The division of the company I work for has fully transitioned to the nurse residency model for new grads. I know there are some mixed reviews in general amongst my peers regarding residency, but I cannot recommend it enough. In my case, orientation was 13 weeks (as opposed to the 5-6 for an "experienced" nurse- even one with only six months before transferring to the ED). During this period there were days spent on the unit with my preceptor, as well as in-person and online didactics to supplement things. It was also a great time for the unit to get my ACLS and PALS taken care of with all the additional education time available. As far as type of facility, if trauma is your thing then apply to the trauma center, but throw some eggs into other baskets as well, just to maximize your opportunities. Again, all places are different, but as has already been mentioned above, commute, ability to pay expenses, work environment, and personal goals are some of the many variables that only you can know for yourself when figuring where to start. Emergency nursing has been wonderful to me, and has helped me to know the next steps I want to take professionally due to the nature of being exposed to so many different sicknesses in so many different presentations. Best of luck in your endeavors to enter the ED after graduation!

...to the people that do med/surg nursing. Seriously. We were boarding the other day and my assignment included three admit holds and one room that was going to be "LA" (yeah, like it ever stays LA). All I can say is that I will always hold med/surg nurses in high esteem, as I never want that as a full-time gig. By the time I finished passing 0900 meds around 1230 (there were about 90 between three people), I felt defeated, and it was only three patients. Eventually they went upstairs and I was able to get back into my ED frame of mind, but man, that just sucked! Reason #237 I'm glad to be an ED nurse!

Most nursing programs, following pre-reqs, will require you to take some terminology, where you will learn that there is no pseudo to his terminology. I think it was in the didactic part of my skills course that we had a separate terminology exam each week for the first month (in a class that was only seven weeks long) in which we had to write down the meanings of roots and combine terms, etc. I totally understand your point about not using medical jargon, or what I like to call 'nursey words', when talking to patients, but depending where you work (I'm in the ED), it's almost necessary just to read and understand the radiology/imaging reports that we follow up on- radiologists ONLY write reports in medical jargon. Not to mention, when you have to give report, and hopefully you review the patient's record to include physician progress notes, you'll have to be able to decipher that cholecystectomy is the same thing as gall bladder removal, or that hyperkalemia is the same thing as high blood serum potassium, in order to be properly informed. You seem to be taking it in stride, but never be afraid to ask questions- most physicians I have met that are around education at all do it because they enjoy teaching students, no matter how gruff they might seem on the exterior.

So I had to take Patho online (I was on a satellite campus that had not yet hired an on-site instructor), and the instructor had her doctorate in clinical pathobiology- she also asked the tough questions. For gross anatomy, I had a retired veterinarian, who also was the head of our cadaver program for the school. While he was pretty easy going, that didn't stop him from asking the tough questions, since a kidney is a kidney with mammals. Consider this: a veterinarian is an GP, surgeon, intensivist, orthopedic, and palliative expert all in one. He was absolutely the highlight of my accelerated nursing program. As for your surgeon being tough or mean, just be glad you are a nursing student taking patho- there are plenty of stories of med students and residents getting kicked out of whatever situation they are involved in for not being able to answer questions. My wife tells the story of when she was in med school and the OB, during a c-section, asked her to vocalize the pathway of blood in the maternal-fetal circulation. When she froze the OB asked the resident, who froze, was given some not nice words, and kicked out of the room to go crack a book and come back with the appropriate theory so that they knew the reason behind what to do/where to clamp/how to react if their patient started to hemorrhage in a similar situation. My point is that physicians (especially surgeons) hold themselves and their peers to impossibly high standards, starting as med students, as they work to improve safety, outcome, and quality rates. Nursing is heading that direction, but the one thing about nursing school (whether accelerated or traditional) is that it's like trying to drink from a fire hose- you get a lot more to the face than you actually get to drink, so stay as thirsty as you can.

I completely see the frustration and distrust this has fostered in you based on the post. That said, as someone that has managed large groups of employees at various levels, I want to second the idea that you schedule to meet with your NM and/or director and raise your concerns, rather than jumping the chain of command. I can almost assure you that nothing good comes from escalating something beyond your leadership that isn't a direct problem with that individual above you. There are always reasons why leadership makes a decision about a certain employee/issue, whether policy, legal, or otherwise, and without having the director's rationale available (or a transcript of their conversations with HR/legal/CNO), it is tough to fully understand how that determination was made- whether the result is agreeable or not. It's just a spotlight you don't want on yourself for overstepping boundaries. In the mean time, keep that NAP on a short leash when it comes to your patients. After all, when you don't have a license you cannot lose a license. If that person gives you the business for holding them accountable then follow the procedures to help your charge/NM/director to be able to initiate progressive improvement plans, and (potentially) disciplinary action, against that employee.

It is a great question to seek out by visiting osteopathic.org, where many of those types of questions are answered. At the most basic, is is a difference in osteopathic vs allopathic (though this term is often seen as derogatory by some MDs) school of thought. Osteopaths are trained from the outset in a model much more similar to the nursing model, which involves treatment of the whole person in addressing a health issue, rather than treatment of the specific ailment. In my ED there are two osteopaths, a majority of allopaths, but also a PA that went through a program at an osteopathic medical school. It is interesting that she has some of the same tendencies as the DOs on account of the culture of the school. As previously mentioned, there are good and bad DOs, just as there are MDs. I have always had good professional and personal experiences with the DOs I know, and I know many on account of my spouse being a DO.

psu, that is terrible in and of itself- if she keeps the BSN with the MSN that's even worse! Not to mention that anyone worth their salt looking to hire someone is going to absolutely judge her when they look on the header of the resume and see that it's out of sorts. I've not been a nurse manager, but in my time working for corporate management in my previous life, those were the kind of menial, small things that separated a serious candidate from someone that was perceived to not be willing to take the time to do things appropriately.

Well if it does turn out to in fact be her nursing degree, a noble-minded coworker might be kind and help her to correct the certainly unintentional dyslexia of credentials so that her degree comes first, followed by the license certification. Maybe it's my years of having to properly wear a military uniform, but as fixated as our profession is around post-nominal letters, coupled with the emphasis that is placed on attention to detail, the very least folks can do is ensure that they list them appropriately. Every time I walk past a colleague with an embroidered pullover I check to see if the "RN" is before or after the degree- and then mentally wince when it is before.

Nothing so exciting as an RN, but in my previous life I was a manager for one of the big two delivery companies (lots of purple and orange), and was running a wee bit behind one morning, decked out in my glorious work uniform. Cop pulls me over, looks at my attire, and says "what do you do for xxxx". "I am an operations manager." "Well go ahead and get on to operating, I don't want any trouble with my Amazon packages making it to my house." No complaints from me.

I have been off of orientation since the start of May (nurse residency has ~13 week orientation period), and every day is a toss-up. One thing that we do on my unit (ED) is run the shifts 06:45-19:15 for days and 18:45-07:15 for nights, with a couple of mid-shifters thrown in through the day. The first 15 minutes are for the oncoming shift to huddle and get report, and the final 15 minutes are for the offgoing shift to try and finish up any charting. 18:00-19:00 is well known as "Power Hour", and there has been more than one time where an ambulance rolls in emergency traffic at about 18:25 with a possible stroke or cardiac arrest- bingo, staying late! I guess my point is to continue honing your time management skills, but accept that there will always be something to hold you back. An hour is a bit much though IMO, as nobody wants to be a slug, but sometimes you have to pass on a little thing here or there to the oncoming to get out on time. Just remember when you pass on that the time will come where they need to do the same, so be ready. Patients are important, but equally important is your downtime so that you can relax, recharge, and be ready for the next day.

In my "previous life" I was a manager for one of the two large delivery companies here in the 'States. Part of my job involved teaching new drivers how to drive the trucks. If I had a dollar for every time I had an employee tell me how nervous they were to get behind the wheel of the truck I would always point out that: 1. this truck is a lot smaller than the big rigs, and 2. have you actually seen some of the folks that drive those big rigs? If they can do it so can you! Needless to say, as an adult learner studying for my BSN I experienced this in nursing school- "if that person can have an MSN/DNP and be a professor..." as well as in work- "if this person made it this many years as a nurse..." then I think I'm going to be okay. That said, no amount of preparation can prevent the slight bewilderment when encountering someone else that fits the criteria.