Angie O'Plasty

As far as FNP vs. ACNP for hospice/palliative specifically, I am not sure. Maybe someone in that field could chime in?

It really depends on where you work. I am in a hospitalist group and work only days and evenings...we have dedicated night shift APPs (the catch-all term at my hospital for NPs/PAs) so the rest of us don't have to do nights. That said, I started out on just nights at a small community hospital...it wasn't SO bad because we could sleep if there wasn't anything going on, but I was still glad when we started rotating and later when I didn't have to work any nights (the aforementioned small hospital merged with a larger one and ultimately all inpatient care was moved to the larger hospital which is where I now work, and with the move came no longer having to work nights). As far as weekends, I work every other as we have a 7 on/7 off schedule which is very common for hospitalist groups. Sometimes this is a bummer as far as trying to coordinate doing things with other people or missing events that are happening on the weekend, but on the other hand it is pretty nice having some weekdays off to go places when they aren't crowded (whether errands or fun places). Hope this info is helpful!

Agreed 100%. We all need to keep learning continuously as clinicians, even once we are past the novice stage. This includes reading, continuing education activities, seeking mentorship, and learning from the days/situations when we "suck" or realize after the fact that there was something we could have done better. Certainly there is plenty of room for improvement in terms of clinical preparation/scientific content/fewer "fluff" classes in NP programs (and I don't mean by making the DNP a requirement, which I think is a terrible and counterproductive idea particularly given the current clinically irrelevant content of DNP programs...just making some changes to master's-level programs and getting rid of the degree-mill type programs), but ultimately it is your own responsibility to put in the effort to become the best clinician you can be. Your first few years in practice will shape your clinical performance more than your schooling, IMHO.

That is a gross overgeneralization...there may be a few for whom that is the case, but I don't think it is the majority. Frankly, your comment is insulting and uncalled for and I can't believe I am dignifying it with a response!

There is really no good solution, is there? Not with the customs we have inherited. I am getting married next year and am still struggling with this. I really dislike the idea of dropping any part of the name I was given at birth...I know some women drop their middle name and move their maiden name into that position, but because my middle name is after a family member I would feel kind of bad getting rid of it. Besides, I don't like the discontinuity of being known by one name for thirty-something years and then totally changing it...it confuses people, and the fact is that you are the same person after you marry than you were before. That said, I can see where not having the same last name as one's kids could create confusion. I think I will end up hyphenating...seems like the best compromise although I am really not excited about having to still go through all the name change paperwork!!

It's a long story. Applied to med school right out of college, didn't get in despite strong GPA, MCAT etc. Was all set to reapply, got to thinking that I might want to have a family someday and in that case wanted some balance in my life which is often difficult as a doctor (though I think that is getting better). Decided to apply to NP programs, got in and became an acute care NP, and took a job on a hospitalist service which is what I am still doing. I really enjoy what I am doing now, although there are times I feel like I should have reapplied and gone to med school because I might have liked that even better and sometimes feel like I just don't have the level of knowledge that I would like to have. That said, I am getting married in the next year and plan to have a couple of kids, so at that point I will probably be glad I made the decision I did.

Maine is independent after 24 months of supervised practice.

That's the best way to handle this issue--plan things so that the patients are taken care of before report. That way nobody has to wait around in pain, and report can be uninterrupted (I happen to be of the opinion that report is not to be interrupted unless there is a true emergency--it's just too easy for errors to be made or information to be forgotten).

Physicians go through residency when they get out of school...they are under the supervision of the attendings during this time. The two years of supervised practice for NPs seems, to me, analogous. That's why I think it makes sense.

It is interesting how different the states are. I am about to start working in Maine, where NPs are required to have a supervising physician for their first 24 months of practice and then can be independent once they have that experience. I think that kind of system makes a lot of sense.

From the description of the situation, I think the doctor's reaction was inappropriate--sometimes we all have to talk to grumpy/upset patients and it's just part of the job. I had to chuckle at the last part of your comment--I have worked LTC as well and know exactly what you are talking about--often literally!

Having worked agency in LTC facilities, I can vouch for this!! Extremely unsafe, especially on a unit where the residents are not alert and oriented (at least for residents who are A&O you can ASK them their name). Unfortunately this situation is more the rule than the exception from what I have seen. I made a med error once because of this issue...I was on a dementia floor, residents didn't have name bands on, and there were two residents with the same first name who were roommates (not a good idea). When I asked a staff member to point out "Dorothy T." in the dining room, they pointed to a resident, I got the meds, and returned to give them. I asked another staff member "this is Dorothy T., right?" and they said yes, or at least that is what I heard. I gave the meds, then asked the other nurse to point out "Dorothy S.", the roommate--and he pointed out the lady I had just given "Dorothy T."'s pills to!!! Needless to say, I had a major case of tachycardia, assessed the patient, and notified the NP who happened to be on the floor at the time. Fortunately most of the meds were things like vitamins, aspirin and Colace (and nothing on her list of allergies), but there was also a cardiac med in there that thankfully this resident was also on, just at a different time of day. We kept an eye on her heart rate and BP and she had no adverse effects, but the whole thing scared the heck out of me and made me that much more stressed out when going onto an unfamiliar unit and passing meds.

YIKES. I give you a lot of credit for working in that environment--you're a braver woman than I!

Well, I haven't had anything all that bad (just the occasional demented patient taking a swing) but here's something bizarre and potentially dangerous that happened a couple of weeks ago when I was covering a shift at a LTC facility. I went into one resident's room to give her her pills, and she showed me her TV remote with only one of the batteries in it, and it was partway out, and it was HOT--so hot it was melting the plastic of the remote!! She said she had tried to get it out but it was too hot (fortunately she didn't appear to have burned her fingers), and handed it to me. I grabbed a big wad of TP from the bathroom and used that to pull out the battery without burning my fingers; the battery was making some weird fizzing sounds which made me drop it on the floor. Then I thought, this sounds like it's going to explode, so I threw a towel on top of it to contain it if that happened but then realized that was probably a fire hazard given how hot the battery was. I ended up throwing the battery out the window into the gravel that was around the bushes--just wanted it out of the building if it was going to explode or catch fire!

That's how I've usually seen it done...why so many CNAs (and nurses!) smoke I do not know, but there always seems to be someone. This thread reminds me of one facility I worked in where there was a resident who smoked and the nurse had to give him a cigarette every two hours and then he would go outside and smoke. Mind you, this guy would get his meds (which included Advair and Spiriva for his COPD) and then ask for a smoke right after. . He had the junkiest cough all the time too. I understand they have the "right" to do that, but having to be the one to hand him the butts really rubbed me the wrong way.