Salter444

I never hear physician extender ever. Midlevel is used in my setting only to describe a group but not an individual. The medical Director may say we expect to hire 4 mid-levels. However, I have never been referred to a patient or other provider as a mid-level, they will introduce me as NP or simply provider. I think of it more as a category and not a slight.

I was told by other NPs NEVER sign a non-compete. Perhaps if the money was sick I may consider it, but there are too many places to work to be worried about a non-compete. Plus, half of the PAs and a few NPs moonlight and I think a non-compete my prevent that - in case you wanted that option

The problem with finding your own preceptor is that the student does not care if the preceptor is good, knowledgeable or knows what the hell they are doing. The only important issue to the student is that they are available and with that these schools do a disservice to the student. Does this mean that schools whom place students are finding the cream of the crop - NO, but at least is there is a dud in the mix the student can provide feedback and this can be addressed.

Depends on the unit and which facility. But typical day. 1. Arrive and find assignment 2. Find night nurse to get bedside report and review gtts, lines and GCS 3. Assess patient 4. Review labs 5. Chart assessment to stay ahead of the game 6. Pull and administer meds 7. Multi-dis rounds (have questions ready) 8. deal with crazy family 9. Argue with slow pharmacyy 10. Yell at lab for losing your specimen 11. Tell family member not to mess with the vent, IV or dressing 12. shove food in face and ignore phone for 10 min lunch 13. haul patient to CT 14. Transfer orders - yes 15. spend 90 minutes trying to get a step-down nurse to take report 16. Field calls from ED on why you cannot take the new patient 17. spend 15 minutes answering stupid questions from new Step-down nurse 18. Transfer patient 19. Pt arrives from ED and room not clean - give stink eye to ED nurse 20. Tell family of new patient to stay in waiting room so you can situate patient 21. Roll eyes at family member who ask you to get them coffee and then tell her the facility is too cheap to provide coffee 22. Call resident and let them know a 20mg push of ativan could possible kill your 88 year old COPD ESRD patient and have order change 23. Lab calls to question why your Trauma patient has a Hemoglobin of 4. (roll eyes and feel sharp pain in temple) 24. Draw odd labs every seven minutes as resident writes one as he is googling the disease management 25. PEE 26. Try to organize notes and pray your night nurse gets there on time 27. Wait 15 minutes as the night nurse chats away with friend in breakroom 28. Give report 29. Race to car as fast as you can 30. Get to car and see you have the PCA key and phone in pocket (cry softly) 31. walk the 8 miles from the parking garage back to the unit to return the key and phone 32. Ambushed by night nurse who did not bother to listen to report and now has questions 33. Answer questions (right eye twitching from continued rolling) 34. Leave unit, go to garage, find car and go home 35. Wonder *** was I thinking when I decided to be a nurse 6

The students with less RN experience probably benefit from a traditional brick and mortar setting where those with extensive nursing background do not need as much hand holding.

Everyone is entitled to their opinion. His opinion is based on his view and not on research or facts - so take it with a grain of salt.

The real question is WHY would anyone choose to work in Ohio?

If we start pulling at strings here (LOL) and deciding what we should be paying for and it impacts us. I have to share the cost for people having children and sending those rugrats to school. I do not have kids and never do I want them but still am taxed and assessed for the little snotgobbers. So, those of you who bemoan the transgender folks remember many of the benefits you enjoy are by those who are paying for some of your lifestyle, whether they approve or not. Plus, I thought religion taught is to judge not lest ye be judged. I use to care for prisoners and I made it a point not to want to know what they were being incarcerated for as I did not want to let that shade of judgement creep into my head. Bottom line it was NOT my place and not my call. So, I made every effort to treat them like actual people. It was not always easy and sometimes I did know their offense and sometimes I did judge, but I fought against it and I am only human and full of faults.

I checked with by BON and have been told this state has no such restriction in practice. Ethical? I am not following how you claim it is an ethical issue.

we may all be speaking Russian by then.

The consensus model sort of died and has not taken hold as was promised.

This reminded me of the nursing students who use to follow me as a ICU & ED nurse. Me: "where would you like to work when you graduate?" Student: "I want to work in CVICU or SICU" Me: "sounds ambitious, what shift?" Student: "Oh, I will only work days and no weekends or holidays." Me: "yeah, good luck with that!" They would actually believe that they could waltz into a hospital and demand Monday thru Friday dayshift without weekends or Holidays. This was not just one student. When you decide you want to work in a particular area or speciality you research what it requires and being the newbie you are bottom of the totem pole and you pay your dues and if that is not acceptable there is always the clinic life.

Yes, it should. The delivery of healthcare is guided by science and not convenience. Again, these are guidelines and in a critical care setting we look at each patient individually. I worked as a nurse at a magnet facility where foley discontinuation was a nursing driven policy based on guidelines, but common sense was omitted. An example...a trauma patient who was to undergo multiple surgical interventions. Per the guideline the bedside nurse was removing foley next day post op only to have the patient be re-inerted the next day for an additional surgery and so on and so on.

From cradle to grave per the brochure ....however, your individual results may vary.

I worked in a few HCA facilities and we were always short and it was not uncommon to be doubled up. The goal was to be 1:1 for the first 6 hours as there were serial labs and lots to monitor. We had shifts where you land a heart and maybe get 2 hours before your second CABG comes rolling in. It was not everyday but too often. Usually you have one stable patient then take the next heart. What made it more bearable is the open heart portion of the unit was an open 12 bed unit and it was easy to keep an eye on everyone at once - so if a nurse had a crashing patient you had many hands helping without the need to call anyone.

Honestly some postings on here serve no purpose other than to stir stuff up and offer nothing of value.

A good preceptor has the job of teaching, evaluating and preparing you to work more independently. We would always use the ShXt Sandwich. You start with what the orientee does well, then what they need to work on and end on a positive. It is tough walking into a new job/role and too many nurses are just angry bitter people. If you are working is a large teaching facility you should have an educator for your unit who you should be meeting with along your orientation process. Ask him/her to put you with another preceptor for a bit. I never was one to keep an orientee with just one preceptor - it helps to see how different nurses organize and you can pick and choose what aspects of their routine you would like to adopt for your own. A billion and a half years ago I was a newbie on a step-down unit and assigned to a nurse who worked in the unit for 30 years. She was nasty, mean and I had to do things exactly as she did or she would throw a tantrum. She would then smile and laugh whenever a physician would come near her only to return to her nasty self when dealing with me. I lasted a week before demanding to be put with another preceptor and things were much better after than. However, I always remembered that nasty lady every time I was asked to precept a new nurse. So, even bad experiences can shape the way you approach your practice. Good luck!

The patient has the right to refuse care and tom insert against his consent is assault. No, the catheter insertion is not a nursing judgement it should require an order from a provider. back in the old days nurses went ahead and did things like that at will, but things have changed and the autonomy of the bedside nurse has all but evaporated.

Some difficult sticks we would use sonosite and you can see those darn arteries can be mighty close to where you want to go.

I lived in Texas and tried to find specific rules as far as FNP and like was mentioned above they do not exist. It depends on the facility and your comfort level. I worked in a facility where FNPs were not hired for IP and across the street the hospital used FNP IP and in the ED.

I would not go crazy attempting to prepare - that is why you have an orientation to cover the basics and then you fill in the gaps as needed. I would have a basic grasp of hemodynamics and try to understand the impact on the patient. Know norms and over time you can work on putting the pieces all together. It does not all come to you on day one or day fifty, but it is a continuous learning and relearning. You need to be comfortable asking questions and never trust someone who claims to know it all. When you are working ask physicians why they order what they order...use anyone you can to learn from and take advantage of the resources the hospital provides. As an ICU nurse your job is to keep your patient safe and recognize when the patient is making a turn for the worse. It really is a fun gig!

Orientation depends on experience, comfort level and basically the individual. The goal should be about 3 months for a newbie, but taking into account on how they do. In the ICUs where I worked we would start slow and see how they individual responded. Some facilities provide classes to supplement the bedside orientation where others had the nurses complete ECHO to provide some didactic critical care information. A good ICU program should cater the orientation to meet the individual needs. I have had nurses go 4-6 weeks and did great where others we went beyond the 3 months to help address any issues. Another good thing is once they are off orientation they should have a "buddy" assigned in case they come across something that they are not comfortable with to need additional help.

If you are going the FNP route you really do not need the ICU experience and at times it can confuse you when attempting to think outpatient while working critical care. I remember studying for exams or the boards and had to remind myself to think clinic/outpatient and not try to think beyond that point. ICU experience overall is beneficial as it lets you see disease processes at the far end of the spectrum and in dealing with many chronic conditions it provides perspective on the importance of maintaining control of these conditions and the complications/risks that can result from poor control. But id your immediate goals are FNP in a clinic. I would stay put and focus on that..

I have kept mine and every time i renew i wonder why the heck am I keeping them. I let my PALS expire but nothing else...

I made $45/hr plus shift diff as an RN in Texas. I have heard Tenn and Alabama are not the best places to work. Texas pays very well compared to many states and has no state income tax. A New FNP can start 100k+