PackMule

Your post was right under mine, sorry I missed it, my specialities are Primary Care Pedi and Psych.....

I had only NICU experience before going to PNP school and did not find it made any difference at all. In fact, the close relationship you have with the parents of a very sick baby in the NICU is great training ground for the essential interpersonal relationship skills that are important in a general or specialty peds setting when dealing with parents. Expanding your horizons beyond the "great placenta" is very liberating. Peds speciality clinics (especially Neurology, Pulmonology, Developmental Peds and probably others) are a great way to run into some of those tiny babies you took care of as they grown up to be children. Good Luck to you!

I take great comfort in that I can always defer to the physicians I work with when something arises that I am not comfortable with. For example, saying things like, "Yes, I can see that you want to do this, take this med, or have this assessment, but the physicians I work don't agree with that treatment approach and I think you should do this, that and the other first, then you can come back and discuss it with one of my docs". I never feel like I have to be the last word in things if I don't want to. If you want to call that good cop, bad cop, then thats the way we can work things at my job should that become necessary. Otherwise, in general, we all see and manage pretty much the same kinds of pts-none are really reserved more for the physicians in my practice. Of course there is one of me and 4 of them where I work.

What my nursing really taught me is to learn and trust my intuitive skills as I gained more experience which made the application of my advanced practice skills, once I got them (assessment and diagnosis) more meaningful. You can take a cook-book, flow chart approach and look at some quidelines to diagnose and treat medical problems, but the intuitive nature of this art you gain working in nursing can't be learned in graduate school. Nursing school is purely laying a foundation. In the real world nursing is so much more. Good Luck in your decision making and enjoy the process as opposed to looking at the end product.

The certification review guide and a good review course is about all I needed and felt prepared for the exam. Knowing general test taking strategies is almost (if not more important) that the knowledge itself sometimes I think. Good Luck!

With the military and increased awareness of mental health issues affecting the soldiers, there aren't going to be near enough mental health providers in this country I'm afraid. County/State Mental Health facilites, Psychiatric Centers, Rehab and correctional facilities are all probably looking, or if there is a base nearby. Probably looking up these places individually will give you a better idea; they may not post help wanted ads with companies.

In short: You should wait You are young, a great advantage. If I were in your position, I would hold off on grad school and see about finding a full time job that may have some type of loan repayment as an incentive for signing on for a certain term. Also, they would probably have some type of tuition assistance which you could take advantage of later. I sound like Susie Orman here (the finiancial lady) but you have got to get your debt gone first. Really having some time "just working" is good for solidifying all that you have absorbed and taking the time to seeing what your next step might be. In the process you could take advantage of some pretty hot new hire offers. I don't think your list of reasons for continuing offset going into further debt. It just doesn't make sense to do that, particularly, as was mentioned about, the salary you would receive for all that debt. You may love your job enough and not want to go back to school and that is OK. Better that than getting a degree that you feel you have to work up to........ Keep us posted!

Really as a youngster of 20 something, I wanted to get out of the hospital (before all the acute care tracks came along) and I wanted to do something broader and more variety than I found in the NICU. I wanted to do stuff! That was the totality of my thinking process when I was a young nurse (think young adolescent) thinking about future schooling. As I approached my early 30's and by now, had a couple of kids, and a more independent job in home health, I found I wanted more of that independence (guess this would be later teens to early adult stage); I thought how great it would be to go back to school and have a job where I could have more independent decision making and what I saw as control over my career. Had to get a BSN, then onto grad school I went. Finished that, and by late 30's or so, had a great job as an NP. Since I was trained in primary care, I felt I needed another NP certification to be certain I would not be seen as practicing out of my scope, so I did a post-masters. And now, I feel like career-wise, I am probably at my chronological age (I am 43 now). For me it was more of a logical progression as I was maturing in Nursing. (Hows that for an Oprah-like answer). When they say, you don't know what you don't know, I have found this very applicable to me so far in my 17 year career. I think I am what I want to be when I grow up. Kind of scary!

In reference to your second question. I did that, had a couple kids in the middle and here was the breakdown for me: ADN: 3 years total RN to BSN: 1 year (YUK!-This was the worst year EVER because it was pointless) MS/NP: 3 years (I think this was part time-working 20 hrs per week) Bonus: 2-3 years for Post Masters in another NP specialty. This should have only taken another year if I hadn't have worked full-time and gone at a snails pace. I think what makes the difference is if you have to work or not. I did, through all of it. I think it could go faster. Good Luck! (Sorry, I re-read your question and you were specifically asking about on-line, so my answers are probably not helpful....)

Maybe its because I've been an NP for years already, but if I had a choice between seeing 40-50 pts per day for six figures and 15-20 per day for 50-60K, there would be no contest in my opinion (yes, I would go for less money). If someplace doesn't pay what I think I need, and if it was a job I wanted, I would negotiate to pro-rate the number of pts downward, no call, perhaps 4 days per week, or something to that effect. I would not work as hard as everyone else for less pay than I need. It depends on the job, really. In all honesty, 75,000 doesn't sound unreasonable, but depends on what type of job, etc.

I had to be full-time and continue employment for 6 months. My manager had to sign off on it and it had to be related in some way to enhance my skills in my present position or help them out in some way. (I did post masters in a second specialty). They reimbursed the whole thing. Each place of employment is different.

woulda, coulda, shoulda....sometimes there are reds flags flying everywhere, you do all the right things, but you are just utterly and completely powerless to do a damn thing about it. see this with young people that you know are just absolutely crazy...you give them meds, do the therapy, and they still end up doing horrible things and cutting people up, etc. i believe in my heart of hearts that despite all the good mental health providers that are working their tails off, that texas has about the worst mental health care system in the entire country. its prioritzed somewhere under road construction i believe, so our precious suv's have a nice road to drive on. i live and work here and this is my opinion.

Raising kids has been a blast. Mine are young teens. Sure, I worry about them, think about their futures, know that I've done the best job I can do to raise them to be independent beings, etc. I love them more than anything in my life and would do anything for them. But constant worrying and emotionally wrenching? I have never felt that...maybe when they are driving later or going somewhere that I haven't taken them I will have a different opinion. I can't imagine what it will be like when they don't live here and I don't see them everyday but we've been headed that way since they day they were conceived.....

I wonder how my patients would respond to me saying "Its nice to meet you, I'm Dr so-and-so's extender" It sounds a little perverted it you think about it too much.....anyway... I'm wondering if I'm being a cry-baby or oversensitive. The organization I work for has recently taken to calling its Mid-levels (like that one too) Physician Extenders. I find the term a little offensive, bordering on downright demeaning and kinda sleezy all at the same time. I cringe everytime I read another policy that has the term on it. Should I voice my concerns about this in a dignified manner stating I feel a little under-valued, yet at the same time, mildly aroused when I hear myself being referred to in this manner? Thoughts anyone?

It sounds to me like your brother needs the help of a therapist and not necessarily a label at this point. I would start with a therapist who has had some experience in trauma and possibly one who is maybe open to the idea that maybe he is "dissociating" (as in the controversial diagnostic category of Dissociative Identity Disorder-previously known as Multiple Personality Disorder). Not everyone believes this is a real "disorder" where the personality fragments into part(s) usually related to a history of severe trauma, neglect, satanic ritual abuse, etc. Missing periods of time could certainly indicate something of this nature. Its been my experience that people with DID have been diagnosed with everything from ADD, PTSD, Borderline Personality, etc, until they found someone who would consider the diagnostic possibility. Having a diagnosis really tells you nothing but what grouping of symptoms he has, and if it is so, so what then? He really needs to see someone who he can talk to and hopefully with his permission, they can invite family in to give some detail about history and pertinent observations. Best of Luck to You.

Not sure about the first question, but I have 2 kids and have never experienced labor. First was a breech 10 pounder. I didn't ask my OB to VBAC but he advised against a VBAC because I had less than a year between pregnancies. I would choose an operative delivery again if given the choice. Mine was a good experience all around.

You sound like me several years ago. Had worked in NICU for many years and felt like I wanted to do more. I kept my foot in working in NICU on a PRN basis and went to Pedi Home Health because I liked the flexibility and automony. I went to grad school and am doing other things now, but I would strongly recommended doing a "trial run" working in another area before you cut the ties so to speak. You never know what you're going to like. Personally, I didn't care for PICU because of the child abuse cases and kids in pain, etc. Home health is primary care nursing at its finest and I loved the continuity. You definitely have to have boundaries in that job because you get to be part of the family. I did find it very rewarding and less stress in general after coming down from the technical aspects of NICU. So eventually I was able to feel more comfortable weaning myself out of the NICU. I also did some PRN work in the Rehab area and also in the Chronic care areas. Not everyone likes chronic care, but I always felt more like a nurse and less like a technician when I was in these areas. Good Luck to You!

Choice really depends on your experience and what population you are comfortable with. I am a former neonatal nurse who "branched out" by getting my PNP. I work in a pedi specialty area (outpatient). I had to do a rotation in a Family Practice Clinic for my post-masters program and had anxiety and panic attacks the whole way through. I absolutely hated it! I think Pediatricians are the best docs to work with, even though they complain about being poorest doctors.

I've never heard of such a program. I understand the principles involved from what it adds to Psychiatry, i.e., doing an H& P, PE, etc. This is so important. I still continue to be shocked that multiple psychotropics are prescribed to a patient and it seems to be more important to ask about how many pets they have then to do palpate their abdomen for a liver, look for enlarged thyroid or lymph nodes, or do an otoscopic exam, but anyways......... What would be the advantage from a Primary Care standpoint? It sounds like a jack of all trades at first, but then the more I thought about it, it really almost sounds very limiting instead, since the population is limited to Psych patients. Are there specific advantages to lumping these 2 together versus getting a dual certification first as one of the primary care specialties (FNP, GNP, PNP), then Psych as a Post Masters? It seems like with dual certification, you can use which ever title, depending on the job. Say for example, you're certified as an FNP primarily, and there is a great job opening in an adult specialty like Obesity or something. You may use your psych background, (and actually, may have a specific group in the practice with psych problems), but your qualification for the job itself would be your FNP. Hope this makes sense! Keep us posted.