IsabelK

What the heck is a Noctor-really? I'm a Nurse Practitioner. I'm not some fake physician. I am, however, a doctor. You can call me Dr. K if you want, but I usually go with Isabel. I think murse is well-stupid. We're all nurses. What am I, wurse (woman nurse)?? And I don't like mid-level provider. I do not provide mid-level care. And if I did, who the heck provides low-level care? As for Advance Practice Clinician or Provider-don't even get me started. I'm Dr. K. I'm a Nurse Practitioner. I'm not any of the above

I agree. Each state has regulations about what you can prescribe and when, especially the scheduled drugs. Do what your BON has said-you'll be able to prescribe those meds soon enough. Don't jeopardize your license by prescribing them before the BON says you can.

~Looks down at self: nope, not short (okay, I am short), not capsule shaped, and not (thank god or I'd be having my LFTs checked) yellow.~ On a more serious note: I know NPs I wouldn't go to, just like I know MDs I wouldn't go to. I know NPs who can't think their way outside a box with a big hole cut in its side. The same is true of MDs. Oh, and PAs, social workers, psychologists, etc, etc, etc...No profession is immune from the bad eggs. But there are studies consistently showing NP outcomes to be as good or better than MDs when doing the same work, especially in primary care, family care, and internal medicine specialties and sub specialties. I'm not at home right now, but I wrote a paper about it in my DNP program and it hasn't changed. The outcomes indicate that NPs can and do provide strong, solid healthcare. In order to do that, an individual NP has to be bright, engaged, and know when to get help. This is (or should be true) of any healthcare provider-none of us can know everything. I am very, very good at what I do, but I am not, for example, a specialist in nephrology. I get help for that. Getting help and admitting I don't know something doesn't make me a minion or stupid. Part of the reason we-as nurses-still face these attitudes is the lack of consistency across the country for LPN, RN, and APRN education. We visibly argue amongst ourselves. We are not cohesive in our message. Unfortunately, if we don't clean up our own mess first, we're still going to be facing these attitudes.

If you want some online stuff, here's 3 of my favorites: Netce.com Westernschools.com RN.com There's about 20 websites I use regularly depending on what I'm looking for. Also check out Fitzgerald, APEA, and Barkley and Associates. Live stuff is easy to find. One of my favorites is the MER conferences. Half days giving you time to run around and enjoy wherever you are. Also get involved in your state NP association. Most, if not all, of them have one day and multi-day conferences throughout the year. I don't know where you are, but I just did a 4.5 day conference in NYS and got 28 credits from it, including 16.5 pharm credits.

I have to do a certain amount of education to maintain my certification. My employer also requires continuing education. All of the NPs and other APRNs I know actually like learning. Did I really read that question correctly?

On my lab coat Isabel K, DNP Nurse Practitioner On my signature: Isabel K, DNP, ANP-BC

I'm still an RN. If you're asking if I miss bedside nursing or being a unit manager, nope....Love what I'm doing now.

I graduated from Loyola University New Orleans' MSN - DNP program in 2015. I did the NP, not the executive leadership, track. The first question I remember them asking was why I wanted a DNP. Then it went to issues I'd had with being an RN and an NP and how those impacte my decision to go on. The interviewer also asked what I planned to do with the DNP when I graduated. Um....there were others but I don't remember. Some aspects of the program can be disorganized, but about 30 of my starting cohort of something like 50 did the program in the planned 2 years. We had a few more join us in 2015 who had taken longer. It was a tough program but worth it...

Just to comment on the paystubs--my company has a VPN (we're all technically telecommuter) and we all log in to see our pay stubs. We can download them and save them as PDFs.

Actually, it is a legitimate order in some of the LTCs I work in where smoking is still allowed for some of the residents. Do I agree? Nope, but I also feel like if you're talking about someone in his or her 80s or 90s and this is one of their few pleasures in life, I provide the education and then write safety orders. Family or friends have to provide the cigarettes and the facility has designated smoking monitors and times. I know of at least a few folks in each of those buildings who like being the smoke monitor because they go out and smoke, too. Most of the buildings, though, are smoke-free now which I like much better. I also write orders for alcohol for the intermittent resident as long as the family or friends provide it.

Not sure...but it's endemic in some of the nursing homes. I would hazard a guess and say "none of the schools I attended" because all my instructors would have killed anyone who didn't get vitals and record them....

No, thank god....but we also made sure to print the tele strip for the same timeframe...lol. By the way, he never did that again....

Many schools set it up for you to do the two at the same time. If you can do it that way, why not? I didn't do it that way, but some of the folks who graduated with their DNP with me graduated having done the DNP-FNP route. All of them said it is doable and most of them had kids. A few worked full time, too. I didn't do it that way because I didn't realize I could, but then again the DNP was a really new degree when I was getting my ANP. Waiting a few years for programs to get up and running probably made sense then, but enough programs are set up to do the DNP-NP route that if I were going back to school I would do it that way.

1. I worked full time while completing my program. I did have a hard time getting my clinical in, but I also found that working per diem during my last semester helped. Per diem made it easier to bring in cash and I had a lot more flexibility about when I worked. 2. I did the MSN-ANP. I found it to be easier in some ways because it was more focused on a specific age range and I already had been a working RN for several years. In other ways I found it much more difficult because it was a whole new way of looking at health and providing health care. My worst rotation was women's health/gyn. 3. Yes, I love being an NP. Really liked being a staff RN, disliked being a unit manager, loved being a staff educator and infection control RN, but being an NP is just overall a better fit. I actually like going into work. 4. I did a part-time online program with one week intensives yearly (went down three times, once at the beginning, and at the beginning of years 2 and 3). Also went down at the end of year 3 for graduation. The course schedule was: summer, fall semester, spring semester, summer (repeat). In the summer we all took two 3 credit classes. Same in the fall and spring. I found the program to be difficult but not impossible. The worst part was trying to find local preceptors, but the school did help with that as well.

One of my favorites when I was a hospitalist NP: I'm sitting on a tele unit at end of the night shift finishing some documentation. Nurse doesn't realize I'm sitting there. Calls on-call hospitalist to report a death. Hospitalist orders: "EKG to make sure he's dead". Um....I could see on the tele monitor that the man was dead. I went in with the nurse and pronounced the patient after listening for a heart beat for one full minute and monitoring for respirations for that same full minute (by the way the patient was a DNR/DNI), called the on-call hospitalist who still insisted on an EKG. We ran it. Definitely asystole. I took it down to him and made him sign it off as "dead". Then we could release the body.

LOL. Actually, I can relate to this one. Many of the LTCs I've been based at I've actually had to write: Vital signs (whatever timeframe): Oxygen saturation, blood pressure, temp, pulse, respirations. Record in the monitoring sections/vitals section of the EMR.

Tori22NP-C: Check the Florida Board of Nursing. It'll tell you your scope of practice allowable under Florida statute.

I carry two phones all the time: my personal phone which I put on silent. I use it for references like Omnio and the Merck Manual. My company provides work cell phones which we are required to carry. It's the number we give to staff, families, etc. it's also one of the ways I can see the on call logs, email, and other company related things. There are legitimate reasons to use a cell phone at work. Texting to make social plans, Facebook, etc doesn't count as legitimate.

I'm an ANP working in long term care, but I'm not a facility hired NP. I work for a company that contracts to the facility to provide NPs for residents who have a specific insurance plan. On an average day I handle everything from simple requests such as a dose of sorbitol for constipation to managing infections, COPD exacerbation, non-compliant diabetics, falls...well, the list goes on. I spend a good portion of my time interacting with staff and with families about how residents are doing and educating staff and families about disease trajectories. I also do a fair amount of advance care planning. I do end-of-life care. I deal with outside consults and usually spend an hour or two a week (sometimes more) on the phone with other providers. Some facilities take care of preauthorizations (a few I worked at did), but I do all of that, too, where I am at now. I function independently from the physician (no collaborating physician required) but I keep the physician updated about major issues. He pretty much doesn't change anything I've done and when he does (when he sees someone every 60 days) he'll let me know so I can track it. If whatever he does isn't working, I can change it. I'm also the team float for my group of NPs, so I sometimes go to other buildings and do visits or help out. I cover another building when the NP there is on vacation. It's amazing the differences in the facilities, but each of them are also very similar in a lot of ways with the same issues for the most part I mentioned above. The best part for me is that I see my residents at least monthly, more often as needed, and I get to know them really well over time so dealing with an individual's chronic conditions, needs, and family gets easier over that same amount of time. If someone tells you that LTC NPs have it easy, we don't. I deal with a lot of issues sometimes all at once. I have to manage multiple comorbidities, multiple personalities, multiple departments, and the administration of the building. People are sicker and have more complex issues than when I was an LPN in LTC even 13 years ago. I do a lot of sub-acute care and sometimes even acute care in the nursing home. I also have to balance orders with what the facility is capable of doing, including do they have the staff to do something one way or do I need to find a different time-frame or way to get something done. That's where a lot of the staff interaction comes in. I ask, we hash it out, I write orders. Sometimes it's just a time change, sometimes it's a "can we do it this way instead because we're better staffed in general here". Collaboration is key across the board. Geriatric medicine is different from general adult medicine because of the specialized needs of geriatric patients, the BEERS list, etc. Love it, but it's not easy.

The facility I'm based at doesn't use standing orders for PRN bowel meds or meds for fever. I don't have a problem with PRN bowel meds (the policy is not to use MOM, thank god). I do want a call for fever. I have written specific orders to cover when to call. Works well, and I can always read the 24 hour report.

I did my DNP though Loyola University New Orleans. Loved the program. Loved the majority of the professors. Did go down 4 times in 2 years. Twice for intensives, once to defend, and once to graduate. Best part: The graduates from that year all stay in touch and we're all planning on alumni weekend next year. I did the MSN-DNP through them.

In NYS there are uncertified nursing assistants who can be called any number of things such as PCT (patient care tech), PCA (patient care assistant), NA (nursing assistant), etc. Home health aids are HHAs. CNAs (certified nursing assistants) are certified by the state after a 100 hour class, a written exam, and a hands on exam. They are not licensed. Only LPNs and RNs are allowed to use "nurse" as a title in NYS. It is illegal to represent oneself as nurse if one is not licensed. When I was a nursing assistant (both uncertified and certified) people would mistake me for a nurse. I would just say, "I will get you the nurse. I am your nursing assistant". I went into a PCPs office once where an MA introduced herself as the nurse. I kicked her out of the room and complained to the MD. She wasn't there the next time I went in.

I dislike the terms mid-level provider and physician extender for advance practice nurses. My practice is my own. I am independently licensed as an RN and as an NP. I am also Dr. K. In NYS, I do not need a collaboration agreement because I am post the 3600 hour collaborative requirement. Physician assistants were designed just for that, so arguably they could be "mid-level" providers and "physician extenders". They are strictly medicine, whereas advance practice nurses are nursing who in many cases straddle the line into medicine. I always tell people my grounding is as a nurse, which forms the foundation for how I practice medicine. I don't claim to know everything. I also don't think an MD or DO (or PA) can claim to know everything. Healthcare is too diverse. I appreciate and love good collaboration. I don't collaborate well with anyone who assumes that I need my hand held because I don't have MD or DO after my name.

Adult Nurse Practitioner--Board Certified. Got the DNP after getting the NP. Work in skilled nursing facilities. Worked in acute care for 19 months when I got out of school and then a geriatrics clinic for 2 years while I got the DNP. Been with my current company a little over a year. Basic procedures--removing staples/stitches, flushing ears. Most of my work is medical management of chronic and acute conditions. I spend a lot of time charting but I also get to play with diagnosis codes, which I like. Love my job even when I complain about some of it. Love the people. Love the residents. Love having a set panel month to month so I really get to know my residents and families.

What is your job title? Adult Nurse Practitioner. What are your responsibilities at your job? I work with a company that places nurse practitioners in nursing homes to manage medical issues/day to day problems of people signed up for a specific health insurance plan. I see the same group of people every month and call the families/HCPs and provide monthly updates. I see people more often as needed. I coordinate medical care. The attending still sees them every 60 days, but I'm the one there every day. How do you see your role in the healthcare team that provides care for their patient population? I'm the go to medical person. If I need assistance, I call the attending. I coordinate the medical care, collaborate with nursing, nutrition, therapy, etc. I'm the day to day in the building person for my residents. What made you decide to work in your field? I like getting to know my residents. I like the challenge of managing chronic medical conditions and working with acute issues as they come up. I also believe that the model (treat in place) is a great model for anyone--people tend to do better in their own environments. What was the preparation for you job? I have an MSN in adult health. I'm a board certified nurse practitioner. I worked for 4 years prior to this job first in acute care then in a geriatrics clinic. I spent 6 weeks orienting before they even let me out in the field on my own. Best part of your job? The people. Worst part of your job? The technology. Technology is getting better. My company is updating everything because we're all telecommuters. What advice would you give someone starting out in your field? Be kind to yourself. You'll make mistakes. You can't know everything. Know when to get help. Know where to look things up. The first 6 months are the worst. It gets easier after that. Don't stay where you hate going into work. It's not worth it. Life is too short. There's a lot of options out there--find one you can be passionate about. Do your continuing ed over the 5 years you'll have to do a recert. Don't cram it into one year or 6 months. It will make you nuts. There's lots of us out here--ask questions, bounce ideas off of us. No question is a dumb one if you ask it. It's only dumb if you don't.