WIBound

I work as a hospitalist and we have the option to wear business attire or scrubs. I prefer scrubs as I tend to find different ways of getting dirty. I usually spill food on myself twice a day. forget to cap pens and all my pockets get ink stains and I spill coffee quit a bit too. Maybe I should wear a bib with my scrubs..

Recently I applied for a position closer to home and a week ago I received an email thanking me for applying. The email went on to question my salary request and asked if I would be flexible in what I was asking for. I responded that yes there is room for negotiation but I am not interested in working far below my salary requirements. I then received a nicely worded response about how the company could not afford to match hospital salaries as they were a value base organization and it was all about making healthcare affordable for the patients. Value based? Well that sounds nice. I then Googled the salaries of the CEO and other executives that are posted online. The value based salary of the CEO is a whopping 73 million dollars and the other executives are barely scraping by with meager salaries ranging from 5 to 7 million. So how could this noble company even consider paying staff a competitive wage. Because you know it is all about the patients and their vision of cost cutting everywhere but the executive salaries.

If your patient is alert it will make your neuro assessment much quicker. I have worked a Neuro ICU and sometimes they would keep QH near assessments as the residents were reluctant to step them down without the attending approval. At the minimum I am checking orientation, memory, having them move all arms and legs checking the face for any deviations...it can be completed is just a few minutes and if you do it often enough the patient will go thru the whole exam from memory. Better do it then miss something..

per the ANA

I started as an ADN and never thought I would spend another day in school, but over time I had the desire to lead instead of follow and even teach. Twenty years later and many years in school I can say I will be a lifelong learner and hopefully there will always be something new to learn and someone new to teach

Actually, facilities are moving toward nursing being a BSN only club. The NP programs are also moving towards a DNP without MS option. Still, you will see MS NPs for years to come but the eventual plan is to have DNP only nurse practitioners. You can't fight gravity or progress.

I disagree... even rung up the ladder you go demonstrates an investment you have made in both your career and education. An RN with BSN should be paid more than an ADN. An RN with MSN again should make more than a BSN. A DNP holds a higher level of education than an MSN and has a right to expect to be paid in accordance. I am not talking large amounts here, but there is a difference.

You teem 'em "slam that sh@t in!" LOL

On a resume list every dang certification and education you have or could think of. It is when you sign your name keep it simple. A. Nurse, RN or A. Nurse, APRN..... However to sign A. Nurse, RN, BSN is silly as as and RN you should be expected to hold a BSN at the minimum. Sort of like A. Worker, High School Graduate - that would be silly.

I would always laugh when nurses put BSN in charting or when signing their name when RN will be just fine. I think it is expected that the nurse should have the BSN and the ANA made the statement ages ago that the entry level for professional nursing starts at the BS level. I get that they want to be separate from the ADN nurses, but it is still funny. I had an educator years ago that would sign her name B. Nurse, RN, ADN, BSN, MSN, ARNP, CCRN, CEN, BC I think she had a few more even and I cannot remember the exact order she wrote them in. She would sign this way and every presentation she would devote a single slide to her title and credentials - there was much laughing at her pretentious nature. I myself only signed RN unlit I was responding to an email and I wanted to be a smart ass then they got the entire alphabet soup. Bottom line is that until you get at least an MS the BSN seems a bit silly.

We are taught not to prescribe abx for colds and viral infections, but in the clinical setting time and time again it is done. I had one provider tell me that if they do not provide the abx the patient will just go next door where someone will and the practice loses the business. Plus with these urgent care clinics every 10 feet the competition is getting much tougher for providers - I man not saying that makes the practice right, but I can understand the reasoning for handing out Zpac like candy. Also, when you talk about people coming to a provider for everything. Those on medicaid and medicare come much more often for the silliest things. I guess if you don't have a job and don't have to pay there is no incentive to stay home and wait it out. People with jobs and insurance only seek treatment if really necessary. I remember doing triage in the ED and would ask so many times, "you came to the ED for that?" It always amazed me what some people considered an emergency. A split toenail, a runny nose, hangover or whatever stupid reason they have to waste our time.

Most places I have seen FNP

I agree with prior comments that if you work for the clinic (in whatever entity) you are staff. And as an NP you are a provider and often referred to as a mid-level provider. Sounds to me you have an office manager problem and those can be sticky - for some reason people who answer the phones or make appointments often act as though they have earned a medical degree.

Why does your employer need to know your plans? Sure tell them you are in school and maybe they can work around your hours. You graduate in May, but what happens if an emergency comes along and you need to withdraw - or god forbid you fail. Until all the grades and hours are in the book nothing is guaranteed. It is a company or facility and not a mom and pop store. The will cut hours, benefits or toss you out in a skinny second to save them pennies. I never understood the whole idea you must give them two weeks or more but they can give you minutes to eliminate a position. Seen it over and over again. You share too much and you may not get a job and frankly you are not required to make full disclosures. You are providing a service and they are paying you for it.

I have a preceptor who is mega fast and she can see the patients in 15 minutes - most patients but what slows her down are the billion calls from pharmacies, labs, patients and calls she has to make to insurance companies. there is way more than just seeing the patient and writing scripts.. Plus when she gets in there are piles of charts with labs etc.. she has to review and sign off or follow up on. 15 min a patient - good luck..

NP programs just don't bother to educate students about contracts and what is realistic. I try to read postings here and speak to working NPs and preceptors. It is so different from practitioner to practitioner. I do get the consensus of the following: 1. PTO minimum of 4 weeks 2. Fees (licensure/DEA etc..) paid by employer 3. CME anywhere from $2000 on up with paid time off to attend 4. Sick days?? I have not inquired much about that 5. Performance bonuses - these can add up quickly, but I need to research more the different types 6. Non-compete. These are bad and do not want any part of that 7. Employer pays insurance 8. Any call or additional duties needs to be outlined in the contract 9. Travel money 10. Increased base after 6 months when you are properly spun up to the position There is still much I am discovering and being told. I would rather accept less money and have hours and patient loads that allow for a bettie quality of life than work myself ragged for 10-20k more a year. Also, I am told the benefit packages are far better when working for a hospital -not sure how true that is across the board.

Current EBP is hob flat with legs elevated not trendelenberg. AACN had a CEU online with 7 myths of critical care - it was interesting. It covered residual amounts and not turning off TF for position changes. I admit I get stuck into practices that I have always done until someone shows me the new research (like years ago when we STOPPED check foley balloon before insertion). Things are always changing!!

Worked as a nurse in an ED that typically staffed with 2 MDs, 3-4 mid-levels (PAs and NPs). Typically there was a midlevel in triage with the nurse to to a quick eval and put in initial orders. The nurse determined the ESI and the midlevel could pull sone 3s to handle in fast track depending on the flow of the ED. The fast-track was always staffed by a mid-level and mostly 4s and 5s with a few easy-breezy 3s thrown in for good measure. In the main ED usually 1-2 midlevels at different parts of the day and they saw 3s and on occasion involved with some 2s (usually given to them by the MD). The MDs would take the more complicated patients and there were times where the mid-level was the one initiating the process of turning over the patient to the MD. Only the physicians covered the trauma/resus beds and they signed off on all the patients (except for 4s and 5s). Only the physical intubated. I know quite a few brand new NPs who have taken jobs in local EDs and none are limited fast track

In my area I have a few friends graduate in the last year and they have started as brand new NP with salaries from 85k to 125K. Not bad for their first job and yes a few did take a pay cut from what they made as an RN. I cannot imagine any of them wanting to return to their RN roles based on money alone. I have to believe if nurses are leaving the NP roles to return to the RN role there have to be more reasons than just money. One of the NPs at my prior job told me how she chased the money after graduation and shared some horror stories of what she put up with. She left and found a better fit for less money and was much happier - she had to give 90 days notice to leave the position she hated. Wow!

That is a good idea to go in with questions for them...I would want to know: 1) what sort of support is available, esp being a new NP 2) how much training to the position 3) curious to know the turnover for the particular position Good Luck!!!!

Sadly, there will always be those hateful B-nurses you are rude and nasty. The love trying to belittle the younger ones cause they allow them to get away with it - they still try that garbage with experienced nurses but we either ignore it or just toss it right back at them. Many times these old hags are clueless about EBP and has done zero to advance their knowledge over the years - they are just unhappy fools. Three months in is not enough time to be much more than a beginner. It takes time and effort. Organization is huge!! Some advice I can offer: 1) have a preprinted report sheet that covers head to toe to help with report 2) find a go to person on your unit to help guide and give advice 3) ask your doctors questions - find out what the plan is and listen. Many providers love to teach - take advantage 4) try to anticipate - this comes with critical thinking but overtime it helps put the pieces together. 5) find resource materiel - U die many apps at work to look up meds and uptodate is excellent for researching conditions 6) I remember those written order days....ask the doc before he/she leaves any questions, check with other nurses or unit secretary people learn how to read horrible writing over time. And if all else fails call the provider and tell them you cannot read it! 7) When you give report on shift change ask the oncoming nurse if you missed anything - rather hear from them than have them complain behind your back 8) give it some time and try not to be so hard on yourself. I am sure you do many things right but magnify the things you are a little weak on. celebrate your success and learn from your mistakes. there is no one way to make a great nurse... Best of luck!!!

I still believe any new nurse benefits from 6months to a year in med/surg or even a step-down area prior to entering ICU or ED. However, I worked with many nurses who entered the ICU right after graduation and became excellent nurses. The ones who had the easiest transitions were the ones who worked in the ICU as techs - they did not need to learn the routine or where things were and knew how to find information. Someone who is brand new to healthcare and never worked in a hospital would find it much more difficult - IMHO

My school outlines that we are to wear business attire, lab coat and the school name badge at all times. However, my preceptors basically said to wear whatever which for me has been scrubs sometimes with or without the lab coat. I am always introduced as the student and always let them know my role. My issue as a student is that it is added time and expense to maintain business attire and I would rather that money and time be placed elsewhere. When I graduate I will follow whatever rules my employer places on me. Still think the lab coat makes one look like a tool!!

I wondered that same thing before I started school and agree Guidelines and algorithms are a huge part of the learning process. I am still confused with some antibiotics - I learn one thing is school and in practice none of it seems to be followed which adds to the confusion. If could go back in time i would have learned the drugs by class.

PA vs NP the opinion all depends on who you speak with... I have known a couple of RNs who went on to PA but the majority go to NP school. I do not know much about the PA programs but I have been told they have more contact hours than a typical NP program. They did recently change the recertification to every 10 years (I think). A PA must always work under some sort of supervising provider where NPs can be free of the supervision in many states. An NP has a terminal point of DNP and not sure what or where a PA can go - as in what options after the PA.