Chen808

If you only wish to work in a hospice setting then you need to network with those who work in that environment. You can volunteer or even take an RN position for a bit so that you can get your foot in the door. I agree with many of the posts that reaching out to NP organizations and others who work in the field is a wise move. My clinic post experience requirements for new hires, but we still hire the occasional new graduate who had had clinical rotations with us or we are referred by another provider. Don't give up. If hospice work is what you want to do then find a way. Best of luck!

Looking of input/thoughts.. has anyone ever had an interaction with a patient or spouse of a patient where you did not feel you could see them again? I had one this week where the spouse was rude and hateful. I understand the frustration they have gone thru being misdiagnosed by their PCP, but to be nasty from the go was a bit off-putting. I made a plan and prescriptions with follow up in 6 weeks - but now that a couple of days have passed I do not really want to see these horrible people again. Is there a point where we can refuse to see hateful people. I have dealt with upset patients, but for the most part they are reasonable. This was the first interaction where I actually was thinking it may get physical. No, I do not work in psych...

I have made it a practice to meet with the student prior to accepting them to precept. I discuss what I expect and give them a scenario or two and have them walk me through their process step by step. I think if they possess the basic understanding I can help them apply the practice, but agree if they do not possess the basic understanding of how to conduct a physical then they do not yet belong in a clinical setting.

I use to precept all the time, but over the years I found that I was burning out on the process. Over time I developed my own personal rules on who and when I precept. I will not accept any students from Walden, Chamberlain or Kaplan as I have had more than one bad apple from these particular programs. I have also had students from the local university who were close to graduation who scared the crap out of me so it can be a crap shoot as with any student. I am too old for the first semester students and prefer to take on those close to graduation to help them put it all together before they take on their new role as NPs. However, I also need some months free of precepting. In our office we rotate and never have more than two students at any given time and we allow them to follow other providers from time to time as there may be an interesting patient or an opportunity to see how another provider interacts in a given situation. Like with everything in life I had to find the right balance that worked for me.

I have friends who are fortunate to have scribes help with charting - mostly in the ED. They are a time saver, but remember you are responsible to sign off on everything they write and you may still need to place additional notes in the chart. When I think about 15 min a patient That would stress me out. It takes one involved patient to throw your whole day off. Sure 15 minutes if fine for about 80% of the stable patients, but 45 minutes may be required for some of the more complicated ones who walk through your door. Also, two weeks off is laughable!!

Many FNPs work the EDs in my city and not just the fast track. Granted the more acute patient are managed by the physicians but that is still a small percentage of the overall ED population.

I think you misunderstood what I was stating. My point was directed more towards the attitude that some NPs believed this school or that school made more qualified practitioners. The school only plays a small part in the type of provider one becomes. Passing the boards states that you are certified to have the minimum knowledge to begin your practice. Sure there are graduates with additional skills but we have no means to quantify that and to consider the school you attended as the qualifying factor is not always the best means. I have been working for 15 years as an NP and to date have yet to meet a new NP who was ready to practice. They all require some means of guidance. granted, many are thrown in the fire and sink or swim (its what I did).

Where you went to school may matter in certain situations. If you live in a town with a large university that pumps out 100 NP students a semester that all providers/employers are familiar with vs an online program no one has heard of. However, so much more goes into it than just where you graduated from: 1) How you interview 2) How much pre-NP experience you bring 3) Fit within the practice (some diversity within a group is nice) 4) Special skills Bottom line we all pass the same boards! At that point in time we are all equal - no matter what anyone else claims! However, just like the basic nursing program it is up to the individual provider to gain experience, skills and knowledge to one day become a expert level practitioner.

FNPs here work ED, Hospitalist and anywhere else needed. ACNPs are more limited and harder for them to find positions here.