MJC2118

Hello all. I have been working as an NP for the past 2 years, in a general cardiology clinic. I have recently come across a position opening in a heart failure clinic at a different facility. I was wondering if anyone could give me some insight as to what this may entail? As it sits now, my facility does not have a designated heart failure clinic. We do see heart failure patients, along with other general cardiology patients, but I know this would by quite different. Thanks!

For those of you who work in primary care, how do you approach patients who come to you with s/s of mental illness?? I lost my sister to suicide in January, and as an FNP myself, it has really had be reflecting on this topic. My sister has struggled with depression for a few years that I know of, and had been to her PCP off an on for this. She had been treated with different medications, but never went to counseling that I know of. To be honest, she wasn't real open about her mental health issues. I'm pretty sure she had undiagnosed bipolar disorder as well. I was just wanting to get others opinions and perspectives regarding this topic. How do you handle mental health/illness in your practice? How do you evaluate them? How often do you refer elsewhere? How comfortable are you with treating mental illness? Barriers to treatment? Do you feel like your FNP program prepared you to handle these patients? Any other thoughts??? Thank you!

I know this is an old post; however, I'd like to thank those of you who had helpful and encouraging things to say. After being in Cardiology as an APRN for the past 6 months, I'd like to share how everything has turned out. Ya know, since I didn't have any experience with advanced EKG interpretation (gasp!). So, I started back in October 2017 and shadowed my main collaborating physician a ton, as well as some of the other physicians I work with. Having gone through a family NP program, there is so much that goes with this specialty, that I never learned. Rightfully so. Being able to shadow them for a while really helped be get an idea of the most common chronic CV conditions I would be dealing with, as well as common medications, diagnostic testing, etc. that I would be ordering for these patients. Every single one of the cardiologists that I work with are helpful and open to teaching. I frequently go to them while in clinic, when I am dealing with complex patients and need some reassurance or direction. They are okay with this! And they make me feel that it is okay to not know everything! This is a learning process, and knowing where my weakness lie, and what I could do better, really helps keep me in check and makes me a better provider. One of the cardiologists I work with told me that 12-lead EKGs are hard. He said that. He's been doing this for 30 years probably. He says it takes several YEARS of reading them to truly get comfortable. With that being said, I feel as thought I have truly excelled in this specialty, and my starting lack of competence with 12-leads has not held be back one single bit. I started seeing patients on December 14, 2017. It was scary at first and I've had to ask a lot of questions. I am now finally getting more comfortable and having to ask less questions, but I don't hesitate to ask for help when I need it. I see patients in clinic 4 days a week, and mostly deal with ischemic heart disease, cardiomyopathies and heart failure, PAF, valvular heart disease, and some resistant hypertension. We have an EP and EP NP that deal most with most of the EP stuff. I love knowing a lot about a given specialty vs. knowing a little about everything. I absolutely love this specialty and I have a knack for it. So glad I didn't let the negativity bring me down.

No, I do not regret going back to school to become an NP. As an RN with 6 years experience, I was making $58,000 a year. I worked night shift, so that was with a differential. I now make $86,000. I live in the Midwest though, so pay is a little less compared to other places. I work in a specialty clinic and right now I see about 6 patients per day, but will work up to about 10-12 as I am new. I see patients 4 days per week, with 1 day to catch up on paper work and patient calls. This day is totally flexible and I can use it to run errands, for appointments, etc... I consider it my off day. I am usually out of the office anywhere between 3:00-4:30 just depending on how busy the day was and how fast I can document, as well as complexity of patients. As an RN, I worked 3-12 hour night shifts per week, and had tons of days off; however, even working 4-5 days per week, I feel as though I have tons of time in the evening to spend with family, etc. Having weekends and all holidays off is a nice perk as well. Having said that, don't let all of these factors be the sole decision-maker for you. Transitioning roles from a nurse to provider, and expert to novice, is extremely difficult and humbling. There are a lot of new stressors you will experience being a provider, compared to when you are a nurse. Not to mention, student loans to pay back. You really have to WANT it, the role itself. Not just the perks that come with it.

Sorry, I just realized you said section patient. Usually in this situation, diets are advanced as tolerated but activity is usually minimal until Mag is off.

Our patients are on Mag for either preeclampsia or PTL, and is usually initiated immediately. With both of these scenarios, the patient should not be eating food (in case of c/s) and should not be up walking around (which isn't exactly safe with Mag, period). So I'm not sure why your coworkers were up in arms about this.

Bed rest, NPO or clears, IVF rate depends on Mag rate to total no more than 125 ml/hr, and mag levels are drawn PRN for s/s

Definitely Up-to-date, as others have mentioned. I also really like Habif's Clinical Dermatology

Yes, you must first get your Bachelors degree before you can get your Masters degree. There are 2 degrees that will allow you to get your RN license. An Associates degree (2 year program if full time, usually) and a Bachelors degree (about 4 or 5 years, depending on program). They both will enable you to get your RN license. However, if your ultimate goal is to become an NNP, then you will need a Master's degree, and you will have to have a Bachelors degree. So, you can do 2 years to get your Associates degree and RN license, then get into an RN to BSN program, then get your Masters. Or you could go straight to a Bachelors degree, work a couple years and then apply to get into a Master's degree program. There are many different paths to your goal, and it really all depends on what path is best for you. My advice would be to decide whether or not you want to start with a 2 year school or a 4 year school, and then work very closely with an advisor. They should be able to help you, and once you're actually in a program you'll learn a heck of a lot more about how it all works.

Thank you so much for your helpful response! That was exactly the type of answer I was looking for. When I was doing clinical in the office, the cardiologist was going over 12-leads with me, and I knew I had some deeper learning to do that was beyond the basics that I am use to. Thanks again!

1. MO 2. Outpatient specialty clinic 3. 1-2 patients per hour/10-12 per day

I am an L&D nurse who works night shift, and at the moment, there are more new L&D nurses on my shifts than experienced, (which is rare usually) so I've had to deal with newbies quite often within the last year or so. I can say this... never be afraid to ask questions and have someone double check you. Doing so should be respected and desired, not frowned upon. That's how you learn. That's how you give safe care while being new and that's how experienced L&D nurses should prefer It. I would much rather have a newbie ask me questions all the time rather than think she already knows everything. An overconfident nurse is a dangerous one. L&D is a fierce job, and not what most anticipate it to be like. It is challenging in ways people don't understand, but it can be very rewarding. You will have good days and you will have bad days, but you will always learn something. Just never be afraid to ask questions and take something new from every experience you go through. In time, you will get more confident and will become proficient. I've been on L&D for 5 years and still ask questions and bounce ideas off of other nurses. We all do. Experienced nurses still come to me do double check patients when they have someone with a tricky cervix. You never stop learning!

I was in your exact situation a year and a half ago. I have had this diagnosis for about 6-7 years, very rarely have outbreaks and when I do it is extremely mild. I often forget I even have It. I work in L&D and hear negative comments about this anytime a patient has HSV. While it annoys me, I just don't let it get to me anymore because I know they are just ignorant. When I had my child, I decided to go ahead and deliver at my facility. My best friend came in to be my delivery nurse so that was extremely helpful. Other than that, I just didn't say anything. If someone saw it in my chart, then oh Well. No one has ever said anything about it and I've not heard of any comments that have been made about It. I did make up my mind that if I caught wind of anyone talking about it, who didn't directly take care of me, then I would be turning their asses in for a HIPPA violation. Luckily, e everything was fine, and it wasn't a big deal. I understand your dilemma though!

Also, I must add, that crossfit has an "on ramp" program for newbies that specifically aims to teach the moves, modifications for moves and proper body mechanics, etc

I don't personally do Crossfit, but know a lot of people that do with my husband being one of them. There is a modification for everything and it's not a requirement to go everyday or to "keep up." Everyone is encouraged to go at their own pace. The way I see it, just from what I've heard , is that the potential of injury occurs when someone pushes too far, too hard or tries to do things that are well beyond their ability at the time. I feel like this is a potential with any form of exercise. It all carries risks. My husband chose Crossfit because of the structure, accountability and support the community provides, but he doesn't overdo It.

You don't need to know my perspective or opinion on why this position is a good fit for me, in order to recommend me some resources, which by the way, was the original intent of the post.

With the utmost respect, I disagree. Cardiology is the right fit for me, and even though I have not had any training in advanced EKG interpretation, it does not mean that I can't do this job. There is not a cardiology NP specialty program out there to my knowledge, so on the job training for these positions is a common thing, at least where I am from. The physicians in this practice are fine with the fact that I will need more training in certain areas and are receptive to teaching. The practice is also willing to pay for me to take some EKG courses. I also did some clinical hours in this practice while I was in school, so I guess they saw potential in me. I feel like anyone going into a specialty practice, is going to need more training. If I had primary care experience, would I not need additional training at all?? I'm not so sure.

Maybe you should read my edited post again before you judge too much. I was referring to advanced interpretation of EKGs. I shouldve been more clear and careful with my wording. I was just trying to make a quick post. We did not HEAVILY cover EKGs, basic understanding of them in order to know whats normal and not normal, and when to refer. Considering i was in a primary care program, NO i did not learn the advanced interpretation skills needed to be in a cardiology specialty, and why would I??

I know how to read basic EKGs. While we went over some EKGs in school as a refresher, it was never a requirement or heavily covered and never tested on. I want more advanced training for this job, that is what I'm getting at. My program was family practice, I'm assuming I'll need more in-depth knowledge about This.

Hello all, I was hoping someone had some good suggestions for EKG resources??? I will be starting my first NP job in a few months, which is a Cardiology clinic position. My program did not require me to learn how to read EKG. I have a few mo months so I am wanting to prepare. I have ACLS and i have taken an arrhythmia course in the past, so I have basic understanding of some things; however, i want to be more prepared than what i feel now, Thanks!

I would also like to add that I continue to work as an RN here because I have been doing so for the last 5 years and have been since graduating because I have to pay bills, but am looking for an NP job. Not trying to be secretive, just didn't know if I needed to turn in all the formal paperwork to HR if I was to be switching jobs soon. Also, I'm pretty sure it is not a policy at my facility to work in an RN position if your are an APRN. A coworker of mine stayed here PRN after getting her FNP.

Ok well first of all, I work for a large hospital... yes, my manager knows I was in school, graduated and am now an NP. I was more or less referring to HR and whether or not I need to have my transcripts, certification all that brought into them. No, I didn't inform HR or our CEO or anyone like that, that I was in school. But yes, my manager knows. I was referring to the formality of it all. Not secretive.

I have worked in a large hospital as an RN for the past 5 years, and have recently graduated with my Master's in Nursing and have recently been certified by ANCC and received my licensure last week. Do I need to let my current employer know about this and my new license? Or does it matter, since I am currently looking for a new job. Sorry, not sure how this all works! Thanks!

I agree with everything the poster said. I took the ANCC yesterday (June 28th), and passed. I would say 40% nonclinical is right. I felt like every other question was a nonclinical question. With that being said, if you have had a strong primary care education that was current with guidelines, the clinical questions will be easy for you. They are basic things that everyone should know. Nothing crazy. I went to an on-campus program, where I had rigorous exams and an exit hesi, and the clinical questions were not a problem. As far as the nonclinical questions, I could pretty well narrow down my answers to 2 and use common sense to select what I thought was the right answer. I had to read some questions a few times to really gauge what they were asking. There were some that i just had to guess on. I used Leik, and only Leik, to study. I made flashcards of all the exam tips and I did all of the practice questions. I also used the FNP mastery app and did all those practice questions. I felt like both of these resources were representative of the exam, especially with clinical info. Leik has a couple nonclinical chapters at the end that I would strongly encourage to look through carefully. The FNP mastery app also has 200 nonclinical practice questions, which were very helpful. I would suggest looking over Research stuff, hierarchy of evidence, ethics, hippa, leadership, etc...

I think this is pretty accurate. I went back to school for an opportunity to get a job that will have me home every night with my family, as well as no weekends or holidays. Working nights and having to miss holidays and important events with my family has been equally as stressful as the job itself. Not to mention the stress that working nights, will put on your body. I will actually even make more money as an NP starting out too (about $30,000). Win-win.