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criticalHP

criticalHP MSN, RN

ICU,CCU, MICU, SICU, CVICU, CTSICU,ER
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criticalHP is a MSN, RN and specializes in ICU,CCU, MICU, SICU, CVICU, CTSICU,ER.

Soon to be FNP..the final countdown!

criticalHP's Latest Activity

  1. criticalHP

    Will DNPs be chosen over MSNs?

    I'm glad you replied to this thread. As a PhD holder, what do you see differentiates the DNP from your doctoral degree? As I understand it, both are research and theory based with no additional clinical hours required for the DNP.
  2. criticalHP

    So I got rejected from NP school...

    I may be interpreting this wrong, but it seems you are saying online programs let anyone it because of their large class sizes. I disagree. Professors have limits on online class sizes, too. I know you said selective schools are not the norm...maybe, but reputable or not, Universities need to maintain graduation averages to remain competitive..yes, its a business. My school interviewed me twice, gave feedback on my application and essay, I was assigned an admission specialist to assist in the process (except the essay), and they phone interviewed my letters of rec. This was their standard. I didn't assume I'd get in...I was told this school is highly competitive, and it will get worse because of the surge of NP students trying to slip in before the 2015 deadline. I was the only summa cum laude to graduate in my class, I have more than enough experience in nursing in some of the best Michigan ICUs, have taught, managed, and hold my CCRN. The GRE was waived b/c of my 4.0, and my resume I was told, and the GPA cut off was 3.5. Just as they did their homework on me to ensure I can pass their courses (and support their graduation rates..its a business) I did my homework on them. Research the schools, know their graduation rate, where the grads end up working, how much they make compared to other 'popular' programs, and how much support you can expect..I would not choose another institution over the one I'm in...I even turned down acceptance at my home state university in lieu of this program. (but still a football fan ) I'm not saying there are school out there that are glad to get your money by accepting (you) into their program...you get what you pay for though. I would suggest researching the schools and choosing one that fits your interests, not one that is easy to get into, or easy to pass. If it focuses on passing board certs, think twice! Like I said you get what you pay for. I pay more, but to me its well worth it because the quality of the education and the content is what counts in the end, and the support doesn't stop on graduation day if its an exceptional program. (I'm not a recruiter, even though it sounds like that :)) I'm very proud of my choice...its distance learning but that doesn't make it easy:twocents: Good luck to you.
  3. criticalHP

    Flexibility of FNP sub-specialties

    I am in the distance program at University of Cincinnati, and am graduating this Dec as an FNP, but my background has always been adult critical care. I haven't dealt with pediatrics in over 10 years until school. I live in a geographically isolated area, so FNP enables me to go anywhere without limiting the patients I can see by age. Because of my critical care experience I have been approached by my hospitals hospitalist service to round on MS/ICU and cover night admits, and I've been approached by the ED director to work as FNP in the ED. FNP will best prepare you for primary care, but in my FNP program we study many things you will not see in primary care...acute care for deep burns, hypothermia, septic shock (drugs, drips, SG lines and all). Why? I'm sure there is a variety of sub-specialty NP students in my courses..acute care, womens' health, pediatric. During the practicum we are separated out into primary care, peds, or acute care based environments. I still see womens' health NP or acute care NP students in my episodic illness courses because they need this, too. So to make a long story short, you can use your past experience to enhance whatever NP specialty you choose. Take a look at the market around you, your likelihood of employment with each specialty, and decide from there. But if you go into something you don't want to do you will not be happy. There are also post-masters certifications in other areas. Say, Adult NP wants to see peds...take the FNP certicifation courses...Good luck!
  4. criticalHP

    How do you prescribe ABX in a retail clinic?

    No probs, and your first instinct is usually the correct one, that is if the original poster gives you all the info (shame on me- it wasn't intentional) :uhoh21: . I felt she was a bit lazy, too. But it did get me thinking about the business angle.
  5. criticalHP

    How do you prescribe ABX in a retail clinic?

    Very nice reply. The NP did in fact explain their (rapid strep) was negative. She would then write the script and say if you feel you need it after a couple of days, go ahead and fill it. One reason she did this is that as a retail clinic there is no lab for which to send the strep swab to cook overnight...and they do occasionally come back + on the cultures. So, they have paid their fee, got a negative result. If they walk out of the door with no script and feel lousy in 2 days they can come back (pay again), go to the ED (where they never pay), or go to the competitor--who will likely give the ABX for the same reasons. Lazy? Perhaps. I can see that at first, but she did educate every one whether they listened or not, and having a NP student in front of her likely encouraged a bit more education on her part than probably occurs. thanks again for the post.
  6. I am a FNP student 8 weeks into my first practicum rotation. I'm mostly in a busy clinic office, but twice I was asked to go to a retail clinic. The clinic is staffed by one NP and a receptionist in a moderately busy outlet. The NP is limited to what can be seen and treated, so basically only ENT, GU. No lacerations, suturing, GI, chest, wheezing...you get the idea; Its quite basic. I'm glad for the experience, don't get me wrong..I can spot a sinus infection across the room now:yeah:. There were some things that bothered me about the politics and the prescribing of antibiotics in the retail clinics, and I'd like to get some opinions from working NPs from all clinic areas before I make up my mind on what is right. Firstly retail clinics are a retail business, and without customers that business, like others, will not succeed. People pay $xx to be treated for whatever illness they have. If they are happy with the service, and perceive it to be of value they will return. What I have a hard time with is that people except an antibiotic along with their $xx fee, even when it is clearly not indicated. I saw people with no fever, clear sinus drainage, no HA, no cough were diagnosed with a sinus infection (and URI) to justify an ABX. The NP I was assigned to said that is what they expect, and if they don't get it they will go to our competitor up the road. If they go to the competitor we loose revenue, and I loose a job" There was no need for me to mention antibiotic resistance; I could read that she felt uneasy and ashamed about this practice all over her face, and I really felt she was in an ethical dilemma within herself. So then, here is the issue: Do we prescribe antibiotics without justification in order to ensure customer satisfaction, good community reputation, and return on investment for the parent organization? Or do we help prevent the development/spread of ABX resistant organisms, and hope the patient understands we are doing this for the good of the HC community as a whole, plus saving them from possible SE of the ABX? (remember, most of these people are uninsured and pay out of pocket) I suppose one could refund their money if they do not Rx an ABX. This would satisfy the customer monetarily and increase trust in the clinic, but then the NP is not making the clinic money, and less business income means over time equals closed doors and unemployment lines. I would love to hear all sides of the issue. I will likely end up working in one of these clinics at some point, but will I compromise my clinical work ethic for the sake of a having a job? I've been an ICU and ED nurse since 1997, and I have always worked to protect my patients, even when it ended me in hot water...I was doing my job as a patient advocate. One more issue...the dark side ...I notice in my geographical region there are NO physicians that run these retail clinics, in fact they removed clinic services from the local ED's. Given the scenario presented could the retail clinic undermine NP validity in the eyes of physicians, and is this intentional? I appreciate all feedback.
  7. criticalHP

    University of Cincinnati - NP

    I have been 'attending' UC online for FNP since Jan 2010, and have one yr to go before graduation. Overall I am pleased with the quality of the education. Each quater is different and depends on the professors individual requirements. With that said, some are better than others. There have been classes where I have not had feedback from professors directly, but rather we were given a general class annnouncement to provide us with information about assignments (classes have about 200+ students). In other classes there was daily personal feedback. The pharmacy class was laughable...the information was outdated, and included meds that were removed from the market in 2007! Hopefully that will change. This is a fast paced program so be prepared to spend many hours at the computer or with your nose in a thick book. IT was a hard adjustment for me, and I eventaully had to cut back to part-time at work. They love research and theory in the first year, but I have to admit the classes were engaging. So far I have felt very postive about UC, and I've recommended them to some of my friends that want to return to school. Good luck to you
  8. criticalHP

    Frontier vs University of Cincinnati

    I'm in the UC FNP program now. The recruiter told it it has been highly competitive since the economy has been so bad. Perhaps b/c so many people are out of work...why not return to school...? Anyway, I am enjoying the program. Every one will have its up's and down's, but for the most part I am satisfied with the education I'm getting. I'm in the distance learning program BTW...support is excellant!
  9. criticalHP

    Special tubing and stopcock for diprivan??????

    Thanks for the reply. Its funny, and by that I mean suspicious, that the stopcocks are manufactured by the makers of propofol. We use alaris pumps too but that is irrelevent with regard to using the stopcock for diprivan in bedside practice. I wonder if the stopcock is something that is used by anesthesia? Any CRNA's care to reply? As far as concurrent drips go, sometimes you have no choice, such as open heart pts with a cordis. We would run NTG, dopa, levo, and amacar, plus insulin,, sometimes others. If sedation was required we had a peripheral (hopefully working) so we didn't "push" the vasoactives, but occasionally propofol would find its way on the cordis line up when no other choice presented itself, and I would try to titrate as little as possible to prevent the vasoactive responses from other drips. IVBP were absolutely never run through the cordis with any drip, and for that matter any other type of central/peripheral line with a drip. No drip--you're good. The CVP port is a good option for intermittent infusions too. In pts needing multiple sedatives and analgesics we would commonly combine versed, fentanyl, and/or ativan at one site. Not too sure on the steroid and insulin combo...seems like they would crystalize --I have not looked this up mind you and I'm sure you have, so if lexicomp or whatever reference you are using says its compatible then, hey :) Do you have an resident ICU pharmacist? They can be very valuable with these issues...a good plug to get your administrations to hire them. Nurses have a lot to do and having one of these smarties on staff can save a lot of time--maybe even a life :redbeathe Thanks again for your reply!!
  10. criticalHP

    Overdoses

    I recall an unfortunate woman who OD's on tylenol by taking capsules, cough syrup (w/ tyl), and lortabs. She went into liver failure and died waiting for a transplant. Another OD was a prisoner that took a handful of stool softeners. The doc laughed in his face (from the door) and said "son, if you wanted to kill yourself you chose the wrong drug--have a nice night". exit laughing...
  11. criticalHP

    Overdoses

    Try some charcoal smoothies for a rippin' good time
  12. criticalHP

    No nursing jobs in 2012 ???

    That is where a strong union comes in to play;)
  13. I don't see how a pregnant woman over #500 makes a difference. The fact is that #500 requires specialized equipment. Its a matter of load--even if it is temporary.
  14. criticalHP

    R/O Seizures

    Sorry, no. It was essentially an interactive lecture to dispell the belief of what a "normal" seisure looks like. He was promoting Keppra heavily at the time. Personally I think--give em ativan. If they're a psych person trying to pull one over on you...works too
  15. criticalHP

    b/p ?

    Firstly know your drugs and the effect they have on the heart and vasculature. If a pt is on metoprolol and they have a HR of 50 and a SBP of 90-100 that may not be safe to give because the BP may be low d/t the low HR . But if the pt had a HR of 130 and a SBP of 90-100 then give the metoprolol to reduce the HR and thereby INCREASE the BP. Remember that BP= HRxSV. For DBP, again know the drugs and how they affect the afterload (PVR). When I make a decision on whether to give or hold a med I consider the risks and benefits of the drug and what effect it will have on perfusion/cardiac rhythm. To choose an arbitrary SBP of 90 as a general rule for holding a med can get you into trouble. If a pt needs a pressure of 120 to perfuse the kidneys or brain then you can see how this rule would jeopordize the pt. MAP is very useful-but when using MAP consider the clinical findings of your pt as well. Are they making urine? What is their LOC? Are you having to titrate your drips up to achieve BP (could indicate acidosis d/t hypoperfusion/hypoxemia). Lots to consider, so try to think it through rather than use a generic guideline. Good luck!:heartbeat