CoolLikeThat

And people ask me why I will never let my children be seen by a midlevel.

The first year can be tough. You graduate and feel you know stuff then go to work for/with providers who know way more and have so much more experience on top of that. It is intimidating and frustrating. There can be a huge learning curve and it takes time and hard work to get better. I was so insecure and self-doubting for the first year. i often felt like a total idiot. I sometimes would talk to a patient and feel bad that i could not answer their questions as clearly or with as much confidence as my docs. I also faced the suspicious angry patient who would look at my badge and look back at me and because I was not the MD they would dispel everything I would say. It takes time and hard work. It will get better as long as you listen, learn and work at your practice. I still have days where I feel dumb or ill prepared but those days are fewer than they were a few years ago. Hang in there and good luck!

I do not think it makes a difference either way as long as you of to a decent school and not a pay-for-degree online program. I moved around a lot and ever program I completed was with a different university in a different state. It was brought up in interviews just as a talking point.

Maybe consider moving up the coast. I receive about 10 emails a week for jobs in Oregon, Washington and no Alaska with some pretty attractive salaries plus moving expenses and loan forgiveness. Some have made me stop and take a minute. I was under the assumption that California was in the same boat of throwing money at anyone who would apply for a gig. I practice is a very cold rural area and the shortage of every medical practitioner keeps the salaries on the high side.

I deployed with an FNP that was put bedside as an RN - the needs of the military come first. She did throw a major girl scout tantrum which did not endear her to anyone.

Yup, If in doubt check with your BON. People on this share opinions that are not always based in facts or my be the case in their state but not all states.

Where I am there is a significant lack of family physicians so just about all the clinics are staffed with NPs with maybe a physician rotating between several clinics. The problems come when these many inexperienced NPs refer patients who should be managed in primary care. Along with a lack of family MDs there are a limited number of specialists and when half of your schedule consists of referrals that are not requiring specialist you cause others to wait even longer for an appointment.

It happens and it provides a learning opportunity. I feel for the ED physicians and those who work primary care as they are faced with everything and have a higher likelihood of misdiagnosing. I see more of the failure to rule out differential DX and settling on the easiest diagnosis possible when seeing referrals from family or IM. However, they knew enough to refer and that reflects far better than just settling with their primary consideration. Mistakes will always occur as we are people in the practice of medicine and as people we are prone to make mistakes. Hopefully, we rule out the red flags and miss the small things...

No I am the farthest thing from a bad ass! I just benefited from one on one training by a brilliant specialist who brought me along slowly and forced me to learn and grow. There is no way an NP program could come close to the education I received over the last four years. If I had the option to sit for the boards ACNP boards I have no doubt I would ace it.

Remember the saying, "Those who can't do, teach"

They did not have an ACNP program near me when I decided to return to school for my FNP. I believe I would have gone that route or even the dual ACNP/FNP route, but programs have changed since then and added more options. My RN background was deeply involved with critical care care and there was a learning curve when my boots hit the ground in an ICU. As a nurse you may think you know but as a provider you are required to know and that can be scary at times. I have been working pulmonary/Critical Care for almost 4 years now and I am seeing and managing patients in the ICU. I intubate, place lines, manage vents and run codes. My practice physicians know I will ask for their help/advice when I need it and we seem to work well that way. I probably will take the post masters acute care program, but at this point I am not sure I will gain much from the program.

Monday thru Friday 8-5 (usually done by 3 or 4) no holidays,nights, weekends or call!!! I work with an intensivist group.

During my RN career I do not ever recall an NP signing off on EKGs and as an NP I am happy to have someone else have the responsibility for that job. MDs in my hospital can read them, but if there is ever any question that bad boy gets read by cards. Can I read them - yes but I am not the expert and would prefer not to have that responsibility. Another issue is the reading of X-rays. Again, I have worked in several facilities where line placement x-rays are only good when the approval is given by radiology. I can read them fine but I never write the order to use a line until confirmed by radiology. I try to CMA as much as possible. I have run into many NP/PAs who feel they can do everything better than an MD and that is fine and good but I like my license and want to keep it for a bit longer.

My A&P class had us responsible for every bone. It was a cool class we had the exam with all these bones in different stations with numbered areas and we went from station to station filling out our blank sheets. I cannot remember hardly any of them but neither can my MD colleagues and truth be known - it does not matter! We can look it up!

In my NP program I was in scrubs and a ponytail everyday even though my program insisted on business attire. Starting my first job I went all out with the clothes and the shoes and actually woke up early to do my hair and makeup. That did not last long!! It is hard to look cute in the ICU when you are placing lines and pulling tubes. Plus, all gowned and gloved it gets very hot and I was slow back then and oh I was a hot mess (literally)! nowadays, I wear scrubs 80% of the time and slacks or jeans on fridays the rest of the time.

How many MD programs are offered online? The education and value of the degree have been devalued by the online programs and I would not be surprised is the salaries continue to tank over the next 5 years.

Nah, not what I meant to imply. Lots of people entering the room help guide the patient care. My point was that in the hospital (not clinic) the physician is usually the team lead. I work in the ICU and the Intensivist are the final say and I never use the Dr title with our patients. I usually tell them who I am and let them know who I am working with so as not to confuse them. It helps to be clear in the hospital because they interact with many providers and non-providers and can become a bit confusing at times.

This makes no sense! in a hospital the goal is not to confuse the patient, because the Physician is the one directing the overall care and he/she should be designated as such. What we do in the hospital setting is for the overall benefit of the patient and not to inflate our egos. In academics everyone who holds a doctorate can be identified as Dr. It is more than appropriate in that setting.

1) be on time 2) be on time 3) be on time 4) if you cannot be on time call or text before you are 20 minutes late 5) whatever forms you need signed or filled out give me them up front and not 5 minutes before you leave 6) Ask questions and be prepared to answer questions - I want to know what you know and how I can help you and if I need to brush up on anything. 7) I don't have all the answers and I have to look stuff up all the time - so expect to look up what you don't know. 8) never ever chew gum 9) be nice to the other staff in the clinic and the hospital 10) don't think you are too good to check a temp or recheck a BP 11) do not get butt hurt if a patient/family would rather not be seen by a student

It irks me when I see other NPs, PTs and NonPhysicians introduce themselves to patient as Dr so-in-so. One instructor told us we should introduce ourself as Dr so-in-so and explain that we are the NP, but that seemed way too much to spit up and explain each time I entered a room.

Here the term used is APP (advanced practice provider) and I kinda like that better although I usually don't care what you call me as long as they still pay me.

yup there is fluff just like the BSN and the MSN, just suck it up and do it!

there is something missing from this story

Don't be bummed if you don't get in. I had a 4.0, but they did not appreciate the candid nature of my goals statement. No worries, I was accepted by Case Western and believe me it was the better school!

I always go with my gut on these calls. I may try to hold out for an entire year, but if you are unhappy and just cannot do it anymore then find something that makes you happy. Plus, if you are moving to DFW you will have no problem cherry-picking exactly where you want to work. I have been away from Texas for years and still get emails and calls for jobs or asking if I know anyone interested. It is one of the best places in the country to find work as an NP. Good luck with your decision!!