ohiosam2

It is highly variable on your state and your individual hospital. In Ohio, you can indeed work in the ED as an FNP. However, at some hospitals (like mine) if you only have an FNP you will find yourself working in the urgent care area. Others might let you on the acute side, but may be less likely to take a new grad FNP because of the learning curve. I have dual certification in ACNP/FNP. I have been working in the ED for some time. I work on the acute side. I intubate, put in central lines, put in art lines, suture, I and D, and put in chest tubes. At this facility, we will not allow FNP's to work on the acute side. End of story. Many nurses have tried to change this policy and have failed. You must be an ACNP to work in the main ED. No FNP will be allowed to do any of the advanced procedures I described above. That being said, it is highly dependent on the state and the institution. My advice would be to check out the ED's in Florida. What kind of NP's are working there? Are they FNP or ACNP? Do some sleuthing to find out what education you need in your area. Being faculty for an ACNP program I will tell you this, make sure your education prepares you to perform the job you want. I will always encourage the ACNP over the FNP for ED because the two programs are completely different. Many will disagree with me here, however I have been through both programs. I went back for my FNP to make myself more marketable. There are some new ENP programs that are up and coming and very exciting for the future. However, some states are not recognizing them yet. Take your time and make an informed choice.

I certainly understand that fact that you feel stressed and burned out! Working as a nurse is to operate at full speed at all times. You are always short staffed and pressed for time. Am I happier now that I am an acute care NP in the Emergency Department? YES YES YES YES YES YES!!!! The job gives me just as much anxiety as nursing did. I am now responsible for people's lives and the care I give in a way that is much different from nursing. I am now more legally on the line for what I order. However, I will never regret my decision to become an NP. At my institution I was tired of working for nursing management. They were much more interested in the color of shoes I was wearing than the fact that they could not staff their unit. The fact that they did not respect the nurses who worked for them was very much apparent. I was tired of being treated like a little kid instead of a professional with a college degree. I made sure that I applied for an NP ER job where I would be working for physician management and would not report to nursing. It was the best thing that has ever happened to me. The physicians at my current institution are very much NP advocates. They show an incredible amount of trust in me and will defend me quickly if another service treats me inappropriately. In other words, they treat me like any other provider. Beware! Not all places are as supportive as the one I am working at. You have to pick who you are working for VERY carefully. I looked at jobs for six months before graduating and asked other nurses and NP's about the different places I was looking at. I made sure the unit was well staffed and that there was a plan in place in case another provider was ill. I also looked into the way the NP's were treated and how much they liked their jobs. Sometimes the grass is greener on the other side. You just have to be patient and take the time to look carefully.

Run, run, run, run!! Why do nurses and NP's feel they have to put up with this? You are not receiving the respect that is due you. Don't tolerate it. I am lucky because I am in a position where the physicians who I work with respect me and often protect me from others who do not. Yes, it is not good practice to leave before 6 months have gone by. So you need to do some reflection and decide if you can stick it out. Don't sacrifice your mental health for this. There are other jobs out there! Do some research and find a place where you will be valued and treated well. You don't have to put up with anything less. By the way it starts with the orientation, if you get an unorganized mess of an orientation, that is a big red flag that you are in the wrong place. Don't sell yourself short, there is a good job out there waiting for you!

You are pretty much new to the floor! Give yourself a break. The floors can get rough. It is really tough to learn how to organize yourself and get a routine down so that you think of things like this. We are all human. I have news for you, we are all going to overlook things. The point is to learn from it, change your practice to avoid it in the future and walk on. This is difficult for nurses. We worry excessively because we care. Twenty years ago I was oriented by this real battle axe of a nurse (God rest her soul I miss her!) and she told me, "Are all of your patients okay at the end of the shift? Good, stop worrying and welcome to nursing. You do your best, you learn from your mistakes and you go on." Take a deep breath. Think about how to avoid this in the future and get back to it. I can tell you will make it because you are worrying. Patients need nurses who care like you. DO NOT give up. By the way, as an NP I can say the doctor should have known better and should have ordered some fluid with some glucose!

There is a turf war. No doubt about it. Look what happened in Ohio when NP's lobbied for independent practice last year. The AMA threw up their heads and howled. Here's the fact: I am not a doctor. I am an NP. Are there things that are beyond me. Of course. We are not asking to be doctors. We are asking for independent practice as Nurse Practitioners. We are not trying to take over medicine or push them out of the picture. We will always need doctors and their expertise. Many of them resent NPs. Many of them do not. As NP's we practice medicine. I do not practice nursing. I medically manage patients and treat them medically. The more 'holistic' part is in the way I approach the patient. As a nurse, I was taught to make a partnership with the patient and for mutually acceptable goals. I bring that over with me in practicing as an NP. I have noticed that physicians approach patients from a more paternalistic view. They want to dictate the patients treatment and expect them to just follow it. I will explore how the patient feels about the treatment and look into any barriers like: lack of money, social issues, family issues. Do you see the difference in my practice? It is a strange hybrid of a nurses demeanor and love of caring and a physicians practice of medicine. Frankly, it makes for better care and is much more patient-centered. Having said all of this, you want to keep one thing in mind. Be very careful where you accept a job as an NP. In the ER where I work, NP's are loved and esteemed. The physicians I work with are an incredible group. They treat me as their colleague and afford me the respect of a provider. God help you if you come down to this unit and yell at me or treat me in a less than respectful manner. They will be all over you so fast, you won't know what hit you. They even ask my opinion about treatments and EKG's all of the time. I am very, very lucky. In this same hospital there are NP's who are treated like nothing more than scribes. I asked around, sniffed around and did a lot of research before taking this job. Make sure you are going to work with doctors who will respect you and let you practice at the top of your license.

TNCC is nice, but not necessary. I would not take it unless the place you are working for pays for the course. I would not spend my own money on it. I echo the other comment though, ATCN is totally worth it. Great course. I actually would pay out of pocket for that one.

Nursing managers do not practice medicine. Our manager now is a physician who offers us a resource and recommendations on how we practice and how best to practice Emergency Medicine. He reviews our charts and will offer constructive criticism and praise for the way we practice and will assist us in education if there is something we are lacking. A nurse manager cannot offer this kind of support or management. Our physician management also has quality indicators that are directly applicable to our practice as providers. Nursing management would have no idea which quality metrics to monitor as they are experts in nursing practice and not medicine. I think a colleague of mine summed it up nicely. We are providers. We are no longer nurses. We need to have other providers managing our practice because what we do is very different than nursing. I will say this too. The statement was made by nursing management that if they would like to manage NPs so that we could assist with the nursing role when we are not busy. I would love to have a day in the ER when I am not busy. I sit down for 4 hours every day to chart on the multitude of patients I have seen that day. Nursing considers this "doing nothing" because they see us sitting in front of a computer. They would like for us to help out with the nursing role on our down time? That is not my role any longer. This is an example of how a nurse manager does not understand the NP role because they are not an advanced practice nurse.

You are being far, FAR to hard on yourself. I was ED nurse for 20 years and now I am an NP in the ED. I have oriented more people that I can possibly remember. Now I orient NP's to the ED. I've done trauma, pediatric ED . . you name it. First of all, three weeks is not enough time to make the judgments they made about you. I do not care for the negative spin that manager placed on you. To tell you to go back to your original job is highly unconstructive and downright unprofessional. Here were are as nurses once again eating our own. The ED is a fast paced environment where you have to think quickly on your feet and make snap decisions. You don't have time to think things through for a long period of time. This is a very difficult thing to do for some people. If you are not used to that high intensity nursing, it is very beneficial to work for on a med/surg or telemetry unit. There you can learn to organize your time and gain more experience in order to move faster. Number two: decided if the ER is really where you want to be. When I started out as a nurse I spent one shift in the ER to find out "if it was for me". A very wise and older physician told me this, "You are either ER or you are not. And there is NO shame in being not." It takes a strong constitution and an ability to work under stress. If this is not you, then don't be ashamed. Not everyone is meant to be there. Number Three: if you really want to work in the ER then don't let anyone on this planet tell you that you can't. You may need to put in some time on an acute care floor or even reading up on skills. But if this is what you want to do, don't let someone else deter you. You can do it with hard work and full dedication. Number Four: there are plenty of ER's! I really don't care for the way this was handled. If you get negative comments and feelings from a place - run the other way! Find another ER at a different hospital. Take it from me, I have worked ER's from California to Ohio. Each one is different and has different management. Some are horrible! Some are the greatest places to work. Find a good one! So if you don't want to go back to your old job - then don't! If you want to do ER - find another one or go to a med surg unit and get some experience and try again. If you think ER is not for you, find something you want to do. Don't let the snap judgments of others get to you. If you are willing to work hard, you can accomplish a lot more than you think you can right now.

I am wondering if anyone has any experience with this. I have been an NP in my area for a few years now and I am very familiar with practice at other hospitals. I currently work in an ER. There are both NP's and PA's in the ER. We work under physician management. As far as I know, the other hospitals in the area also work under the physician management teams. Recently there was a very big discussion going on in the hospital. It seems that the nursing management felt that they should be in charge of both PA's and NP's. Fortunately, the hospital physicians absolutely refused to allow this. I was shocked. I do not feel a nurse manager should be dictating practice to those who are advanced providers. During the discussion, nursing stated that many hospitals around the United States are putting their NP's and PA's under nursing management instead of the physicians. Is anyone out there under nursing right now? If so, are you having difficulties with this arrangement?