Pros & Cons?

Trauma Columnist · Oct 2, 2006

Nursing is a very wide career field. That said, there are many types of NP's. I am a Clinical Nurse Specialist in adult health. I work alongside (and do the same job as) an NP in outpatient crhronic dialysis. I enjoy it very much. I have loads of flexibility with my job as to times that I work as long as my patients are seen. The compensation is very good for my area and the perks are nice too.

I would suggest that you first become an RN and then decide what specialty you want to pursue. Its hard to choose a specialty without experience. GOod luck.

Starphoenix · Oct 3, 2006

Thank you for your reply!

I know I either want to be an Adult NP in an office setting (working with a specific population), or a Geriatric NP.

CrazyPremed, MSN, RN, NP · Oct 4, 2006

What is your healthcare background?

CrazyPremed

Starphoenix · Oct 4, 2006

No formal background, only what I've gleaned from years of illness and research. :wink2:

I plan to enter an RN to MSN program. (Please, I want no debate here about the merits of experience, etc. :nono: )

I'm looking for the pros and cons commonly experienced by folk. I'm hoping to get a decent number of responses. I edited my subject title (hoping that works, haven't been posting on the board much). I'm looking for a "day in the life" kind of thing, too.

I'd love to hear from NPs in any field, whether working at a hospital or office. Adult, Family, Geriatric, Women's Health....

Thanks! :biggringi

Trauma Columnist · Oct 5, 2006

Okay - I can give you some more details. I am a CNS (Clinical Nurse Specialist) in a large (11 MDs, 4 PA's, 3 NPs, and me) nephrology practice. The NP's in the practice do all the medical management of dialysis patients at 11 facilities. I have two units totalling about 200 patients. Since many of these patients have no primary care provider, I provide those services too. According to Medicare guidelines, chronic hemodialysis patients must be seen once per month by an MD and three more times by an advanced practice nurse, PA or MD. My schedule today was:

Leave the house at 0630 to go to downtown unit - see 30 patients

Go to north unit at 0930 - see 20 patients, look at labs, do some paperwork

Back to downtown unit at 1230 and see another 20 patients. Field questions, do PT's/INRs for charge nurse (lab tests), see several "ill" patients. Do an H&P for a patient to be have elective surgery. Do some more paperwork and go home at 1800.

Most days I don't work 12 hours but I have the flexibility to work a longer day and take a day off too. I do have call responsibilities once per month for a Sat/Sun 0700-1900 each day at two hospitals about 55 miles from me. When I go there, I do rounds on each of our patients (usually 5-15 patients) and then do any consults/ER consults that are ordered).

I have a very interesting job and no two days are alike which is what I wanted when I took this job. My background is ER and ICU and I thrive on chaos.

Hope the detail is what you wanted.

Starphoenix · Oct 5, 2006

Wow! That's some schedule and responsibility! I, too, thrive on chaos, so I was chomping at the bit reading this. :)

Thank you for responding.

Any other takers?

ERNP · Oct 11, 2006

I'll bite....

I get up at 830 and drive like a wild woman to make the 54 miles to my rural ER job on time. Which means I usually make it by 11:10am.

I look at the 5 charts in the rack and think..... my goodness but these people do get out early. Put stuff in locker and go out and begin to see those waiting. Who are they?? You never know in advance. Sometimes it is a "head cold Wednesday" or it might be "heart attack Tuesday". It is the luck of the draw.

Typically, I will see a wide variety of ER patients with the following complaints, not necessarily in the listed order or on the same day.... headaches (migraines and those only called migraines).... toothaches (the infected and the broken)... foreign bodies in orifices and eyes (thankful that the orifice is usually the ear or nose).. head colds.... pneumonias.... heart attacks... dysrhthmias.... TIA.... stroke.... abdominal pain is my favorite mystery.... UTI... lots of orthopedics... lots of pediatrics.. respiratory failure.... seizures.... overdoses.... CPR in progress... car wrecks (some walking and some wishing they still could walk).... bike wrecks, lacerations, burns.... DVTs .. PEs.... and let's not forget our special patient population with psychiatric challenges... gun shots, stabbings, beatings..... little old ladys just looking for some company....families convinced something has drastically changed in mama (we have seen her more in the last 7 months that they have, but they know something is dreadfully wrong)....COPD patients wishing for just a little more air....people who feel vomiting once is a true medical emergency....fevers... pregnant people with pregnancy problems...people wanting pregnancy tests..... occupational injuries of all types but usually at least one with a fall from a height that shouldn't be fallen from....fingers cut off and in plastic bag waiting for the opportunity to be grafted back to their original position.,.. people brought to be cleared medically for a trip to jail.....sexually transmitted infections.... let's not forget back pain... injuries to any part of the body that can be injured... sickness to any part of the body that can be sick....

I sort out about 35 - 40 of them before I go home very tired (like right now).

Basically, if you have never seen it in the ER, it doesn't exist because we see it all.

Starphoenix · Oct 11, 2006

Thank you for "biting."

I wondered why you called attention to not forgetting the "special patient population with psychiatric challenges." That's kind of insulting, don't you think? I happen to be one with "psychiatric challenges," but I live a full and productive life. It's little wonder there is no coverage parity with this kind of attitude, and I don't care if you were trying to be insulting or not. Nobody likes being called "special." You hear that about those who are developmentally disabled, too. "Oh, Timmy. He's SPECIAL. You know, he rides the little bus...."

RNinSoCal · Oct 11, 2006

Starphoenix,

ERNP was not trying to insult you. You would have to be a nurse, PA/NP or ER MD to understand the specific problems of treating a medical problem in someone who also has underlying psychiatric problems. It is simply something you would have to experience to understand. I freely admit that I can not know what is like from the pts end either. I won't go into detail about my experiences but let me say that the mental illness often causes the pt to complicate and sometimes obstruct their medical treatment. Not all pts with mental illness have this problem, but we see the extremes more often than the average as health care providers. Try to remember that this site is a place where nurses speak freely about their experiences as nurses.

Thanks, and best of luck on your journey toward a new career.

Trauma Columnist · Oct 11, 2006

Star - please know that ERNP wasn't insulting. I worked in a level one trauma center for 10 years as a staff nurse and case manager. The mentally ill are truly a challenge for us in the ER because we are not equipped to handle them. The ones we see in the ER are not the folks that take their meds, go to therapy, live productive lives. These are the acutely decompensating hallucinating, often drunk and/or high patients that just literally bring chaos to the ER.

In IL, our wonderful governor closed two central IL mental health inpatient facilities in 2002. He decided that the community care system was what he wanted. However, there are some patients that can't function without routine and structure. These are the folks we see in the ER.

It is very sad that this happened because it has resulted in poor to no care for our mentally ill and very frustrated ER staff. There is not much we can do with the acutely mentally ill in the ER: haldol, ativan, sedate and/or send them to jail. None of this truly helps them!

As an aside, I have a mentally ill son who is an adult. He has had run-ins with the police, his employer, his friends and of course us. The way he has been treated is appalling and personally very distressing to me.

My son is the reason that I became an ER case manager. I may not be able to offer solutions but I do care and I treat the mentally ill as human beings. Sometimes that is all I could offer in the ER.

fidelio · Oct 11, 2006

Thank you for "biting."
I wondered why you called attention to not forgetting the "special patient population with psychiatric challenges." That's kind of insulting, don't you think? I happen to be one with "psychiatric challenges," but I live a full and productive life. It's little wonder there is no coverage parity with this kind of attitude, and I don't care if you were trying to be insulting or not. Nobody likes being called "special." You hear that about those who are developmentally disabled, too. "Oh, Timmy. He's SPECIAL. You know, he rides the little bus...."

I wouldn't be too quick to lecture the nurses or NPs on this board until you have worked in their ranks. If you ask for the "nitty gritty" and then in return scold a nurse practitioner for not being politically correct, you are going to put people off. The correct response is to listen. Caring for people all day long requires a tremendous amount of fortitude and emotional muscle. After the patients get what they need from us, we try to be supportive by listening to one another rather than policing each other's choice of words. On a different note, I have noticed that some of the very best nurses have health challenges. Illness can be a great teacher. Good luck with your research.