13 years out of practice. How to come back

[Saifudin]

Hello Colleagues,

I am an ANP since 1982 and left clinical practice when I moved to the middle east to work in 1995. I have been DON in an addiction and later a full mental health facility since and am now planning to repat after one more contract (1 year). I am also about mid-way through a masters in health care adm. I need a year to organize and transition.

I would like to go back to medicine, not sure if as an NP. I like administration and leadership but also being involved clinically. After this amount of time with nurses from 6 different countries, generally low level or "technical status" and no place to go but up (so-to-speak) getting back into work in the States seems a bit daunting.

First question, what is a good way to go about a comprehensive review of medicine for NP practice. I try to keep up on CE's but over time, I've had to concentrate on addiction and later psych, which was dropped in my lap and now, with the masters, well, that eats up most of my time.

I thought about looking to volunteer on my return perhaps in a shelter or similiar environment to get back skills. History taking, exam, etc., its like riding a bike. I teach alot in my job and have to but definately fine tuning or perhaps and tune-up is needed.

I have combined experience of over 30 years, so any suggestions, idea or similiar experiences would be great to hear.

Thanks

[ghillbert, MSN, NP]

I'm surprised you can keep your license without practising for so long.

I'd contact the BON and ask about reentry/refresher courses.

[henrysmom]

I am in a similar situation and I tell you what I am doing. I finished my MSN FNP in 1997 and worked for a year as an NP. Hated the clinic I worked in, went back to the bedside (SICU) for several years and then worked several years in a hospice/palliative care position (actually a great place to learn some primary care stuff over again). Now I am working as a case manager, but am looking to replace an NP who is retiring in a year or two. I was board certified by ANCC, but let it lapse a long time ago.

First off, I feel comfortable about pharmacology, took a 40 hour refresher course about two years ago and actually taught pharm at one time. The one area I feel real weak in is advanced assessment. Don't do many head to toe exams in hospice.. So I am re-taking the advanced phys assessment at a local college this fall. Have bought the CDs of the Fitzgerald review course and plan on listening to them and using it to guide me into re-studying stuff I feel weak in. Did buy a few textbooks again, the Uphold one, the Fitzpatrick derm book, Jarvis, and have a few others. In order to take my cert test again, I have to take 150 hours of CEUs, the phs assessment will count as some of that, but I plan on taking real focused CEUs in areas I feel I am not up to date in. Will re-assess at that point and hope to take cert test maybe next summer. I also work with several NPs who have offered to let me sort of tag along with them to refresh knowlege.

All in all, I feel pretty confident that I haven't lost most of what I was taught, but certainly there are areas I need to re-address, like diabetes and OB, lots of them actually and hope to crack the books this fall and re-learn! Kim

[Saifudin]

Thanks for your response. My RN and NP licenses are for life. Its registration that must be kept up. I am also ANCC certified as an adult NP since 1984 and I maintain that. In fact, I am very careful to keep it going at least for another 5 years or so and depending on what career path i take once back in the States. Actually, through my clinical instruction and rounds I maintain a level of physical practice and try to keep my CE file with a steady accumulation of credit ours, usually through medscape so re-cert is easy. Also. I periodically speak in conferences locally and those hours aer accepted.

I appreciate the suggestions of review materials for NP practice. Good suggestions. Bedside practice would be a real shocker, although, i have thought about even as a temp just to see what it's like now. Once your re-certified I would definately maintain it if you can.

Just a final note to Gilbert, I'm old school nursing and there are just certain things you never lose in the basics. In fact, with the level of staff I have in Saudi, I teach nursing process in all orientations. Most nurses coming to my facility lack even that essential knowledge. Do you still give back rubs in PM care?

Thanks all

[Saifudin]

Hello Gillbert,

You make me feel so old since I haven't practiced for 'so long' (lol). I am still quite active with a strong pulse and good respirations just not in the usual type of American practice environment.

Saifudin:chuckle

[ghillbert, MSN, NP]

There was no insult either stated or implied, I was merely attempting to answer the question you asked, which was "13 years out of practice. How to come back". I'm not sure what point you were making about back rubs or how it relates to your question, or my post.

13 years out of practice IS a long time, regardless whether you personally are old, young, "old school" or "new school". Skills and knowledge in subjects like advanced pathophysiology, advanced physical assessment, pharmacology, etc are not basics and DO lapse over time.

[Saifudin]

Hello Gillbert,

Let's lower the defensiveness a bit. I didn't mean to insult you. I thought my 'lol' (laugh out loud) was clear enough. Perhaps I didn't explain myself well enough.

By out of practice i mean bed side nursing. That does not mean my skills are gone. As a director of nursing one is never out of touch with the profession, in fact, you must go deeper into a variety of aspects that go beyond the bedside. I am highly skilled and a strong leader, at least, that is my perception of myself, yet, I have plenty to learn and a great deal I want to learn. That is a process that is never ending.

Going back to the States after 14 years perhaps is like a foreign nurse emigrating for work to the States. I can offer quite a bit to an organization while there are areas I will need to strengthen, review and learn, but that is the case with any career change, advancement, etc. My question that I am seeking feedback with is where and do I fit in. Just trying to figure exactly what I would like to do will take some time figure out. I'm evaluating that.

I have 3 aspects to my professional work, nursing, NP and nursing management. That's 3 areas that I try to maintain a working knowledge base. it can be a daunting task, particularly in graduate school. So , now, how to put it together and enter a facility in the States, what type of facility, even, what state and city are all my questions that I am beginning my research on. Along the way I am looking for colleagues with similar experiences, insight and suggestions.

Thanks for your response and chance to clear up any misconception.

Saifudin

[traumaRUs, MSN, APRN]

I agree that you will have a lot to offer a facility. Maybe you could start by narrowing it down to large teaching hospitals as they may offer more of the environment that you are used to? Are you wanting to combine your three roles (nursing, NP and management) into one job? Or, do you like one role more than the others? I gather its been awhile since you have done bedside nursing? What type of NP practice are you currently doing? Primary care? And finally, what type of NP are you? In my area, the FNP is the sought-after degree and the ACNP's are having a hard time finding work as are the PNPs and NNPs.

[Saifudin]

Sorry for the late reply. Thanks (TraumaRUS) for your post. I am director of nursing in a mental health facility and not in NP practice. I am a certified adult NP but out of direct practice for the past 13 years, however, the NP background has been invaluable in my work both in nursing and in my outspoken advocacy of proper medical practice in my facility. Middle east practice in a government hospital is a challenge to say the least.

I like leadership and management but will need to gain some new skills like budgeting for example in order to work in a directors position.

I think I just have to send my CV with a good cover letter then discuss with recruiters, etc in order to find a suitable place. It may mean a trip or two back to the States. At least it bumps up the air miles.

[traumaRUs, MSN, APRN]

I think that sounds like a good game plan.