Nurse Practitioner Salary Expectations
The wide range in what you will find when typing “how much does a nurse practitioner make” into google is astronomical. It’s so hard to make big decisions about school, career change when you have no idea what the ROI will be. In this article I break it down into two categories: Salary by field of study (population/role) and Specialty/Sub Specialty.
Clinical Pearls: Is it DKA or HHS?
Should be pretty straight forward, but even amongst seasoned providers this can sometimes be debatable. Especially when you don’t have all the labs back. Often we are called to admit a patient for DKA because they do not seem appropriate for a routine floor or even step-down ICU admission. The Internal Medicine/Hospitalist team may not feel comfortable taking a patient but on your evaluation they do not seem to be on the severe end of the spectrum. You aren’t alone, my friend. Let’s talk about admitting a DKA vs HHS patient and how you make a diagnosis.
When Should You Start Job Applications
January…the month following December graduation. It’s a joyous time, and you absolutely should be celebrating. But what comes next? What I see across the nurse practitioner forums and social media are two big concerns: board exams and job acquisition. I wrote about board certification and how to prep for this a few weeks ago; today I’d like to focus on a topic that I think half the people are getting wrong. That is timing for job application. Many NP students ask when is the right time and the responses are mixed. On a recent post I tallied it was completely split 50/50. Half the people felt you should apply while in school and half felt you should wait until exam and licensing is complete. My argument is that if you are waiting until the latter you are behind the eight ball. Statistically speaking, I know this is likely to stress out half of you and that is not my goal. Hear me out, there are many reasons why I advocate for earlier efforts. Let’s talk about job applications.
Clinical Pearls: DIC
One of the rare and weird things in medicine that combine a dramatic constellation of opposites. Caring for someone in the throes of badness from two dichotomous problems leaves one in a state of floundering. Do I treat the clotting or do I treat the bleeding? What will kill them first? It’s universally known that getting the diagnosis of disseminated intravascular coagulation is a dreaded event. DIC is a downstream complication that arises late in the game with several diagnoses that we see in the ICU, and unfortunately in our maternal population. Every time an OB calls our team to see or transfer a patient to ICU my shoulders instantly feel tense. Let’s talk about the pathophysiology behind this dreaded state and what our treatment options really are.
Nurse Practitioner Boards Preparation
After one has achieved the degree, put in the herculean effort to study, stressed beyond reason, hyper-fixated on all the possible outcomes, and then stood in this place of last minute test anxiety, bargaining with one’s maker is where you may find yourself. Based on the conversations I have with NP students I precept and online / via my mentoring business, I can confidently say only a tiny fraction of new grads are immune to this fear. There are some things out of our control as a neophyte, but boards preparation is not one of them. Taking control of how you ready yourself for this exam definitely impacts anxiety level as well as success rate. In this post I will discuss the best way to prepare for your nurse practitioner board certification exam
Clinical Pearls: Liver Failure
Oh the ways the liver can fail. As a new nurse practitioner this one was hard to get down. Cardiology is generally seen as the bee all end all when it comes to keeping our bodies running, but I’d like to talk about the under appreciated liver. Hepatology is fascinating because the normal function of the liver is supremely multi-faceted. Throw in a little pathology and any number of pathways can be deranged and within those any degree of severity can be seen. From acute to chronic to acute-on-chronic, severity can run the gamut. Decompensated cirrhosis is a common killer in most ICU’s. Given how poorly understood this disease state is, I’d like to talk about the complexity, progression, prognosis, and management of liver failure in the intensive care unit.
Mistakes To Avoid On Your Resume
I’ve seen a fair number of nurse practitioner resumes in my day. Seems like my large group is always cycling through new hires. In addition to that I look at all the resumes that come through for my consultation/interview prep business. It’s interesting to me the variety of what folks are doing across the nation. When I wrote my first NP resume I assumed we all heard the same HR lecture and wrote them the same. Most people have professional looking resumes but there are some industry specific issues that I find am repeatedly addressing with clients. In this post I’ll discuss the most common mistakes I see on the nurse practitioner resume.
Clinical Pearls: Evaluating For Intubation
When is it time to say it’s time? I think back on the really bad days of the pandemic when I walked from room to room asking myself this question repeatedly. Honestly, for intensive care unit level covid that’s what it felt like - a few random meds that typically didn’t help, supportive care, and careful vigilance for when it was time to go on the dreaded vent. Our patients feared it, our families feared it; it was the elephant in the room every time you walked in. Outside of covid pneumonia, there are a million reasons why a patient needs mechanical vent support and failing lungs are just one component. This is a very common question I get asked when I am training a nurse practitioner student Here’s how I approach evaluating a patient for intubation need.
NP vs RN: Differences in employment structure
This topic comes from a question I received from a client asking to explain how nurse practitioners fit into a physician run group. She expressed her surprise to learn that many APPs and physicians who work in a hospital are not employed by the hospital and asked for feedback about how this works and how nurse practitioners fit into this model. I definitely understand this confusion. As nurses, we are used to standard hospital or health system employment with clear hierarchical management. In this post I’ll talk about my experience with this and the main differences between NPs and RNs in regards to:
Who employs you.
Who manages/directs you.
How you get paid.
Who your colleagues are.
Clinical Pearl: Status Asthmaticus
Not a common problem in most ICU’s, but you do get the occasional severe case of asthma. When you do, it can get a little hairy. Mostly because these are generally young people and there’s only so much you can do. Sort of like Covid when it gets bad, there’s not much to offer. You provide the medicine, the supportive devices and wait for their bodies to heal themselves. Same with asthma, you order the standard treatment and then pray it doesn’t get to a point where you have to intubate. In large part, our primary goal in ICU asthma is to not make them worse with counter-intuitive ventilator strategies. Let’s talk asthma.
How To Find A Nurse Practitioner Job
“The NP market is saturated.” If I had a dollar for every time I heard this…ugh. I take exception to this phrase because I feel like people use it either to make excuses or to discourage nurses from advancing their degree. Now, I’m not saying the job market for APPs - both nurse practitioners and physician assistants isn’t loaded with candidates, but the issue is more complicated than simply a matter of numbers. My experience is regional - based upon my personal work experience and those of my colleagues, networks, former cohort, and preceptees. In my neck of the woods here in Georgia and the greater Atlanta area - I would say it is highly competitive and this varies based on the degree and specialty. For example, should you want to do general cardiology you will have zero issues. Should you want critical care, it will be considerably harder to find something as a new graduate. I also talk with nurse practitioners across the country who share similar woes but there seems to be a distribution and experience gap. What does this mean? Well, in many places (I would say here in Ga also) there are plenty of job postings. The issue is they aren’t getting many applications because of one of several issues:
It is in a less desirable location
It is paying less than desirable salary
It requires experience
It is the less desirable shift
This means that for new graduate nurse practitioners or those who don’t want the rural areas; the off shifts there will be a lot of competition for the few jobs you can apply. If you are having difficulty finding a job here are some strategies you can employ.
Clinical Pearls: Epi Doses
Is it the 1:10,000, the 10ml, the carpujet, or the cardiac dose of epi? Might they all be the same (insert shrug)? Epinephrine doses, along with heparin doses, are shrouded in mystery. I feel like this is a manufacturers gatekeeping. A way for big pharma to appear smarter than us plebians. Back in the day this is how people used to refer to epi, and I still find that folks use these interchangable terms and that is why there is confusion. And that’s a big deal. This is not a benign drug. It has a huge range of effects from local anesthesia to systemic life saving efforts to jump start your heart into hyperdrive. Here’s the scoop on Epinephrine.
Toxic Workplaces And What to Do About Them
I talk to a fair amount of nurse practitioners who are in a space of indecision. My goal is to help them sort out what will best serve their {whole} life goals. It’s always about balancing work-life factors with career goals. Some of them are considering leaving the profession and going back to the bedside or doing something else altogether. Some are coming to me seeking interview/job acquisition help and what we discover is that their confidence has been wrecked by a unhealthy work environment. I’d be willing to bet many of you have experienced this in the past or are stuck in this situation currently. It’s truly a sad state of affairs these days particularly for nurse practitioners. In this article I wanted to talk about this phenomenon and what some options may be for you.
Clinical Pearls: Pressor Selection
The foundation of critical care practice stands upon heart and lung support. As you know a multitude of problems lead to these downstream complications, but at its core what we do in the unit is handle worst case scenarios. Even for a new nurse practitioner with loads of years at the ICU bedside, pressor selection can be difficult at first. What I hear from students is “Levo, let’s just start Levo.” They say this because it has been their experience and it’s of course discussed everywhere. But when I ask them to defend the selection there can be a dearth of knowledge. Ultimately, they may be right, but I argue that as a competent provider one must have a good understanding of the pharmacodynamics of the drug AND the pathophysiology of the disorder you are treating. Why? Because while the physician/team you are practicing with currently may never question you, at some point you will need to explain your rationale. And on a baser level you need to accurately treat the problem or you could 1)chose something ineffective 2)make things worse or 3)harm the patient. Let’s talk vasopressors.
Nurse Practitioner Fellowships
When I say fellowship, I’m really referring to two types of post-graduate training: nurse practitioner residency and nurse practitioner fellowship. What’s the difference? A residency is more general and encompasses a broader scope of practice. It may be a longer time frame as well, most range between 6-12 months. It is ideal for someone who had little bedside experience or sub-par education in school (be it academic or clinical). A fellowship on the other hand is specialized and has a particular focus of interest. It is ideal for someone who has a strong sense of what they want to do and/or lack the opportunity to find a way into the niche.
Clinical Pearls: Waveform Capnography
End tidal carbon dioxide (ETCO2) measures exhaled carbon dioxide, it therefore reflects the efficacy with which CO2 is pumped back to the lungs (indirect measurement of cardiac output) and then exhaled (ventilation). Waveform Capnography is a continuous tracing, or waveform, of ETCO2. It is very useful when assessed as a trend.
The Best Nurse Practitioner Podcasts
Are you an avid auditory learner? I’m slightly obsessed with podcasts. I tend to go on benders based on what is going on in my life. I listened exclusively to travel podcasts for eighteen months when I planned a European trip a few years ago. I have always liked to use podcasts as an adjunct to my professional education as a nurse practitioner. IMO it’s hard to utilize them exclusively just because the search functions are not as robust (there’s a lot to dig through to find one talk about a subject like normal labs, etc) and the content is long. But, once you find a quality show that addresses your specific population it’s great to listen to on a more regular basis (versus a search approach). The nuggets of wisdom you can garner from these discussions can greatly impact your practice. You may have to be willing to wait for them, but if you were going to be doing the dishes anyway, why not multi-task? In this post I will share my favorite podcasts (which are mostly ICU): what I love about them and how I use the info in my career as an ICU nurse practitioner.
Clinical Pearls: Thromboelastography (TEG)
A thromboelastogram is a study designed to tell you about hemostasis, in other words, when and how a clot is formed and then broken down (fibrinolysis). Traditionally this is measured by PT/PTT/INR which tell you extrinsic/intrinsic and common pathway problems that lead to bleeding or present a risk of bleeding. The TEG goes beyond this and offers you information about the aforementioned, plus platelet function, clot strength, and fibrinolysis. It is a study offered at many institutions and is most commonly utilized in the operating room or trauma settings. Increasingly, it is being seen more often utilized in emergency rooms and intensive care units.
Negotiation 101
You nailed the interview, the offer has been made, you’re staring at numbers and trying to make sense of them. Is this a competitive offer, can I ask for more, what will happen if I make them mad? The thoughts and indecision can get real heavy for some. They certainly did for me. Maybe it’s because I’m female, maybe it’s because I despise burdening others, maybe it’s because I’m used to nursing offers which are straight forward. Either way, I royally suck at asking for the things I want. I find that many new nurse practitioners have similar struggles. Even more struggle with the unknown of negotiation, they know they want to ask but don’t know how and when to ask, push, or just stand their ground. This blog post will discuss how I learned to approach contract negotiation as a nurse practitioner.
Clinical Pearls: Pleural Effusions
Pleural effusions can be a big barrier to improving respiratory status in the ICU. Deciding how and when to treat them becomes easier once you break down how to diagnose and treat.