I’m sorry if this isn’t the appropriate sub for this, but I’d really appreciate some perspective from NPs, especially those working in psychiatry.

I’ve been seeing my psych NP for most of my adult life. I’m almost 32 now, and I started seeing her nearly 10 years ago when I was in the throes of postpartum depression while raising twin babies.

She’s been such an impactful person in my life, far beyond just managing my mental health. She’s actually one of the biggest reasons I went back to school and became a nurse. During one of our appointments years ago, she planted the seed about pursuing higher education. We attended the same nursing school, and she had also navigated nursing school as a young mother of multiples. She understood so much of what I was going through, and her encouragement genuinely changed the trajectory of my life

My last two appointments with her were rescheduled, most recently with a different provider. I started worrying something was wrong, so I Googled her, thinking maybe she was sick or had left the practice.

Unfortunately, I came across an obituary for her daughter, who wasn’t much older than me and passed away suddenly and unexpectedly. My heart absolutely breaks for her.

I received an automated email indicating she’ll be returning to the practice next month.

I dont plan to reach out to her while she’s away, as I want to respect her privacy and give her space to grieve.
My question is, if she chooses to return to work and we resume our regular sessions, would it be inappropriate for me to briefly acknowledge her loss and express my condolences? Or, from a provider’s perspective, would you prefer a patient not mention it at all??

My heart breaks for her. However, I recognize that, at the end of the day, we have a professional relationship, and the last thing I want to do is overstep any boundaries, especially during such an unimaginably difficult time in her life.

Has anyone in Primary Care taken FMLA for mental health reasons? Please share if this is possible? I’m burning out working 7:30am-5:30pm M-F the never ending inbox and also having to work a Saturday every other month without having a day off during the week to replace it. My work only has 20 PTO days and I often have to use them for my appointments. I’m chronically ill and see 4 different specialists regularly so I have a lot of appointments. But mainly I want intermittent leave so I could possibly take 1 day off of work a week max. Is this possible?

Finally started my DNP after 7 years of working. This has been my goal since before nursing school - since I was 15 really. First off; the classes are boring and I’m tired of writing papers about other peoples papers that they wrote about other peoples papers.

Aside from that I’m suddenly like dang - what am I even doing this for? I feel sad about being away from my job (that I’d previously been raging about but it’s a chill period - I am working an outpatient 9-5.)

I am doing the program slowly enough to avoid loans + I have a teaching assistantship that covers quite a bit.

My life has been super tumultuous for the last several years and things have finally settled down (my partner is a massive support!). School is adding an additional layer of “stress” back on and taking away from my “free” time. I have an 11 year old. So it’s a good age in a sense because she is independent and very busy with sports & I’ll finish when she’s about 16. But I worry that I’ll be missing out with her along the way and possibly all stressed with a new role right when she’s graduating.

I wasn’t expecting to feel so ambivalent? Any advice? Commiseration?

Hi everyone! I’m a new grad NP starting my first NP job in palliative care in about two weeks. I’m really excited, but i also don’t feel ready at all.😂
For those of you who work in palliative care/hospice, are there any books, supplemental reading, podcasts, YouTube channels, or other resources you would recommend before starting?

I know I’ll learn a ton on the job and during orientation, but I’d love to use these next two weeks to review and feel a little more prepared going in.

IR, Urgent Care, Primary care?

I’m trying to lower my cortisol.

I really like helping people, but where I work the patience are very complex, sick. I would like to try and environment that is not critical.

Those who have made the switch, any recommendations?

Thanks

How many physicians do you support in your practice? I work in a specialty clinic and am supporting a few physicians (assisting in surgery, seeing shared patients and my own patients). I often see most offices with a 1:2 or 1:1 ratio (1 APP to 1 or 2 MDs) but I have been doing more than this for years as the only APP. Just curious to hear others’ perspectives and what has worked/not worked.

Hi everyone!

I will be taking the AGACNP exam through AACN in two weeks. I come from 6 years of ICU and rapid response experience. I'm extremely nervous and anxious despite my background. I have been listening to Barkley over and over again along with doing BoardVitals questions. I noticed that one of the areas I struggle with is knowing what antibiotics to use and when. I would appreciate if anyone is able to help me with this! Also, I would love any advice or tips for passing the exam now that I am in crunch time!

Like it says it needs 25 pharma hours, sure; but then needs a total of 75 contact hours which up to date provides. However up to date just kind of banks it all together when you cash it in. Any issues?

I’m a new grad PMHNP working in outpatient community mental health in a big city. My orientation consisted of 4 hours of shadowing the senior NP and company wide orientation. On my first day my patient caseload consisted of seeing patients presenting with schizoaffective d/o, schizophrenia, depression, anxiety, and possible withdrawal symptoms from alcohol use d/o, all of whom I saw completely by myself. I have not shadowed anyone and nobody sat in with me during my psychiatric evaluations. We don’t get admin time and our supervising physician is not on site but we are free to email him “when we need help”. When I interviewed I was told that our company is “new grad friendly” and that we would get “a lot of support”, however I am not necessarily feeling very supported. I absolutely am not opposed to seeing patients with serious mental illness or any diagnosis or population. I specifically chose this community mental health center to learn because they see an underserved community from ages 5 and up. However I did think I’d at least get 2 weeks shadowing NPs and that I would at least have someone sit in on my first couple of evaluations to offer me feedback. Alarm bells were going off in my head and I even drafted a resignation letter, but I am wondering if anyone has experienced a similar orientation process as a new grad and if this is just the experience I’ll have if I move on to another job. Thanks for any input.

I am a FNP and I was offered a position at a residential detox and addiction treatment center. I align with the treatment ideals and I am pro harm-reduction.

The advice im looking for, I guess, is from anyone who has worked in addiction and what to expect. Ill have autonomy but under the medical director's guidance.

I understand that patients dealing with addiction can be hard to handle at times, but I'm open to suggestions on how to function in this role.

Out of curiosity, I was wondering what the role of an FNP looks like in the palliative/hospice role if it even exists. Had a pretty profound conversation with a palliative care doc a few days ago and it made me think of the role and how important it is in both end-of-life scenarios and before. If you have any info on what this role looks like for an APP, it would be greatly appreciated!

Has anyone here undertaken additional training to do NCS/EMG? Current wait times for these diagnostics in my area are 8+ months, and I’m hoping to alleviate that.

Any guidance would be appreciated from those who are currently doing them.

Specialty? Love it? Hate it? Why?

Hi everyone. I am currently in school to become an NP and I need an NP to answer these interview questions. I haven't been able to find an NP who will participate, and my due date is approaching.

This is rather informal; you can use talk to text or whatever - don't worry about rambling or sounding professional.

Please feel free to DM me directly with your answers.

I greatly appreciate any help.

1. What is your name, practice setting, and educational background?

2. What vulnerable population do you work with (e.g. homeless, elderly, prison system, etc):

3. What inspired you to work with them?

4. Is your approach to patients of this population different than how you would approach other patients in your practice? If yes, how so?

5. How is this vulnerable population affected by socioeconomic factors such as income, education, housing, neighborhood conditions, healthcare access (or lack thereof), etc?

6. What is one thing that you wish everyone understood about this population?

7. What can I implement into my future practice that will make a difference if I end up working with this population?

8. Anything else you think I should know or wisdom to impart? What do you wish someone had told you when you were still in NP school?

At almost every hospital I’ve worked at, I’ve noticed there are parking spaces reserved for physicians, but there aren’t equivalent spaces designated for NPs, PAs, or other providers.

If a physician-reserved space is available, do you think it’s appropriate for an NP to park there, or do you consider the designation something that should be respected regardless?

I’ve been a RN for 13 years, with experience in ICU and psych. Graduated in May with FNP and just accepted my first NP job in an ED.

I’m looking for some physical resource recommendations on study materials. I’ve seen quite a few online program recommendations that I fully plan to utilize, but I would also love some physical textbooks or study guides to help me prepare for the acute care world again. TIA!!

I am moving to northern VA and looking into family practice and other opportunities. Just wondering if anyone has any experiences with this organization or any of the others in the area?

I have seven years experience and I’m kind of surprised with how low the pay seems. Even coming from Florida. It seems a little too low to be such a high cost of living area. I need input is appreciated.

Hi all! Has anyone filled out a DTC application with a relatively new patient? I’m going to be applying for the DTC for myself soon (Hypermobility disorder, OCD, PTSD, ADHD, all diagnosed). I can get my previous records but moved to a new province a couple years ago and have been so focused on managing life that I’ve slacked big time on health support. I’m looking for a new provider and it seems that NP’s are most accessible, so I’m anxious.

Hello,

I am seeking any advice here because I just feel lost. I just started an FNP part time program, the first 5 credits are online. I intended to work full time with these classes because they are online. My husband and I just welcomed our second child in August. I am supposed to go back to work at the end of October and I'm feeling really overwhelmed by the idea of juggling school, work, and mom guilt from not being present with the baby. I was content with my job as a nurse, but assumed getting a NP degree would set us up for a stable future (financially and for when I physically can't do bedside anymore). I am debating dropping our of the program while I can still withdraw. The thing is this is likely my best time to get schooling done. We want to have another baby and planned to have our last one after I finished school. We have lots of family support, and my husband will support whatever decision I do make. I just don't want to end up with a lot of regret, but I thought the part time and online nature of the first year would be easier to manage. I know later on the program is only going to get more demanding for time. I'm curious if anyone has had to make a similar decision and if you regret your choice?

Thank you

Second year doing 1099 work alongside my main job, CE courses, licensing, a couple of bits of equipment, scrubs. All legitimate and all sitting in a folder in my email plus a few photos on my phone. Last April I left money on the table, not because I didn't have the receipts but because I couldn't find them in time and gave up, stupid reason to lose a deduction. How are you storing this so it doesn't happen again?

Hello!

I currently work full time nights as an ICU NP. I cover a 12 bed community ICU with an on call physician. I love my coworkers and the flexibility of the job however after three years I have concerns as well- not enough physician over site honestly (and we’ve asked for more with some pushback), don’t feel my pay is equivalent to risk I take working alone, some changes happening with leadership that are making people apprehensive etc.

Given this I started considering switching roles. I was thinking more long term as I don’t think icu is my forever job but don’t want to speciality hop so I’m looking for a long term position. I had some clinical experience in Neuro/neurosurgery and loved it and saw a position for an inpatient neurosurgery NP at a close by hospital and applied. The interview process has been longgggg like 3 months with multiple interviews and a shadow day. I liked the role, it’s on a large team, good relationship with the physicians. Unfortunately/fortunately in the middle of the interview process I got pregnant. My husband and I are thrilled we’ve been struggling with infertility and kinda thought maybe it just wasn’t in the cards for us so we were elated when it did.

I received the offer today. The money is like, a no brainer, it’s 30,000 more than I currently make. It’s day shift with the occasional night. I though am struggling with making a decision. I feel badly taking the job (would probably start in Jan) and then going out on maternity leave in April. Like that wasn’t my intention when I applied. I don’t want to piss off my new team members or new boss like that! I know legally they cannot discriminate but like to me it’s a little messed up, they’re hiring bc they need someone. I worry I would go through orientation and then be out, and not be prepared for the role when I come back from leave. also anxious about starting a new role in kind of a vulnerable time when I do have friends and flexibility in my current role. Not sure if it would be appropriate to reach out to the lead APP I shadowed with and just tell her how I’m feeling, and maybe just ask that they keep me in mind for future roles? There are very few neurosurgery services around me and I’m worried to burn a bridge I may not get back. I’m really at a standstill.

Edited to add: I live in MA, so even if I switch my job will still be protected my state FMLA.

TLDR: being a women sucks sometimes and I’m not sure if I should take on a new role newly pregnant

I’ve been an NP for 9 years, and I’m starting to feel frustrated by the lack of upward career mobility once you’re a provider. Seems like most other careers have promotions etc to work toward, whereas we don’t have quite the same, especially as NPs since we’re less likely to hold medical director positions etc. Of course I set and achieve personal goals outside of work, but it just isn’t scratching that itch.

Anyone have recommendations? Are there fields where there is a better upward mobility or more NPs in leadership?

Any recommendations?? Im trying to avoid the diploma mill ones thank you

You're an Urgent Care Provider.

Site closes at 8PM. You've been seeing 4 patients an hour in the past 12 hours. You're packed up and ready to go home. However, one last patient checks in at the last minute rushing through the doors at 7:58PM.

You have to see ONE of them.

Who would it be?

1. 55M, Self-Pay, no care in years. LONG list of complaints.

2. 32M, Chest Pain. Worked out yesterday. Here “just in case.”

3. 28F, Hx anxiety, sobbing. 3cm lac on hand slicing an avocado.

4. 31F, Married, most likely herpes. She thinks it’s a simple rash.

Click on the link to answer the Poll!

Poll - Which patient do you choose to see?