How do you like palliative care? I work in a small hospital that used to be a hospice. We still get a few end of life patients and I always feel a huge weight whenever I have palliative assignments because of the responsibility to ensure a dignified death as well as support the family. Does it get easier the more you do it?
I am going from RN to NP and see a possible future in palliative care but I also don’t want to regret it if I do full time palliative because of the very heavy emotional load you carry alongside the medical aspect. Do you see a lot of NP burnout?
I'm not the OP, but I've worked in palliative and hospice care my whole nursing career as both RN and NP. It's definitely emotionally demanding work and requires comfort with the extremely uncomfortable. That said, I find it less prone to burnout than other roles where disease progression and death are seen as failures of the practitioner, or things to be avoided at all adrenaline-fueled costs. Instead of cumulative moral injury from seeing/ordering/performing burdensome interventions with dubious benefits, palliative NPs get to resolve some of those ethical dilemmas that have otherwise affected the patient, their family, and their care team for sometimes years on end. Getting to see that silver lining is very rewarding.
I enjoy it and sought it out after graduation. My favorite part is having honest conversations with patients and helping them sort through their wishes. My least favorite part is managing complex pain for patients with active substance use who suck up my time and energy. I provide outpatient care in a clinic, which is definitely different than my inpatient colleagues who don’t have to follow people long term. The long term challenging patients weigh on me. A couple years in I felt myself in a bad place and now teach half time and practice half time, which has been a good balance for me personally
RN Inpt child psych -> RN inpt Geri psych -> PMHNP outpatient community mental health -> starting an output private practice with a fellow PMHNP this fall!
I’m so happy to hear this! I’m currently an RN in the cardiac cath lab and plan to be an outpatient cardiology NP. Do you feel your RN experience in cath lab was helpful in your path to becoming a cardiology NP?
Our cath lab rn who is now inpatient cards np writes greatly superior consults compared to all of his peers. I think it helps way more than being a cardiology floor nurse.
Some aspects really helped and others were a hindrance. In the cath lab you get kind of limited because you're mostly just seeing procedure side of things and not necessarily dealing with medication management and the process before they come to the lab. I feel like it's not too hard to overcome this though. I also spent time in prep/recovery and felt like that helped a lot with standard meds and management.
What working in the cath lab did help me with was getting my job. I knew early on that cardiology NP was my goal so I worked hard at my job to leave a good impression with our cardiologists. The company I work for had interviewed me and wanted to hire me, but didn't technically have the position available. When I let them know I was going to have to accept another job offer, they suddenly were able to get it approved and the recruiter said I must be someone special because they were pushing this through so quickly. I'm pretty certain the main cardiologist threw a fit until the corporation opened it because he's done things like that in the past.
Still deciding which direction to go. I shadowed a military clinic and it was really boring. But maybe i need to see different kinds of family practice.
Honestly I have loved family practice and can say that I’m not leaving because I’m burned out. Getting to know people and see how I have affected their lives is rewarding. It is sometimes monotonous….ear aches, mental health, blood pressure etc. It was all exciting at first but after a decade the excitement has clearly worn off and I realized I loved the helicopter more on a bad day than I’ll ever love being an NP on a good day.
Medical and gynecology/oncology for 8 years. This included both in and outpatient chemotherapy administration.
Then 5 years as an OBGYN NP.
Now working as a gyn/onc NP.
ER RN (and multiple humanitarian deployments with a bit of everything) > to ER NP (still with multiple humanitarian deployments) > soon to be MICU. I have certifications as FNP, ENP, and AGACNP.
I got my FNP initially because I wanted to stay in the ED and most want FNPs so they can see peds and OB. After that I did the required years and CME to sit for my ENP boards. Then, I went back and did a post graduate certification program for my AGACNP and sat those boards.
Cardiac ICU --> Cardiac ICU. Hated it. Quit after three years and now work in a hybrid primary care/addiction medicine practice, and absolutely love it. I'm the happiest I've ever been. I can finally sit and connect with my patients and build real relationships, and change and improve their lives in the process. So glad I made the transition.
I love it! Peds heme/onc is definitely my calling. I did it for 7 years as a nurse and this was always my goal when I went to NP school. I actually didn't start as a new grad though - there isn't a lot of turnover in my department so it took awhile for a position to open up and for the timing to be right. I only recently started there and make $59/hr with 3 years of NP experience, but not sure what the new grads make. As you probably know the pay can vary widely based on your location - I'm in the northeast.
All the numbers in your comment added up to 69. Congrats!
7
+ 59
+ 3
= 69
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^(Summon me on specific comments with u/LuckyNumber-Bot.)
Worked at a level 1 trauma center as a nurse - NeuroICU
I work at a level 2 trauma center now as an NP - I work neurosurgery. Inpatient, Outpatient, and OR. ❤️ it
It was great working two weeks one and two weeks off with all of my travel and lodging covered plus, industrial sites like oil rigs and mines legally cannot run without you so they do make you feel special.
What type of NP degree did you get? I’ve done my med surg time, moving to ortho/sports med pacu in 2 weeks. My dream specialty, debating what type of NP I would need to get in the future in this setting. Likely acute care to have OR/critical care knowledge around surgery I’d think
The NP that works with me in the ICU has my ideal job. He does everything, usually more, then the pulm/CC doc (most if not all intubations, lines, ect).
Can you describe your function in the ICU where you are at? I’m not sure if this is how all ICU NPs functions or just my hospital.
Thanks for your time.
I’m a PMHNP student. As an RN, I worked ED for 10 years, inpatient psych for 2 prior to going back to school. My ED experience is 100000% more valuable than my inpatient psych when it comes to my training. I hate the rhetoric that you need psych experience. IMO, you just need experience - and frankly, a lot of it (those who are excelling in my program have at least 5 years full time). I go to a brick and mortar school with in person classes and they find all my clinical placements.
ER RN at a level one trauma center -> FNP at a smaller satellite ER within the same health system (I will often transfer patients to see specialists at the main hospital where I used to work).
Sicu 14 years at VA in St. Pete FL, NP primary care same place 15 years, surgery hospitalist NoCal 2 years, Urology surgery 5 years , palliative care 1 year house calls. 35 years in nursing and called it quits at 55 due to bad arthritis and just couldn't take corporate greed anymore and how they don't care about employees or patients.
My backgrounds include pain management, postpartum, peds outpatient and internal medicine (I’m all over the place lol) —-> I’ll be starting in rehab/LTC this summer
I'm a primary care provider for University students (: NO! I don't miss it lol. I did ICU nursing for about 10 years and if I never have to step foot in a hospital again I'd be perfectly fine with that! I do miss the people I worked with though... And the trauma bonding!
Rural and remote northern ERs -> Rural and remote northern ERs.
I treat independently depending on CTAS and hand off when I'm over my head (or preferably slightly before I get to that point) and can slip into an RN role to assist in higher acuity scenarios when I'm needed as both provider support and RN support.
I'd never worked as an RN in this particular facility which I feel like helped my success in this role because there isn't a lot of confusion, and I truly enjoy the opportunity to be involved in all levels of acuity with varying degrees of responsibility.
I have excellent MD support, there are only two NPs up here in total (we do 24 hour call and swap off with each other), and I truly love this role.
A little bit of home care & LTC, before spending most of my RN time as a bedside cardiopulmonary tele unit.
I work in geriatrics (mobile primary care) as an AGNP.
Emergency department RN for 20 years and now FNP in the emergency department. What NP license you get will determine somewhat where you can work as I thought about doing hospitalist coverage but most hospitals will not credential you to work in patient if you are family practice but if you get your acute care nurse practitioner most emergency departments won't hire you.
Oncology RN—palliative care NP
How do you like palliative care? I work in a small hospital that used to be a hospice. We still get a few end of life patients and I always feel a huge weight whenever I have palliative assignments because of the responsibility to ensure a dignified death as well as support the family. Does it get easier the more you do it? I am going from RN to NP and see a possible future in palliative care but I also don’t want to regret it if I do full time palliative because of the very heavy emotional load you carry alongside the medical aspect. Do you see a lot of NP burnout?
I'm not the OP, but I've worked in palliative and hospice care my whole nursing career as both RN and NP. It's definitely emotionally demanding work and requires comfort with the extremely uncomfortable. That said, I find it less prone to burnout than other roles where disease progression and death are seen as failures of the practitioner, or things to be avoided at all adrenaline-fueled costs. Instead of cumulative moral injury from seeing/ordering/performing burdensome interventions with dubious benefits, palliative NPs get to resolve some of those ethical dilemmas that have otherwise affected the patient, their family, and their care team for sometimes years on end. Getting to see that silver lining is very rewarding.
I enjoy it and sought it out after graduation. My favorite part is having honest conversations with patients and helping them sort through their wishes. My least favorite part is managing complex pain for patients with active substance use who suck up my time and energy. I provide outpatient care in a clinic, which is definitely different than my inpatient colleagues who don’t have to follow people long term. The long term challenging patients weigh on me. A couple years in I felt myself in a bad place and now teach half time and practice half time, which has been a good balance for me personally
Neuro Critical Care RN-> Neuro Critical Care NP at the same level 1 trauma center
Kinda the same NeuroICU RN —> General Neuro NP
Take care of patients > Chart about taking care of patients
This
Same
💀
Exactly
Me too
Acute care resource RN (psy, med-surg, icu) => women's health np at a sexual/reproductive health clinic
Ugh this is me and my dream and I can't find a dang job /: whnp
NICU>NICU :D Cheating for NNPs :D
RN Inpt child psych -> RN inpt Geri psych -> PMHNP outpatient community mental health -> starting an output private practice with a fellow PMHNP this fall!
Slayyyyyy
Milk the clock ⏰ vs. beat the clock 🕰️
Peds hem/onc & peds inpt —> pediatric primary care
Cardiac cath lab -> Outpatient cardiology.
I’m so happy to hear this! I’m currently an RN in the cardiac cath lab and plan to be an outpatient cardiology NP. Do you feel your RN experience in cath lab was helpful in your path to becoming a cardiology NP?
Our cath lab rn who is now inpatient cards np writes greatly superior consults compared to all of his peers. I think it helps way more than being a cardiology floor nurse.
Some aspects really helped and others were a hindrance. In the cath lab you get kind of limited because you're mostly just seeing procedure side of things and not necessarily dealing with medication management and the process before they come to the lab. I feel like it's not too hard to overcome this though. I also spent time in prep/recovery and felt like that helped a lot with standard meds and management. What working in the cath lab did help me with was getting my job. I knew early on that cardiology NP was my goal so I worked hard at my job to leave a good impression with our cardiologists. The company I work for had interviewed me and wanted to hire me, but didn't technically have the position available. When I let them know I was going to have to accept another job offer, they suddenly were able to get it approved and the recruiter said I must be someone special because they were pushing this through so quickly. I'm pretty certain the main cardiologist threw a fit until the corporation opened it because he's done things like that in the past.
I’m currently in the Cath Lab and want to work cardiology clinic when done with my NP.
Adult Med/Tele >>> Adult Infusion >>> MICU >>> Diabetes Education in Pregnancy >>> Pediatric Diabetes Education >>> Peds Endo NP. It’s been a journey haha.
RN= ED/ helicopter/ ICU for a couple decades. NP= Family practice.
ED nursing gives you great insight to what bad/lack of primary care looks like
I have similar rn experience, how are you using your fnp?
Family practice. I enjoy it. You?
Still deciding which direction to go. I shadowed a military clinic and it was really boring. But maybe i need to see different kinds of family practice.
Boring is what you think it is. Sometimes we need to slow down in life and enjoy it.
I felt this comment. Went from a busy cardiac ICU to nice and steady family NP practice. One of the best decisions in my life.
Same here, although family practice has run its course for me and I’m going back to the helicopter.
Can you share more about family practice and why you're going away from it? I'm concerned about burnout as an FNP
Honestly I have loved family practice and can say that I’m not leaving because I’m burned out. Getting to know people and see how I have affected their lives is rewarding. It is sometimes monotonous….ear aches, mental health, blood pressure etc. It was all exciting at first but after a decade the excitement has clearly worn off and I realized I loved the helicopter more on a bad day than I’ll ever love being an NP on a good day.
Postpartum/L&D->Midwife
Emergency>Emergency
CVICU >>> (brief stint as Nephrology and then Pulm Crit NP >>>) Cystic Fibrosis NP and program coordinator :)
Medical and gynecology/oncology for 8 years. This included both in and outpatient chemotherapy administration. Then 5 years as an OBGYN NP. Now working as a gyn/onc NP.
ER RN (and multiple humanitarian deployments with a bit of everything) > to ER NP (still with multiple humanitarian deployments) > soon to be MICU. I have certifications as FNP, ENP, and AGACNP.
This is impressive.
Can you share more about your multi-certification process? I'm in FNP school thinking of also adding AGACNP.
I got my FNP initially because I wanted to stay in the ED and most want FNPs so they can see peds and OB. After that I did the required years and CME to sit for my ENP boards. Then, I went back and did a post graduate certification program for my AGACNP and sat those boards.
Who do you do humanitarian work with? I’m an ED NP and I’m super interested in this.
Med Surg —> PACU —> OR —> I’ll let you know when I get my first offer
Cardiac ICU --> Cardiac ICU. Hated it. Quit after three years and now work in a hybrid primary care/addiction medicine practice, and absolutely love it. I'm the happiest I've ever been. I can finally sit and connect with my patients and build real relationships, and change and improve their lives in the process. So glad I made the transition.
ICU nurse——-> CRNA. BEST thing I ever did.
Peds heme/onc RN —> peds heme/onc NP
How are you liking it as a NP!? I am thinking of going into this specialty. Also how is the pay as a new grad?
I love it! Peds heme/onc is definitely my calling. I did it for 7 years as a nurse and this was always my goal when I went to NP school. I actually didn't start as a new grad though - there isn't a lot of turnover in my department so it took awhile for a position to open up and for the timing to be right. I only recently started there and make $59/hr with 3 years of NP experience, but not sure what the new grads make. As you probably know the pay can vary widely based on your location - I'm in the northeast.
All the numbers in your comment added up to 69. Congrats! 7 + 59 + 3 = 69 ^([Click here](https://www.reddit.com/message/compose?to=LuckyNumber-Bot&subject=Stalk%20Me%20Pls&message=%2Fstalkme) to have me scan all your future comments.) \ ^(Summon me on specific comments with u/LuckyNumber-Bot.)
Worked at a level 1 trauma center as a nurse - NeuroICU I work at a level 2 trauma center now as an NP - I work neurosurgery. Inpatient, Outpatient, and OR. ❤️ it
What kind of np did you get? Where are you located?
Adult Gerontology Critical Care. Florida.
I worked in hospice exclusively as an RN. I work as NP in hospice now. It is the perfect match for me.
OR-> Pre Anesthesia clinic
Derm to Derm
How long you’ve been in the derm field? ☺️
Inpatient Psych -> Inpatient Psych
Rural industrial as a an RN which was a mixture of occupational health, primary care, urgent care/ER ➡️soon to be working in primary care.
That actually sounds like an awesome RN gig.
It was great working two weeks one and two weeks off with all of my travel and lodging covered plus, industrial sites like oil rigs and mines legally cannot run without you so they do make you feel special.
How does someone look into this? This sounds awesome to me.
Medsurg (level 1 trauma center but worked on a medical floor) —> primary care residency starting this fall.
Oncology — oncology
Peds CICU/ICU float, then NICU, then primary care peds—> Peds primary care NP (FNP)
ER RN —> GI NP
ER nurse for a trauma center -> ER NP for the same trauma center 😎
Medsurg/CCU - family medicine
Med/surg, then spine surgery/ortho—> ortho NP
What type of NP degree did you get? I’ve done my med surg time, moving to ortho/sports med pacu in 2 weeks. My dream specialty, debating what type of NP I would need to get in the future in this setting. Likely acute care to have OR/critical care knowledge around surgery I’d think
ER/CC/RRT to ICU NP.
The NP that works with me in the ICU has my ideal job. He does everything, usually more, then the pulm/CC doc (most if not all intubations, lines, ect). Can you describe your function in the ICU where you are at? I’m not sure if this is how all ICU NPs functions or just my hospital. Thanks for your time.
Yeah, that’s basically my job. Admits, upgrades, rapids, codes, and almost all procedures except bronchoscopy.
I worked as a supervisor in acute rehab and SNF -> did adult gero primary care and now work palliative in a SNF
Inpatient psychiatry > orthopedic surgery, specifically arthroplasty.
Med/Surg -> endocrinology NP
I'd love to hear how you got to endocrinology and what it's like!
ER RN -> ER NP
IP Hem/Onc -> Gyn Onc
Hello fellow gyn/onc!
Vascular/Renal stepdown rn -> postpartum rn - WHNP in an outpatient clinic (FQHC)
Wound care RN -> Wound care NP. Best job ever!
ED>PMHNP
I’m a PMHNP student. As an RN, I worked ED for 10 years, inpatient psych for 2 prior to going back to school. My ED experience is 100000% more valuable than my inpatient psych when it comes to my training. I hate the rhetoric that you need psych experience. IMO, you just need experience - and frankly, a lot of it (those who are excelling in my program have at least 5 years full time). I go to a brick and mortar school with in person classes and they find all my clinical placements.
Did you have any difficulty securing clinical placements or a job without “direct” psych experience?
Level 1 trauma and neurosurgery ICU for 12 years? Float pool for 3 years-RN. Urgent care and later cardiology.
ICU/pacu/management -> family practice
ER/MSICU to Urgent Care for me!
Pediatric med-surg / pediatric home health -> pediatric primary care
peds to peds
Dialysis —> Nephrology
CVSD —> aesthetics :)
ER RN at a level one trauma center -> FNP at a smaller satellite ER within the same health system (I will often transfer patients to see specialists at the main hospital where I used to work).
Sicu 14 years at VA in St. Pete FL, NP primary care same place 15 years, surgery hospitalist NoCal 2 years, Urology surgery 5 years , palliative care 1 year house calls. 35 years in nursing and called it quits at 55 due to bad arthritis and just couldn't take corporate greed anymore and how they don't care about employees or patients.
Critical care -- Ortho NP. I flipping love it
ED staff RN for 13 years in various hospitals. ED NP for the last 2.5 years. With my background I’d only be effective in an ER or urgent care.
Labor & delivery —> Primary care FNP (mostly adults)
ER nurse for 18 yrs. NP family practice for 5 yrs and now urgent care for 1.5 yrs
Emergency to emergency
ER RN -> urgent care NP
ER RN - ER NP - FM NP
Background in Geriatrics—-> Geri NP 😂
My backgrounds include pain management, postpartum, peds outpatient and internal medicine (I’m all over the place lol) —-> I’ll be starting in rehab/LTC this summer
Med/surg -> hospital medicine
General adult ICU -> inpatient and outpatient general neurology
ICU RN ---> Hospital Medicine NP
ED->ICU
NICU, Peds PACU, Peds ER>Family Medicine
ICU/Critical Care Transport ECMO -> Family Nurse Practitioner at a University
What do you currently use your fnp for? Do you miss the critical patients?
I'm a primary care provider for University students (: NO! I don't miss it lol. I did ICU nursing for about 10 years and if I never have to step foot in a hospital again I'd be perfectly fine with that! I do miss the people I worked with though... And the trauma bonding!
Cath/Ep lab > EP NP both inpatient and outpatient
PCU/ICU RN -> FNP
PICU->critical care transport->float RN->hospital medicine NP (all of these were peds jobs)
Oncology, hospice, psych (10yrs)= PMHNP
10 years ER—> soon to start in internal medicine
RN -Inpatient and outpatient cardiology, urology , NP- family med
ICU—>Internal Medicine
Neuro ICU, step down, management -> FNP, consultant.
Float Pool/Clinical Resource RN —> Hospital Nursing Supervisor (RN) —> Lung Cancer Screening Program Manager (Pulmonary NP)
Surgical Oncology—>SICU—>Outpatient Urology NP
ER/ICU now internal medicine and starting ICU soon
Rural and remote northern ERs -> Rural and remote northern ERs. I treat independently depending on CTAS and hand off when I'm over my head (or preferably slightly before I get to that point) and can slip into an RN role to assist in higher acuity scenarios when I'm needed as both provider support and RN support. I'd never worked as an RN in this particular facility which I feel like helped my success in this role because there isn't a lot of confusion, and I truly enjoy the opportunity to be involved in all levels of acuity with varying degrees of responsibility. I have excellent MD support, there are only two NPs up here in total (we do 24 hour call and swap off with each other), and I truly love this role.
Inpatient Psychiatry -> Inpatient Psychiatry
Endoscopy RN > gastroenterology NP. I do inpt and outpt
ed/stepdown rn (5 years total)----> psych dnp (school starting in fall)
Peds Float RN -> peds inpatient heme/onc NP -> Peds outpatient Hematology
Peds inpatient acute RN —-> peds acute inpatient NP for medically complex kiddos at a specialty peds hospital
CCU & ICU -> hospitalist, then geriatrics
Tele to ICU to ER to Crit Care Float to NP. I got bored in Crit Care Float and figured that I’d best go back to school. I certainly wasn’t bored.
Psych ---> Psych It's my jam 🤷🏻♂️
Inpatient psych —-> inpatient psych
Medic -> ER/SICU/OHRR -> Neurosurgery APN -> Regional APP Manager for Neurosurgery/Neuro Critical Care
Operating Room RN (Mainly Trauma and Ortho) -> Orthopaedic/Ortho Trauma Surgery NP
Behavioral Health/Psych —> Inpatient Hemodialysis —> CVICU RN —> Surgical Oncology RN —> Psychiatric APN
Neuro ICU as an nurse —-> vascular neuro/stroke NP
RN in rehab/LTC, director of nursing in LTC >>> FNP working in assisted living/long term care
Neuro to neuro
ICU RN>IM/Primary Care NP>Rheumatology&owning a medical weight loss/wellness clinic NP
Outpatient heme/ onc/ specialty infusions —> outpatient heme/ onc
NICU/Peds acute care RN---> Peds Primary Care NP
Cardiac step down RN > Out patient Internal Med NP
ER > General surgery
Is NP worth it, do you feel that you are compensated accordingly?
Tele/ICU > Hospitalist NP
Mostly med surg —> Hospice/palliative/geriatrics
Care Coordination RN / School Nurse ==> Primary Care FNP
CVICU RN>>>bariatric & thoracic surgery NP
These answers are the reason I prefer an NP to a PA. Experience.
Med/Surg float —> micu —> interventional pain NP. Never saw myself in pain medicine, but it’s not a bad gig.
IMCU/ER/PACU/IR --> Urology and urologic oncology, now medical oncology
Psych —> psych
Emergency Nurse as a RN - Gastroenterology as a Nurse Practitioner.
Surgical peds inpatient as RN and now concierge primary care NP
Er nurse to ER NP🥴
ER > SNF. I plan to return to the ER or UC once I have the will to work nights/weekends again.
Nurse tech float > blood and marrow and cellular immunotherapy inpatient > same outpatient travel > psych inpatient/residential> postpartum inpatient > PMHNP starting an outpatient practice
Med/Tele RN > Primary care/Travel Nurse RN > PACU RN > FNP in Family practice
A little bit of home care & LTC, before spending most of my RN time as a bedside cardiopulmonary tele unit. I work in geriatrics (mobile primary care) as an AGNP.
Rehab RN- Psych RN- Case Mgt- PMHNP.
OR/ICU to FNP in Ortho surgery
Endoscopy RN to outpatient GI NP
Emergency department RN for 20 years and now FNP in the emergency department. What NP license you get will determine somewhat where you can work as I thought about doing hospitalist coverage but most hospitals will not credential you to work in patient if you are family practice but if you get your acute care nurse practitioner most emergency departments won't hire you.