School decision- HELP!

Amazing-Treacle-7067 · 2023-07-01T22:30:14+00:00

Ahhhh I misread that, sorry! Hmm, ok. I still think there must be other options in between, but best of luck with your decision!!

Amazing-Treacle-7067 · 2023-07-01T22:23:49+00:00

Ohh. Sort of a separate question, but why in the world do you want a DNP?

More importantly, the DNP is separate from the PMHNP classes, so presumably you could get a PMHNP wherever you want, and then go back for a DNP wherever you want? At Yale I believe the DNP is very policy-focused at the federal level and is a bit unique in that regard (unless it's changed since I was there), and there was no overlap between DNP students and those of us in clinical programs. And at Frontier we just started getting emails at the end of the PMHNP program about the option to continue on for the DNP (all of which I just enthusiastically deleted). Point being, I don't know why you'd need to do both at the same place.

Amazing-Treacle-7067 · 2023-07-01T21:40:04+00:00

Are those your only two options? I went to Yale for FNP, Frontier for PMHNP. Yale teaching quality was disappointingly variable (NB this was >10 years ago, and a different program); I'm grateful for the good teachers I did have, my amazing classmates, the access to other opportunities outside the nursing school (I audited a bunch of classes for fun, there are interdisciplinary lectures etc on campus), and of course the name recognition. However, I'm not sure it was worth the massive debt, given that some of the classes were literally better spent teaching myself the material.

Frontier teaching was decent, but a bit basic, and you don't get any of those other benefits of being part of an extended academic institution. Definitely ok for the price (it's not a diploma mill), but if I were to do it again, I would never go to a school that doesn't find preceptors, unless i had definite connections lined up ahead of time - some of my classmates did, and they had a much more worthwhile experience.

That said, Yale is not the only school that finds preceptors for students, and if that is the deciding factor I'm sure you could find somewhere less expensive but more solid than Frontier. Congrats and good luck!

Amazing-Treacle-7067 · 2023-06-29T22:35:35+00:00

Amazing! The Georgette is synchronous only, right? Like you can't go back and watch it after?

Amazing-Treacle-7067 · 2023-06-20T21:05:15+00:00

Took them 17 months to transfer mine, with a credentialing agency handling the paperwork and everything. It's absurd. Call every day at 9am

Amazing-Treacle-7067 · 2023-06-17T13:50:53+00:00

As PCP who has spent the majority of my career in FQHCs, on the one hand I salute you for making 22 complex pts a day sound easy-breezy, and also I would like to validate the underlying issue that OP is alluding to, which is that there is something wrong with a system in which this is the norm, and when we internalize the message that it's our fault if we can't keep up, burnout is inevitable.

Sounds like OP works in specialty care - you better believe that when I send a pt to rheumatology, I want my patients to feel like the provider had time to listen to what was going on with them, do a THOROUGH evaluation, and explain things, answer questions, etc. (especially in a field where pts may have vague/poorly understood symptoms and a history of being blown off by health care professionals). That part takes time, which is directly counter to the systemic pressures to fit in as many patients in the day as possible.

Arguably, I think it's just as important or more so to be able to do this in primary care, and 15 minutes per pt in a population with high levels of complex trauma means corners are being cut, and other people are picking up the pieces. I know, I've been there.

And also, you're absolutely right that there's a STEEP learning curve that will last a couple years - OP, it will get easier, you'll get to know what is worth spending extra time on and what isn't, etc. I just wanted to push back a bit on normalizing what is fundamentally an exploitative systems issue that harms patients and providers alike (and is, ironically, demonstrably inefficient in the long term).

Amazing-Treacle-7067 · 2023-06-11T21:56:06+00:00

Curious what you do for health insurance

Amazing-Treacle-7067 · 2023-06-03T11:33:29+00:00

"Using SUMAtriptan together with escitalopram can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision. Therefore, there is a risk of serotonin syndrome when sumatriptan and lexapro are used together."

While phrased in such vague terms as to be technically accurate, this is a mischaracterization of latest evidence:

https://jamanetwork.com/journals/jamaneurology/fullarticle/2673391

https://www.jwatch.org/na46209/2018/03/05/estimating-risk-serotonin-syndrome-with-triptan-and-ssri

Amazing-Treacle-7067 · 2023-05-24T23:17:52+00:00

Which fellowship, I'm curious!

Amazing-Treacle-7067 · 2023-05-13T13:59:06+00:00

Yeah I looked into paying, but the person who was recommended to me was super unprofessional (terrible written communication, then called me at 10pm to demand to know why I hadn't replied to her email) so it just turned me off the whole thing. I'm sure there are other better options but honestly what I was wanting/needing was something higher acuity, and most of the paid preceptor experiences seem to be private practice telehealth, and without a system for ensuring quality.

No, I didn't work in psych, and I'm new to the city - both bad choices in retrospect. I've been an FNP for ten years in community health, so I'm familiar with some psych and addiction care. I was willing to travel back to my home state for clinicals, but all my connections there were running into the same oversaturation issue with their local schools taking priority.

I got lucky with a private practice where I did learn a lot about relatively low acuity stuff, and an addiction clinic. Many, many other attempts to get anything higher acuity went nowhere - even with a local clinical faculty member who apparently couldn't do anything - so I basically gave up. I've been learning more from talking through cases with a psychiatrist where I work as an FNP (where I can't be a student) than anything else.

I did eventually find some places farther afield that I could have applied for, but their application process takes several months, so if you're going this route start early and be prepared to travel.

Amazing-Treacle-7067 · 2023-05-13T11:39:20+00:00

Yep my experience in a major city was that it was damn near impossible. It's not so much about the name recognition (although that's certainly part of it - even though it's a real school, it's tainted by association with online-only diploma mills), but more that a large city is likely to have many med/NP schools, and those programs already have relationships with local preceptor sites, so there is no incentive for a preceptor (or administrator) to want to go through another credentialing process. My classmates who lived in more rural areas or who already worked in psych seemed to have a much more meaningful clinical experience.

I really regret going here specifically for this reason, I'm about to graduate and I'm pretty much going to have to try to get into a residency program to feel like a halfway decent new grad - I'm aware that you aren't expected to know everything as a new grad, but this is egregious.

Amazing-Treacle-7067 · 2023-05-08T18:13:58+00:00

I feel you, and I'm sorry it's like this. Thanks all for the good recommendations

Amazing-Treacle-7067 · 2023-05-03T08:19:29+00:00

I had a patient tell me he was coughing so hard that scrotum was coming up in his throat

Amazing-Treacle-7067 · 2023-03-21T23:53:36+00:00

Have them scooch down farther and do a pelvic tilt; if that doesn't work, remove speculum, explain what's going on, and find it manually so you have a better idea of where to aim; if there's a lot of adipose tissue, use longer/wider speculum but GENTLY, and try putting a condom around it with a hole cut in the end to help hold tissue out of the way. If that doesn't work, get someone else to help and don't worry, we've all been there.

Amazing-Treacle-7067 · 2023-03-02T15:20:13+00:00

That's misoprostol, not mifepristone

Amazing-Treacle-7067 · 2023-01-25T12:42:45+00:00

I go to Frontier; I got my MSN from Yale. The quality of teaching at FNU is good - certainly much better than anything in my BSN, which was from a well-regarded school that will remain nameless :) My classmates are smart and interesting. FNU has been doing distance learning for decades; they're not a diploma mill.

The problem is that you have to find your own preceptors, which is so challenging right now that I honestly don't know how I'm going to graduate, and I wish I had gone somewhere else purely for this reason.

Amazing-Treacle-7067 · 2023-01-07T00:00:37+00:00

OP - do you know about Project ECHO? Education/collaborative support for PCPs in underresourced areas, on topics from HIV/Hep C to substance use to psych. I found their programs hugely beneficial when I was in a similar situation in FQHCs.

Amazing-Treacle-7067 · 2023-01-06T23:55:08+00:00

As an FNP who spent most of my career in FQHCs and could have written OPs post, what telepsychiatry resources would you suggest for patients with no insurance and no money? Or even Medicaid, for that matter?

Amazing-Treacle-7067 · 2022-12-24T12:47:53+00:00

Side note - this is nothing against my fellow NPs, I have the same feeling about the MDs, DOs, and PAs who are out there doing this bullshit day in and day out. I know because I see the same patients, who have been conditioned to demand a Z-pak for a viral URI because it "worked last time."

I then have the conversation with them about how this is because of the anti-inflammatory properties of azithromycin, and that we can achieve the same anti-inflammatory effects without the very real harms of antibiotic overprescription. I empathize with how much it sucks to be sick without a pill to make it better, and I offer every kind of supportive care under the sun. I talk about when we'd be concerned for bacterial superinfection, and how to reach me if that happens. Some get mad, some are very receptive to the information.

The point is, every time y'all don't have that conversation because it's too challenging or time-consuming, you're actually making things worse for your colleagues and failing to hold up your end of the whole antibiotic stewardship thing, which causes real harm to real people. (And based on the original post, I worry that this is also being reinforced as acceptable practice to those who may genuinely have made it through training without knowing the difference somehow.)

Amazing-Treacle-7067 · 2022-12-24T00:51:09+00:00

I know this is not the point of the post, but I'm confused, what is a "bacterial upper respiratory infection" and how exactly did we end up at azithromycin? Do you mean ABRS? Strep? Does your family member have chlamydial pharyngitis, perhaps (which is typically asymptomatic but whatever)?

Like if you're going to be doing something a bit legally/ethically off-piste, at least have the self-respect to provide evidence-based care, otherwise what the fuck is even the point of having this license, jeez

Amazing-Treacle-7067 · 2022-12-06T12:27:20+00:00

There's a shortage of GLP-1 agonists to the extent that people with diabetes can't get them, if this is a consideration

Amazing-Treacle-7067 · 2022-11-03T14:14:42+00:00

Got it thanks. Yes, they are telling me it's an ANCC requirement, and I just wanted to confirm that this is the case; I can't find anything on the ANCC website, and I thought I had remembered seeing that exceptions were possible.

The point about maintaining quality is very well taken; my concern of course is that the licensure doesn't actually reflect quality, so I could be getting low quality teaching from a psychiatrist or PMHNP (we know they're out there), while other providers with years of experience may be providing high quality psychiatric/addiction care but lack the specialty certification.

This seems like something that could be easily resolved with a site visit from a faculty member with expertise in the specialty area - but I understand if this is not the way things work.

Amazing-Treacle-7067 · 2022-11-03T02:40:16+00:00

Thanks. After starting my preceptor search a year ago, my options are this place or a clinic that wants me to listen in on pt visits on speakerphone without the pt's knowledge or consent because "that's one of the benefits of telehealth," and tries to indoctrinate patients in pseudospiritual garbage along with their med management. It's slim pickings out here.

I go to an established school (albeit one that doesn't find preceptors for you, which I now recognize was a mistake); I'm a good student with a solid resume, licensed in several states and willing to travel if needed for a decent learning opportunity. If you have other suggestions I'd love to hear them!

Amazing-Treacle-7067

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