Becoming a plastic surgery PA?

[HenryH]

If someone was aspiring to be a plastic surgery PA, is there a particular career path they'd be advised to follow? After completing a PA program, would it be a good idea to pursue a PA residency program in surgery? Or would it not make much of a difference since there aren't any residency programs that provide specialized training in plastic surgery?

Also, I know of a PA who works for a local plastic surgeon (private practice/cosmetic), and she charges a $250-per-surgery fee to each patient he works on; I'm not sure if the surgeon pays her a salary in addition to this fee (I'm guessing not). On one of the contracts patients have to sign prior to getting surgery, it's actually stated that they are required to pay a separate $250 fee to the PA.

Is this type of arrangement (in which the PA collects their own fee from each patient the physician sees) common in the surgical field? It seems like it could provide for a very lucrative income for the PA -- but then again, I never seem to come across job openings for PA's to assist private-practice/cosmetic plastic surgeons. Is this the reason? Is private plastic surgery an uber-competitive field for PA's to break into because of the lifestyle/income potential? Or are most PA's more interested in working with surgeons who help patients who actually "need" surgery?

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[deleted6669]

your best bet to do plastics would likely be to do a surgical residency after pa school and take all your electives in plastics.
I know a few PAs who get surgical first assist fees. a friend of mine( a residency grad) got a regular salary and benefits + 15% of the surgeon's fee every time he first assisted.

 

[HenryH]

your best bet to do plastics would likely be to do a surgical residency after pa school and take all your electives in plastics.
I know a few PAs who get surgical first assist fees. a friend of mine( a residency grad) got a regular salary and benefits + 15% of the surgeon's fee every time he first assisted.

Thanks for the advice. I wonder if the PA I'm familiar with would be considered a special case -- I don't think she works in the clinic with the surgeon at all; she only assists him in the OR (and takes call, I would suppose). Is this unusual? Also, is it unusual to separately charge the patient a fee for her services during surgery, as she does?

It sounds like the PA you know who gets the 15% of the surgeon's fee has the better deal. It seems especially apparent when considering that, if the surgeon performs a facelift for $25k, then that means the PA earns 15% of that, which is $3,750 (just to give one example). Is that actually how the arrangement works? It sounds too good to be true, but then again, I guess that the money is well-earned, especially after having undertaken the rigors of an 80+ hour/week residency.

But when I do some basic hypothetical calculations, it seems like a plastic surgery PA whose compensation schedule fits the above model could easily earn $300-400k on top of their base salary. Did I crunch the numbers wrong, though?

BTW, I don't mean to sound as if I'm chasing money and nothing else; I know that I'm not interested in primary care and will become either a CRNA or surgical PA, but as the student loans pile up, I'm definitely interested in having the ability to quickly and substantially start paying off that debt as soon as I start my career (whatever that happens to be!).

I'm currently enrolled in a nursing program now and am on-track to graduate next July. Do you think there's any hope of getting into a surgical PA residency program as an NP graduate? I ask because I've heard that a number of the FP/IM/ER residencies will take NP grads, so I was just wondering. It just seems like such a waste to flush all the money and progress that has been spent pursuing my nursing career up to this point down the drain.

 

[deleted6669]

Thanks for the advice. I wonder if the PA I'm familiar with would be considered a special case -- I don't think she works in the clinic with the surgeon at all; she only assists him in the OR (and takes call, I would suppose). Is this unusual? Also, is it unusual to separately charge the patient a fee for her services during surgery, as she does?

It sounds like the PA you know who gets the 15% of the surgeon's fee has the better deal. It seems especially apparent when considering that, if the surgeon performs a facelift for $25k, then that means the PA earns 15% of that, which is $3,750 (just to give one example). Is that actually how the arrangement works? It sounds too good to be true, but then again, I guess that the money is well-earned, especially after having undertaken the rigors of an 80+ hour/week residency.

But when I do some basic hypothetical calculations, it seems like a plastic surgery PA whose compensation schedule fits the above model could easily earn $300-400k on top of their base salary. Did I crunch the numbers wrong, though?

I'm currently enrolled in a nursing program now and am on-track to graduate next July. Do you think there's any hope of getting into a surgical PA residency program as an NP graduate? I ask because I've heard that a number of the FP/IM/ER residencies will take NP grads, so I was just wondering. It just seems like such a waste to flush all the money and progress that has been spent pursuing my nursing career up to this point down the drain.

THE 25K you mentioned above is the total fee for a facelift, not what the surgeon gets. a lot of that goes to the facility, the anesthesiologist, etc.
my friend's cut worked out to a few hundred bucks/procedure but this was ortho, not plastics. his total salary base + procedures was still under 200 K but > 150.
there are pas who just do surgical first assist and they only get a flat fee per procedure. many work for multiple surgeons.
PA surgical residencies only take PAs. there are some(2-3 out of probably 50) in nonsurgical fields that take nps but none in surgery that I know of. most NPs just don't have the background in school to do a surgical residency.

 

[HenryH]

THE 25K you mentioned above is the total fee for a facelift, not what the surgeon gets. a lot of that goes to the facility, the anesthesiologist, etc.
my friend's cut worked out to a few hundred bucks/procedure but this was ortho, not plastics. his total salary base + procedures was still under 200 K but > 150.
there are pas who just do surgical first assist and they only get a flat fee per procedure. many work for multiple surgeons.
PA surgical residencies only take PAs. there are some(2-3 out of probably 50) in nonsurgical fields that take nps but none in surgery that I know of. most NPs just don't have the background in school to do a surgical residency.

So it looks like I've arrived at a crossroads of sorts -- if I apply to PA programs to start (hopefully) in January, I'll have ended up wasting all the time and money I've spent pursuing my nursing degree. On the other hand, if I follow through with graduating from my nursing program next July and end up applying to NP/CRNA programs, I will never have the option of pursuing a surgical career.

So I'm assuming the PA residency programs wouldn't even make an exception for a NP who has graduated from a program such as UAB's program that combines the acute care NP degree w/ RN first assist certification?

 

[deleted6669]

So I'm assuming the PA residency programs wouldn't even make an exception for a NP who has graduated from a program such as UAB's program that combines the acute care NP degree w/ RN first assist certification?

NOPE. I wouldn't expect any of the np residencies to make an exception for a pa, do you?
using your rn to get into pa school isn't a waste. it used to be that 1/3 of pas were former nurses. it's a good foundation for becoming either a pa or an np.
and as a pa, rn you could always do an online np program for double credentialing while working as a pa if you ever wanted both certs.
this may help. association of plastic surgery pas site:
http://www.apspa.net/new/

 

[Divergent]

So it looks like I've arrived at a crossroads of sorts -- if I apply to PA programs to start (hopefully) in January, I'll have ended up wasting all the time and money I've spent pursuing my nursing degree. On the other hand, if I follow through with graduating from my nursing program next July and end up applying to NP/CRNA programs, I will never have the option of pursuing a surgical career.

So I'm assuming the PA residency programs wouldn't even make an exception for a NP who has graduated from a program such as UAB's program that combines the acute care NP degree w/ RN first assist certification?

You should definitely finish nursing school if you plan on applying to PA school, since the experience from working as an RN would allow you to apply to more schools. You're almost there anyway, just finish it.

I don't think you should say that you'd "never" have the option of pursing a surgical career as an NP (CRNA's are anesthesia providers, so naturally they wouldn't be doing surgery). I'd say that it's easier to have an intraoperative/first assist role as a PA than NP, simply because PA schools all have a surgical rotation, plus there are one year residencies in general surgery and other fields available. However, there are NPs that first assist in the operating room, in addition to the usual role of pre-operative and post-operative management. Your best bet for that would be, as you know, completing the RNFA in addition to your NP (though there are NPs that don't have the RNFA that still FA). Perhaps you could also tailor your NP clinical rotations to also include intraoperative experience (it would obviously be best to find an NP preceptor that also first assists).

So yeah, it may be easier as a PA, but I wouldn't say "never" for NPs in plastic surgery.

Maybe you should Google "plastic surgery NP" and "plastic surgery RNFA" and see what you find. Here are some examples:

http://www.atlplastic.com/bursteinteam.html
http://www.drjjwendel.com/index.cfm/PageID/18231
http://www.atlantafacialplasticsurgeon.com/fernando-burstein-md/medical-team/
http://www.sumterplasticsurgery.com/carla-foley-npc.php
http://houston.olx.com/registered-nurse-first-assist-rnfa-plastic-surgery-iid-424233405
http://www.quatela.com/OurSurgeons/juliechatt/


It also seems that there are many NPs that provide dermatological services in plastic surgery practices.

 

[Divergent]

NOPE. I wouldn't expect any of the np residencies to make an exception for a pa, do you?
using your rn to get into pa school isn't a waste. it used to be that 1/3 of pas were former nurses. it's a good foundation for becoming either a pa or an np.
and as a pa, rn you could always do an online np program for double credentialing while working as a pa if you ever wanted both certs.
this may help. association of plastic surgery pas site:
http://www.apspa.net/new/

Not sure why you'd want to do an online NP program as a PA already. Plus you'd have to do the clinical preceptorships/rotations as well. Not worth it, IMO (and with all that schooling you might as well have gone to med school).

 

[HenryH]

Divergent, thanks for the advice and links to the plastic surgery NPs' websites. I'll check those out.

emedpa -- generally speaking, do you know how common it is for a PA to only work as a first assist for several surgeons? Is it hard to arrive at such an arrangement with a surgeon? Or are PA's who have completed residencies considered shoe-ins for such opportunities? I wasn't sure if it was usually expected that a PA have a minimum number of years working in surgery before applying for first-assist-only positions.

From what I've been told, the PA who works as a first assist for the local plastic surgeon works only for him because, even working just 2 days/week in the OR with him, she apparently still clears the $100k mark. Of course, this is all based on speculation and hearsay.

BTW, do you know how competitive the surgical PA programs tend to be? I couldn't seem to find information on matriculant statistics anywhere on any of the programs' websites...

 

[deleted6669]

Not sure why you'd want to do an online NP program as a PA already. Plus you'd have to do the clinical preceptorships/rotations as well. Not worth it, IMO (and with all that schooling you might as well have gone to med school).

Someone with both credentials can work anywhere. some places like PAs, some like NPs.
I know folks who have done it.

 

[deleted6669]

emedpa -- generally speaking, do you know how common it is for a PA to only work as a first assist for several surgeons? Is it hard to arrive at such an arrangement with a surgeon? Or are PA's who have completed residencies considered shoe-ins for such opportunities? I wasn't sure if it was usually expected that a PA have a minimum number of years working in surgery before applying for first-assist-only positions.

From what I've been told, the PA who works as a first assist for the local plastic surgeon works only for him because, even working just 2 days/week in the OR with him, she apparently still clears the $100k mark. Of course, this is all based on speculation and hearsay.

BTW, do you know how competitive the surgical PA programs tend to be? I couldn't seem to find information on matriculant statistics anywhere on any of the programs' websites...

some PAs open their own first assist companies after a residency + 5 yrs in practice or so. not common, but folks do it. there are lots of surgical post grad programs. if you apply to a couple you will get into one. norwalk and montefiore are considered the 2 best programs.

 

[pamac]

So it looks like I've arrived at a crossroads of sorts -- if I apply to PA programs to start (hopefully) in January, I'll have ended up wasting all the time and money I've spent pursuing my nursing degree. On the other hand, if I follow through with graduating from my nursing program next July and end up applying to NP/CRNA programs, I will never have the option of pursuing a surgical career.

So I'm assuming the PA residency programs wouldn't even make an exception for a NP who has graduated from a program such as UAB's program that combines the acute care NP degree w/ RN first assist certification?

Never have the option of a surgical career? Hardly. Just obtain an RN first assist certification. I met an NP that has one. Works in derm. Makes bank. Mostly used the first assist cert before derm, but still, it's possible.

There really are no guarantees out there that you'll get a job doin anything, regardless of the route. There are tons of surgical PAs, but just because there are doesn't mean you will be a shoe in to anything. I think it's quite a bit more straightforward to do PA if you want to do surgery, but the nursing degree isn't any kind of waste to have, and it opens up the door to CRNA, which is an option you don't have as a PA. Yeah, there is anesthetist assistant school if you want to throw another 100k down on your student debt from PA school (and you don't even have to be a PA to do AA school), but you are more restricted than a CRNA, can only practice in a handful of states, and will probably never see that changing.

Ultimately, I've found that the more complicated a plan is, the higher the likelihood to get sidetracked. If you want to do surgery, probably do PA. Get your RN, and do some time in OR. That will help you decide on what to really want. At that point, if you do go PA, you'll have some background, which will prove handy in school and in your job search as a PA.

 

[HenryH]

Never have the option of a surgical career? Hardly. Just obtain an RN first assist certification. I met an NP that has one. Works in derm. Makes bank. Mostly used the first assist cert before derm, but still, it's possible.

There really are no guarantees out there that you'll get a job doin anything, regardless of the route. There are tons of surgical PAs, but just because there are doesn't mean you will be a shoe in to anything. I think it's quite a bit more straightforward to do PA if you want to do surgery, but the nursing degree isn't any kind of waste to have, and it opens up the door to CRNA, which is an option you don't have as a PA. Yeah, there is anesthetist assistant school if you want to throw another 100k down on your student debt from PA school (and you don't even have to be a PA to do AA school), but you are more restricted than a CRNA, can only practice in a handful of states, and will probably never see that changing.

Ultimately, I've found that the more complicated a plan is, the higher the likelihood to get sidetracked. If you want to do surgery, probably do PA. Get your RN, and do some time in OR. That will help you decide on what to really want. At that point, if you do go PA, you'll have some background, which will prove handy in school and in your job search as a PA.

Thanks, I'll take your suggestions into consideration. So does the NP who has the RN FA cert. just do dermatology now? Are they working independently doing fillers, etc., or for a physician? Just curious about the type of arrangement they practice through.

To be honest, lifestyle considerations are a big factor for me -- I know some guys who are into this, but I'm not interested in working 60-80 hours/week, taking tons of call, spending my life at work, etc. This is one of the reasons I was drawn to plastic surgery as a specialty (whether as a PA or NP). It sounds especially nice to be able to essentially set my own schedule as a full-time first assist PA/NP.

 

[pamac]

Thanks, I'll take your suggestions into consideration. So does the NP who has the RN FA cert. just do dermatology now? Are they working independently doing fillers, etc., or for a physician? Just curious about the type of arrangement they practice through.

To be honest, lifestyle considerations are a big factor for me -- I know some guys who are into this, but I'm not interested in working 60-80 hours/week, taking tons of call, spending my life at work, etc. This is one of the reasons I was drawn to plastic surgery as a specialty (whether as a PA or NP). It sounds especially nice to be able to essentially set my own schedule as a full-time first assist PA/NP.

The NP does derm clinic and office procedures, Botox, injections....typical derm issues. I guesse that stuff doesn't really relate to plastic surgery stuff like you seem to be curious about. I don't really work around much of that kind of thing, so I think of derm when I hear "plastic surgery" rather than the big procedures. This NP in particular is part of a practice as an employee... Maybe even in some kind of partnership of sorts, but its essentially physician founded and focused. i guess there would be nothing to keep them from doing their own work on the side due to status as an independent provider, except maybe contract stipulations that I didn't ask about (I don't know this person well enough to get into private details anyway). They are well compensated within the existing structure of their employment, and I imagine that a lot of business comes to this NP due to the reputation of the clinic, which means what the physician essentially built. Could the NP go off and make decent money on their own? Why would they want to risk losing out on a good thing with a stream of clientele and none of the headaches of running a practice?

I've heard of an NP that did Botox for a chiropractors clients under an arrangement where the chiro's "wellness" customers would come to the chiro, who would in turn have the NP supervise injections. The chiro paid very high amounts. I wasn't even in nursing school when I heard this, but it seemed like a good way to loose a license to practice. At the very least, it would damage your reputation among well regarded providers you'd want to work with or for.
Incidentally, I also knew a fairly bad RN that made the jump to a spa like aesthetic practice that makes over 100k as well, and this was shortly after graduating RN school. Another terrible choice I'd stay away from, but the nursing world is forgiving of such things, and that poor quality nurse could probably go bedside again later on if they were so inclined (let's hope the money keeps them where they are at).

I think you can find the quality of life you are looking for as a nonphysician provider of either type (pa or NP). You'll just have to decide how you plan to balance the scales, and by that I mean you may have to sacrifice money for the schedule you want, or geographical location, or what kind of work you want to do. It's hard to get it all. You get something like derm, and you have experienced PAs and NPs lined up to break into that ahead of you. And there's no guarantee that a doc that will hire you will pay you what you deserve. There are people who post pretty awful offers from derm docs where they don't pay much and expect you to sign terrible contracts. Even then, some folks take them up on the bad deals because they insist the training they will get at that practice will help them upgrade later on to a better practice.

The thing about setting your own schedule, and especially as a contractor, is that you pretty much have to play ball to be able to drum up business and maintain a good reputation. As an employee, your bosses unfortunately will expect you to work your guts out. So there's no counting on a sweet gig, even though they exist. You might find that staying in nursing might be a good path to laid back lifestyle. I love my 4 days off. Took a fat trip last month and only needed to use a few days PTO.set up my schedule to miss very few days. I'm fairly new as a nurse, but I have friends two steps up the ladder from me breaking 100k, albeit working overtime and such. Still, one extra day a week can hike your pay upwards of 25k or more, and you still get 3 days off. When I want more cash, I patient sit for my hourly wage plus overtime and do homework. So when you talked about wasting money on nursing school, you might want to consider your options. There are PAs and NPs with sweet gigs, but the ones near me make around 100k if things are going really well for them. So in my mind, when I get my NP, I'll have to decide where I want to head. Bedside nursing can beat you down, so unless I'm making good money in management working in good conditions, I'll make the jump to NP and probably not look back. You hear NPs all the time talking about how they love the change of pace from bedside, so that is good enough endorsement for me. The NPs I've seen that seem to forgo NP specific work in favor of RN roles are generally either unable to land an NP spot (I know only one of those), or high enough in management that they make more than they would as an NP, or have opportunities to keep moving up into extremely lucrative management roles (I know of several of those folks).

 

[HenryH]

The NP does derm clinic and office procedures, Botox, injections....typical derm issues. I guesse that stuff doesn't really relate to plastic surgery stuff like you seem to be curious about. I don't really work around much of that kind of thing, so I think of derm when I hear "plastic surgery" rather than the big procedures. This NP in particular is part of a practice as an employee... Maybe even in some kind of partnership of sorts, but its essentially physician founded and focused. i guess there would be nothing to keep them from doing their own work on the side due to status as an independent provider, except maybe contract stipulations that I didn't ask about (I don't know this person well enough to get into private details anyway). They are well compensated within the existing structure of their employment, and I imagine that a lot of business comes to this NP due to the reputation of the clinic, which means what the physician essentially built. Could the NP go off and make decent money on their own? Why would they want to risk losing out on a good thing with a stream of clientele and none of the headaches of running a practice?

I've heard of an NP that did Botox for a chiropractors clients under an arrangement where the chiro's "wellness" customers would come to the chiro, who would in turn have the NP supervise injections. The chiro paid very high amounts. I wasn't even in nursing school when I heard this, but it seemed like a good way to loose a license to practice. At the very least, it would damage your reputation among well regarded providers you'd want to work with or for.
Incidentally, I also knew a fairly bad RN that made the jump to a spa like aesthetic practice that makes over 100k as well, and this was shortly after graduating RN school. Another terrible choice I'd stay away from, but the nursing world is forgiving of such things, and that poor quality nurse could probably go bedside again later on if they were so inclined (let's hope the money keeps them where they are at).

I think you can find the quality of life you are looking for as a nonphysician provider of either type (pa or NP). You'll just have to decide how you plan to balance the scales, and by that I mean you may have to sacrifice money for the schedule you want, or geographical location, or what kind of work you want to do. It's hard to get it all. You get something like derm, and you have experienced PAs and NPs lined up to break into that ahead of you. And there's no guarantee that a doc that will hire you will pay you what you deserve. There are people who post pretty awful offers from derm docs where they don't pay much and expect you to sign terrible contracts. Even then, some folks take them up on the bad deals because they insist the training they will get at that practice will help them upgrade later on to a better practice.

The thing about setting your own schedule, and especially as a contractor, is that you pretty much have to play ball to be able to drum up business and maintain a good reputation. As an employee, your bosses unfortunately will expect you to work your guts out. So there's no counting on a sweet gig, even though they exist. You might find that staying in nursing might be a good path to laid back lifestyle. I love my 4 days off. Took a fat trip last month and only needed to use a few days PTO.set up my schedule to miss very few days. I'm fairly new as a nurse, but I have friends two steps up the ladder from me breaking 100k, albeit working overtime and such. Still, one extra day a week can hike your pay upwards of 25k or more, and you still get 3 days off. When I want more cash, I patient sit for my hourly wage plus overtime and do homework. So when you talked about wasting money on nursing school, you might want to consider your options. There are PAs and NPs with sweet gigs, but the ones near me make around 100k if things are going really well for them. So in my mind, when I get my NP, I'll have to decide where I want to head. Bedside nursing can beat you down, so unless I'm making good money in management working in good conditions, I'll make the jump to NP and probably not look back. You hear NPs all the time talking about how they love the change of pace from bedside, so that is good enough endorsement for me. The NPs I've seen that seem to forgo NP specific work in favor of RN roles are generally either unable to land an NP spot (I know only one of those), or high enough in management that they make more than they would as an NP, or have opportunities to keep moving up into extremely lucrative management roles (I know of several of those folks).

Since you brought it up in your post, I'll be honest about saying that I'm really not interested in being a bedside "med-surg" nurse. With me being in an ADN program, the majority of our clinical rotations are focused on med-surg nursing, and I honestly cannot see myself doing bedside nursing for the rest of my nursing career. That's another reason I'm interested in these specialty fields in nursing.

Regarding the RN you mentioned who took the cosmetic/aesthetic practice job immediately after graduating -- why do you say this is a terrible choice for a nursing job? Because she's a bad nurse, or because nurses who take those kinds of jobs develop bad reputations? Because honestly, the lifestyle/compensation factors sound enticing, but I guess it wouldn't be worth ruining an entire nursing career over...

 

[pamac]

Since you brought it up in your post, I'll be honest about saying that I'm really not interested in being a bedside "med-surg" nurse. With me being in an ADN program, the majority of our clinical rotations are focused on med-surg nursing, and I honestly cannot see myself doing bedside nursing for the rest of my nursing career. That's another reason I'm interested in these specialty fields in nursing.

Regarding the RN you mentioned who took the cosmetic/aesthetic practice job immediately after graduating -- why do you say this is a terrible choice for a nursing job? Because she's a bad nurse, or because nurses who take those kinds of jobs develop bad reputations? Because honestly, the lifestyle/compensation factors sound enticing, but I guess it wouldn't be worth ruining an entire nursing career over...

By bedside, I'm referring to med surg, icu/ccu, telemetry, ER, even OR, .... Basically places where you act as a nurse in a hands on role. Each of those types of positions is a good place to gain skills and make yourself marketable. Quite a few of the RNs where I work are capable of jumping to different units when needed, and many work at different facilities on other units PRN for good pay. Med surg really isnt a bad place to start, but I never liked to hear everyone insist that's te best place to "pay your dues", so I didn't start there. I carry less of a patient load with more critical patients, but I recognize how useful a med surg origen would be.

So basically, my beef with that nurse mostly was because they were not good at being a decent RN in general. If this person ever comes back to real nursing, they will probably be even worse due to not developing skills early on when they could have taken root. Later on, this nurse will probably have misplaced confidence from being a "nurse" injecting botox, and doing nothing else. That isn't the case for everyone that does something like that, but it's the image you run the risk of getting.

 

[deleted6669]

So basically, my beef with that nurse mostly was because they were not good at being a decent RN in general. If this person ever comes back to real nursing, they will probably be even worse due to not developing skills early on when they could have taken root. Later on, this nurse will probably have misplaced confidence from being a "nurse" injecting botox, and doing nothing else. That isn't the case for everyone that does something like that, but it's the image you run the risk of getting.

we have a specialty inpt unit at one facility that I work at and all of the RNs there have forgotten how to be nurses. they call down to the ER to have our techs draw blood, do ekg's, etc.
if they need an IV they call our nurses. all they do is push paper and give PO meds. it's a joke. medical assistants could do their jobs easily and would likely improve the quality of care. it's where old burned out nurses in our system go as a bridge to retirement.

 

[pamac]

we have a specialty inpt unit at one facility that I work at and all of the RNs there have forgotten how to be nurses. they call down to the ER to have our techs draw blood, do ekg's, etc.
if they need an IV they call our nurses. all they do is push paper and give PO meds. it's a joke. medical assistants could do their jobs easily and would likely improve the quality of care. it's where old burned out nurses in our system go as a bridge to retirement.

Getting typecast is never a good idea, and one I'm avoiding. Transition pool type qualities are great for a resume. All my nursing mentors have been able to float peds, behavioral health, ER, icu, med surge, maternity, nicu, cardiac, etc. They are mobile and get job offers all the time and great schedules. The folks that don't develop those abilities get to languish in the comfort of familiarity until it becomes a drawback.

 

[HenryH]

Just to play devil's advocate (and because it really does sound like a good gig), are plastic surgery/cosmetic nursing positions difficult to obtain as a new grad? It seems like those positions would be very popular/competitive among new grads, but maybe not if most of them want to gain experience as "real" nurses. Then again, nursing salaries in my area tend to be so low that if "fluff" nursing pays even slightly more than bedside nursing, then everyone probably wants to do it (at least around here).

 

[pamac]

Just to play devil's advocate (and because it really does sound like a good gig), are plastic surgery/cosmetic nursing positions difficult to obtain as a new grad? It seems like those positions would be very popular/competitive among new grads, but maybe not if most of them want to gain experience as "real" nurses. Then again, nursing salaries in my area tend to be so low that if "fluff" nursing pays even slightly more than bedside nursing, then everyone probably wants to do it (at least around here).

I'd guess that it's more of an issue of who you know that can hook you up. As new grads, you usually have very little appeal to very many employers compared to experienced nurses across the board. You do need to have some basic nursing judgement even in an environment like that. I don't know how popular such a job would be.

 

[HenryH]

I'd guess that it's more of an issue of who you know that can hook you up. As new grads, you usually have very little appeal to very many employers compared to experienced nurses across the board. You do need to have some basic nursing judgement even in an environment like that. I don't know how popular such a job would be.

That's what I figured. It probably won't do any good, but I guess I could start making cold-calls to local plastic surgery/cosmetic practices as I get closer to graduation. My chances would probably be even lower than most other new grads' chances, considering that I will have an ADN and not a BSN degree.

 

[pamac]

That's what I figured. It probably won't do any good, but I guess I could start making cold-calls to local plastic surgery/cosmetic practices as I get closer to graduation. My chances would probably be even lower than most other new grads' chances, considering that I will have an ADN and not a BSN degree.

I don't think the degree will matter as much compared to a hospital, actually. If you know for sure that's what you want to do for a career, there's no shame in that. I just think it puts some limits on you that I'd be uncomfortable with. The good thing is that nursing is so broad that you can really find your niche. There were a few folks in my class that really had little interest in doing nursing, and gravitated towards very focused jobs. There are some really hands off positions out there. I even was offered a job that had some real potential that didn't involve anything but my RN by my name. It was something that would lock me into a path away from bedside, but it would have paid well, and had a big future ahead of me. But that's not why I got into this. Granted, it was something that would indirectly help more people overall than I do on a daily basis, but the work seemed boring. It was also narrow. What happens when I get sick of that and want to do bedside before I'm really experienced?

What were you thinking you'd get out of nursing?

 

[HenryH]

I don't think the degree will matter as much compared to a hospital, actually. If you know for sure that's what you want to do for a career, there's no shame in that. I just think it puts some limits on you that I'd be uncomfortable with. The good thing is that nursing is so broad that you can really find your niche. There were a few folks in my class that really had little interest in doing nursing, and gravitated towards very focused jobs. There are some really hands off positions out there. I even was offered a job that had some real potential that didn't involve anything but my RN by my name. It was something that would lock me into a path away from bedside, but it would have paid well, and had a big future ahead of me. But that's not why I got into this. Granted, it was something that would indirectly help more people overall than I do on a daily basis, but the work seemed boring. It was also narrow. What happens when I get sick of that and want to do bedside before I'm really experienced?

What were you thinking you'd get out of nursing?

To be honest, I went into nursing with the goal of becoming a CRNA, although I have also had a long-held interest in surgical subspecialties (as previously discussed). For the last few years, I have also pondered becoming an NP and working in some particular specialty. After having completed a full semester's worth of clinical sessions, however, I can tell you that I don't see myself being a career med-surg/bedside nurse. But if you think about it, that doesn't really change anything about my original plan -- it just re-affirms that I definitely want to either become a CRNA or pursue a career in surgery/cosmetics.

I know that people like me are often looked down on as the "bane" of nursing, but the way I look at it is, if someone has the goal of becoming a CRNA or some other type of APN, then what's the problem with it as long as they want to become the best APN they can be? (not that I perceive that you have a problem with it)

 

[pamac]

To be honest, I went into nursing with the goal of becoming a CRNA, although I have also had a long-held interest in surgical subspecialties (as previously discussed). For the last few years, I have also pondered becoming an NP and working in some particular specialty. After having completed a full semester's worth of clinical sessions, however, I can tell you that I don't see myself being a career med-surg/bedside nurse. But if you think about it, that doesn't really change anything about my original plan -- it just re-affirms that I definitely want to either become a CRNA or pursue a career in surgery/cosmetics.

I know that people like me are often looked down on as the "bane" of nursing, but the way I look at it is, if someone has the goal of becoming a CRNA or some other type of APN, then what's the problem with it as long as they want to become the best APN they can be? (not that I perceive that you have a problem with it)

No harm in that approach at all, really. Bedside isn't my goal long term either. Frankly, anyone who says the only goal should be to go bedside or else be a sellout is off the mark. Nursing has all these great options out there to pursue. I don't even believe all the hype behind the "start in med surg", or "pay your dues before becoming an NP" philosophy. When I looked into pa school, it drove me nuts all the advice I heard about checking boxes as an EMT basic or cna to get hce to apply. Guesse it's better than nothing for most of the undergrads applying to actually touch a patient, but it's far from what the founders originally hoped for. Of course, it would behoove you to at the very least perform well as a nurse, because while the knowledge may not transfer over extensively between being a provider and an RN, the ability to manage complex issues and pressure will be very useful, as well as universal. And if you can't stand the idea of being decent at betside, you won't be gaining the 2 years minimum critical care experience CRNA schools want you to have to apply. Im the type that puts all I have into my work, even if it were to be a stepping stone position. We all know folks who disdain what they are doing because they have their eye on a bigger prize, and the outcome of that is likely to be a decreased work ethic in the interim. I do what I can to appreciate what I have in hand because I don't know that the next step in the plan will end up being as great as I would imagine it to be. If for some reason I have to take a detour, I don't want to be stuck in a place that I can't be happy.

 

[Divergent]

That's what I figured. It probably won't do any good, but I guess I could start making cold-calls to local plastic surgery/cosmetic practices as I get closer to graduation. My chances would probably be even lower than most other new grads' chances, considering that I will have an ADN and not a BSN degree.

The best thing to do is to find an RN-BSN program, and apply to start it immediately (like in the Summer or Fall of the same year) after you graduate your ADN. Many hospitals that express preference for BSN grads will also consider ADN grads that are also enrolled in a BSN program. My hospital pretty much doesn't consider ADN grads anymore, yet a new grad coworker got her job a few months ago with an ADN because she already was enrolled in a BSN program. Check your state schools for that if you have any nearby, so you can save money. Also, many hospitals also have tuition reimbursement that can help tremendously.

You'll need it anyway if you still consider CRNA/NP, as well as PA (can't remember if you said you already have a bachelors and/or a higher degree in another field, I think you did, IIRC).

 

[pamac]

The best thing to do is to find an RN-BSN program, and apply to start it immediately (like in the Summer or Fall of the same year) after you graduate your ADN. Many hospitals that express preference for BSN grads will also consider ADN grads that are also enrolled in a BSN program. My hospital pretty much doesn't consider ADN grads anymore, yet a new grad coworker got her job a few months ago with an ADN because she already was enrolled in a BSN program. Check your state schools for that if you have any nearby, so you can save money. Also, many hospitals also have tuition reimbursement that can help tremendously.

You'll need it anyway if you still consider CRNA/NP, as well as PA (can't remember if you said you already have a bachelors and/or a higher degree in another field, I think you did, IIRC).

That's what I'm seeing as well.

 

[HenryH]

Yeah, I actually do have a biology degree (B.S.), so there are technically a few CRNA programs out there that would accept me with only my ADN degree (but I do plan on doing an RN-BSN bridge program anyways).

If I had to pick one aspect of nursing that I really don't like -- and I know this is a very wimpy and insignificant thing to complain about -- it's having to clean up crap, puke, and other "private parts"-related tasks. Surgery, blood, guts, viscera -- none of that bothers me.... but for some reason, I can feel my stomach turn when it's time to change an adult diaper or do something else crap-related during clinicals. So yeah -- I really don't think I'm cut-out for a long-term bedside nursing career.

It's funny... I know other guys who really wanted to become CRNA's but ended up applying to PA schools because they just weren't sure if they'd be able to handle the "nitty-gritty" of being a nurse. Let's hope I make it to the finish line! LOL

 

[pamac]

Yeah, I actually do have a biology degree (B.S.), so there are technically a few CRNA programs out there that would accept me with only my ADN degree (but I do plan on doing an RN-BSN bridge program anyways).

If I had to pick one aspect of nursing that I really don't like -- and I know this is a very wimpy and insignificant thing to complain about -- it's having to clean up crap, puke, and other "private parts"-related tasks. Surgery, blood, guts, viscera -- none of that bothers me.... but for some reason, I can feel my stomach turn when it's time to change an adult diaper or do something else crap-related during clinicals. So yeah -- I really don't think I'm cut-out for a long-term bedside nursing career.

It's funny... I know other guys who really wanted to become CRNA's but ended up applying to PA schools because they just weren't sure if they'd be able to handle the "nitty-gritty" of being a nurse. Let's hope I make it to the finish line! LOL

For me it's mouth care on vented patients, and suctioning certain airways. But I keep finding that there are ways to get drug into about any gross situation in medicine, even if you set out to avoid it. Case in point... I'm in ER working on a coding patient in the middle of the night. I look around, and 100% of us weren't in the "I love street person with rotting flesh smell", nor seek to surround ourselves with it regularly. I think what gets me through things I dislike is just focusing on the task at hand, and staying busy. And it's not like you are swimming in feces all the time. But yeah, you'll see some unpleasant things in bedside nursing.

I don't dislike the negatives enough that it tips the scales for me in a major way, yet. I do really dislike hefting obese patients, though. I greatly want to avoid injury dealing with those folks. That right there is something that makes me want to move on to NP or CRNA. As a guy, I get female nurses saying things like "oh it's nice to have a male to help us lift!" which gets my packaged response that basically says "you can only expect me to lift as much as one of your female friends, or else we need to go get more help".

CRNA is a lot different than PA, so your friends may have missed out on a career they might have really liked. I guess anesthetist assistant is available if you are fine with the drawbacks.

 

[sarjasy]

For me it's mouth care on vented patients, and suctioning certain airways.

C'mon man, there's nothing like pushing the button after you've advanced suction down the ET and feeling the clumps of snot getting vacuumed through the tube. It's friggin awesome if you ask me. 😀

As for gross ER stories. How about the doc (they're not exempt from gross stuff either) who bent over to look at a deformed toe nail on a diabetic patient's large toe and pushed on it (she was in the ER for AMS, not the toe BTW). When he did, the nail fell off onto the bed and maggots came crawling out of her nail bed. I though he was going to throw up. I literally got buzzed by flies the whole trip to CT.

 

[pamac]

C'mon man, there's nothing like pushing the button after you've advanced suction down the ET and feeling the clumps of snot getting vacuumed through the tube. It's friggin awesome if you ask me. 😀

As for gross ER stories. How about the doc (they're not exempt from gross stuff either) who bent over to look at a deformed toe nail on a diabetic patient's large toe and pushed on it (she was in the ER for AMS, not the toe BTW). When he did, the nail fell off onto the bed and maggots came crawling out of her nail bed. I though he was going to throw up. I literally got buzzed by flies the whole trip to CT.

Ugh. Trach care isn't too bad... Mouth care around the vent with crusties around the tube, and you are brushing, and a tooth falls out because it's rotted loose... I'll clean a thousand butts and not mind. Mouth care is something I don't prefer to do.

Yes, doctors often have it bad. Many a time I've seen gross stuff emerge in the middle of something delicate that they have to keep working through.... Sterile field stuff.

 

[deleted6669]

I had a deal with my last medic partner- anything out of the mouth/nose was my responsibility(vomit/sputum/epistaxis, etc).
anything out of the butt was all him.
given our pt population I think I came out ahead with that bargain.

 

[pamac]

I had a deal with my last medic partner- anything out of the mouth/nose was my responsibility(vomit/sputum/epistaxis, etc).
anything out of the butt was all him.
given our pt population I think I came out ahead with that bargain.

Although I'm sure I could be proven wrong by a lot of ambitious patients, I would still imagine that I can expect what comes out of a butt. But there are several things that could come out of a mouth that upset me more. Blood, vomit, mucous in all it's varieties.... And then the different mixtures among both, not to mention the different formulas of vomit based on what went in. Crap is crap. You know it's crap when you are dealing with it. But some vomit is worse than other vomit. There are a million and one new ways to see it... No two episodes look the same.. Oh man. Yeah, mouth stuff gets me.

 

[sarjasy]

Crap is crap.

No, there are many varieties. There is GI bleed crap, tube feed crap, ostomy crap, all the various manifestations of "normal" crap, and everyone's favorite, c. diff crap.

 

[pamac]

No, there are many varieties. There is GI bleed crap, tube feed crap, ostomy crap, all the various manifestations of "normal" crap, and everyone's favorite, c. diff crap.

But it all gets treated the same.... Avoidance. It's universal. Nobody is expected to do anything with it but treat it like its radioactive. Maybe send some to the lab (where they open it up under an air hood and never smell it). But someone hacking up a wet, chewy, cheesy, flem ball into a issue that they keep on their blanket....

Or stuff that comes out of a drain....

But I'm used to most of it at this point. Now I just dread an admit half an hour before my shift is over.

 

[HenryH]

I guess it just depends on the person, but for me, there is an inherent triggering of my gag reflex when I see/smell/get close to crap. I guess I'll just have to get used to it if I decide to work in the ICU....

 

[pamac]

I guess it just depends on the person, but for me, there is an inherent triggering of my gag reflex when I see/smell/get close to crap. I guess I'll just have to get used to it if I decide to work in the ICU....

Not just icu. Pretty much everywhere. OR, not so much. This month I've been in ER, icu, med surg, and peds.... Feces made an appearance in each venue. Fortunately, none of it landed on my person (not counting my gloves). Break it down into its constituent parts and it might seem less gross... Maybe. Probably not, though.