r/nursepractitioner

Yelling/ combative patient.

Has anyone had to deal with a combative patient who yelled at you during the entire encounter?

I specialize in sleep medicine and also practice minor pulmonary medicine, mainly managing established asthma and COPD. My schedule involves seeing patients at the clinic in the morning and doing sleep medicine telemedicine in the afternoon. Most of my telemedicine encounters are great, but I recently dealt with a patient who is required to maintain DOT certification. So they have to be tested for OSA and undergo subsequent treatment if they meet the criteria.

Anyway, from the very beginning, this patient was agitated and clearly unhappy about needing OSA treatment. Patient kept cutting me off, eventually started yelling inaudibly, and then hung up on me. Patient needs my clinical note for DOT license recertification, but honestly, I don’t even think patient understood why we were meeting in the first place.

This was the worst patient encounter I’ve ever had, even though I’ve been practicing for a little less than a year. I wonder if it’s easier for someone to yell at their provider because the visit is online? It’s just hard to comprehend how someone could be such a piece of work and so verbally abusive. I actually feel bad for patient. I can imagine how miserable patients life must be if patient treats someone who is trying to help this way. Anyway, I just wanted to reach out.

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u/OctupusTiger — 15 hours ago

I passed Pharmacology!

I've posted here in the past a few times about pharm: before even beginning my program about my fears for this class, then midway through seeking help for doing poorly... now I'm happy to say that I passed it! I'm so thrilled :) Just feels good to share the news!

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u/Pileapep — 9 hours ago

Respiratory

Hi everyone

Im very excited because I am moving onto a "clinical " interview for a respiratory position. I have enjoyed respiratory a lot thus far.

I have 1 year NP experience. What kinds of things do you think they'll expect me to know? I am most familiar with COPD and asthma. If you're in respiratory, what kinds of questions did you get in your interview?

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u/igottaknow_ — 22 hours ago

Struggling with visibility during ear cleanings in clinic, what are people using?

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I work in urgent care and end up doing a lot of ear cleanings, and lately I’ve been getting a bit frustrated with how hard it is to actually see what I’m doing. We mostly rely on basic rinse kits and manual instruments, and even with extra light it still feels like I’m working a bit blind sometimes.

It’s not that I can’t get the job done, but there are definitely cases where I don’t feel as confident as I’d like, especially when the wax is deeper or more compacted. I’ve been thinking there has to be a better way to improve visualization without making things overly complicated or unsafe in a clinical setting.

I’ve heard about camera-style options that show a live view, but I’m not sure how practical those are when it comes to proper cleaning between patients or just day-to-day use in a busy environment.

For anyone doing this regularly, what do you rely on to get a clear view while working?

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u/Koreee_001 — 1 day ago

Need some advice for AGACNP ANCC exam

Hey yall. I graduated a little more than a year ago with my AGACNP (it was a bridge/ post-master's cert) and I need to take the exam. I took the exam last year without ANY studying and got 326 and it said on the results that the passing minimum is 350. So, I took off 30 days from work, I have been studying the barkley book/CDs basically everyday for 8-10 hours. I also have been doing the SM review questions online. I have about 500 questions left. I have about 11 days left until the exam. Any tips that you guys can provide me would be great. I think I struggled the most in the non-clinical portions. Thanks in advance!

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u/damalixxer — 23 hours ago

Can someone explain compounded GLP-1 prescribing in med spas

Hi everyone,

I’m a new WHNP just starting in a med spa setting and I’m trying to better understand the use of compounded medications, specifically GLP-1s, and where this fits from a clinical, ethical, and legal standpoint.

Most of my training and the guidelines I’m familiar with focus on FDA approved medications (Wegovy, Zepbound, etc.). However, in this setting, a lot of the prescribing involves compounded versions of semaglutide or tirzepatide through compounding pharmacies, often mixed with additives like B12, B6, or L-carnitine.

I’ve been doing a lot of research and I’m having trouble finding clear, evidence based guidance on how this is approached in real world practice. I’m hoping to get insight from providers who have experience in this space.

Some of the questions I’ve been thinking through:

- How do you approach prescribing compounded GLP-1s in a safe and defensible way?

- Do you follow the same general GLP-1 guidelines such as BMI and comorbidities, or is it more individualized?

- How do you decide on additives like B12, B6, or L-carnitine? Are there evidence based reasons, or is it more based on pharmacy or clinic protocols?

- From a consent standpoint, do you have patients sign a waiver or informed consent acknowledging that the medication is compounded and not FDA approved as a finished product? What does that conversation or documentation typically look like?

- Why do med spas tend to prefer compounded GLP-1s over FDA approved versions that could be sent to a regular pharmacy?

- In your own practice, do you ever send prescriptions for FDA approved GLP-1s to pharmacies like CVS or Walgreens instead? If not, why?

- From a liability standpoint, how do you protect both your patients and your license when prescribing compounded medications?

I’m not opposed to learning this side of practice, but I want to make sure I’m practicing safely and responsibly. Right now it feels like there is a gap between evidence based medicine and what is commonly done in med spa and wellness settings, and I’m trying to understand how experienced providers navigate that.

Any insight or personal experience would be greatly appreciated.

Thank you 🙏

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u/swirl_pop — 1 day ago

Help with Pediatric NP Program!

Hi! First of all I've learned a lot from these subreddits, so thanks to all who participate. Hoping to solicit some advice. I'm an RN with about 12 years of experience and have been accepted to two very different pediatric nurse practitioner programs. I'm torn because they both offer different advantages, would really appreciate some insight! Also important - my job will pay all tuition costs as long as I remain working full-time (which I plan to do).

Option 1: State school pediatric acute care. Thee years part-time. Very low tuition that would net out to about $6k over the entirety of the program. Larger classes, a bit far from where I live, but mostly distance, so not terrible. Must find my own clinical placement.

Option 2: Semi-prestigious private school dual acute/primary care. Also three years part-time, but with slightly more credits (45 vs 50) and clinical hours (740 vs 825). Exorbitant tuition is reimbursed, but with tax the program would cost about $27k total. Clinical placement is provided. I'm also slightly drawn to the "name" factor since I'm going into a competitive, lesser paying specialty.

I can afford the higher tuition, but I'm unsure if it's worth the extra for dual certification, clinical placement and name recognition. I'm fairly certain I want to remain in acute care, but I could see myself wanting to move to primary someday, so the increased optionality is appealing. I've also spoken to the deans of both programs, and haven't been dissuaded by either. My primary questions are:

  1. In your experience, if you picked it, did the "name" school get you anywhere?

  2. To those going back to get advanced post-NP certs, do you wish you did it the first time?

  3. Are there any other considerations I haven't thought of?

Appreciate you all in advance!

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u/weeniebells — 1 day ago

Tips to choose the best nurse practitioner programs

I've been comparing FNP programs and honestly the "best nurse practitioner programs" rankings online are mostly useless, they rank by prestige or USNWR scores and none of that tells you what it's like being a student there while working full time. So I just started asking around and figuring out what actually matters on my own.

Clinical placement support was the big one, some programs basically tell you good luck finding your own preceptor and I talked to people from some universities who spent months scrambling with zero help. Other programs have dedicated placement teams and if you're working full time this alone can make or break everything.

Cohort size matters more than I expected too, I avoided the massive programs on purpose because I wanted an advisor who knows my name not my student ID, some of the bigger online schools run cohorts of 200 plus and the advising feels like a call center honestly.

Flexibility that's actually real, not just "online" but built for shift workers. Some programs have synchronous sessions at 2pm on a Tuesday which if you work days is completely useless, I looked for mostly asynchronous coursework and clinical scheduling that doesn't assume a 9 to 5.

Board pass rates, specifically AANP or ANCC, not generic "student success" language. If a program won't share their pass rates openly I moved on.

And actual cost after financial aid not sticker price, the number on the website means nothing until you factor in employer tuition assistance and how fast you can finish.

I crossed off the huge enrollment mills pretty early and the programs I seriously considered were a mix of smaller state university online programs and a couple mid-size private ones. I did most of my research on nursing career advancement site is good for seeing different NP tracks side by side (and they have actual human advisors available for support), you can also try to ask chatgpt to help you figure out what questions to even ask.

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Best study aid for boards?

I posted a while back asking people's opinions on the live versus online Barkley's course for AGAC and appreciate all the advice offered. Now that graduation is imminent I'm trying to nail down which study aid to actually use. Besides Barkley's I've heard about Rosh Review, Fitzgerald, APEA, and at least 1-2 others. Is there any consensus on what people think has the most bang for its buck?

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u/JonSarcasm — 13 hours ago

New Grad Urgent Care NP

I will be beginning an urgent care fellowship this summer that transitions into a full-time job and would love to hear advice from other NPs with UC experience on what they recommend to study and tips for success. Share your thoughts!

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Future DNP-FNP in AL (Aug ‘26): When to start job search, and how to get appropriate income?

The closest metro to me is Birmingham, and due to my spouse’s job, we cannot easily relocate. I like the area, but know that NPs in AL are often given terrible offers. I don’t want to be that new grad that takes whatever is offered, and ultimately pulls the collective average down.

As someone with additional education in research/clinical trials and public health, how can I leverage this in my first FNP counter offer? (I plan to reengage in clinical research/academia once I’m am a more competent provider).

How can I even make a counter offer knowing that I have no working experience in the field I’m applying to? I’ve never requested a counter offer in the past, so I’m looking for any insight….

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u/Intelligent-Cell2593 — 5 hours ago

Minute Clinic

Current job offer as a new grad at CVS minute clinic but looking for insight and advice on others experiences working or having worked there. I appreciate it!

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u/liahkimmm — 2 days ago

The singular of “nares” (pronounced properly as two syllables) is “naris,” just like the singular of “testes” is “testis,” but why not just say “nostril?”

There is no such thing as a “nare”

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u/Enough-Skin2442 — 2 days ago

In FNP school but confused why

Hi I’ve been bedside about 9 years. Mostly ICU and PCU. I’m approaching 50 in a couple years. I decided I really want to move out of bedside into something different. I also live in South Florida where the RN pay is not really cutting it for COL. I don’t know any FNPs truthfully. Just NPs I’ve worked with in the hospital which have been acute care. I don’t want to continue in acute care though which is why I chose FNP.

And I felt like in some ways my decision was not really researched enough. I don’t even fully understand what type of jobs I can go for. I’ve tried 5x8s and found it brutal. I was too tired to parent and fell off in my outside life. I really want a job that is 3x12s. I am a really good nurse. I have a good understanding of meds, anatomy, clinical decisions etc but I’m wondering what type of job’s a new grad FNP can go for. I’m only almost 2 semesters done, and I’m part time at a good established school but I do often wonder what the outside will be. Any feedback appreciated. And I know this is Reddit so I expect some mean comments but I’m tired yall.

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u/Depends_on_theday — 3 days ago
🔥 Hot ▲ 147 r/nursepractitioner

Psych breakdown for NPs: Stuff that comes up constantly in practice

Hey everyone! Whether you're heading into a psych rotation or already practicing, figured this breakdown might be useful. Psych issues show up in every specialty so this stuff is worth having in your back pocket.

The psych ROS mnemonic — "Depressed Patients Seem Anxious, So Claim Psychiatrists"

D Depression/mood disorders

P Personality disorders

S Substance abuse

A Anxiety disorders 

S Somatization/eating disorders 

C Cognitive disorders

P Psychotic disorders

Medical conditions that mimic psych disorders

Skip the medical history and you risk misdiagnosing:

  • Hypothyroidism (looks like depression)
  • Hyperthyroidism (looks like anxiety)
  • Diabetes (overlaps with depression symptoms)
  • Cushing's (depression, confusion, mania)
  • COPD / Sleep apnea (anxiety, panic, depression)
  • TBI (depression, anxiety, mania, OCD)
  • MS (mood changes, hallucinations, delusions)
  • CO poisoning (agitation, confusion, hallucinations (can appear 2-40 days after exposure))

The Big 5

MDD: Mnemonic: MSIGECAPS (Mood, Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidality). Need 5 of 9 symptoms x 2 weeks. SSRIs first-line.

Anxiety: GAD, social anxiety, panic disorder, phobias, postpartum anxiety. Somatic symptoms are key (chest pain, SOB, palpitations, trembling). SSRIs/SNRIs first-line, benzos short-term only.

Schizophrenia: Onset 16-30, ~80% inherited. Positive symptoms (delusions, hallucinations), negative (flat affect, anhedonia), cognitive (memory, decision-making). Second-gen antipsychotics preferred. Watch for metabolic syndrome.

Bipolar: Use DIG FAST for mania: Distractibility, Indiscretion, Grandiosity, Flight of ideas, Activity, Sleep decreased, Talkativeness. Lithium still gold standard for Bipolar I. Pro tip: patients usually seek help during depressive episodes, dig for mania history.

Substance Use Disorder: 2 of 11 DSM-5 criteria within 12 months. Priority is nonjudgmental care. Know your withdrawal presentations, alcohol and benzo withdrawal can cause seizures.

Patient rapport tip

Try symptom assumption: "With the stress you're experiencing, I'd understand if you're feeling more anxious than usual." Opens the door without judgment.

Hope this helps and happy to hear anything you'd add or change. If anyone wants a more detailed version with medication tables and full diagnostic criteria, feel free to DM me.

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u/juan_nphub — 3 days ago

Lawsuits at SNF

How many NP work at SNF that keep getting sued for various things? I work in Florida so lawsuit is something we hear constantly as a threat. I’m starting to see some lawsuits closer to the year I started working.. usually it’s more on the facility than providers but a lot of providers just dragged in. Anyone been in this situation? I try to document as best I can but if the nurses don’t tell me something, it’s not like I just know something is wrong

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u/pandagreenbear — 1 day ago

Not working as a nurse while pursuing NP

I’ve been a nurse 26 years (bedside) and I’m just DONE. I will have income coming in from my side hustles that are not healthcare related. Id also like to spend time with my elderly parents in their final years on earth without being stressed from work.

I’d love to pursue either Psych NP or Adult/Gerontology NP full time without working as a nurse for the 2-ish years it’ll take me to finish. I’m worried this will look bad when I’m looking for a job. What do you think?

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u/Silly_Weather9511 — 3 days ago

DNP Students and ANCC

This post could be answered by anyone who took the ANCC-BC or another sequelae of the ANCC. If your hours and three Ps are completed, can you test without degree conferral? I read the website and emailed customer service at ANA - still confused. It was like their CS rep did not look past the subject line of my email. I still need to finish the DNP portion of my degree but want to test beforehand so I maximize the built-in study course in my program.

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u/wild_flower33 — 3 days ago
▲ 2 r/nursepractitioner+1 crossposts

Book References

I’m trying to create a library of books for AGACNP? Does anybody mind sharing what book they have been using for subjects like Assessment, Pharmacology and others? Did you prefer digital or physical copy?

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u/Alarming_Attention87 — 3 days ago