ER NP's/RN's

Originally posted by FNP grrl
i'll be starting in the fast track of an ER as an FNP soon. i have worked as an RN for years in the ER. i also work as an FNP in an urgent care. the roles are very different. as an FNP, i have more in common with the docs in the ER & urgent care than i do the RNs.

in urgent care, i work side-by-side w/ a doc. we each pick up charts & go in to see the next patient pretty much identically. i always consult w/ the MD any time the pt is very sick or very complicated or if i simply need some more in-depth medical information.

i am not required to present patients to the docs...it is my judgment whether or not to consult with them. once i got past the beginning stage in the urgent care, i consulted less & less. there are whole shifts now when i don't really discuss any of my patients w/ them. we work as colleagues. the docs co-sign all the midlevels' charts in that setting (PAs & NPs). in my state, PAs must always be countersigned, while NPs don't have to be countersigned after an initial time period passes.

i can write any RX that docs can in this state- ie, NPs here have full prescriptive authority, including narcs. this varies from state to state however.

NPs and PAs get a full history, examine/work up a patient, write orders, interpret tests, write Rx and make medical diagnoses just like docs do. all of that is outside the RN scope of practice. i am not saying RNs don't order & interpret tests 'cause we all know they do!! i'm still an RN- i haven't forgotten. ER nurses are especially independent as we all also know. however, legally speaking, the RN cannot give medical orders or make a medical diagnosis.

NPs and PAs also do more invasive procedures than RNs usually do. in my fast track/ urgent care setting, that means suturing, I&Ds, pelvics, reducing fractures & dislocations, digital blocks, etc. some NPs & PAs assist in surgery, put in chest tubes & central lines, intubate, etc. just depends on the setting.

in the fast track job, i will be seeing patients (alone) that were triaged specifically to fast track- they are supposed to meet certain criteria to go to fast track in the first place- not a perfect system of course. all depends on who is triaging & how busy the rest of the ER is. the docs are nearby & i can consult whenever i need to.

$$wise, i will be making quite a bit more as an NP that i did as an RN- plus productivity bonuses. of course, i never worked a lot of overtime as an RN either. and i never worked in a place where there was a severe RN shortage- so i am sure there are some travel/agency RNs in certain areas who will be making more per hour than i do. and ER pays better than, say, the health department. but overall NP salaries ARE higher than RN salaries.

the thing that i love about NPs is that they practice medicine with a nursing framework.