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SoundofMusic 10,311 Views

Joined Apr 7, '07. Posts: 1,016 (55% Liked) Likes: 2,165

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  • May 23

    As a new NP this is such an eye opener to me and I thank you for this post. I never thought about needing my own malpractice insurance as my company provided a policy. I will now be looking into my own policy. I thank you again.

  • May 22

    Thank you for sharing your experience. I often think about what incredible responsibility is on my shoulders in my work position. It does not take much at all to make an error, especially with an electronic record where clicking one wrong button can mean something very different gets ordered. I am sorry for your struggle and I hope you are on the upswing now.

  • May 22

    Quote from SoundofMusic
    Oh gosh ... a travel nurse ought to have a triple policy.... so much risk, especially also not knowing your staff all that well. I have to wonder about the lawyers, too. Mine never asked if I had insurance -- but I wish I had.
    The facility will throw the travel nurse under the bus any chance they get!

  • May 22

    While I'm not an APN, this really validates my feelings about holding malpractice insurance. I've spoken to a few nurses out there and I keep hearing, "It increases your likelihood of being sued because the lawyers find out who is insured. " Thus, pulling a Jerry McGuire and "show me the money." I feel it's better to be safer than sorry and I'm a travel nurse so I'm put in very unfamiliar situations all the time. Sorry for the struggle but I appreciate your thoughts.

  • May 22

    @SOM - yes, any discipline stays on our state's BON site FOREVER and it flashes a bright RED like some sort of beacon when you do licensure lookup.

  • May 22

    I've used my malpractice insurance services twice. They were great and I highly recommend it to all.

  • May 22

    Thank you for your post. Very sobering. Glad to see you came out the other side stronger and wiser. Thank you for sharing what you learned.

  • May 22

    What an excellent well thought out article. I feel for your pain as I had a bad experience as a new grad that nearly killed me too. Although I'm not an advanced practitioner it was my own personal holocaust. I remember a more seasoned RN telling me, " The SBON doesn't exist to protect nurses, it exists to protect patients [in theory]". It was a God-awful experience I could live a hundred life times without ever enduring again.

    Best of luck to you in the future, and I would be proud to have you as my own PCP - disciplinary action from the SBON or not!

  • May 22

    This post is very timely and thank you so much. There are so many things to be concerned about in nursing and advanced practice. Everyone's your friend when the money is being generated, but when an error is made, perceived or real, you stand alone. I am always concerned about the billing. When the physician says "don't worry about that, the billers will take care of coding and billing." Then you never know how it was billed. Your codes could be changed and you don't know. I am also very concerned about new APNs who think they know so much. Even new MDs are worried. Use caution. Finally, considering we can't have health care without nursing, the BON is very harsh and punitive. I don't have malpractice insurance, but the application is on the table and will be completed. Thanks again to the OP and all others who were so honest on this thread.

  • May 15

    This sort of thing is terrifying and one of those things so many people assume will never happen to them (and thankfully for most people, won't). Even though I have employer covered insurance and have never been targeted myself, I still have a pretty comprehensive occurrence malpractice insurance policy on the side.

    I work extra in nursing and rehab facilities, and even though it's easy enough, families in these facilities seem to be overzealous and love threatening the facility with lawsuits or state notifications. Although the angst is typically directed to the facility itself, I always feel like its just a matter of time before I get dragged down into some BS lawsuit, which is why I protect myself.

    I had a physician tell me one time that good malpractice insurance is something that you hope and pray you never have to use, but when you do, you're thankful you got it.

  • Jun 3 '13

    Quote from JUSTanLPN
    Question is: is this common? How did you land such a gig?
    In general, I don't know if it's common or not to the majority of practice types. I know it's very common in my group. There's 2 other NPs and we pretty much all have the same deal, +/- a few $k/year.

    Telling you how I landed the gig won't help you or anyone else duplicate my results. But I can tell you how I approached developing my skill set as a NP. My thoughts are that my professional NP background really laid the groundwork for earning as I do. Here was my approach:

    1. Learn the hospitalist role.
    My first gig out of NP school was with the local university med school Cardio Vascular and Thoracic surgery department. It was a grueling work schedule with a very steep learning curve for a new grad. I had nearly a decade of critical care and trauma background as a bedside nurse, and I believe that carried me early on. I learned a lot about managing, as the surgeons put it, "the little things." Those little things were, dehydration, UTI's, diabetes/hyper/hypoglycemia, delirium, etc., in the hospital setting. The surgeons didn't like being bothered with the non-surgical conditions, that's where I came in. Naturally if pt's were too complicated a MD hospitalist was consulted to take on that role. This role taught me a lot about regarding when pt's were surgical candidates and if they were not, how to approach managing the conditions to give the pt the best chance at being a candidate.

    2. Learn the primary role.
    Less than 2 years with surgery I moved on to the primary world. My acute care background was perfect for a full risk clinic that worked very hard to keep pt's out of the ER and out of the hospital. I ran the treatment room for ambulatory conditions. Things like managing supertherapeutic INR's for coumadin pt's, COPD exacerbations, hyperglycemic events, dehydration, CHF exacerbation, Pneumonias, a whole slew of things.
    It was also a tough gig, becuase most other clinics will send these type of pt's to the ER. Basically the decision of admitting the patient is left up to the ER physician. And there's nothing wrong with this approach. But being a full-risk clinic means all of the pt's medical expenses are paid by the clinic, including ER visits and hospital stays.
    When I didn't have pt's on my schedule as acute visits, I helped with the chronic visits. Learning much about the difficulties that PCP's face. It's very much a thinking mans role. I loved it. I was good at it. An independent company tracked the clinic expenses and our quality measures.
    One of the metrics measured that was very much an indicator of how well our clinic was doing both financially and in quality was READMISSION rates.
    Average medicare readmission rates nationally and locally hovers just below 20%.
    Our annual readmission rate when I was there was less than 9%, 8.7% to be exact.
    I'm very proud of that. I still have a copy of that report.
    The year before I arrived the clinic was at 14%.

    Also, some of the conditions that were not safe to be treated as ambulatory type but also didn't quite have the necessity for hospital admission were handled by admitting the patients to the local skilled nursing facility.

    3. Learn the politics.
    They are especially important in a specialty practice that relies on referrals. I learned this well in my surgery role.

    4. When you feel ready, take your skills to the highest bidder. That may also very well be your current employer.

    So to summarize my long oration here, I would say to you the following.

    Learn to manage your patient in the hospital and out of the hospital.
    Learn to navigate your way through all the practice settings, ambulatory, skilled facilities/NH/s, hospitals.
    Learn the importance of alliances and the local politics by anticipating the repercussions of your actions and how they may affect your practice. Walk that fine line.
    Learn to not be satisfied with competence, strive for excellence.
    Learn how your practice benefits from your work, and how much ($$$) they benefit from it.
    Learn to negotiate with confidence.
    Love what you do and you will do it well.

  • May 28 '12

    I just quit a job after a month because if nastiness from other nurses. I've been a nurse over two years, but this was my first job in a sub-acute. At age 42, I've had plenty of jobs and have NEVER experienced anything like this place. The training was terrible -- mostly the nurses would just go ahead and do things instead of training me properly. How many times did I hear, "You should know this by now! You're late! You're too slow! The other nurses are going to talk about you!" Ridiculous. I can care less what excuse anyone could come up with to rationalize this atmosphere. On what was supposed to be my last night of training, the BOSS said in front of everyone, "Let's see if she finally gets it or if she's going to crash and burn." I quit the next day. And I didn't crash and burn. Not all nursing jobs are like this. I've had such fantastic luck up until now, including working with level 4 prisoners, who were more respectful than these nurses! I deserve better and so does the next person. Thank you for sharing. In a strange way, my feelings were validated!

  • May 25 '12

    I work family practice which is heavy on psych and fat. I've heard every reason under the sun why a person can't shove less food in his pie hole, walk anywhere, or get off of the couch and stop watching Oprah (which causes fibromyalgia BTW). Focus on psych and learn how to look like you are listening while planning your grocery list at the same time.

  • Nov 12 '11

    I couldn't believe it when my facility said pt's have to answer that they were ALWAYS satisfied with their care in order not to get dinged.Most people I talk to say they never give an" always" in a survey even if they were at a 5 star hotel and having the time of their lives!
    It is not humanly possible to please everyone ALL of the time.Human beings are not perfect. There is no doubt that the value based purchase model will cost the hospitals.

    I work at a great hospital people work hard and care about the pt's.I already feel like we give 100%. Now we are asked to give more.I don't mind working on improvements to pt care,I am all for that, however, I have already seen cut backs and layoffs in my hospital and everyone is getting stressed out and morale is effected.

    The government is simply going down the wrong path in order to pay off their debt.

  • Oct 23 '11

    I am not an NP yet. However, I am in the same situation you are in. I have decided that I will quit my RN job once clinicals gets too heavy. I want to focus on my studies and build my competency while I have my preceptor within my reach. Once you get your NP license, your employer will not have the kind of orientation that you get when you started your first RN job. They will expect that you know your stuff and are ready to work. Therefore, I believe that we owe it to ourselves, our families and future patients that when we graduate; we are competent NPs. We have invested so much time, energy, money, and made sacrifices already. Good luck! Keep me updated and I will cheer you on. Let's graduate together!


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