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SoundofMusic 9,860 Views

Joined Apr 7, '07. Posts: 1,006 (55% Liked) Likes: 2,129

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  • 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!

  • Oct 23 '11

    Quote from SoundofMusic

    And remember, a lot of people decide to go to grad school and be NP's, because they can't seem to get any traction as a nurse ...nurses are far too busy undermining each other, writing each other up, and all that ridiculous CRAP. For me, I know it would take me YEARS to get ahead due to all of the politics, all of the favoritism ... and I don't have "years" as i am getting older. If anything, that is what I hope to get away from ...not necessarily patient care. Oh, and 12 hour shifts. . . maybe. Hopefully.
    Agree. I'm not getting any younger either !
    It will take me years to progress to management and it will be at the same rate as those grandfathered in with older nurse training here in Australia.
    Retrospectively it has been a waste of time getting a bachelors and graduate degree when there are lots of competitors for management jobs who possess a hospital certificate, a piddly post-grad certificate and 10-20 years experience in the same speciality.
    Going to NP after a couple of years experience makes more sense and I can understand why the newbies do it

  • Oct 18 '11

    I am not satisfied. I feel overworked, underpaid and underutilised. I got into nursing because I wanted to help people and make a difference in their lives. 2+ yrs in and I just want to get out. Nursing school did not prepare me for the realities of nursing.

  • Oct 18 '11

    I had a prior career and now 25 years in nursing. Most of my nursing has been bedside but now I am in case management. I like it for what it is (good pay, steady hours, no w/e, nights, holidays, no on call). I enjoy the use of my knowledge base. I get my life enjoyment from my family and hobbies (yoga, knitting, reading, travel).

    That probably doesn't sound like much of an endorsement for a nursing career but I'm just happy I have a job I can do and good benefits. I think we are in the age of "lowered expectations".

  • Oct 18 '11

    hahahaha! Also great to hear as you walk in the door at home ... "oh, so glad that you're home, now we can tackle that clogged toilet, clean the crayon off the wall, jr has a fever, history project, fill in the blank."

  • Oct 18 '11

    Bicycle vs. pavement, ETOH on board, coming to room 15!

  • Oct 18 '11

    "That quad in Room X is having a colonoscopy tomorrow. He started the GoLytely about an hour ago."

  • Oct 17 '11

    Quote from Altra
    I will say that I have met a few nurses (from various specialty practice areas) who seem to regard any deterioration in a patient's condition as the personal fault of someone, somewhere. This is unrealistic, unproductive, and unprofessional. It does reflect the culture of the society at large, but it is a shame when health care practitioners can't use their education and experience to grasp the reality that illness/injury are not always someone else's fault.

  • Oct 17 '11

    Quote from anotherone
    at the end of the day it doesn't matter to anyone else how many gi bleeds, pe's, dvts, fluid overload you caught or suicidal/psychotic pts you kept safe. what matters is how fast you got the chairs for the visitors. that's what you will get e-mails about.

    Best post ever for its straight-to-the-heart-of-what-matters

  • Oct 17 '11

    I actually had a lovely little old man thank all of us for "waiting on me so nice."

  • Oct 17 '11

    at the end of the day it doesn't matter to anyone else how many gi bleeds, pe's, dvts, fluid overload you caught or suicidal/psychotic pts you kept safe. what matters is how fast you got the chairs for the visitors. that's what you will get e-mails about. i UNDERSTAND that the public is too ignorant or doesn't understand that we aren't just hospital waitresses, but when your own managment doesn't understand that you didn't run into a room with a chair because you were trying to save someone's life, then it is a issue. and that is the big lack of respect. not the lack of respect from the drug seeker who whines that the q1min dilaudid(exageration) wasn't given on time, but that your own nursing manager doesn't understand that you weren't exactly sitting around reading magazines instead of getting him his prn meds.......