Latest Comments by rn_patrick

rn_patrick 1,032 Views

Joined: Jun 27, '07; Posts: 21 (57% Liked) ; Likes: 82

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  • 6

    This is my own biased, un-researched list. leaving this out here for other people to find. Ideally learning from my mistakes.

    1. Google where you are going to be working. Maybe even google the last couple providers attached to the clinic if you can find them. Maybe find out if the person you are taking over from lost their licenses for malpractice before you start.

    2. What is their policy on pain medications, benzodiazepines, and prescription stimulants. Do they have a policy? Are their dose limits, are their rules for "Emergency refills." You don't want to be the one on a holiday Friday when you get asked to do a refill for Xanax 2mg TID for your co-worker's patient.

    3. Is the Collaborative MD going to get your back on clinically difficult situations? Are they engaged in the practice or there to sign some charts.

    4. Is the practice run or managed by a Prescriber? Many times the Executive Director can be a social worker or similar.

    If so do they understand that the expectations of how we as NP's practice is different. The standard of care is treating the patient for the problem, time is a factor. The real issue is did you address the problem, at the standard of care, and not miss anything important, and do all the things you needed to do to meet the standard of care. "Can we just reschedule them...?"

    Do they also respect when you say no to things like inappropriate request? Number 1 reason I have seen people request a different provider is controlled substances.

    5. Do they schedule lunchtime meetings frequently, or before shift or after shift meetings? I find this lack of respect for your time sets the tone for other things in the practice. We all know Lunch is for calling patient's back and getting caught up in charting. Many NP's stay late doing the same, since patients who work are home to take a call. Also day-care and super scheduled kids these days, before and after work is scheduled like a military operation.

    6. Do your peers and the MD usually leave work somewhat on time? On-time does not mean having dinner with the kids and then charting after they go to bed from home.

    7. Are the NP's names on the door. On the wall? Or is it just the docs?

    8. Is they pay within 15% of the average for your specialty for the area? Is for smaller practices if you think you are going to be there a while an opportunity to join the partnership?

    9. Is there a productivity bonus?

    10. Is the staff and office "Ready to go" for the first patient of the day. My dentist the first appointment is 9:00 but the receptionist and I are standing out there at 9:00 waiting for the manager with the key. So 9:00 is really 9:20.

  • 2
    AnnieNP and Oldmahubbard like this.

    Previous practice eventually said that they were not doing the paperwork/letters for Emotional Support Animals. Apparently legal was concerned about lawsuits from people abusing the system. I know I had two patients state to me my landlord said I can't have pets and this means he has to let me. With several seeing eye dogs and other highly trained essential animals being attacked and harmed by "Fake service dogs" I think that the Airlines, national organizations for blind and disabled people are going to push to make a standard.

    As a former landlord the patient is right I'm looking at a possible easy lawsuit if I say no. "My medical professional said I get this accommodation and you would not let me." Other tenants may resent that they may have had to give up their pets prior to moving in or want pets and can't have them. Highly trained service dogs don't bark unless their is an emergency.It may do thousands of dollars of damage to the unit (Which is why I had a no pets policy in the first place). If you ever have had to remove subfloor because a cat urinated through the carpet, pad, and that smell won't come out you know what I am talking about.

    This animal may bark or make noise all the time. Many tenants choose no pets buildings for that reason. Leading to other tenants to move out. Finally their pet might be on a "Banned breed" list and now I can't get a policy to cover the building, or I have to pay 2x as much. Then there is also if said animal hurts a person or a child. The patient's above have nothing so your sitting there with a policy and money in the bank.

    I don't agree with breed bans, but it's right there in the policy.

    Hopefully the big corporate landlords do some lobbying on this problem.

  • 1
    traumaRUs likes this.

    Quote from Oldmahubbard
    It would be very hard to make anything in LTC if you are a consultant, only seeing maybe 5 patients by referral here, then drive 20 or 30 miles, see another 5 patients, rinse and repeat.

    I am part of a team, I carry my own patients, and see many of them monthly. Most of my facilities are quite near my home. Less than 5 miles.

    The few that are not that close, have negotiated a substantial stipend, in addition to the billing.

    My state has long been in the process of discharging the chronically mentally ill to the community, and they end up in LTC.

    Some of local SNF's are full of schizophrenics.

    They are very poorly managed by PCPs.

    I have also taken over several facilities where "psychiatrists" took the facility stipend, and didn't show up for months at a time.

    I am there each week, or every other week, according to the contract.

    I am known for my willingness to work with other professionals to come to a consensus, and I even give out my home phone number and email to encourage communication.

    For all you truly sucky psychiatrists that are worried that NPs will take your job?

    You should be.
    That's how I got started 5 years ago. The corporate group had a couple not-so-great nursing homes and assisted living type group homes and I was given three of them to take care of. One of the Geriatricians turned out to be the medical director of the local hospital and got me in the door of their psych practice.

    I just saw an ad for the former collaborative MD from that corporate group went and started his own company and the starting salary for that is 40K more than the CMH clinic pays. I was really green when I worked with him last, but definitely could try and talk to him about a position.

    I'm really starting to focus on Quality of Life as I enter midlife. Some of that continues to also feel that we are doing good work by being engaged and helping this population. I don't push paper around an office.

    I appreciate all the comments. I'm thinking either changing specialties, or working for a group like you are may be a good choice.

  • 2
    ICUman and Oldmahubbard like this.

    For me the pay raise was not the dominant factor though it helped. It was more breaking out of the every other weekend rotations. Yes I know there are RN positions that have that as well but typically they pay really poorly but many RN's would gladly take a pay cut to be home every weekend and every holiday.

    I think the DNP is a waste of time and money and a way to get 100% more (40 credits vs 80 credits) revenue for the graduate schools.

  • 0

    Quote from Jules A
    Community mental health is rough. I did a brief stint years ago although my pay was excellent. They tend to cry poor but have major financial backing and are able to pay if you insist on it. I can't imagine only having 12 patients a day unless there are 4+ intakes included as that is a very low census especially with what I suspect is a high no show rate.

    I'm considering retiring early also. As much as I love what I do the new NP trends are wearing on me. I have no interest in making less than I currently do and new grads are coming out of school accepting 30% less...
    We have a decent number show up. The systems here need some work which is part of my frustration. There is no productivity bonus for the on-payroll NP's, so they don't need me suggesting ways to increase volume which since they are salaried means more work for the same money. I know what they pay and it's about 20-30K under market.

    I'm thinking changing practice areas which may help.

  • 1
    Have Nurse likes this.

    I appreciate the lengthy response Oldmahubbard. I did LTC when I first got out of school. Wasn't a bad gig but I would have worn a car out every 4-5 years with the mileage. Struggled a bit with the pt's families, the "Don't change the meds unless all 4 brothers and sisters have signed off on it..."

    But you are right usually if they are not there the facility has a bigger problem.

    I'm definitely aiming for more work-life balance. I read a few simplicity blogs and have been moving in that direction for a while. The main reason I came back to this place was to guarantee I have enough hours for my 2022 renewal.

  • 0

    Hello everyone:

    About 1 1/2 years ago I submitted:
    http://allnurses.com/advanced-practi...e-1079070.html

    I made it to January, gave notice. About 1 week after I left I interviewed for a Locums position at a similar type job. Was accepted and worked there for 6 months 3 days/wk. They wanted to hire. I declined. I also was getting a little tired/frustrated with the practice by the end.

    I went and did some non-nursing things out of the country. They called me in January and asked if I wanted to come back for a Locums because the person they hired when I left quit. I needed enough hours like I said to get to 1000 hours for my 2022 renewal anyway.

    This place is typically 12 patients a day which is low for psych visits from what I am seeing here and talking to others. The clinic made another offer, and then they offered to extend another 13 weeks. I've been stalling on saying no because I want to do it graciously.

    I have concerns about this practice and like the last job they want and need to hire 2 full time NP's to meet their current patient volume. Like last post someone said "And where do they plan on finding them?" The hospital had better benefits, PTO, and pay and they had trouble hiring. This place is not going to find two APN's easily.

    I'm 6 weeks in and I was short with the receptionist on Tuesday when management closed the office early for snow. That I have to sit down and apologize to her. I'm also again getting frustrated with this practice. There are some liability issues mostly from not having enough providers to see them.

    The question is: This keeps happening where I keep no matter where I go getting frustrated about the staffing and patient followups. This is my 2nd community mental health clinic though. Being understaffed, underpaid, and under resourced is part of the role.

    I have had periods of the hospital job where I liked it. I know I am not good at "Sitting in a box" for 40 hours a week seeing patients. I also like work/life balance and I'm wary of those 50-60 a week NP positions. I work quickly but I'm not a "5 minute doc" like some of my former colleagues.

    I don't want to leave practice but I am in a place where I can semi-retire. The ACA did not get repealed by the current administration so as long as I make less than 50K a year (part time) I can get affordable coverage. I did this last year. At the end of this contract my licenses are secure until 2028 since I have the hours for the 2022 renewal. At that point I should be able to retire fully.

    I also think there is a lot of good that I and we as NP's can accomplish and having licenses to prescribe medications is not a thing to be casually discarded.

    I could use some advice as in books, articles, or other ideas to move forward.

  • 1
    Oldmahubbard likes this.

    You are almost certainly Salaried. They can make/expect you to work 100 hours a week and then you have the option of quitting or putting up with it. Good managers/business owners want to retain good employees and reduce turnover.

    One of the culture issues with Medicine and partially in the USA is working these heroic endless hours where you are asleep on your feet and making errors. The MD's sound like practice owners so the end result is they make more money (and possibly get taxed at better rate) the more money you make for them.

  • 0

    No don't do it. I was in a full time job with minimal to no clinical supervision and it was horrible, dangerous, and very ahrd to get up to speed.

  • 2
    Eagle2110 and LydieA like this.

    Started at 24, RN at 27, APN/NP at 32.

    I only survived RN school because of the life lessons before that. I was not ready for the intensity or the stress.

  • 0

    I was thinking of what sort of rate increase? 1.5x or 1.25x. I'm thinking my benefit package at my current fulltime job has to be close to 50-75% of rate including their 1/2 of SSI, PTO, and health insurance.

  • 0

    Sounds fair. They will tell you what to do. Not the first and not the last time this happened.

  • 1
    julesjameson3333 likes this.

    About 40 right now. Combination outpatient hours and in a team setting on in-patient. It really depends on where you work and what the expectations are especially on-call and if you have to round to do consults.

  • 0

    What happened that you went up 200 points in 9 days? That's a huge bump up in scores. Were you coming in from working an overnight when you first tested? That would be the first question if I was in the director's shoes.

    Secondly what is your GPA and your grasp of the material? Would your professors rate you as a strong student with a good grasp of the material? This if they even consider it would be key. Are you an A student or a C+ student? Are you seen as someone who struggles with the content?

    Is it three months starting now, or three months next year starting in Fall 2017 for whatever class you failed? Like Molemedic said they could fail you out completely.

    The other thing is your professor already went to the Director and got you a retake of the class. You followed chain of command which is very important in this field, and got your answer. If you are considering going to the director good politics is going to the instructor first and asking their opinion. You also may get the feedback of "This is your best offer, take it or get out."

    Finally the director's hands may be tied. For reasons of liability and equality the cut off is the cut off. It's in the handbook, it's written down. The schools policy might dictate what has to be done and followed.

  • 1
    mindofmidwifery likes this.

    Firstly, nice gift. When you said gold I was thinking a solid gold case like a Rolex Submariner, or a Omega Seamaster. Something in the 10-15K range. A quick search shows that this is a 100-200 dollar watch tops. It's probably gold tone or gold plated.

    So you know I actually understand the topic: I wore and broke 3 or 4 Seiko 5 Mechanicals (about $75 each), and had at home a vintage Omega F300 (about 300-400) that was too delicate even for my days off. I'm wearing a Casio quartz stainless watch with a stainless steel band for work now. Probably if I knew what I know now I would get a Citizen Ecodrive the base model with a steel bracelet (about 150). Nursing is a tough environment for watches.

    The stainless watches you can take a toothbrush and soap to and cavi wipes once in a while. No steam or boiling water though. Hot tubs are hard on the seals also. Do not submerge in harsh chemicals since the seals may degrade.

    Since this is a plated watch it will eventually have the surface finish come off. Also once the back is opened for the first battery change in 3-5 years all bets are off.

    Wear it to work, clean it once in a while, and when it starts to look shabby consider a model from above or any other stainless cheap quartz movements with a metal bracelet.


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