Latest Comments by Dembitz

Dembitz 3,511 Views

Joined: Mar 5, '09; Posts: 53 (40% Liked) ; Likes: 77
Nurse Practitioner; from US
Specialty: 4 year(s) of experience

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  • 0

    Quote from travelRN555
    Yes. This is exactly what I'm talking about. I know what I need to do as far as care, but it's knowing how to specifically go about it. Like, how do I arrange the PT, how do I go about getting prior authorizations from insurance companies for medications and rehab, etc. What labs are going to be covered for today's visit, what do I need to document to ensure proper billing/coding? When does the patient require a specialist as opposed to managing their problem in office, what specialists do I refer to- is based on insurance or provider preference?

    I have been an emergency department bubble where providers have any and all resources at their disposal and there is no need to worry about what insurance companies will and will not cover, plus all the XRs are read and reported by radiology, so while the ER providers may read them themselves, an official read is mere minutes away.
    Are you really responsible for arranging PT and getting all prior auths? Generally there should be nurses or MAs who take care of most of that, only involving the provider if a peer to peer review is needed. And all images should have a formal read by radiology. Depending on the situation you might be in a position to make treatment decisions before radiology can complete the read, but there's nothing wrong with saying, "nothing immediately pops out to me on this xray, but we need to wait for the radiologist to formally review your xrays." There's a reason radiology is its own specialty.

  • 2

    Quote from RNpandoraRN
    I've also observed that FNPs, ANPs in the fields of Neurology, Acute Care, etc. tend to make more money in my area. My field - obgyn, women's health, even midwifery - seems to be the red-headed step child in the area.
    I live in a high cost of living area. Dual certified as WHNP and ANP. My first job as a new grad in a non-women's health field paid $85,000 in a somewhat lower income part of the state. I interviewed for a WHNP position closer to home in a much higher income part of the state (New England states are small, cost of living varies dramatically in a small radius!) and was told they NEVER pay NPs more than $75,000. For whatever reason, women's health jobs do pay less.

    (Didn't take the job, currently making well over 6 figures but not in a women's health position.)

  • 0

    I used the Kelsey purple book and felt well prepared. There's also an online test available for purchase somewhere, but that was 3 years ago so I don't have the link anymore.

  • 5

    Not offensive at all. I introduce myself by my first name, but many of my patients call me Dr. LastName anyway. I correct them the first few times, then give up. I've been called much, much worse.

  • 6
    RunBabyRN, gypsyd8, KelRN215, and 3 others like this.

    Quote from Kayartea
    I am unable to answer the poll as the questions are written in an incredibly biased manner and have little to do with the question that was before the court. The insurance provided by Hobby Lobby does cover contraception. It does not cover drugs their owners regard as abortifacients. For those who cite paying for viagra, it is paid for by insurance companies as it is used to control pulmonary hypertension, and that is also why it is paid for for women as well as men. The only use for Plan B is to prevent implantation of a zygote. Putting up straw man arguments does not help support your opinion.
    And IUDs, particularly the Mirena IUD, have uses other than contraception. (I haven't seen any information about coverage of Mirena for dysmenorrhea/endometriosis for companies that fall under the new SCOTUS decision.)

  • 4

    I wonder if this is an issue of lack of experience rather than micromanaging. How long has the nurse been on your unit or working in a similar environment? Is it possible that she asks for all this information because she doesn't yet have the experience to know what information will be relevant for her shift? My thought would be to have her immediately at the end of each shift determine how much of report was relevant to her clinically that shift and how much was not, but this might be a better task for someone in management to take on.

  • 0

    My employer specifies 3 month notice for all providers. My experience is that most credentialing processes take about that long.

  • 2
    HappyWife77 and Julia77 like this.

    I can really only speak to the ortho-type imaging. In the system I use, I choose the body part I want xrays of and it comes with certain standard views. For knees you need to decide weight bearing or non-weight bearing (hint: always weight bearing if possible). For wrists, if you suspect a scaphoid fracture you need to ask for additional scaphoid views. Most ankle injuries should get foot images as well to r/o metatarsal fracture.

    I very rarely (once maybe?) order CT scans for musculoskeletal injuries. I order MRIs if I suspect any ligament/tendon damage or disc injuries, almost always after at least a month of conservative treatment. Shoulders can be done with our without contrast (arthrogram -- dye injected directly into joint space, very painful), and I've heard lots of arguments for both (dye better for labral tears and possibly small RTC tears, but advances in MRI technology now show that non-contrast is pretty comparable to contrast). If I'm not sure, I refer to Ortho and let them make the decision.

  • 2
    BCgradnurse and kanzi monkey like this.

    Quote from Riburn3
    I would also argue the quality of experience as an RN is incredibly important to the utility it provides you as an NP. If you graduate and go straight to wound care, where your job is typically assessing wounds and doing dressing changes, I can't imagine that being too helpful as an NP no matter how much experience you have.
    Just to argue for the sake of arguing, I had to refer a patient to a wound clinic this week for a burn I probably could have managed in office with more wound care experience (and dressing supplies). I don't think any particular RN experience is essential to being an NP (possible exception for inpatient NP care, which I've never done), but I think you can make any RN experience useful.

  • 0

    Not certain they'll only take ANCC, but all our NPs in my group are ANCC so it hasn't come up. It's possible other NPs at the hospital are AANP, but as this isn't an issue for me I didn't really check. I took the exam a year and a half ago, never really even thought about taking AANP.

  • 0

    ANP/WHNP here. Couldn't find a WHNP job, working as an ANP with no OB/GYN at all. I miss it and want to get back into the field, but I'm not sure I would advise doing WHNP alone to anyone as the job opportunities really are so limited.

  • 5
    DoeRN, hgrindle, SHGR, and 2 others like this.

    It's not the science prereqs, it's the 4 years of med school + residency. Most of medicine is routine. I think it's a great distribution of resources if I, for example, manage the knee sprain myself and send the guy with the torn ACL to see an orthopedist after he's already had an MRI done. I actually think advanced practitioners (NPs and PAs) should outnumber MDs in an ideal situation.

  • 14

    Quote from Susie2310
    This is a pathetic argument. Your post is all about what's good for you. Yes, it's all about money, and sadly, because it's all about money, there is a demand for midlevel providers. Patients deserve to receive quality medical care from experienced physicians. Quite often lives are at stake. My family and I, and everyone we know, want to receive quality care from physicians, not from people who are not trained as physicians and are basically clueless (which is what we have experienced). If I want cookbook medicine I have a copy of an Emergency Medicine manual on my ipod.

    Here's a personal example. Family member with severe sepsis: midlevel spends an inordinate amount of time doing the work up, has to consult with the doctor multiple times, the whole thing takes forever and we are there for hours in the office. Finally the smiling idiot thrusts paperwork in my hands and says my family member needs to be admitted to hospital. How about expediting the admission? No, my critically ill family member has to be admitted through the admission office which takes a further hour or more. Now multiple hours have passed since we first presented at the Urgent Care. Then finally my family member gets a bed, and guess what, there are no orders for an hour or more. Meanwhile my family member is barely clinging to life. And sepsis requires prompt treatment. I could go on and on.

    To further illustrate my first paragraph, recently my family member was very sick with what appeared to be a bad infection. On calling the specialist's office (we had been told by the doctor to come in to see him right away if we experienced any further problems), and relaying all of the above to the receptionist, the receptionist says "You can see the PA this afternoon." I said, "We don't want to see the PA; my family member has a lot of medical problems; we'll go to the Urgent Care." Suddenly the receptionist asks me to wait while she speaks to the doctor, and guess what, my family member was told to come in immediately. And yes, it turns out that after the doctor's assessment my family member needs surgery very soon. I refuse to play around with seeing midlevel providers when my family's lives are at stake.
    And I saw a patient recently who refused to see a particular MD (one known nationally as a thought leader in his field) because previously, the MD had told the patient repeatedly that he had a strain when he in fact had a major musculoskeletal injury that required surgery. I've been an NP for one year. I saw the patient for another injury, listened and did a thorough exam, ordered appropriate imaging and got him in to see the right specialist to fix the problem. And I still think that MD is brilliant academically, just not with people.

    There are good and bad apples in every field.

  • 0

    I'm thinking about doing camp nursing for a week or two over the summer. Camp is a 3 week session and a 5.5 week session, but they take nurses for shorter periods of time as available. The camp is located in Western North Carolina. Any idea what typical salary is for 1 week of camp nursing (mostly just curious, that's not a make or break factor)?

  • 5

    $70,000 in a small poor town is a lot more money than $85,000 in a major city.