coast2coast, MSN, NP 6,701 Views
Joined Jul 9, '10.
Posts: 404 (42% Liked)
I see this frequently with psych patients - they want you to engage in a power struggle. Drives me nuts, every single time.
I worked in a FQHC through the National Health Service in an urban community health center. The facility was really nice, but we were treated a like indentured servants (which we kinda were). The staff (MD, NP, PA) were extremely supportive of each other and it was a wonderful learning experience, but I burnt out fairly quickly. We had to see upwards of 30 patients a day and got 15 minutes per visit, be it a URI or a full physical with Pap. A lot of time was spent waiting for available interpreters, as many of the patients did not speak English. I saw conditions I never would have seen in a suburban primary care practice, but we did n't have the resources to spend time with our patients and do sufficient teaching. I never got out on time, never took a real lunch break, and would spend hours of my free time charting. So, I have mixed feelings about it. I did get my loans paid back, I learned a ton and met some great people, but I had no life for almost 3 years and was always stressed.
Minimum 30 days ... My last position I gave them a 'soft' warning at 6 months and official resignation at 90 days, but that is probably an extreme situation (large patient panel being left and clinic couldn't retain adequate number of providers).
There's no way you will see 25+ patients/day and leave at 3pm if this is family practice/primary care. The 'productivity' bonus is a joke, as is lack of benefits. Keep looking.
No offense was intended, I was merely trying to counter what I see as a widely-held belief that things like legal status are not a routine part of healthcare delivery.
An acute care example would be someone needing dispo to rehab or skilled nursing. Sure, a patient can come in emergently and by EMTALA be treated, and immigration status I would agree does not impact that emergency treatment, in general. But what do you do with someone who ends up profoundly disabled, but without the income or health insurance to be accepted into some level of rehab? Like any inpatient who overstays their welcome in acute care, the barriers to dispo become a matter of common knowledge and therefore, at times, judgment. It shouldn't impact care but the potential is there.
I apologize if my original comment seemed to negate your personal experiences, on re-reading I can see how it could come off like that. I just want to engage in a discussion on a topic that I am obviously quite passionate about, not looking to cause offense.
I'm not aware of any healthcare facility that makes any sort of determination of the immigration status of individuals presenting for care. Everyone has been treated the same and no one has asked about immigration status, in my experience.
I think there is a lot of misunderstanding between RNs who perhaps are not familiar with the APRN role.
I've been an APRN for 9+ years and I did absolutely love bedside nursing. However, I equally love my roles as provider and prescriber. Like other APRNs have mentioned, I do help pts. My pts are for the most part seriously ill with a much shortened lifespan. I discuss end of life issues almost daily.
I do provide a service but mostly I provide care.
Best decision I ever made was to leave a doctoral program (pre nursing career). Don't be scared to do what you need to do.
Pediatric Emergency Care:
January 2013 - Volume 29 - Issue 1 - p 63â€“66
Comparison of Rectal, Axillary, Tympanic, and Temporal Artery Thermometry in the Pediatric Emergency Room
Batra, Prerna MD; Goyal, Sudhanshu MBBS
I don't understand this one- I thought that elevated TSH always indicated hypothyroid. Can someone explain this to me?
The highest TSH I've ever seen before was 157. Pt very fatigued, low heart rate, low B/P, overweight, and so on.
Chronic hgb in the 3.5-4.0 range. Dying of metastatic probably rectal dancer, survived almost a year.
a1c 16.9, very alive and one of my best-behaved diabetics now.
TSH 490. Manic but definitely alive
a1c's of 15, systolic BPs in the 200s, and trigs of 3000 sadly become very mundane very quickly in community practice. It's amazing how resilient the human body can be.
I may be too late for this but ... THAT IS WAY TOO LOW! Waaaaaaaaaaaaaaaaaaaay under average for SoCal. New grads in community centers are starting over 90 at multiple locations in metro LA.
I know you are a new grad and need to get hired, but man oh man I would tell this doc to stuff it and call me when she was ready to discuss a serious salary.
You will never successfully renegotiate for lost income. Realistically you will do well to get 2-3% per year in most places unless you have an RVU structure in place. When you take the job is really your only moment to get what you want/need.
anyhow. PM me if you want to discuss the LA market.
I was offered a full time job at an IM clinic. I asked for $48 per hour compensation with full benefits because i thought this was reasonable for a new grad in southern CA. The average is $44-46/hr.
On my second day of orientation, my boss told me that she is going to switch my pay to salary. She said she will offer me 75k per year. I was really shocked!
I told her that at the hospital, although without benefits, I get paid $52 per hour. Then she said that i shouldn't expect that much because being a nurse is different from being an NP. She also has to train me and that will take time. Then i countered and said i am willing to meet her at $88k. Then she said she can only offer up to $80k. Then i said i also have to make ends meet at home so I will think about it over the weekend.
Then she said she will call me back this weekend for a final offer.
Any suggestion or tips on how to handle this negotiation when she calls me back? Should i walk away from a low ball offer? Or is it worth it to get that experience for a year then go? This negotiating acitvity is exhausting! ;-)
I want to get an offer of at least 86-88k. I am better off working at the weight loss clinic at $60/hr
Never. I have also stopped giving out my direct extension at work and am now directing patients to the receptionist or nursing line.
99% of my calls and messages could/should be handled by someone else. I found that by my being involved they generally took much longer to resolve and wasted a great deal of time.
You REALLY, SINCERELY, URGENTLY need to speak to me and only me? You know where I work every day ... If it's not worth making an appointment to you, why on earth should I give you my time off the clock?
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