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Content That reeya Likes

reeya 4,089 Views

Joined Jan 23, '11 - from 'Lala Land'. Posts: 122 (23% Liked) Likes: 53

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  • Sep 7 '13

    I went to UAB, and I thought it was a good program. For any program out there, you will get out of it what you put into it. No one can read those books for you, lol. And I don't think anyone comes out of school feeling what you are describing, i.e. high knowledge base and confident in skills. That's what you develop on the job. I continue to be told that it will take 1-2 years for me to feel confident in my role and years beyond that before I really can handle any situation. But I feel ready for the transition from student to NP based on the education I received.

  • Sep 6 '13

    I can't tell you about all my life experiences until certain time limits have passed, however, as screwed up as the world is PMHNP is a great way to go. More interesting than plugging holes in people and inserting tubes, etc. (Been there, done that) All you need for equipment to practice is...well nothing but your brain. In contrast to other NP areas, you have the option of using ancient "techniques" if you wish. For example, I've trained with Shipibo shamans in the Amazon and Q'ero Indians in the highlands of Peru. Now I'm studying ways of the Kalahari bushmen (certainly more interesting than working on the DNP!) I can run a fire ceremony, do soul retrievals, for example as well as prescribe modern meds or do therapy. Ask an FNP or any other NP to practice as they did in the old days, lol!

  • Mar 16 '13

    Forgive my formatting, the iPad doesn't play well with AN ...

    1. Apply for NP license (4 weeks). <-- at this point you can practice if someone co-signs your scripts
    2. Then furnishing (3-4 weeks). <-- can Rx everything but controlled substances by yourself
    3. Then DEA (1 week). <-- sky is the limit

    those are approximate timelines. If you have submitted anything, CALL the BON once it's two weeks past the submission date. Obviously this requires the patience of a zen master, but if you can speak to anyone in the advanced practice department they can often expedite your application.

  • Mar 16 '13

    Hi Reeya! So are NPs now independent in California? Do you all still need a collaborative agreement?

  • Mar 16 '13

    I'm not aware of any requirement for a percentage of NP chart to be checked by the collaborating physician in California. If there is a requirement, that is likely coming from a reimbursement standpoint and is mandated by insurance carriers (though I'm not also aware of any that do so). A physician in California may not enter a collaborative relationship with more than 4 NP's at a time.

    http://www.rn.ca.gov/pdfs/regulations/npr-i-25.pdf

  • Feb 25 '13

    Hi Reeya - I have both contract and employee relationships in my current work settings. My accountant has recommended that I negotiate at least 20% above my typical hourly employed (W2) rate for contract (1099) work. This increase is to account for the local/state taxes that must be paid in addition to the self employment tax, etc. Both situations (W2 vs. 1099) have benefits and drawbacks based on your particular tax situation; though I can assure you that your employer will be saving significantly more than $2 per hour by paying you as a contractor rather than employee. I would suggest that you consult with an accountant (definitely money well spent) as you explore which options are best for your situation.

  • Feb 25 '13

    As someone who used to be self employed, let me tell you that taxes are a HUGE hassle. I would take the $2 less per hour and let someone else handle all of that nonsense. I am an employee now and I appreciate the time that I am not spending dealing with paperwork and setting money aside for quarterly taxes. PLEASE, stay an employee!

  • Feb 25 '13

    An extra $2 hour would definitely not make up for the loss of benefits and the extra taxes you would have to pay! Sounds like they are trying to take advantage of you! Stay regular staff! Also I don't know where you'd be able to get health insurance for $100/mo! Sounds like a terrible idea if you ask me!

    They would not be trying to get you to be indept if it were not to their benefit. Think about it! Now if they were paying you double ie $100+/hour than perhaps, not $2/hour, no way!

  • Dec 20 '12

    So I start my new job at a Family practice office on Tuesday. They asked me to come "shadow" a doctor for 4 hours yesterday so I can get a feel for the job. The doctor was so nice! So down to earth...and truly a God sent. We saw two patients together...then it turned into him giving me a prescription pad and having me go see half the patients by myself. He was very impressed with me and even offered me a second job where he is the medical director. I kept telling him I had some friends I graduated with that don't have jobs that would jump at the opportunity to work for his other practice, but he kept saying he wanted me because I am good . Talk about a sigh of relief!!! I was so anxious and so nervous..well I still am. But that lifted the weight of the world off of my shoulders. I kept checking in with him to see if he agreed with my A/P because I am so use to having a preceptor to do that with. He kept saying "your fine, you are fine!" LOL. He told the office manager I was good to go..I hope this doesn't mean I wont get an orientation when I actually start on Tuesday. I ended up staying the whole day and seeing half the patients.

    I can already see some "Improvement processes" I want to work on once I get the flow of things. The hardest thing is going to be knowing when to have patients follow up with me. Because I did all my clinicals at free clinics and we could have them follow up as much as we liked. Now I have to learn what the insurance company will allow and expects.

  • Jul 6 '12

    Today I passed the AANP FNP! Just wanted to spread the word that the studying, headache, anxiety and possible ulcer is worth it! Don't give up!!

  • Jun 10 '12

    Sorry to hear that you didn't pass. Try this for your next test:
    1. Compile your notes and perform a systems review.
    2. Review course through APEA, this course is geared towards the AANP.
    3. Maria C. Leik review book
    4. APEA 150 question test.
    Good Luck.. remember that this is an entry level test, not a test of things that you will learn in several years. Keep it basic and answer your questions according to the national guidelines.

  • Jun 3 '12

    I start at the begining of July. Cant even wait. I am still looking for other jobs too though..just incase.

  • Jun 2 '12

    Some things to do:

    1. For your first job, ensure that you have an adequate, written out plan for orientation. I'm still with my first APN job (6 years now) and I had 5 months of orientation, both didactic and clinical with both APNs/PAs and MDs.

    2. Since APNs must produce x-amt of revenue, have it written into your contract a stepped-up increase in the number of pts seen. For instance, the first month after orientation, you will see say 5 pts/day, the second month 7pts/day, etc..

    3. Have a resource person in the office/clinic/practice that you can go to with questions. Make friends with this person - lol!

    4. Ask questions. If something doesn't feel right, don't do it - stop and get a second opinion.

    (I have to say that I didn't follow my own advice and as a result had a very very difficult first year out in practice).

    Good luck!

  • May 12 '12

    Okay so a long post. But I wanted to share my preparation with everyone as well, I know when I was preparing it just made me feel better!!
    I found the exam straight forward, yet challenging as well. However, I truly put in TONS of effort at preparation. I probably flagged about 20-25 question s that I wanted to review at the end. I was able to narrow all my questions down to 2 answer choices which was a great feeling. You are also able to go back and forth to other questions if you want to. Take notes, some of the questions had material (lab values, assessment data) that I was able to apply to other questions

    I just wanted to share with everyone how I prepared:

    -APEA – I reviewed her book, plus I have her book of questions. I wound not recommend this on its own though.
    -Fitzgerald – CD’s and Certification review questions (2010 version)
    -Family Nurse Practitioner Certification Intensive review fast facts and questions (2008, Maria Leik from Springer Publishing, $38.00) Highly recommend. I read this book in a weekend and then worked on the questions .. I think there are 500 in this book. And yes there are a few typos, but still worth it! If you get it from Springer publishing I think some of the typos have been fixed. I also read a new one will be coming out in 2012 sometime.
    - Necessary NP, 1000 Questions by Kellerman ($80.00 and worth every penny) she gives great detail in the rationale. Really liked this one! Lots of things in there that I was not aware of before I began studying and I am pleased to say I believe a couple concepts that I knew were because of this book!!)
    -I did the AANP practice exam 75 questions ($50.00) Does not tell you the right answer only if you are right or wrong. Have a pen and paper so you can write things down, they don’t let you review your questions. I paid for this exam a second time to see if I improved and if the questions changed. The questions did not change, but I must have learned the concepts because I went from a 77 to 93.
    -I also purchased 5 tests from AANP-FNP online. I found this to be geared more toward ANCC but if you can get through those these were pretty good questions.
    -I also did a second APEA test , the one like we did in class.. I was not pleased with how I scored and wanted to see if I could improve. Some of the questions I think were repeated from some of the questions I had on the class exam.

    I cannot stress enough to start doing your questions if you haven’t started. The exam is not to trick you, remember it is to test your basic knowledge as a new nurse practitioner. I do not think I could have over studied and my energy, time, and maxing out my CC was worth it..
    Remember assessment class…. THIS IS A BIG area of concentration on the exam!!

    Good Luck to you all…..

  • Mar 30 '12

    First off, I don't work in nursing facilities. The opinion I'm giving is based on results of my personal online search regarding the billable dollar amounts that correspond to the services you will be providing. I have very limited understanding of nursing home billing.

    To me, this is outright disrespect on that physician's part of your worth as a provider. Not only is this person so greedy to take away more than 50% of the cash value of the services you could be billing for, he is arrogant enough to make you work under a 1099 agreement making you an independent contractor.

    Physicians and nurse practitioners use CPT Codes to correspond to the type of Evaluation and Management they provide in nursing facilities. For example, an initial visit is 99304 to 99306 and subsequent visits are 99307-99310. Discharge day visits are 99315-99316. Other nursing facility visits are 99318.

    There is a cash value attached to those CPT Codes. The 2011-2012 rates are avilable online if you do a search:

    Code
    2011 Pay
    (CF =33.9764)
    2012 Pay
    (CF =34.0376)
    Change in Pay
    2011-2012
    % Change in Pay
    2011-2012
    99304
    $88.00
    $89.86
    $1.86
    2.1%
    99305
    $123.67
    $126.96
    $3.29
    2.7%
    99306
    $157.31
    $161.00
    $3.69
    2.3%
    99307
    $42.13
    $42.54
    $0.41
    1%
    99308
    $64.89
    $66.03
    $1.14
    1.8%
    99309
    $85.28
    $86.80
    $1.52
    1.8%
    99310
    $126.39
    $129.00
    $2.61
    2.1%
    99315
    $61.50
    $69.78
    $8.28
    13.5%
    99316
    $79.84
    $100.07
    $20.23
    25.3%
    99318
    $90.04
    $91.90
    $1.86
    2.1%


    For example, if you saw a nursing home resident and coded the visit as 99310, your reimbursement is $126.39 based on 2011 rates. That physician is only paying you $12.00 for that visit, who gets the rest of the $114.39? To me, this is blatantly unfair and bordering on slavery.

    Sources:
    AMDA: Advocacy - Payment - Physician Fee Schedule
    http://www.fmda.org/CMSJA4246Jan2006.pdf


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