Latest Comments by BostonFNP

BostonFNP Guide 48,701 Views

Joined Apr 4, '11. BostonFNP is a Primary Care NP. Posts: 5,147 (63% Liked) Likes: 13,082

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  • 0

    Quote from Oldmahubbard
    Just gross and disgusting. I am not sure who is working this hard for this reimbursement. In my world, which is Psych, reimbursement averages at most 200 dollars an hour. Still it works out to over 300k, considering an 8 hour work day and fair PTO.And Psych NPs often make 100k.

    Yes, they are making a huge killing off us, and the "supervision" or "collaboration" consists of a few minutes on the fly.

    Our collaboration requirements were discontinued on 1/1/2015 for experienced NPs. The Governor said that the collaboration requirement was a financial arrangement, not a clinical arrangement.
    And many NP-owned practices have to pay a physician 30-40k a year to "review" charts which consists of 15-20 minutes four times a year.

  • 2
    BCgradnurse and Oldmahubbard like this.

    Quote from Oldmahubbard
    Knowing I am bringing in 350 in reimbursements.
    This is why NPs need independent practice: to reset the market. I have several colleagues that see 25+ patients per day and bring in at least $600-700k/year that are being paid $100-120k/year. Physicians have been making a killing on NP and PA for a long time.

  • 1
    SopranoKris likes this.

    Quote from anne_marie_oregon

    To be honest, the reason I am choosing Chamberlain really has to do with the cost. I am in my 40's - and still renting ... and I would like to buy a home before I am 50. This means ... I just don't want to go into huge student debt right now. My LIFE PLAN GOALS (smile) are to get through my Master's program with my FNP and get a home of my own before I am 50. If I was in my 20's ... or maybe even 30's it might be different ... and I get that physicians are brand conscious. Chamberlain is $650 per credit hour.
    Have you talked to local NP employers? Will they hire a Chamberlain graduate? $650/credit-hour is only a bargain if you 1. get a good education and 2. can get a job afterwards. Even at $650/cr-hr you are still making a big investment of both money and time and you need to think about whether it is worth it or not. In a perfect world you should be striving for the best quality program not the cheapest, as I am sure you would want from the person taking care of your or your kids, but I understand in the real world other factors play into this. Just consider to investment before you make it. A quality program might cost a bit more but may also mean less time looking for a job, not having to move to find a job, or a higher paying job; all of these things impact the overall cost-benefit.

    Also Chamberlain (to my knowledge) does not assist in finding clinical placements which is another significant issue that can results is lost time and money. Consider that as well.

  • 1
    Dodongo likes this.

    Quote from Nicola301975
    A few years ago all the nurses I worked with that became NP's had job offers within 2months. Fast forward to now, most of my co workers that I graduated with within the last year still has not found a full time position, if any at all. Another issue is the low salary that I have seen posted.
    Where did they go to school and where did you go to school? Same program?

  • 1
    FullGlass likes this.

    Quote from FullGlass
    USC is a private school. They will offer a financial aid package to accepted students, so the cost is individual to each student and is not necessarily the "list" price.

    USC has a HUGE alumni network in California. They also have a well regarded medical school. Who do you think hires most NPs? MDs do. And MDs are extremely conscious of school reputation. As a new grad NP, you are going to face a highly competitive job market for your first job. Your school will matter.

    As many other posters have commented, be leery of any NP school that does not find your preceptors. And if you have to find your own preceptors, you may or may not get good ones.

    I would definitely pick USC over Chamberlain.
    This is solid advice. Take it.

  • 1
    Jules A likes this.

    Quote from Jules A
    Anyone else have the feeling there might have been a $5 bet on how long it would take us to turn on each other like a pack of rabid dogs?
    It's a good bet I'd take it!

  • 0

    Quote from FullGlass
    Since FNP programs are now primary care programs, why would I advise such a person that they should become an FNP? The schools themselves state that their FNP curriculums are primary care only.
    To be totally frank, this is where your inexperience shows: you are speaking like FNP programs suddenly changed their didactic and clinical education in response to the consensus model because you had no experience with nursing prior to it. The truth is, by and- large, they have not changed at all; long established programs have existed relatively unswayed for decades. These program are responsible for the quality outcomes that NP practice is based on.

    Quote from FullGlass
    Someone who is serious about going into acute care should study acute care, whether it be PA, AGACNP, or Peds Acute Care NP. There are ample programs out there for acute care.
    But PAs do not just study acute care, they study everything, they are generalist educated. If an NP wants to practice exclusively in intensivist or hospitalist roles, they should be certified in AC for their age group.

    Quote from FullGlass
    Many hospitals will NOT hire an FNP for an acute care role. While hospitals in rural areas and certain locations may do so, it's not something I would advise someone to count on.
    This, at the moment, is completely and utterly untrue. How much experience do you have in acute care and in hiring/job seeking in this market? Now we could argue that changes should be made, but as it stands, it is blatantly false to say employers are not hiring FNPs for acute care, especially in the ED/UC setting.

    Quote from FullGlass
    Practicing outside the scope of one's training also carries legal risks.
    Of course it does, provided there is harm done. Link us to some data that suggests there is an increase in malpractice for non-traditional APNs. This would then also include ACNPs practicing outside of acute care settings, which the data suggests is far more common practice.

    Quote from FullGlass
    If a med student said they wanted to be an ED doc, would it be logical to advise them to strive for a primary care internship and residency? No, it would not.
    Obviously it would not, there is no such thing as "primary care internship and residency", though there are "tracks" within medical specialty. If you take the residency programs that do exist (internal medicine, family medicine, ob/gyn) you;ll find that many of these physicians work in both acute care and primary/secondary care settings.

    Quote from FullGlass
    So why is it a good idea to advise a prospective NP student who wants to work in the ED to knowingly enroll in a program that will not provide him/her with any acute care training whatsoever? Someone who is contemplating NP school should select the program that will maximize the chances of achieving their career goals.
    If the student wants to be a certified ENP, you tell us what program they should attend. Here are the requirements (Frequently Asked Questions - ENP - AANPCP).

  • 3

    Quote from Dodongo
    I agree with the majority of the points made in the article. I just have an issue with how they try and present common vs complicated health problems. An unexplained fever that has lasted for a few weeks. That's a problem that can absolutely be handled by an NP. Or multiple complex diagnosis. How many NPs, both inpatient and out, manage patients with multiple comorbidities on multiple medications. It's just not that simple. Expect a physician if you think you have a complicated problem - an NP is fine if you think your problem isn't a big deal. Patients don't know.

    And the comments section kills me. Haha.
    The sentiment to the layperson is the same though, they neglect to mention if you have any unexplained/complex problem you would be referred to a specialist physician whether or not your PCP is a NPP or physician.

    Comment sections are always the dregs of the Earth.

  • 1
    BCgradnurse likes this.

    Great post thanks for sharing.

    I actually thought the article was a pretty good one. Some things are oversimplified but in general I agreed with everything that was said.

    We have some posters here who would cringe to read "But is seeing one of them as good as seeing a medical doctor? In most cases, yes, says Ateev Mehrotra, M.D., an associate professor of healthcare policy at Harvard Medical School."!

  • 9
    vanilla bean, macawake, djh123, and 6 others like this.

    Quote from EGspirit
    Keep in mind, the reason I did all that I did for him was because a bunch of lazy nurses before me never did--probably atheists.

    Judge me? Go judge yourself.
    It would seem you are doing a bit of judging yourself doesn't it?

    Quote from EGspirit
    He couldn't do for himself, so I did for him.

    I did unto him, as I would have it done unto me.
    Are you sure this man was a practicing Christian? You state you took care of him more than once, did you have a conversation with him about his faith, his wishes? Or did you have that conversation with his family? Are you confident that what you did "for him" was something he wanted for himself?

    I am sure that you would be fine then with a Muslim (of Hindu, or Jewish, or Shinto, or Athiest, or any other religion) nurse do thins to you while unconscious, correct?

    Quote from EGspirit
    And I can tell you right now, he was lucky I was his nurse.
    Do you ever consider in your practice if the thing you do are in your own best interest or the patients?

  • 0

    Quote from FullGlass
    The OP had a question and the correct answer is that an NP who wants to practice acute care should study acute care! It is highly irresponsible to suggest otherwise.
    The particular question was about the ED. The facts here are that the majority of APNs working in that role have FNP training. The majority of ED/UC employers require or prefer it. ENP-certification requires either FNP training plus clinical experience in emergency medicine, completion of an approved fellowship program, or completion of a ENP program (combined FNP and ACAGNP programs): this certification is only two years old. The extant data on the safety of APN in the emergency department is based on APNs which were not certified, the majority of them being FNP trained.

    Share with us some of the data you are using to make a determination that ACNPs in this setting have better outcomes or are less prone to malpractice suits. My mind can always be changed by data.

    I don't believe that FNPs (or PCAGNPs) should be working in intensivist roles, and unless they have had provider-level experience I also don't believe they should be working in a hospitalist role or psych roles. It happens though, frequently, and thankfully this has traditionally maintained good patient outcomes. In the same vein, should ACNPs be working in specialty clinics? Nothing is clear cut, but in the end, the data is still good on outcomes.

  • 5

    My son has hit his head a few times and the school nurse has called me about "concussion education and awareness"; the most recent time she used my work number because I didn't answer my cell then apologized that she had talked to me in layman's terms the previous times. I told her that when it's my kid I want to hear things just like every other parent does. I tell his pedi the same thing.

    Don't feel about about it! Parents want to be parents in that situation.

  • 0

    Quote from Dodongo
    it's only ever FNPs practicing in areas they weren't trained for - specialty trained NPs generally don't try and practice outside of their training. You see it on this forum all the time. FNPs saying they went FNP to "have more options" and "to be able to practice wherever they want". It's unfortunate that schools promulgate this idea. The specialty NPs understand the difference.
    Statistically this isn't true; a larger percentage of ACNPs work in nontraditional settings compared to FNPs (not really even close). We may here more "talk" of it here but that's typically because there doesn't tend to be the same type of "outrage" when ACNPs are working in non-traditional settings and/or there are less tradition jobs for the number of ACNPs.

    (Keough V.A., Stevenson A., Martinovich Z., Young R., Tanabe P. (2011). Nurse practitioner certification and practice settings: Implications for education and practice. Journal of Nursing Scholarship, 43(2), 195–202.)

    A matter of semantic perhaps, but remember FNP is a specialty just like ACAGNP or PNP is. All NPs are trained as specialists.

    Quote from Dodongo
    I don't think the state boards of nursing will ever be specific (about anything) and say where a certain NP can and can not practice.
    Based on NCBSN data (though a bit old): "Results indicated that 18 states and the District of Columbia (37%) had specific regulations defining NP SOP by certification and/or educational preparation while 23 (45%) did not. The remaining nine states (18%) had SOP regulations that were interpreted as being ambiguous in relation to certification and/or educational preparation.

    (Blackwell, C. W., & Neff, D. F. (2015). Certification and education as determinants of nurse practitioner scope of practice: An investigation of the rules and regulations defining NP scope of practice in the United States. Journal of the American Association of Nurse Practitioners, 27(10), 552-557.)

  • 0

    Quote from FullGlass
    Actually, this is in line with what I said.
    It is not in line with what you said, your statement was factually inaccurate. Again, the vast majority of ED/UC NPs are family trained (upwards of 70+% compared to ~10% acute care). The APRN Consensus Model (with a failed target date of 2015) has sought to provide more structured guidance to scope of practice but has largely been unsuccessful (for better or worse). We can debate the merits of this but the fact remain the same.

    Quote from FullGlass
    While in the past, FNPs may have had acute care training, that is not generally the case now. Current FNP students only receive primary care didactic education and clinical rotations, with the exception of urgent care. They do not have hospital or ED rotations, nor do they receive didactic education geared to acute care. Reputable schools are very clear on the dangers of a new FNP grad working in an acute care setting. given they have received NO education or training to do so! How can a new grad NP who has had NO clinical rotations in acute care safely practice in that setting? In addition, this would be a serious liability issue.
    This also isn't totally true, many FNPs still have acute care, emergency, and UC clinical rotations. Many quality NP programs have added additional training in emergency and urgent care to their NP programs and other have had this for decades. FNPs certainly have more training in emergency and urgent care than ACAGNPs have in pediatrics.

    More importantly, all of the extant data that on the quality of care provided by NPs in the ED/UC settings was based on the majority of NPs being family trained.

    Quote from FullGlass
    Your post correctly points out the additional education and training required for an FNP to safely practice in an acute care setting.
    Again, this is inaccurate. My post points out what is required to be board certified in emergency for an NP: and FNP degree in total or in part, with a few small caveats.

    Quote from FullGlass
    As for EDs preferring NPs who can treat all ages, that is going to depend on the area and on the facility. Large hospitals often have a separate ED, or section of the ED, for children. There are also children's hospitals. In addition, acute care is not just the ED.
    The post asked about ED not acute care in general. Again here, the vast majority of ED/UC care is provided without the luxury of having an adjacent pediatric or obstetric hospital ED. Sure it exists, just outside of the norm.

    Quote from FullGlass
    I find it ironic that many on this forum are opposed to NPs who did not work as RNs, yet are fine with an NP who did not get any NP-level acute care education or clinical rotations practicing in an acute care setting. It is imperative to adhere to scope of practice, just like a peds NP should not practice in a geriatric facility.
    Every provider is bound by their board to practice within the breadth of their experience and training (physicians to PAs to NPs). If you are practicing outside of this your license could be in jeopardy.

    That being said, it may also be ironic that some on this forum who have no experience in any type of nursing or provider role feel inclined to post as experts on topics they have zero to little experience or expertise in.

  • 0

    Quote from DO_question
    So I've heard of several EDs steering away from providers that are not trained to treat Peds. Run into that much? Mostly a non-issue?
    The vast majority of NPs working in UC and ED settings are FNP trained because of the ability to see all ages plus OB; prior poster was incorrect about that.

    There is now a board certification exam for Emergency NPs available (as of 1/2017). It requires an FNP certification plus practice hours in an ED, an approved ENP graduate/postgraduate program (FNP+AGACNP combined program), or an approved ED fellowship. More info on this at AAENP's website.