lhflanurseNP, MSN, NP 11,278 Views
Joined Jan 6, '13.
Posts: 644 (40% Liked)
I too misread the ND for MD...too quick sometimes. There are 20 states that license NDs as physicians however each state has it's own licensing board for NDs and it would depend on the scope of practice. Without knowing more....
If you are NOT prescribing, but only following the "orders" and the protocols set up by the physicians and the clinic, AND you use your nursing skills to assess for complications (fluid overload, reactions, etc) this would be no different than doing IV antibiotics, chemotherapy, etc in a "traditional" setting.
First...I am so sorry to hear this. It is quite frustrating and unsettling. Have you checked out your local or neighboring health department? I remember my peds preceptor up and retired 3 months before I was to start working with her!
Googs...I do not do telemedicine. I have patients from all over the country and often times they will not be back for 3-4 months and we will speak on the telephone if the conversation is more than a simple email. I would normally see this patient in my office and bill accordingly, but I can't get a definitive on how to appropriately bill for these "visits" with Medicare. The traditional telemed code is not in the Medicare fee schedule.
As mentioned earlier, many schools recognize cheating. The fact that nothing is done is sad, but while the student is in school, the school is getting money. This is not just limited to nursing. Cheating goes on in many "professional" programs. The saving grace is students who really do cheat are weeded out with the board exams...they haven't really "learned" anything. As previous posters have noted, don't paint a target on your back with your fellow student. Keep you nose to the grind stone and continue striving to learn and "do it right".
Many employers offer a service for this sort of thing...does yours? As previous posters have noted...you need to address this NOW...not wait until "insurance kicks in". With today's deductibles, you will most likely still be paying for the visit anyway. If this is not an option, contact your local mental health center. Nursing is inherently stressful, you need help to figure out why you are feeling this way. Biofeedback may be something to look into as well...especially since you are having physical reactions to your anxiety. Good luck and our prayers are with you.
The physician does not necessarily have to see the patient on the same day, but should see at least once a year...BUT...to bill under the MD/DO/DPM license, they must be on site otherwise the billing should be under you. Same goes if you see the patient for a new complaint...if you are initiating the visit...it should be under your NPI unless you have the physician see the patient on the same visit. Real tricky. Is it abused? I am sure it is!
OP, the fact that you question your "ability" is admirable! No one fresh out of school knows/experienced everything whether you are a nurse, nurse practitioner, physician, teacher, lawyer...the list goes on. School provides the bare minimum to pass the boards associated with the degree. You actual learning begins in your clinical rotations as well as your first few years of practice. I am always leary when someone "knows it all" during, right after, and even with experience. Medicine is constantly changing...no one can know everything! You will do just fine!
As per Jules...get it if you can. It is not cheap, but if you can swing the $731.00, it is nice to have. You just have to update your work area as necessary.
What code(s) are you using for telehealth time with Medicare? The codes I found are not in the Medicare fee schedule, so I am stuck. I have several patients out of state and I want to charge for calls lasting more than 10 minutes or are more involved than just letting them know a simple result. Any constructive help will be greatly appreciated.
What are you thinking as your "end goal" for a job? If you are drawn to the ER or acute care settings, then the acute program may be better suited for you. If you are considering an office position or "hospitalist", then the non-acute program would be better. If you are really unsure, I would suggest shadowing some NPs in these various fields to see what you would like. Good luck!
Moving to a new area then having to find preceptors can be quite a challenge! Have you checked with your state NP association to identify preceptors in your area? You may contact your school's resource person and explain the situation. They should have a list of previous preceptors that they can share with you as well. Good luck!
I had been fortunate enough to get all the way to the submit page...then CRASH! Anyway, I was finally able to submit my application about 2:30 in the afternoon. Am now just waiting to get the results....
One thing that can help is doing as much clinical time as you can. Just doing the "minimum" hours doesn't cut it. The problem most NP students have is they still have to work so they wind up shortchanging themselves in regards to the clinical practicum hours. This is where you will learn the most...well...hopefully if you have good preceptors/mentors. I try to get my students to get more involved in the clinical rotations...I even do "projects" in which they need to research an actual patient scenario and come up with how they would evaluate, diagnose, and follow the patient. I cannot tell you how many times the answers are typical "nursing"...vital signs, oxygen, diet, some even tell me "what ever the physician orders". One of my pet peeves why NP students need more experience under their belts and be in positions where they have actually had to do critical thinking. Something to consider is while working as a nurse...look at your patient and consider what would you order? why? what about follow-up outside the critical setting?
Not so much ideas...but a path. What do you anticipate, or need, to learn during this rotation to help you further your goal to be NP? Are you going into women's health, family practice, or adult/gerontology? How can this rotation help you now and in the future. I believe if you look at it critically you can help postulate your goals...good luck!
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