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This is a discussion on HELP NEW NP!!! in Nurse Practitioners (NP), part of Advanced Practice Nursing ... Taking my first positon in busy family and internal medicine practice. I need help how do I get...by jessarnp33 Nov 14, '12Taking my first positon in busy family and internal medicine practice. I need help how do I get organized, confused with coding. I am not sure what is best reference for meds. I use medscape. I am so used to my preceptor for backup and now feeling confused. Any advice. Just needing to get set up and get myself going. Thanks!
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- Dec 26, '12 by AlisabethYou are going to be fine! Someone from your new office needs to sit down with you and go over the billing codes for about 15-20 minutes. Billing seems complicated at first, buts its really not and you will notice you use a lot of the same codes over and over again. I use Epocrates for my drug reference. Take a small notebook with you to jot down notes. It may seem a little scary at first but within a few weeks, you will be thinking how silly it was to be so nervous. You are going to do great!!
- Dec 27, '12 by traumaRUsAlways use the standard for your practice. Nowhere is it ePocrates. Rather, its usually Uptodate. It takes a while to feel comfortable and organized.
- Dec 27, '12 by BlueDevil,DNPagree with uptodate. Epocrates is handy, but not a standard of care to reply on.
Also agree that they should give you a half a day with a coder. It is in their best interest to make sure you know the ins and outs. The better you know how to code, and code properly to the max, the less you leave on the table.
If they are smart, they will start you out slowly and let you come up to speed over a few weeks. I saw 8 patients a day my first week. 4 in the morning, 4 in the afternoon. The following week I went to 6 in the morning/6 in the afternoon, and the following week 8/8. I think I stayed maxed at 16 a day for about 2 months. That gave me time to really get comfortable with the EMR, the routine, get to know to whom I needed to send patients for referrals (new to the city as well and unfamiliar with the systems), get comfortable with procedures I was doing independently for the first time, etc.
By the 3rd of 4th month I was seeing 20+ patients a day. I was not keeping up with charting, but I was seeing them, lol. I think it was a year before I could see my typical 22-26 patients a day and have my charts finished and leave on time at 5pm. Sometimes that still doesn't happen more than 3 years in, but more often than not my chart is finished as the visit is finished before I leave the exam room, and I leave on time most days. I live 3 minutes from the clinic, and these days I am usually home by 5:15, the latest. That first year though I had many 9pm nights!! When I had those late nights, my practice manager made sure to block some afternoons later in the week so I could leave earlier, a sort of "comp time." It was their way of making sure I didn't burn out.
It is a big learning curve. Your practice should be giving you plenty of tools and support, especially at the beginning.
- Jan 1 by AtomicWomanAs someone who just started seeing patients on my own in the last few months, I want to urge you to negotiate a slower pace for the first couple of months at least. The doc I work for totally got it and said no way did he expect me to be "up to speed" immediately or even particularly quickly. He was so right. There is so much to learn, and so much *follow-up* that has to be done. I joke that my work starts when the patient leaves the exam room! I use epocrates to do a quick drug dose check, but I love uptodate and would be lost without it. 5 Minute clinical consult is also good for primary care. I walk around with a small binder that has some information I use often: which drugs interact with grapefruit? Which antidepressants can be directly switched with another antidepressant and which require a taper and/or washout before switching? Is that drug on the $4 drug list? Just useful bits I have been collecting and which save me a lot time having at my fingertips. And would say that right now I still feel like the slowest NP on the planet!