Questions for Current NPs

[JesseMJ]

Hi All,

I'm new to the site and have found it quite informative so far. I am applying to several accelerated MSN programs this fall, as well as 2 accelerated BSN programs. I have a strong interest in cardiology as an area of focus. To help with the decision-making process, I wanted to ask a few questions of some current Nurse Practitioners:

• Do you feel being a NP is a lot more rewarding than having a regular BSN degree?
  
• How are the opportunities for doing research or working in, say, a cardiology practice?
  
• Do you feel that having an advanced nursing degree will be increasingly important in the future?
  
• What does having an MSN allow you to do that you can't do with a BSN?
  

Thanks for any info you can provide. I've done some searching on the forums and FAQ sections, and found there is a big debate about accelerated programs. I've read a lot about both sides, so I won't begin to get into that whole argument. Thanks again.

Jesse

[Corey Narry, MSN, RN, NP]

The Old Guy,

I agree that Northern California RN's are the highest paid in the entire US and a lot of that has something to do with (1) the strong unions and (2) the fact that the cost of living here is outrageous and the salary has to be able to support that. That's a good thing because some Southern California counties (i.e., San Diego county) that are just as expensive to live in do not pay RN's as well.

If you are truly an NP, then you are very misinformed and need to realize the power you have as an individual provider to command the salary that you rightfully deserve. You can blame CANP all you want for not standing up for the profession. Politics is a difficult animal to deal with if you do not have the will nor the energy to fight the fight and be part of a cause. NP organizations across the US, with the exception of the ones that are in independent practice states, are having the same issues with NP-restrictive laws that result from a strong physician lobby. If you found that the easy way out in Northern California is to work as an RN, get paid $60+ an hour, work overtime, work off shifts, work holidays, and yes, make $150,000 a year, then more power to you.

Some of us found that we can seek employment where we can have a salary that recognizes our degree and specialty and not have to work at the bedside, where let's face it, involves a lot of sress physically on your back, being treated like a commodity (even though there's a union), and not having the ability to do more for the patient other than report a change in vital signs and critical labs to a house officer or resident, or worse, having to call an attending from home. I truly enjoy my job more than wallowing in the fact that I earn more than the bedside RN's. There's bliss when I don't worry about being cancelled if the census is low, not having to write care plans and patient teaching record every shift, completing a 7-page admission profile, emptying foleys and drains, or waiting for the turn team so the patient gets repositioned.

For the record, I do not work for Kaiser and without having to say where, it already leaves you with the other two facilities I have mentioned in my post that have a closed physician practice model and hires NP's and PAs extensively. I think you are wrong about Kaiser facilities. I know some NP's who do work there and are very happy with their salary. I also have friends in the Sutter hospitals and are very happy with their salary as well. I am not as familiar with CHW other than the fact that this corporation is struggling financially more so than the norm because it's a fact that everyone else is having some degree of revenue issue in this economy anyway.

[nomadcrna, DNP, CRNA, NP]

I apologize. I tend to get irritated because so often someone comes on and states things about NP practice issues and they are NOT NPs and the info is totally wrong.

The physicians at Kaiser are still EMPLOYED and are not doing fee for service. The usual model is a base salary and RVU bonuses. The number of RVU increases with the number of patients seen. So the more patients seen, the more money you make. You also make more for the organization.

The NP are many times under the same model. Your DON was wrong, period. If the organization is not billing for NP services, they need to be fired.

The state practice laws are totally different then billing. No matter the practice laws, NPs are still able to bill for their services the same as our physician counterparts. The pay the NP receives is not the same as what is billed out. You can bet the NP is making the organization money, more profit then less they have to pay the NP.

As Juan stated, the NPs need to be aware of their worth and what is billed under their names. ONly then can they know their worth and realize they should be making much more.

I have worked in about all the various practice models. All my practice has been independent, I refuse to work in states or practices where I"m not independent.

I have done fee for service where I billed the various insurance companies, medicare and medicaid for my services. I've done a closed practice, where the physicians and Nps were employees of a corporation owned by the hospital. I've contracted my services to hospitals various ways to include daily rate, hourly rate and by units (as in RVU or units). I've done this as family practice, ER and also anesthesia.

I am now in a salaried position as a solo provider working for a corporation that has a clinic. They bill for my services, I get a set amount. I much prefer this model over all the others.

Once again though, just to be clear. NPs or their their employers bill for the NPs services in the same manner physicians bill. No difference except for medicare/medicaid which is usually set at 85% of what the normal physician cost billing is.

[TheOldGuy]

Dearest Juan, I am not misinformed. California law prevents hospitals from hiring physicians with only a few exceptions eg non-profit teaching hospitals. Consequently, the majority of hospitals in California do not hire physicians - and they don't have any incentive to. Similarly, hospitals don't have incentives to hire NPs.

By the way, I don't know what you mean by "wallowing in the fact that I earn more than the bedside RN's".

Kaiser NPs make more than RNs by CNA contract. Unfortunately, Kaiser hasn't been hiring a lot of NPs - an issue that CNA is attempting to address - and is specifically identified in the new contract. In any case, Kaiser doesn't "bill" Medicare/Medi-Cal due to its HMO structure.

I am very frustrated with CANP - rather than fighting for at least a defined scope of practice, much less independent practice, they are busy lauding their lobbying efforts at trying to fight non RNs from administering meds in schools....

Lastly, how in the world can you say you don't miss emptying foleys?? (levity)

Nomad, I appreciate your perspective - It is not that I don't know that NPs can bill. What I'm saying is that in this state, there are many administrative and legal roadblocks that prevent NPs from practicing "to the full extent" - and requires a separation of hospital and physician. Both the hospitals and physicians like that separation because it also protects them from liability issues.

Look guys, if I was wrong then NPs would be making more money right?

Let's not fight about this anymore ok? We seem to have different perspectives based on our own situations/experiences. I just think that NPs are underpaid and underutilized and that as a profession we don't have the same power or advocacy that medicine has. The AMA nationally, and CMA in California work very hard to maximize physician income...not so much for NP organizations....

Peace.

[zcoq72mehs]

In regard to an MSN degree possible hindering employment:

I am a bit confused about this.

assume you have a bsn and an msn

How does a given employer KNOW you have an MSN?

In a tight market wherein you have to put food on the table (survival), couldnt you just state that you have a BSN?

Do you have to show them a copy of your diploma or something?

Atho I am only entry level, nobody has ever required proof of my degree

I am assuming it *might* be more precarious if both degrees were granted, one after the other, from the same institution, i dunno.

I think Western Governors University offers a BSN and an MSN

If you get the BSN first, I am assuming you will get said diploma.

Then, if you get the MSN next, I am assuming you will get said diploma.

Then, in a tight market, you could just show a copy of the bsn degree?

If anyone has insight into this, please do share.

I am thinking, for certain, if the degrees were obtained from two different institutions, the likelihood of discovery would be negligible.

I am not sure how WGU handles the situation--perhaps the employer really does inquire at the university as to the highest degree granted?

WGU is appealing, in my case, as it does not seem to require group projects, and all classes are offered online at their site, rather than trying to piecemail courses from other institutions that may have online bsn without online required coursework

thanks.

[zcoq72mehs]

A separate, non-related question, except that NP's may be able to answer:

It is easy enough to learn about heart murmurs and xrays.

However, when it comes to learning about eye exams and ear exams, I am most ignorant.

It seems that when it comes to this kind of learning, I am rather 'slow' if you will.

Are there any quality videos available on eye and ear exams that could be watched repeatedly, that are also comprehensive???

thanks, again.

[Corey Narry, MSN, RN, NP]

Dearest Juan, I am not misinformed. California law prevents hospitals from hiring physicians with only a few exceptions eg non-profit teaching hospitals. Consequently, the majority of hospitals in California do not hire physicians - and they don't have any incentive to. Similarly, hospitals don't have incentives to hire NPs.

By the way, I don't know what you mean by "wallowing in the fact that I earn more than the bedside RN's".

Kaiser NPs make more than RNs by CNA contract. Unfortunately, Kaiser hasn't been hiring a lot of NPs - an issue that CNA is attempting to address - and is specifically identified in the new contract. In any case, Kaiser doesn't "bill" Medicare/Medi-Cal due to its HMO structure.

I am very frustrated with CANP - rather than fighting for at least a defined scope of practice, much less independent practice, they are busy lauding their lobbying efforts at trying to fight non RNs from administering meds in schools....

Lastly, how in the world can you say you don't miss emptying foleys?? (levity)

When I said wallowing in the fact...all I meant was that I really try not to concern myself too much about making sure I earn more than non-APN's because I will likely come across some nurse manager with 20+years experience who surely makes more than I do.

I really am not trying to argue or "fight" as you put it in your post. I am just presenting a different perspective. There are NP's that do make so much less than RN's in California...but then I lived in Michigan and there are NP's in a similar situation there. There is definitely room for change. For us who practice as NP's, we like the role much better and that's what motivates us to be NP's. It's a cliche but its not hypocritical to say we're not doing it for the money.

Hey, good luck to you my friend. Maybe we'll meet in person one day.

[TheOldGuy]

Absolutely agree with you Juan - it is not the money that is the motivation. I would hope that would be the case for most docs too. I just think that if I'm doing essentially the same work as a doc I ought to be getting paid essentially the same pay - I get upset about the "85%"!

I'm sure you've noticed that whenever a couple of docs are talking, money is usually a topic in one way or another - not so much when a couple of NPs are talking...I've noticed a big reluctance to even discuss money. I'd like to make it a more comfortable issue because if we're the only ones not too worried about it then we will get screwed...

Its interesting to note how CRNAs have been far more "practice protective". While every nursing school under the sun is trying to crank out NPs, CRNA programs have developed a more conservative approach. Higher standards for entry, much more rigorous program, much less fluff, fewer schools, fewer grads, much more money.....

I sometimes wonder if the perspective about money is a gender issue given the gender differences of CRNAs, NPs and Docs. But that is a whole other discussion....

Have fun and take care!

[allennp]

Absolutely agree with you Juan - it is not the money that is the motivation. I would hope that would be the case for most docs too. I just think that if I'm doing essentially the same work as a doc I ought to be getting paid essentially the same pay - I get upset about the "85%"!

I'm sure you've noticed that whenever a couple of docs are talking, money is usually a topic in one way or another - not so much when a couple of NPs are talking...I've noticed a big reluctance to even discuss money. I'd like to make it a more comfortable issue because if we're the only ones not too worried about it then we will get screwed...

Its interesting to note how CRNAs have been far more "practice protective". While every nursing school under the sun is trying to crank out NPs, CRNA programs have developed a more conservative approach. Higher standards for entry, much more rigorous program, much less fluff, fewer schools, fewer grads, much more money.....

I sometimes wonder if the perspective about money is a gender issue given the gender differences of CRNAs, NPs and Docs. But that is a whole other discussion....

Have fun and take care!

You know this issue of cranking out NP's I think is a issue. I question the quality of graduate, particularly when concerning the programs that fast track them thru with out RN experience. Even those with RN experience find it a challenging path. issues with leaving students to find their own clinicals et..... It is very concerning and I think in the long run a negative for our profession.

A

[nomadcrna, DNP, CRNA, NP]

I agree totally. We need to crank up and change the NP education.

I have said before that it would be a huge benefit the the NP would all have the same base generalist education and then specialize to various specialties afterwards. Especially with the DNP coming, its a perfect time but the ivory tower academics (no offense) would rather teach EBM or research. Its cheaper and easier, makes the schools more money but our profession suffers.

[TheOldGuy]

It is interesting to note the similarities between current NP education and the state of medical education described in the Flexner report.