Why bother? - page 2
I have been a NP for over 10 years and am ready to throw in the towel. THe frustration and anger I feel cannot be expressed. Over the last few years I have seen increasing... Read More
Jul 17, '02One more thought. It seems to be a way to inhibit the growth of NPs going into private practice and thereby threatening physician income.
Jul 19, '02This is really scarey. I've been an NP for 3 years and haven't regretted it one bit, but the financial compensation for all that I have been through is not quite there yet. I work locum tenums and I can tell you that the temp nurses still make more than the temp NPs just because of the state of nursing. I don't know if this is a good thing considering the state of nursing now and the quality of nurses the schools are send out in the quickest amount of time to help with the shortage. I have definately seen a diffence from when I graduated 7 years ago to now. And these people are functioning as physcian extenders? I'm nervous!
Jul 25, '02The other point I wanted to make was this.... who is supposed to be monitoring the practice of nursing? This is practicing medicine without a license. I would think that hospitals would be unwilling to accept the liability for having nurses practice medicine. What about HICFA or MEDICARE? Surely there is some regulating body that would jump all over these issues.
Will it take increased consumer awareness and a lawsuit to make the medical profession, hospitals, and theses nurses take notice and practice ethically and legally? I wonder if any of the patients realize they are being billed for a "physician visit or service" that is provided by a nurse? Hmmm....
Jul 26, '02After a few short years in NP practice, I gave it up. I did the work of an MD, made a fraction of the salary, and had the liability of a practicing physician. Besides, being an NP took me away from being a nurse.
Jul 26, '02That is clearly insurance fraud, and those MD's should be reported to the respective insurance agencies, be it medicare, medicaid, or HMO.
In my town, I consider it a blessing to have a MD's office who actually has a nurse working there and not a CMA who thinks they know better what the pt needs when I call for a home health pt. I have never seen this practice in any of the hospitals where I worked. I personally don't see what is wrong with writing a history and physical, as assessment is a RN's job. WE do essentially the same thing when admiting any pt to the hospital, home health or anywhere. BUT, the fraud here is the physician charging for that service. Do these doc's make rounds in the same day?? If they actually see the pt, and review what the nurse has written, I think they are legal. These nurses are basically being paid to be the doc's secretary, granted they have to think about the orders, but frankly, I think I'd rather have a smart nurse admit me who remembers to order the tylenol so I don't have to wait hours to get a tylenol for a h/a b/c the doc didn't order it.
Bottom line is if the doc didn't lay eyes on the pt the same day, he is fraudulent and should be reported.
The nurses? I don't know, they are technically writing verbal orders aren't they? That is legal as long as the doc signs w/in 24 hrs. And legally a RN can do a H&P. So, they really may not be practicing outside of their realm.
I made a decision not to become a NP b/c I didn't think I could ever be reimbursed for my education. I'm still trying to pay off the darn BSN!! And Medicare is making everyone's life a living hell!
Tim, I am shocked to hear you say you didn't feel like a nurse as a NP. I would think you'd feel even more like one, but since I have never walked in those shoes, your statement is an eye-opener.
Jul 27, '02You are incorrect in saying a RN can do the H &P. Yes nurses do physical assessments, but to do the indepth physical and assessment requires advanced physical assessment course work as well as advanced pahtophysiology which is a required component of a NP's education. Also the H & P is more than just the physical exam, it requires a medical assessment, differential diagnosis and plan. Yes there are nursing diagnoses as well but the H & P entails medical decision making that is then listed as medical diagnoses that are then scrutinized for billing accuracy.
Also these nurses are not just "writing verbal orders" if they never discuss the patient with a MD. And if the MD hasn't seen the patient how can he give an order?
Jul 27, '02Hoolahan:
Isnt' that a shock, indeed? I had thoughts that becoming an NP meant something else. Friends that I graduated from my NP program describe their practice as everything from my experience [medicine only--- no time for nursing] to being a 'glorified' office nurse (whatever the hell that means!).
I never had time to be a nurse while I was an NP... the scene was always too hurried "you've got patient's waiting!!!, what's the delay???!!!"
I keep the license, and the certification but I will never practice full-time again. I missed being a nurse to much.
Jul 28, '02lalaxton,
If Medicare and other third party payers are on the lookout for fraudulent billing practices then how is it this has never caused a problem for any one ? It is extremely easy to spot in the hospitals, everyone I know tells me it is common practice , and when I have pointed it out to administration there was never any folowup? Can it be that this is just something to be swept under the rug until some perceptive patient or family decides not to pay a bill because they never saw their physician?
Jul 28, '02Olympiad, I didn't realize there was such a difference in the way an H&P was , chalk it up to my not being a NP or walking in your shoes. I guess I feel since my own assessment skills are strong, from all those years of critical care, and then the comprehensive physical and history we have to submit to please Medicare in Home health, that it was like comparing apples to apples. Apparently that is not the case for a NP.
Tim, what a shame you went through all that work to feel let down in that way. But, I am glad you feel good about your choice. Being happy is so much more important.
Jul 28, '02I think that Tim GNP brings up a good point about not being able to keep nursing in NP. I too have given up a full time practice as an FNP because I was too busy "seeing" patients. The nursing aspect was now to be left to the nurses in the clinic, my role was different. I now teach in a nursing program and work, part time, when I want to as an NP, this allows me to continue to do nursing, and do the other thing too. Joe NP
Jul 29, '02Is it any better for NP's in disease management type programs? Primary care doesn't appeal to me that much.One of the reasons I started the NP program was that the jobs that I would like to go for need an NP certification. Plus I wanted more autonomy. I worked as a wound care specialist for a long time and got to the proverbial glass ceiling, so I thought that an NP certificate might help with that. Any input would be appreciated.
Jul 30, '02Olympiad,
In response to your question I think you will see this practice mainly with surgeons, as they are paid per procedure and do not bill for daily visits. If they did bill for daily visits and the RN saw the patient without the MD ever laying eyes on the patient, that is fraud. (Surgeons do see the patient at least once......) However, some docs try and get by this by having the RN write the note and he co-signs. Many months later if the chart is audited he can say that he indeed saw the patient because he co-signed her note and then it becomes a case of his word against yours (or whoever tried to blow the whistle..)
WHy are so many docs getting away with this? Not sure, maybe Medicare/Medicaid systems already overloaded with not enough money to go after MD's who have much more money to fight with?? Maybe patients who dont know better are not complaining?? Maybe too many people saying this is the way its always been and it's just too big a problem to tackle???
If they paid you to blow the whistle on these docs would you do it??
Jul 30, '02Lalaxton,
No I would not blow the whistle on anyone for money. I am considering reporting them if I can be assured anonymity because it is ethically and legally wrong for patients to recieve care from a nurse and be billed a physician fee, for the medical plan of care to be made by a nurse, and for nurses without prescriptive authority to be ordering medicines and tests. It is ironic that physicians have tried for years to prevent APNs from having access to becoming providers of care, having prescriptive authority, and reimbursement priviledges arguing that we are less trained, educated and provide lower quality of care. But when it comes to saving them a few $$$ they are more than willing to hire a RN for half the salary, much less education and allow them to practice as an APN. Just goes to show you that for many of them quality of care is just lip service.