Why bother?

  1. 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 numbers of physicians hiring RNs to help with their practice.
    Theses nurses are functioning as physician extenders and perform all of the functions that a PA or NP would normally perform.
    THey are able to do this because the MDs cover and sign for them. Yes the nurses are practicing outside their scope of practice. No one seems to care about the legality, much less the moral or ethical issues. THe physician is the big winner here. He can bill for his services on a daily basis in the office or hospital and then have his nurse provide the service.
    He can then pay the nurse a fraction of what he would have to pay a NP. Imagine going to the hospital and seeing the MDs nurse for your initial encounter, who then performs your history and physical exam, writes all admitting orders, including medications and diagnostic studies. THen when you get the bill, it is for the MDs service ! This way he is able to get much more done in a day and continue to make money.
    I think the bottom line is $$$$$ and that the future for those considering going back to school for an advanced practice role is in serious jeopardy.
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  2. 37 Comments

  3. by   NurseAngie
    I believe what you are saying. Isn't this how all things seem to be heading though? How unfortunate for NP's.
  4. by   night owl
    Isn't this the same as the med techs passing meds instead of a licensed nurse??? It's all about $$$ isn't it?...Using less to make more...
    Things that make you go {{{hmmmmm}}}
  5. by   nakitamoon
    Agreeing with nightowl here,,,,, all aspects of healtcare are touched by this and it all boils down to the $$$$$$
    Patient beware!!!!!!!!!!!!!!!!!! ~Moon
  6. by   NurseDennie
    Yep! And the "nurses" in the doctors' offices I've been in lately have all been Med Assistants, NOT nurses.

    Love

    Dennie
  7. by   suwanee
    i am an er np in NY- and the senior nurses make more than I do, meanwhile the attendings that sign off on my charts without ever laying eyes on my patients make more than twice me!
  8. by   live4today
    MONEY - MONEY - MONEY.......MONEY! (It's a song.....have you guys heard it?)

    Dennie.....I am soooooo digging that fat cat! My husband saw it and his eyes almost bucked right out of his head! I knew they would once he saw it. He said that is some pretty good trick photography to get that cat to look so big. :chuckle :kiss
  9. by   JailRN
    Doesn't surprise my, just sickens me.
  10. by   green16
    Is this a common tread? Are NP jobs going to be threatened by this practice?
  11. by   green16
    Is this a common trend? Are NP jobs going to be threatened by this practice?
  12. by   2ndCareerRN
    That is exactly why I have decided NOT to do the FNP thing. After looking at what it will cost, how long it will take to repay loans (if I get any), and how much money I can make traveling, it just did not make any sense to pursue that line of education.
    By traveling I will be able to choose where I work, have my wife visit for mini-vacations monthly, and probably make more money as a traveler than I will be able to as a FNP.......which is actually pretty sad.


    bob
  13. by   lalaxton
    I have also seen this trend. Unfortunately, those RN's who are practicing outside their scope of practice are putting their licenses on the line, not something I would want to do. Those physician's who support this practice are also practicing questionable medicine. The Medicare and Medicaid programs are on the lookout for fraudulent billing (eg. the physician bills for a visit that a nurse made without laying eyes on the patient) and I have seen some who have been burned this way. It may be easier for a surgeon to get away with this practice as they are sometimes reimbursed per procedure and not per hospital visit.
    My suggestion is this, if you are an NP competing with an RN for the same position, point out the liability issues to the physician/employer (not to mention the extra education), this alone could justify the extra cost of hiring the more qualified NP over the RN. Also point out that a NP can bill for their services (in most states) and be an asset (that is bring in $$) and more than pay for their own salary instead of just being an employee who is costing you money.
    I successfully competed for a job in this way: I put together a 'portfolio' of my resume, detailed description of my education, a detailed explanation of the difference between an NP, RN and PA and was able to convince the physician group that an NP was the way to go. I did a cost analysis of my potential billings VS my asking salary and was able to show them they would still make a profit (money talks!). I still made more than the most senior RN's in the area. At present ( graduated with my MSN 2 1/2 years ago) I make twice what I was making as an RN.
    Hope this helps! Dont give up, there are lots of jobs out there and you are certainly worth fighting for!
  14. by   olympiad27
    Thanks for all the great responses. Some days it's just harder to deal with than others I guess. I must say that it really dissappoints me and lowers my opinion of the medical profession as a whole. It may be unfair to generalize but it is becoming such wide spread practice. It does seem to be the "trend" though. And I have tried pointing out the benefit of hiring someone who can bill for their services, thus generating revenue and offsetting the salary. Last year I billed about $20,000 above my salary and that was without performing any procedures, just patient visits, admissions, etc.

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