ICU NP hours, salary, program info

Nursing Students NP Students

Published

Hi all,

I am interested in the following for ICU and or in patient practitioners please.

Type of NP:

Years experience in current role:

Area of Care: (critical care team, hospitalist, etc) really looking for ICU only.

Size of ICU/ICU's:

Bill independently or for supervising physician?

Do you do procedures? what? (chest tube insertion, central lines, intubation, LP)

How were procedure competencies done?

How are you staffed? (24/7 nurse practitioner coverage, 12 hour days, how many full time NPs work for your program)

Do you have weekend/night requirements? if so, are you paid extra?

paid hourly or salary? overtime?

monthly take home pay?

Yearly pre taxed income?

orientation process for new NP's in ICU role/length ?

benefits:

typical week day in your shoes?

I am asking the above questions to reexamine my current critical care program which is failing and we are unable to keep employees in this role. I Have been with the program for 2 years and we have been through 5 full time employees in that time frame. I will answer the above questions in regards to myself to give you a better idea of what I am looking for. Thank you for all responses and even suggestions.

Type of NP: FNP

Years experience in current role: 2 years

Area of Care: (critical care team, hospitalist, etc) really looking for ICU only. ICU

Size of ICU/ICU's: 18 bed SICU, 8 bed CICU, 12 bed CVICU

Bill independently or for supervising physician? bill for physicians. nothing is billed independently. require a supervising physician in this state

Do you do procedures? what? (chest tube insertion, central lines, intubation, LP) Just started doing intubations and central lines with 2 of the 6 physicians.

How were procedure competencies done? no formal format. we need one!

How are you staffed? (24/7 nurse practitioner coverage, 12 hour days, how many full time NPs work for your program) When we are fully staffed our icus are covered with an NP/PA 24/7. We do 12 hour shifts 7-7

Do you have weekend/night requirements? if so, are you paid extra? We must work 1 Saturday and 2 sundays a month. no extra pay for these days or differential. We have full time night NPs who get a $10/hour differential. they also need to pick up 1 Saturday and 2 sundays a month.

paid hourly or salary? overtime? Salary, typically work 40hrs/wk. no overtime, just recently got approved for a bonus shift since we were so short. This is paid for working a 12 hour shift only and is $400 for the 12 hours (this is less then my regular pay)

monthly take home pay? 4000

Yearly pre taxed income?84000

orientation process for new NP's in ICU role/length ? 2 weeks with NP, then on your own

Benefits: We get $400 education. We accrue sick/vacation time at the same rate/fashion as the RNs in the entire hospital. I believe it is 7 hours a pay period (biweekly) no bonuses, no overtime, no raises this year (the whole hospital didn't get a raise) everyone did get a $500 bonus (all full time hospital employees) . medical/dental, 403B, etc

typical week day in your shoes? come in at 7am, get sign out from night NP. We have progress notes that all the data and medications are filled out by the night NP every night. I go through these and check labs and abgs and make sure nothing needs to be urgently addressed. Multidisciplinary rounds start at 830. RN presents patient. I will interject any information that was left out. During rounds we (NPs) work as a scribe by writing orders. The MD writes the exam, assessment and plan. once rounds are done, I input billing for all the patients (for the MD) into IMBILLS.

If a new admit comes, the process depends on the MD working. some like to see and workup the patient together, do orders together, and I am left to dictate. Some will have me see the patient and call them with my assess/plan, and I do orders/dictate. The critical care team must dictate a transfer summery for our hospitalist team if a patient has been in icu >72 hours, I always do these. I typically discharge patients to LTACs. We must track family conferences for the physicians, and make sure they are completed within 3 days of icu admission (with a special progress note filled out that I typically have to fill out for them)

Night shift NPs are required to input all patients into apache (this is timely) and complete all the data/medications/labs/I/Os on daily progress notes on all patients by 7 am.

This (typical day in my shoes) is why I am inquiring about other critical care teams, and how their day flows. I feel like a secretary most days, and am seeking to revamp the program.

All input and help is greatly appreciated.

Up Vote Up Vote ×

Well, as a pre-NP, I can't give you that info but I can at least tell you for me personally why I would never want that position. Perhaps it might be similar to what other NPs think and explain the high turnover. It looks to me like it's essentially an RN job with NP title and responsibilities. One of the main reasons I want to be an NP (aside from enjoying higher education) is to get OUT of the horrible 7am-7pm 12 hour days with constant weekend and holidays. I also feel as an NP, you should be in an entirely different payscale and benefits structure than staff nurses, and yet the salary is similar to some experienced staff nurses, the vacation accrual is the same as a staff nurse, the hours are the same as a staff nurse - yet unlike a staff nurse you get nothing extra for your forced weekends.

On the other hand, maybe that's okay with some nurses, so I suspect another issue might be the 2 week orientation. If you hire new grad NPs, and are only giving them 2 week orientation, they might be leaving because they're overwhelmed. FNPs aren't typically trained in a lot of the inpatient procedures, and considering how many people are now going to online programs with little to no hands on time, a 2 week orientation just doesn't cut it.

So, my advice to keep employees happy and perhaps stop the high turnover:

1. Negotiate independent contracts with each new employee vs using the RN benefits scale, which makes it seem like their graduate education isn't valued. Draw up a contract defining salary, paid time off, CME, etc for each employee after negotiations.

2. Beef up the orientation, allow for time to see an practice all procedures, spend time with other NPs and physicians on the unit, practice and receive feedback, etc before letting them go on their own.

Up Vote Up Vote ×
Specializes in ACNP-BC, Adult Critical Care, Cardiology.

I'm a Critical Care NP and I've been in this role since 2004. I've worked in 2 states and by far my current setting is the best clinical environment I've ever been in. We have a stable team of 12 full time ACNP's with a few Per Diems. Our turn over is very low and if we do have an opening, we have numerous applicants (from both coasts). Our lead NP has presented our ICU NP model at a previous Society of Critical Care Medicine conference and have published the role in an edition of ICU Director ( a journal presenting the business side of critical care). I'd rather answer questions by PM if you are interested.

Up Vote Up Vote ×
Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Hi again. Just re-read your post. Re-examine your billing practices and even go far as to speak to an expert. I am not sure you can perform E&M (H&P, progress notes, discharge summaries) and have the physician sign off and bill under their name. At least not for CMS patients and you know majority if ICU patients are elderly and on Medicare. Doesn't matter if you're not in an independent practice state. There have been reports of fines due to fraud where NP's who did the E&M we're not billing. Seriously research it as a friendly advice.

Up Vote Up Vote ×
Hi again. Just re-read your post. Re-examine your billing practices and even go far as to speak to an expert. I am not sure you can perform E&M (H&P, progress notes, discharge summaries) and have the physician sign off and bill under their name. At least not for CMS patients and you know majority if ICU patients are elderly and on Medicare. Doesn't matter if you're not in an independent practice state. There have been reports of fines due to fraud where NP's who did the E&M we're not billing. Seriously research it as a friendly advice.

Shared billing can be done like this as long as the requirements are met.

Actually re-reading the OPs note, if you are seeing the patient and billing under the physicians NPI without them seeing the patient and participating in the plan then that is fraud.

The problem I have with what the OP describes is most of this is not an advanced practice role. We have research nurses to do APACHE scoring. We have computers that fill in the I&Os for notes etc. Outside of LTAC orders I don't see anything that requires a license.

Up Vote Up Vote ×
Specializes in Psychiatric Nursing.

The model of an MD and NP seeing the pt together and then the NP doing the orders may be ok for a new np but not for very long.

The secretarial work should be done by secretaries.

The job description of MD and NP should be the same. Ie HP, diagnosis, orders.

Up Vote Up Vote ×
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Shared billing can be done like this as long as the requirements are met. Actually re-reading the OPs note if you are seeing the patient and billing under the physicians NPI without them seeing the patient and participating in the plan then that is fraud. The problem I have with what the OP describes is most of this is not an advanced practice role. We have research nurses to do APACHE scoring. We have computers that fill in the I&Os for notes etc. Outside of LTAC orders I don't see anything that requires a license.[/quote']

All I know is CPT codes 99291 and 99292 as well as procedure notes can not be submitted under shared billing. We also have Epic for our EMR and notes are so much easier to do now.

Up Vote Up Vote ×

I can't help out because I work in a family practice office. All I could see is that you get $84K take home for 40 hours per week ? That's insanely low. No wonder you can't keep that going!

Up Vote Up Vote ×
All I know is CPT codes 99291 and 99292 as well as procedure notes can not be submitted under shared billing. We also have Epic for our EMR and notes are so much easier to do now.

Critical care codes and procedures have to be billed under the NPI number of the person who performed them. E/M can be billed under the physician NPI as long as the requirements are met:

http://nurse-practitioners-and-physician-assistants.advanceweb.com/Article/Shared-Services-Billing.aspx

If you use the shared billing (especially with prolonged service codes) the E/M billing can reimburse almost as much as critical care billing. Unless your ICU is dramatically different than most, you should generate a fair bit of E/M billing. Our group published data showing an average of 10% E/M time across 7 ICUs. In our center each ICU handles it differently. Some do shared billing and for some attendings its not worth the time to document participation.

Up Vote Up Vote ×
Specializes in PICU.

I am a brand new PICU NP (still on orientation). Salary and benefits sounds similar, but we do not get extra pay for night/weekends/holidays. We do get extra pay if we pick up an extra "overtime" shift, just to encourage people to pick up holes in the schedule. However, the similarities seem to end there. The MDs do the progress notes, so they can bill. It is in our job description that we are not scribes. Orientation is a minimum of 3 months (some of my friends in other ICUs are getting 6 months), 2 weeks is ridiculous. We can do CVLs, LPs, intubate, chest tubes, art lines, procedural sedations for MRI and such. We get training on all procedures in the sim lab. We take a group of patients and manage all of their issues and consult with the attending when we need input. We create the plan and review it during rounds with the attending. We act at the same level as the fellows and generally do not work with any of the ICU fellows, so there is less competition for procedures. We work 12 hour days, 16 hours nights and some 24 hour shifts. We work 1 night a week and 4 weekend days a month. We provide 24/7 coverage for about 37 beds.

It sounds like not all of your docs are really supporting the NP role. Without that, you will not keep NPs, imo. All of the attendings I work with are happy to teach me and want to see me learn and grow. They also want to me to stay long-term and they highly value their NPs. It makes for a great work environment. I can't imagine trying to do this job without that.

Up Vote Up Vote ×

Hi All,

Thanks for the responses. To clarify billing. The H&P is dictated under the physician and they see every patient and do an assessment of their own. Also this is the hospitals rules, not the physicians. If they had a saw, we would be more autonomous .

Also,are most critical care NP's doing procedures. I just convinced them to start letting us be competent to intubate and place picc lines, but they are reluctant to let us place central lines. My thoughts are most other ICU NPs are doing central lines, and chest tubes. If I ever leave this job for another critical care job, I will be at a disadvantage not knowing how to place a line or chest tube. Is that accurate?

thanks!

Up Vote Up Vote ×
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Hi All,

Thanks for the responses. To clarify billing. The H&P is dictated under the physician and they see every patient and do an assessment of their own. Also this is the hospitals rules, not the physicians. If they had a saw, we would be more autonomous .

Also,are most critical care NP's doing procedures. I just convinced them to start letting us be competent to intubate and place picc lines, but they are reluctant to let us place central lines. My thoughts are most other ICU NPs are doing central lines, and chest tubes. If I ever leave this job for another critical care job, I will be at a disadvantage not knowing how to place a line or chest tube. Is that accurate?

thanks!

You should push for getting privileges to do procedures. That's the only way you can be competitive in this field and will help attract more NP's in your group and keep them.

What type of hospital do you work for? Is it a teaching hospital? You know that really shouldn't matter. I have worked in 3 different hospital ICU services - 2 teaching hospitals with residencies and fellowships and 1 non-teaching community-based hospital with no residents. In all 3 places, the NP's placed lines of all kinds. I was inserting chest tubes and performing bronchoscopies in 1 of the 3 and can intubate in the other 1. So yes, I think it's common for ICU NP's to do ICU procedures.

I think the uphill battle in your case involves that fact that you are not billing. Procedures are revenue generators. There is a price tag for every central line or arterial line you place. Also, does this reluctance have more to do with the culture of the hospital and the Medical Staff board? Some places are just that afraid to allow NP's to do things that they interpret as encroaching into their turf. I really don't know how you can turn this around other than showing the Intensivists you work with facts and numbers from a literature search on what ICU NP's do around the country.

Also, let me ask you this? How do the physicians place lines? In this age of ultrasound guided central venous catheter placement, is it really that hard to place lines with adequate training? You may find it surprising that where I work no other group of providers are more adept at central lines than the ICU NP's with the exception of anesthesia providers. It's not because the ICU NP's are plain awesome (though we are), it's because we have the most number of cases of lines placed in the hospital. It's all about practice makes perfect and providers who do certain procedures constantly become experts at it.

Up Vote Up Vote ×
+ Add a Comment