AGPCNP inpatient rounds

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Specializes in Assistant Professor, Nephrology, Internal Medicine.

Background: 1.5 months away from graduating and taking boards as an AGPCNP. I live in Illinois.

I have been offered a job with a physician that I work with on a regular basis. The job entails me to round mainly on nursing home patients, nephrology clinic, and some inpatient rounds on the weekends. My question is the legality; does this constitute a scope of practice issue? I understand that there are recommendations from various organizations. Any input would be appreciated.

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Specializes in Nephrology, Cardiology, ER, ICU.

Hi there - I live in IL also and nope no problem with you doing that. Is this a nephrologist that you are working with? The reason I ask is that I work for a large nephrology practice and we have 8 APPs (advanced practice providers) rounding on our pts.

Getting credentialed at the big two chronic dialysis units is not much fun either.

I'll be glad to answer your questions about nephrology - its a pretty specialized field which is why I was asking if you were working with a nephrologist.

I also wanted to add that the IL APN Practice Act "sunsets" in 2017 and here are the proposed changes:

We are gearing up for another big push for full practice authority in 2017. We have a lot of work to do and need all APNs in the state to support our efforts.

  • Change APN to APRN throughout the act and other laws

RATIONALE - consistency across states and to align with the APRN consensus model

FOR THOSE PRACTICING AS A CRNA

  • Remove language that references the requirement of physical presence by physicians during the delivery of anesthesia services. Specifically, remove where this language below appears in the Nurse Practice Act or related Acts:

"and remain physically present and available on the premises during the delivery of anesthesia services."

FOR THOSE PRACTICING AS CNP, CNM, CNS PROPOSALS INCLUDE:

  • A transition to practice for newly licensed APRNs.
    • After 3000 hours (of practice in Illinois) the APRN may practice without the WCA. They will need to notify the department of that intent.
    • The transition period shall include a written collaborative agreement with a physician licensed to practice medicine in all its branches OR an Advanced Practice Registered Nurse who has five years of practice in the same certification.
    • All currently licensed advanced practice registered nurses may or if desired will be grandfathered as long as they meet the following criteria:
      • Un-encumbered license with appropriate national certification for at least 5 years
      • Notify IDFPR of their intent to practice without a written collaborative agreement

RATIONALE - National trends show that a transition to practice model leads to successful passage.

  • Increase pharmacology continuing education requirements
    • Total hours will not change 50 hours CE per renewal cycle
    • 20 hours must be pharmacology with 10 of those hours specific to Schedule II

RATIONALE - National trends show that a transition to practice model leads to successful passage. CE recommendation - To circumvent issues that may occur due to continued conversations in Springfield related to the use of schedule II gateway drugs that may lead to substance abuse (heroin overdose)

This is important for all IL APNs.

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Specializes in Assistant Professor, Nephrology, Internal Medicine.

TraumaRUs,

Thank you for all of the information, I was hoping you would be one to respond to this. I have read your previous posts about nephrology and being in Illinois. Yes, the physician that I will be working with works in internal medicine and nephrology- so I will be doing both in a variety of settings. She also wants to pay me as an independent contractor, so I am considering setting up a business and business account to help with taxes. Do you have any knowledge about this?

Thank you once again!

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Specializes in Nephrology, Cardiology, ER, ICU.

Hmmm....as a 1099 employee? What about your benefits? Is she going to cover malpractice, DEA, NPI, licensing, credentialing? PTO, retirement?

Chicago is a high cost area, I personally would be loathe to do 1099 there.

You don't have to post what she offered but I wouldn't do 1099 for under $150,000. I work in central IL for a large nephrology practice and know what I bring in to the practice and my salary is almost that with benefits. Credentialing alone will run you at least $250 per hospital, and I'm not sure how much Davita and Fresenius charge but its not cheap. Then you have insurance. My practice pays for my malpractice but I also keep my own additional as I volunteer quite a bit.

She is going to be pulling in $$$ from your hard work and you are going to be working, working, working and then working some more.

If you are doing dialysis rounding, the paymentto nephrologists is approximately$200 for one visit per month, $250 fortwo or three visits per month, and $300for four or more visits per month. And this was 2012 rates! As an NP, you (or your rather your doc) will receive 85% of this - which depending on how many pts she has could add up quickly. In order to get the $300/month per pt, one visit has to be by a physician. However, in most areas, APPs do the rest of the visits and sometimes if the doc is otherwise occupied, we do all the visits.

So - you really want to think about this arrangement. BTW if you want to work in central IL we will probably have an opening next year...

Journal of the Society of Nephrology, 2012

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