Jump to content
2019 Nursing Salary Survey Read more... ×

From medical staff to nursing

NP   (5,179 Views 46 Comments)
by Jules A Jules A (Member)

13 Likes; 2 Followers; 46,155 Visitors; 8,863 Posts

advertisement

You are reading page 4 of From medical staff to nursing. If you want to start from the beginning Go to First Page.

juan de la cruz has 27 years experience as a MSN, RN, NP and works as a Adult Critical Care Nurse Practitioner.

525 Likes; 3 Followers; 8 Articles; 57,378 Visitors; 3,747 Posts

Midwifery is also different from the NP world, though, in an important way---all of our educational programs are overseen and accredited by the same organizations---AMCB and ACME---because we're a much smaller group. There are many online midwifery programs out there, but literally no midwifery programs in the U.S. I know about have sub-par standards, because the overseeing bodies are truly rigorous. Sure, some are ranked higher than others, but there just aren't really any midwifery "diploma mills." The standardization of this is really important and keeps our reputations intact (to those really willing to look at the data and appreciate the benefits of midwifery care).

This is exactly why PA's, CRNA's, and CNM's have the better reputation in terms of program rigor.

I agree that the main issue is inferior NP diploma mills churning out grads and grossly harming the profession. I have no idea what the solution to that problem is, honestly, but I wish you well in your endeavor to maintain a professional and skilled reputation for NPs at your institution.

My solution is to split up the NP regulatory and certification bodies. The monopoly imposed by ANCC and AANP in terms of certification and the CCNE in terms of accreditation must end. There aren't many PNP-AC and NNP programs because those certifications are not under the purview of AANP nor ANCC. However, their program accreditation is still under CCNE which oversees a huge number of graduate nursing programs.

There was a time when Adult ACNP programs were rare - now that the demand is there, programs are springing out of nowhere with a seemingly instant blessing of CCNE accreditation. I propose FNP's have their own certification and program accreditation board, Adult ACNP's have their own boards, Psych NP's have their own..., you get the idea. Problem is, I'm not sure how this can undo the damage that has been done.

Share this post


Link to post
Share on other sites

delawaremalenurse works as a Occupational Health NP.

1 Like; 7,733 Visitors; 227 Posts

All my patients also have be seen by and have a physician assigned to them which adds liability to my psychiatrist colleagues and reduces my value. They have to sign off on my discharge prior to the patient being discharged which is always a hassle. It used to be just a co-signing the need for admission for CMS.

Interesting...so everyone is assigned a physician. Is the physician required to see the pt first and then the NP "takes over" until discharge? Looks like all the charts are to reviewed and signed off on by a physician for d/c.

Just makes me think that there is a revenue component to this change...namely being able to co-bill with the physician for increased reimbursement rates.

My 2 cents...

Share this post


Link to post
Share on other sites

Dodongo has 7 years experience as a APRN, NP.

57 Likes; 2 Followers; 10,099 Visitors; 675 Posts

I'm sure this new change is rooted in money somehow. I'm inpatient and every inpatient APP note is cosigned by the physician for no other reason than billing. There is just a little addendum at the bottom of my note that says they agree with my assessment and plan, and viola, 100% reimbursement.

Edited by Dodongo

Share this post


Link to post
Share on other sites

206 Likes; 2 Followers; 5,536 Visitors; 937 Posts

Is this billing scheme legal though?

Share this post


Link to post
Share on other sites

Dodongo has 7 years experience as a APRN, NP.

57 Likes; 2 Followers; 10,099 Visitors; 675 Posts

Is this billing scheme legal though?

Is this question for me? If so, yes, it is. They are required to go see the patient at some point within 24 hours of my examination. Some do more than others at this point. Some literally say "Hi, I'm Dr. So and so, if you have any questions ask the nurse." Others will at least listen to heart and lung sounds and ask a few pertinent questions. Depends on the relationship between the physician and APP. Unfortunately, we just hired a new grad PA and NP (from Walden) and they're both clueless.

Share this post


Link to post
Share on other sites

13 Likes; 2 Followers; 46,155 Visitors; 8,863 Posts

Additionally frustrating is that insurers are still slow to get on board to cover midwifery care at equal rates, or even at all, when we could be SAVING them tons of money.

Great post, thank you for joining in. One of the big pluses for CNMs is that CMS does allow your patients to be seen by only you as opposed to NPs. Is that correct? My understanding is CMS allows us to have admitting privileges deferring to hospital bylaws but patients must still be under a physician's care. Not that it is appropriate in all areas to lose physician oversight but certainly in psychiatry and possibly other inpatient areas it would be.

Midwifery is also different from the NP world, though, in an important way---all of our educational programs are overseen and accredited by the same organizations---AMCB and ACME---because we're a much smaller group. There are many online midwifery programs out there, but literally no midwifery programs in the U.S. I know about have sub-par standards, because the overseeing bodies are truly rigorous. Sure, some are ranked higher than others, but there just aren't really any midwifery "diploma mills." The standardization of this is really important and keeps our reputations intact (to those really willing to look at the data and appreciate the benefits of midwifery care)..

Say a prayer that your specialty doesn't sell out like NPs did. I think CNMs and CRNAs are the only APRN subset that hasn't accepted this awful state of educational affairs possibly because many of the NP big dogs are university employees?

Share this post


Link to post
Share on other sites
advertisement

13 Likes; 2 Followers; 46,155 Visitors; 8,863 Posts

This is exactly why PA's, CRNA's, and CNM's have the better reputation in terms of program rigor.

My solution is to split up the NP regulatory and certification bodies. The monopoly imposed by ANCC and AANP in terms of certification and the CCNE in terms of accreditation must end. There aren't many PNP-AC and NNP programs because those certifications are not under the purview of AANP nor ANCC. However, their program accreditation is still under CCNE which oversees a huge number of graduate nursing programs.

There was a time when Adult ACNP programs were rare - now that the demand is there, programs are springing out of nowhere with a seemingly instant blessing of CCNE accreditation. I propose FNP's have their own certification and program accreditation board, Adult ACNP's have their own boards, Psych NP's have their own..., you get the idea. Problem is, I'm not sure how this can undo the damage that has been done.

I think these ideas are excellent but the universities, who the the highest gross to gain, have a foot hold in our profession which I think is even stronger than the accrediting bodies.

What freaks me out, if I'm remembering correctly is that you and Boston used to blow me off when I was ruminating about what a sham our profession was starting to become. Despite me disagreeing it was in an odd way comforting that you both who I hold in high esteem indicated things weren't as bad as I thought. In recent times it seems as if you both have started criticizing our education which now really worries me.

Share this post


Link to post
Share on other sites

13 Likes; 2 Followers; 46,155 Visitors; 8,863 Posts

Interesting...so everyone is assigned a physician. Is the physician required to see the pt first and then the NP "takes over" until discharge? Looks like all the charts are to reviewed and signed off on by a physician for d/c.

Just makes me think that there is a revenue component to this change...namely being able to co-bill with the physician for increased reimbursement rates.

My 2 cents...

They aren't required to be seen by physician first just at some point be seen and our dc summary signed off on. It is coming from medical staff being touted as standard of care not admin so I don't think it is about reimbursement and at least in my department the docs aren't submitting billing on these patients.

Share this post


Link to post
Share on other sites

13 Likes; 2 Followers; 46,155 Visitors; 8,863 Posts

I'm sure this new change is rooted in money somehow. I'm inpatient and every inpatient APP note is cosigned by the physician for no other reason than billing. There is just a little addendum at the bottom of my note that says they agree with my assessment and plan, and viola, 100% reimbursement.

You guys might be right and if this is the case I'd have no problem with it. I'm all about making the most money possible whether for my family or my facility. Why wouldn't they just say that instead of focusing on the disappointing abilities of recent hires?

Share this post


Link to post
Share on other sites

LibraSunCNM has 10 years experience and works as a CNM.

83 Likes; 24,386 Visitors; 1,069 Posts

Great post, thank you for joining in. One of the big pluses for CNMs is that CMS does allow your patients to be seen by only you as opposed to NPs. Is that correct? My understanding is CMS allows us to have admitting privileges deferring to hospital bylaws but patients must still be under a physician's care. Not that it is appropriate in all areas to lose physician oversight but certainly in psychiatry and possibly other inpatient areas it would be.

Say a prayer that your specialty doesn't sell out like NPs did. I think CNMs and CRNAs are the only APRN subset that hasn't accepted this awful state of educational affairs possibly because many of the NP big dogs are university employees?

I believe you're correct that CMS allows patients to see only us but we still get about 80% of what MD reimbursement is for the same care given (better than the 65% we got before the ACA). Oversight laws vary greatly state to state as well. We have independent practice now in 23 states plus Washington D.C., written collaboration requirements in 7 states, and collaborative practice agreement requirements in 20 states.

While the profession has grown tremendously even in the 5 years since I graduated as a CNM, I don't think we'd ever be able to "sell out" in the same way NPs did, because of the nature of the job. People don't become midwives as an easy way to get out of floor nursing and make a ton of money, because it's just too damn hard of a job. You don't do it unless you're really passionate about it, for the most part, because otherwise why would you? The hours can be brutal, the pay isn't even comparable to NP pay a lot of the time, and the liability is high.

I think higher education in general has just fundamentally changed since online universities have taken off. Diploma mills are incredibly profitable, and so degree inflation is through the roof everywhere. I feel like online MBAs and BSNs are similarly worthless these days. While I believe more equitable access to education is always a good thing, I do think the quality and rigor of higher ed is getting laughable.

Share this post


Link to post
Share on other sites
×