Hiring an RN into private practice

Nurses General Nursing

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Hello everyone! I am a psychiatrist and in the process of starting my own practice, it will deliver transcranial magnetic stimulation, an FDA approved treatment for major depression. It's very safe, well tolerated, and only in extremely rare cases can be associated with a seizure during a treatment. Only 25 or so documented cases of the tens (maybe hundreds) of thousands treatments to date. Some were in people actively drinking heavily and others were from the experimental days of TMS when the treatment intensity was too high. So the likelihood of seizure is very low. I'm looking for advice on how to recruit 1-2 RNs to deliver the treatment. It is a very chill job description, just apply the coil and deliver an 18 minute treatment to the patient (no IVs, draws, nothing). It will be first shift, 0800-1600 and the rest of the time is spent answering the clinic phone, following up phone calls, medical records, etc. I won't be able to offer benefits and the hourly wage I can really offer is $20/hr, for working 50 weeks a year, that is 40k. However, there is a bonus that I am thinking of offering for each billed patient encounter, of $3. I'm projecting about 45 patient encounters billed a week, that's an extra 11k or so and as the practice grows, so does that bonus. Anyone have any input on what population may be interested in this type of opportunity and how I can market this? I have no idea how to find well qualified nurses (good sites to post the listing, or maybe good places to find nurses who are interested in a more chill job description but maybe less competitive pay) and especially someone who can be reliable since the treatments are 5 days a week. There is also the bonus that the nurse can have flexibility in their hours too. Thank you for all the input!

"I'm glad to see there are plenty of RNs who don't assume all MDs are sworn enemies. I'm sure it shines in your work as well."

That speaks volumes on your end. I have worked with MD's for 35 years, never once thought of them as a sworn enemy.

Don't need you to shine my work, it speaks for itself. Just.. pay me for what I'm worth.

I don't think anywhere in that post I specifically said you were thinking anything. Or referencing my work. I was actually referring to this humorous post below.

Some of the overtones here reek of the thinly-veilied "you and your ilk will always be our sworn enemy," though.

Wretched Evil Doctor who wants to make money at the expense of a professional RN!

Damn some of you guys are brutal. I agree the low pay + no benefits probably won't attract many RNs but no need to be rude about it. It's all about how you say things. OP I'm glad you're getting the truth and the feedback you need.

I'm puzzled with why you haven't talked with your lawyer and find out exactly why he or she is insisting you need an RN. I'm having a hard time imagining what liability an LPN would expose you to that an RN wouldn't. An LPN can take vitals and perform all of the monitoring, they just aren't licensed to interpret the findings and implement and develop interventions based on the findings.

I would imagine the interpersonal skills of your staff are going to be very important to the success of your program. I would also think you want to draw from the largest pool possible to find nurses to meet your practice needs. The pool of RNs who will meet your parameters - $20/hr, no benefits and a start up practice - is going to be small, but the pool of LPNs would be larger. Why look for a unicorn in a kiddie pool unless you know for sure you need to?

I'm puzzled with why you haven't talked with your lawyer and find out exactly why he or she is insisting you need an RN. I'm having a hard time imagining what liability an LPN would expose you to that an RN wouldn't. An LPN can take vitals and perform all of the monitoring, they just aren't licensed to interpret the findings and implement and develop interventions based on the findings.

I would imagine the interpersonal skills of your staff are going to be very important to the success of your program. I would also think you want to draw from the largest pool possible to find nurses to meet your practice needs. The pool of RNs who will meet your parameters - $20/hr, no benefits and a start up practice - is going to be small, but the pool of LPNs would be larger. Why look for a unicorn in a kiddie pool unless you know for sure you need to?

Thanks for the input. That is actually really helpful. I only recently got that news from my attorney and am awaiting a response where I've proposed other staff I can hire without exposing unnecessary liability. In the meantime, I wanted to get an idea of what the market looks like and what people on the other end reading the job descriptions on these job boards would be thinking. It would make no sense to invest in putting up a listing no one cares for, might as well brainstorm now and have a better thought out recruiting strategy.

I think your best bet is to hire 2-3 semi-retired or retired nurses who aren't ready to let their licenses go. Everyone gets a few hours of work per week, a few bucks and not a whole lot of stress. They can cover vacations for one another if they want to augment their 2 weeks with unpaid time. I think schedule flexibility would be the biggest selling point to attract a few seasoned but low-needs RNs. Good luck.

I'm just curious as to what other profession is paid according to their need? Older nurses deserve the same pay, or more, not less. I feel this is very age discriminatory.

Also, if you're working 50 hours a week that is not retired or semi-retired. Actually an older nurse deserves more pay for her experience! Why would you think it is okay to pay older nurses less? I really don't get that train of thought at all.

Who cares that much abut flexibility at 50 hours a week with 2 weeks vacation?

I'm just curious as to what other profession is paid according to their need? Older nurses deserve the same pay, or more, not less. I feel this is very age discriminatory.

Also, if you're working 50 hours a week that is not retired or semi-retired. Actually an older nurse deserves more pay for her experience! Why would you think it is okay to pay older nurses less? I really don't get that train of thought at all.

Who cares that much abut flexibility at 50 hours a week with 2 weeks vacation?

The math is 40 hours a week. At the end of the day it boils down to what 1) works for the prospective employee and what they'd like to do (in my practice in psychiatry, I see a lot of retired professionals go on to do other lines of work, not for the money but to keep structure in their day, some found full retirement to just be too boring and even depressing and some even volunteer. I especially see it in individuals who decided not to have children or live too far away from other family, most of my patients found that too much idle time was not healthy for them.) and 2) what the employer can even afford. As I said before, I'd love to pay more but I don't have that kind of money which is why I am looking into other options.

Every single reference I can find - dozens - talks about the MD establishing the correct dose and technicians or medical assistants administering. Some mention a requirement of having BLS, some mention training through the company making the equipment. Of course HIPAA training would be mandatory.

For example, from The Clinical TMS Society Consensus Review: "When rTMS is prescribed (by an MD) as treatment for any medical condition (Class 1 studies), it is advisable that a licensed physician, serving as medically responsible clinician, closely supervises the rTMS application given the more likely medical instability of the patients. The rTMS application can be carried out by a properly trained medical assistant. All personnel have to be trained to recognize and to manage a seizure or a syncope, and there should be full access to emergency treatment and life-support equipment. The responsible clinician should also make sure that the medical assistant is properly trained in how to deal with potential acute complications."

The Clinical TMS Society Consensus Review and Treatment Recommendations for TMS Therapy for Major Depressive Disorder - ScienceDirect

Specializes in IMCU, Oncology.

Your attorney may be suggesting a RN due to scope of practice. From the NCSBN website: "This tool is intended to be used by nurses, facilities, boards of nursing and other stakeholders in determining whether specific activities, interventions, or roles are permitted under the nurse's level of education, licensure, and competence while meeting the standards established by the nurse practice act and rules/regulations of each state or jurisdiction."

A medical assistant cannot practice under a RN's scope of practice, which is likely what is required during an acute situation such as a seizure. I am not familiar with the LPN's scope of practice. However, many hospitals do no hire LPN's in acute or critical care. LPN's are often hired into physician clinics.

You may find it useful to look up RN, LPN, and MA scope of practice on the nursing board of whatever state you are located.

Curious MD, ultimately you are responsible for your patients. If you hire a MA or LPN who is not licenced or trained to handle an acute situation such as a seizure, although rare, you will be liable and could lose your license.

Maybe you can hire a part time RN, 20 hours a week with no benefits to work only during the scheduled times of the TMS treatment. I am assuming TMS would occur at specific times during clinic hours.

Otherwise, I do think your desire to hire an RN trained under a certain scope of practice for $20/hr with no benefits is unreasonable. You could be attracting RN's who may be heading toward retirement years but also RN's who may be unable to find jobs elsewhere for whatever reason.

Find Your Nurse Practice Act | NCSBN

Thanks HelloWish! Since I'll be at the clinic 4 days a week, I was thinking of hiring a tech to do treatments during times I am in the office. I'll be seeing patients, to help generate more income for the practice and I'd literally be in the next room available for any emergencies. For that 5th day I'm at the VA, perhaps then I can hire a more qualified individual. The Clinical TMS Society says the MD only needs to be available by phone in case of an emergency. But I am also aggressively trying to recruit a psychiatrist and ideally, have him on site when treatments are administered. The fortunate thing is that statistically based on more recent data gathered in the community, risk of a seizure is less than 1 per 30,000 treatments, all were self limiting and I also plan to have IMs on site if needed.

Specializes in Hospice.

Regarding $20/ hour, there is quite a spectrum of wages related to what part of the country one is in. In my area, $20/ hour starting pay actually reasonable. Maybe consider hiring 2 part-time nurses - full time with no benefits could be a deal breaker for some people.

Where I work (totally different area of nursing), I have several colleagues who work part time for various reasons. Some this is a choice/ preference due to family obligations or health conditions (that still allow them to be wonderful/ competent nurses as long as they don't overdo it - hence part time). Others the part time is in addition to another full time job. I had two part time jobs for a while and loved it - one was lower acuity/ stress and the other much more intense. It worked great for me at the time. Now I found a full time job that fits for me.

Specializes in Tele, ICU, Staff Development.

I've seen this done at Cedar Sinai with a doctor present at all times. The clinic is run like an efficient, safe outpatient surgery clinic. Consents are signed, NPO prior is confirmed, allergies checked. IVs are started on patients for sedation and emergency access. Discharge instructions are given. A crash cart is nearby as are ACLS trained staff.

I'm just surprised at what you are describing.

Specializes in Psych, Corrections, Med-Surg, Ambulatory.
I'm just curious as to what other profession is paid according to their need? Older nurses deserve the same pay, or more, not less. I feel this is very age discriminatory.

Also, if you're working 50 hours a week that is not retired or semi-retired. Actually an older nurse deserves more pay for her experience! Why would you think it is okay to pay older nurses less? I really don't get that train of thought at all.

Who cares that much abut flexibility at 50 hours a week with 2 weeks vacation?

Of course the nurses themselves determine what their needs are. I just described the situation a nurse would likely have to be in to go for that job, as long as the job entailed just a few flexible hours per week. It certainly wouldn't be everyone's cup of tea.

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