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!

Well... if you're willing to hire maybe an RN "in recovery" you can post this in the recovery forum on here. There are lots of nurses on probation looking for a job that does not involve controlled substances and would love any job, period.

I'm actually very supportive of this. Actually, I can think of two RNs who went into recovery and were recruited into private settings. Both loved it and did well, both actually decided to stay, moved up in the clinic and assumed additional admin duties. As a psychiatrist I understand a core piece to recovery is restructuring a sober lifestyle with as little access to the substance of choice as possible. Having a job they enjoy and find meaning in is a powerful augmenting agent to the treatment and open time is a powerful risk factor for relapse. I understand also from an employers standpoint their hesitance to hire someone with history, but it is also a vicious negative cycle for the person who is genuine about their recovery.

I'm just going to be honest with you, it going to be hard for you to find a nurse to work for that in long term. I recently took a position myself that entailed low pay because I was told that all I would be doing was office work. It turned not to be true and I only lasted one month.

Ive started drafting a job posting and plan to give as detailed a job description as possible at interview. Frankly, I believe in being...well...frank even at the interview. I want the prospective employee to know what they are in for and I want to know what I'm potentially in for if I hire them. Now, I know we are both still trying to put our best faces on at the interview, but my philosophy is if one of us know it won't work, best to say so earlier than later.

Where do you guys live exactly?

Some of you are exaggerating.

There are lots of fields only offering $20/hr with no benefits.

When I did private duty nursing as an Rn with 5 years experience through an agency I was paid $20/hr,and health insurance was crazy expensive,at $200/week. No other benefits were offered either,no vacation,401k,etc. This was in South Carolina.

But those jobs probably don't entail the amount of work or responsibility that being a nurse entails.

This thread is actually depressing. :dead:

I would just suggest indicating the salary and "no benefits" on the job ad itself just to not waste your time... but I'm sure you'll find someone. The average nurse IS looking for more money but certainly there will be people willing to do it. Someone sick of the higher intensity of the hospital that maybe is looking for an easy "retirement" job, or someone in recovery, etc.

Maybe a retired RN who still has her license? Or a new grad who is still looking? This is better than flu clinics and that is seasonal, so maybe those RNs are available.

Or maybe someone in recovery that has a lot of restrictions that makes a regular job hard to find?

These are my thoughts. I would never consider a position like this in an office setting for any amount of money, even if my state BON said the responsibilities were within my scope of practice. This does not appear to me to be a low risk, low liability position, even if the procedure is considered low risk for the majority of patients. I think NurseBeth and Wuzzie gave the most relevant comments. Maintaining competence at ACLS requires significant time and effort, and as I see it, if this procedure is not done as part of a hospital group, in a setting and with staff that are competent to monitor the patient's cardiac and respiratory function throughout the procedure, and if necessary implement resuscitation/advanced airway procedures, with O2 available, and with a crash cart close to the patient, one will be unprepared to deal with an emergency and will not have a team close by should an emergency arise. For example, if the patient has a seizure and stops breathing, they will need emergent medical care, and staff will need to be able to provide manual ventilation. In the OP's setting there is no anesthesiologist to intubate the patient and manage their airway. If a seizure results in significant cardiac arrhythmias, one will need to follow ACLS protocols, and this will require a number of staff and specialized equipment.

Interestingly risk of a seizure from TMS versus from taking an antidepressant, the latter is actually higher. And that's if you include the TMS seizure cases from TMS experimental days, people who were drinking heavy but not disclosing that, and the psychogenic seizures. The Clinical TMS Society deemed it not necessary to have IV access, oxygen, suction, etc. available for safe practice of TMS (page 342 from 2016 guidelines) in an outpatient setting and most treatments are done in outpatient psychiatric clinics. I plan to have protocols established though.

Specializes in NICU.

i think that would be ideal for a retiree,depends on travel distance and uniform expenses,parking availability,post in AARP.

You will find a qualified RN. In my area, many nurses are leaving the hospital setting for outpatient clinics. It's just my opinion, but the "suits" that run the hospitals in my area seem to only care about lawsuits and protocol. The pt. ratios, acuity, and pay are the contributing factors to these trends. There are nurses out there that have insurance through their spouse that will take a pay cut to work in a relaxed environment. But I would make sure you hire a MEDICAL nurse with ER, ICU experience as opposed to a psych nurse with limited clinical skills..... and that's not meant to be insulting to psych nurses! I love and appreciate them! But if it was my practice, I would hire someone who has routinely treated seizures as opposed to maybe once a month.

Specializes in Outpatient/Clinic, ClinDoc.

As a few peeps have already said, while $20 an hour isn't great, it's not horrible in some areas.

New grads where I live make only a few bucks more than that. And I applied a year or two back for an "RN required" non clinical job - they called me back and warned me the pay was only $16/hour (low even for here).

I'd be willing to bet OP would find takers unless the standard payscale was a LOT higher in Wisconsin. Still, an LPN should be considered - that would be excellent LPN pay where I live (about $15/hour is the norm). And part timers/per diems would be even better!

Specializes in Flight, ER, Transport, ICU/Critical Care.

I guess the practice issues don't bug me. Well, not much.

Once you come from flight, you literally fear little. As long as we can clear it all with the BON and Boards of Medical Licensure and write standing orders & have a way to maintain clinical competencies, have clear EMS backup great equipment, plan for contingencies and treat patients with the best standards of care - I'd have no issues.

While, I wouldn't worry about seizures. I can manage a seizure. The hopefully rare status seizure will need nasal intubation or at least a way to maintain airway/ventilators support/oxygenation and that is in my scary wheelhouse, but still. Airway... matters. That's what standing orders are for - being competent with an Ambubag and nasal airway will matter. So would having advance IV access - more on that later...

The main thing is meeting rock solid standards of care for patients.

Every patient is treated the same way each and every time.

Prepared for every contingency. Emergency.

Onward.

My real question comes from an issue brought up by Nurse Beth.

The real issue is... she mentioned at Cedars noted that the patients are IV sedated for the procedure.

My big question, IS THIS PAINFUL. IS THIS WELL TOLERATED? DOES IT GENERATE NOISE OR HEAT?

Now, before you answer, I've had 5 MRI's in the last 3 years and it's really tough to be in a closed machine for 40 minutes. Just being anywhere, doing anything medical for an extended time is tough. Will it be tolerable for these patients? I'm ok, but I have no issue with closed spaces - I could see noises or small things or constructing devices bothering someone.

I'm genuinely curious why one center would line and load their patients undergoing this procedure?

•• Should the patients at your center be IV'ed and O2'ed as a precaution?

•• Is light sedation going to be necessary for "some" patients?

The treatment seems intriguing to me.

If I lived there, the money is fine - and there is potential to do better - right? If you were local to me, it sounds awesome even. I'm free of debt - so I'm free to choose low stress, no routine heavy lifting, little drama and interesting - nice gig.

Good Luck

:angel:

Could you offer the treatment only on certain days and pay the person more $ per hour as a part timer. Say $35/hr to work 25 hours per week? What does the BON in your state say about who can do the treatments?

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