should I take an FNP job in Florida?

Gator FNP · Jun 24, 2009

I live and work in Florida. If I were a new FNP, I would not choose FL as my first choice. I have worked in several offices and what happens is: I see the pt, do everything, send them to checkout, and I get the MD to sign whatever I need signed, no questions asked. This way the pt is not waiting long.

It is very frustrating, especially the last office I worked in, had alot of ADHD, needed signatures. The state has been fighting for 15 years, we lost again this year for the right to prescribe controlled substances. If I obtained a signature for a prescription, I would write in the plan, consulted with MD, signed script, and given to pt. I, however, did not consult, he/she signed.

Pick another state in the Southeast for the warmer weather, then move to FL when the law changes. It is beautiful here, I live on the east coast, would not consider moving at this point.

Hope this was helpful.

SandBetweenMyToes, BSN, RN · Jun 24, 2009

Thanks for the candid reply. I too had my sights set on Florida after getting my FNP (starting in the fall), but I had read that report (Pearson report I think) that gave Florida low marks for NP's autonomy. Are you working in a clinic or a doc's office? Do you mind if I ask what city? I had my heart set on the Space Coast...

BChapp3182 · Jun 25, 2009

I am a new grad in south Florida. Recently an NP was left blank presigned rx slips and she was prosecuted for practicing medicine. She also would see the pt. write the script and have dr. sign. She got in trouble for that as well. I think she lost her license and even did jail time, but I can't remember the details. I know the board wanted to make an example out of her.

In south FL the job market is horrible. The cost of living here is astronomical. Property taxes are insane.

My classmate went back to TX after graduation, tons of jobs, full autonomy in rx and practice, cost of living is great. She's renting a 4 bedroom 3 bath house with large yard, 2 car garage all for $1200 a month, just outside of Dallas. A house like that here would be easy $3200/mo. She was paying $1400/mo for a 1 bedroom 800 sq foot apartment here! She says the people there are so friendly, neighboors actually know each other. In south FL everyone keeps to themselves, people are rude for the most part and you have got to be fluent in spanish to compete in the job market here. It really sucks.

I wish I could move to TX or AZ (somewhere warm) but have too many ties here.

I do see lots of jobs in northern FL, like Tampa/Orlando area. But it's just as expensive.

core0 · Jun 25, 2009

I am a new grad FNP and wanted to move to Florida to enjoy the sunshine.
I was disappointed to learn that Florida is one of only 2 states in the US (the other is GA)
where NP's cannot write prescriptions for controlled substances. wow.
I heard that in some practices, the physician will leave a signed pad for the NP (isn't that illegal?), or the NP must
lay out the prescriptions for the Dr. to sign "when he has a chance"(isn't that illegal too?). Isn't the provider supposed to see the patient? I imagine that the Pt is standing around
and wondering why they didnt just see the Dr. while they're left waiting.
That really doesn't sound too good of a situation to me, but I would like to hear from those of you that know the real deal. It sounds very subserviant, but I hope I am overreacting.
So....Should I forget about FL until the laws get changed?
How can FNP's have autonomy with this law? Are they working like PA's only?
Any chance of this awful law changing soon?
thanks for your input!

Just out of curiousity why would you think that PAs don't have any autonomy? For what its worth FL is considered the worst state in the nation for PA practice. We have a model practice act and Florida does not meet a single one of the model items:

http://www.aapa.org/component/content/article/26--general-/490-model-state-legislation#Model%20State%20Legislation

David Carpenter, PA-C

morganvibes · Jul 21, 2009

Hi,

I didn't say anything about PA's- can you explain what you mean?

I don't know what PA's can or cannot do.

SandBetweenMyToes, BSN, RN · Jul 21, 2009

You wrote:

"How can FNP's have autonomy with this law? Are they working like PA's only?"

I, like David, was wondering what you menat about the PA comment...

morganvibes · Jul 21, 2009

Ok, I see that now, sorry.

I meant that in other states, NP's can practice on their own, even open up their own practices, whereas PA's must be directly under the supervision of a Physician.

Obviously an NP cannot practice on their own in FL if they can't prescribe controlled substances.

Like I said, I am not an expert on the scope of practice for PA's but that's what I thought was the main difference.

core0 · Jul 21, 2009

Ok, I see that now, sorry.
I meant that in other states, NP's can practice on their own, even open up their own practices, whereas PA's must be directly under the supervision of a Physician.
Obviously an NP cannot practice on their own in FL if they can't prescribe controlled substances.
Like I said, I am not an expert on the scope of practice for PA's but that's what I thought was the main difference.

You need to understand how supervision works. In Florida as in most states the physician merely has to be available by phone (the same for PAs and NPs). Direct supervision has a very specific meaning. There is no state that requires continuous direct supervision for PAs. You also use autonomous and independent interchangeably when they are not. There are 12 or 13 states (depending on how you count them) that allow NPs to practice without any physician involvement as long as they don't bill Medicare or Medicaid. The vast majority of NPs work for someone else just like PAs. Within these jobs there are varying degrees of autonomy. Autonomy in a particular job is earned. Its not earned by demonstrating "independence", its earned by demonstrating competence.

If you consider practice ownership as "independence" then the percentage of PAs owning practices is similar to the percentage of NPs at around 2%. For PAs this is probably an understatement since the last salary survey put the percentage with some type of ownership at 4.5%.

The primary difference between NPs and PAs in my opinion is scope. The NP scope is defined by their training and certification. PA scope is defined by the the supervising physician. Depending on where you practice the scope can be very similar or more limited.

David Carpenter, PA-C

ivanh3 · Jul 23, 2009

You need to understand how supervision works. In Florida as in most states the physician merely has to be available by phone (the same for PAs and NPs). Direct supervision has a very specific meaning. There is no state that requires continuous direct supervision for PAs. You also use autonomous and independent interchangeably when they are not. There are 12 or 13 states (depending on how you count them) that allow NPs to practice without any physician involvement as long as they don't bill Medicare or Medicaid. The vast majority of NPs work for someone else just like PAs. Within these jobs there are varying degrees of autonomy. Autonomy in a particular job is earned. Its not earned by demonstrating "independence", its earned by demonstrating competence.
If you consider practice ownership as "independence" then the percentage of PAs owning practices is similar to the percentage of NPs at around 2%. For PAs this is probably an understatement since the last salary survey put the percentage with some type of ownership at 4.5%.
The primary difference between NPs and PAs in my opinion is scope. The NP scope is defined by their training and certification. PA scope is defined by the the supervising physician. Depending on where you practice the scope can be very similar or more limited.
David Carpenter, PA-C

Some great points David. I know this is off topic, but can you give me (post or private message) some the sources for the percentage of owning practices? I am taking a class right now, and that would be some great info for me to share with the class. I seem to be finding some misperceptions about the PA profession, and you know me, I like to keep people up to date!

Ivan

core0 · Jul 23, 2009

Some great points David. I know this is off topic, but can you give me (post or private message) some the sources for the percentage of owning practices? I am taking a class right now, and that would be some great info for me to share with the class. I seem to be finding some misperceptions about the PA profession, and you know me, I like to keep people up to date!
Ivan

The numbers for NPs come from Advance for NP (questions 6).

http://nurse-practitioners.advanceweb.com/Sharedresources/advanceforNP/Resources/DownloadableResources/NP010108_p28table11.pdf

For the PAs its a little more complex. On page 19 Table 3.22 there is a question about ownership. It breaks it down by type.

http://www.aapa.org/images/stories/2008aapacensusnationalreport.pdf

David Carpenter, PA-C