Is age just a number?

B52Bomber · Nov 25, 2016

Well my focus absolutely is almost solely a correct diagnosis and appropriate medication. Your example although I'm sure it makes you feel very thorough and holistic is classic for nursing and imo will not serve you or the greater good for patients on the waiting list to see a prescriber. How long have you been a psych NP? How many patients do you see in a day?
I have therapists, case managers and my secretary to figure out who is going to help them, how they are going to pay for their meds and encourage them to remain motivated for treatment. My employer isn't paying me over $100 an hour to do that stuff. Its medication management only.

Less than a year, but I'm in a private practice position with 2 psychiatrists and an NP (who is also a psychologist and prefers psychotherapy over med management). We also have 4 therapists. Mind you our clinic is specialized in alternative medicine and many of our clients are referred to us for our use of neurotransmitter testing and other therapies not commonly offered elsewhere. Because of this, many of our patients seek out our services while continuing to see their original therapist so I do end up coordinating and developing their plan of care on deeper assessment of their needs. I see anywhere from 7-12 patients a day depending on what kind of visit. We actually offer 1hr for initial visit and 30min for follow-up.

Sour Lemon · Nov 25, 2016

I think 5 years of quality nursing experience is more than enough. I can't speak for other specialties, but nursing experience for the NICU is a must and (thankfully) virtually all schools recognize this and require a few years experience. I had 6 prior to becoming a NNP working at a tertiary center on a unit that promoted strong nurses. It made me a much better clinician coming out of the gate and the role transition wasn't as difficult as I thought it would be (ironically my anecdotal experience has been that NICU nurses who have 15+ years experience have a harder time transitioning to a provider way of thinking).

I have a relative who transitioned to an NNP role after 15 + years of NICU experience. I'm not sure she has a harder time "thinking like a provider" because of her experience ....but I do believe that she may be more cautious than someone who's seen a third of what she's seen.

Jules A, MSN · Nov 25, 2016

but I do believe that she may be more cautious than someone who's seen a third of what she's seen.

And I would bet more able to identify the signs a baby is going south much sooner than someone who hasn't cared for thousands of babies on any level. The different treatments she has witnessed over the years especially in an emergency would make me think regardless of her ability to transition to the provider role that she would be far more qualified than someone with a mere 750 or whatever clinical hours who is deluded in thinking they are prepared to take care of these most vulnerable of all patients.

Jules A, MSN · Nov 25, 2016

Less than a year, but I'm in a private practice position with 2 psychiatrists and an NP (who is also a psychologist and prefers psychotherapy over med management). We also have 4 therapists. Mind you our clinic is specialized in alternative medicine and many of our clients are referred to us for our use of neurotransmitter testing and other therapies not commonly offered elsewhere. Because of this, many of our patients seek out our services while continuing to see their original therapist so I do end up coordinating and developing their plan of care on deeper assessment of their needs. I see anywhere from 7-12 patients a day depending on what kind of visit. We actually offer 1hr for initial visit and 30min for follow-up.

That makes sense, thank you for replying. Do you mind disclosing your rate? My guess is at that low volume and with lack of focus on billable time its probably at the low end? In my area, Washington DC, psych NPs should be starting in the $150,000 year range.

babyNP., APRN · Nov 25, 2016

And I would bet more able to identify the signs a baby is going south much sooner than someone who hasn't cared for thousands of babies on any level. The different treatments she has witnessed over the years especially in an emergency would make me think regardless of her ability to transition to the provider role that she would be far more qualified than someone with a mere 750 or whatever clinical hours who is deluded in thinking they are prepared to take care of these most vulnerable of all patients.

To be fair- I did say my "anecdotal" experience (3 clinicians, one of whom could never transition and ended up going back to bedside with 20+ years experience). Anecdotal evidence doesn't speak for everyone and not even the majority- that's why it's anecdotal. There are good and bad clinicians with 2 years of RN experience and the same with 20 years experience. I know of one transport RN with a similar amount of experience who did great with the role transition and I suspect a large part of it was because she made a lot of independent decisions while out on transport (no provider went with the ambulance or plane).

But to answer your post, keep in mind that virtually all programs require at least 2 years experience and most encourage more, so it's not like they're new grads.

It's also not about recognizing when a baby is going south. Any decent NICU RN can do that already. It's about knowing what to do when that baby goes south- what your differential diagnoses are to treat the underlying problem rather than "reacting" to the problem, which is what a good NICU RN is trained to do- low blood pressure, ask for a bolus and pressors. Sudden anemia? Ask for a transfusion. But why are these things happening in the first place?

Again- this is not a one size fits all. My experience is certainly not the standard (well, it may be, but we have no way of knowing otherwise).

PG2018 · Nov 25, 2016

I can't reply in quote. The space won't work.

In the ED, I honestly can't recall ever taking a psych patient other than stapling the wrists on a woman who slashed herself to die. With the jail nursing, lol, that's a whole different ball of wax. I'd attribute most of my psych exposure to my time on the streets as a patrol officer, and really that's only helpful to me in the sense that I'm great with recognizing deception and fairly good with elicitation. It's there where I recognized the need for clinicians and chose to embark on that career path figuring I could do more to help larger society and set about on a greater trajectory.

B52Bomber · Nov 25, 2016

That makes sense, thank you for replying. Do you mind disclosing your rate? My guess is at that low volume and with lack of focus on billable time its probably at the low end? In my area, Washington DC, psych NPs should be starting in the $150,000 year range.

No problem, I love your responses it makes me think/see the bigger picture about diffferences in care and opinions of other providers. As for rate... considering it's Detroit, it pays the bills but my retirement investments won't show much growth LOL. Its over 90K which compared to my colleagues is great. I always strived to seek out my own clinicals and preceptors (usually were MDs because of their expertise) which definately helped me obtain great experience and job opportunities. Other students seemed to expect rotations handed to them and then complained how much they hated them. I actually enjoyed most of my program because I supplemented my education with certificates or trainings such as a SANE program but I would have never gotten that offered by my program.

abbnurse · Nov 25, 2016

I should've stated "don't solely provide." In psychiatry I'm not specifically concerned with WHAT their diagnosis is or WHAT medications I choose to use for treatment, rather HOW will the patient access them and WHO will be there to assist them through their treatment? I'm not solely concerned with the what's in treatment but the "ADLs" of their life being met admist their circumstances within their life that placed them where they are. Our care is multifactoral and at times I feel like I'm more focused on everything but simply their diagnosis because how can you treat if there's no access, support, negativity, or unmotivation to be treated?

Thanks for this. Good luck to you ! You've got a wonderful, exciting career ahead of you! :up:

Jules A, MSN · Nov 25, 2016

I always strived to seek out my own clinicals and preceptors (usually were MDs because of their expertise) which definately helped me obtain great experience and job opportunities. Other students seemed to expect rotations handed to them and then complained how much they hated them. I actually enjoyed most of my program because I supplemented my education with certificates or trainings such as a SANE program but I would have never gotten that offered by my program.

This was how I rolled also. I created my own excellent clinical experiences and fostered relationships that are still serving me well today. For as much as I was bitterly disappointed by the simplicity of the material and overload of nursing fluff silliness there were a few courses and all my clinical experiences that I thoroughly enjoyed.

ReNitaRN1968 · Nov 26, 2016

The reality of all of this, is that no matter how you look at this situation PA/NP's do not have the proper training [8-12 years of medical school]. So with that said, let's look at the means to an end for the use of NP's. Is it so needed that a shortage in doctors demands for the need of NP's? Is this the reason why some states allow NP's access to "full Practice" when caring for patients.

The Problem:

According to the NCSL, the shortage of physicians is that the number of medical graduates who choose to practice rural primary care is insufficient to replace the rural doctors who are retiring. A recent study found nearly 30 percent of rural primary care physicians are at or nearing retirement age, while younger doctors (those under age 40) account for only 20 percent of the current workforce.

We simply can't keep up with the supply and demand. Factor in the time for medical school and the increasing population. The NCSL states,physician supply in rural areas is already low, compared to non-rural areas of the country. Only about 11 percent of the nation's physicians work in rural areas, despite nearly 20 percent of Americans living there. Moreover, physicians providing care in rural areas often serve large geographic areas that require long travel times. These areas may be substantially underserved by hospitals and other health care facilities. Demographic shifts, such as the aging rural physician workforce and the growth in the rural elderly and near-elderly population will increase demand for primary care services.

So with that said, this movement will happen and increase in NP/PA's. So it do not matter the age or time spent as a RN until the BON puts stipulations on this issue.

PG2018 · Nov 26, 2016

I just spent Thanksgiving in a rural area. Geez. Not a single decent restaurant for two hours and nowhere to to buy quality underwear. It's not like we were at a tranquil farm with granny. It was cousins who own a telecom company. I see why nobody wants to work rural.

Skippingtowork · Nov 29, 2016

I can't believe this is acceptable actually regardless of the person's age and yet another reason my family doesn't see NPs for their medical care. What a shame the schools have become so money grubbing.

If you needed a physical therapist or an occupational therapist, and they had a doctorate, would you ask their age or how many years of experience they had? What about the PharmD. These are the degrees that are out there, so why the problem with nursing? I worked with an NP that was 23 years old, looked like 16 and operated like she had been working for 20 years.