Need to Interview an NP

Hi Michelle - I'm not an NP, but rather an adult health CNS - would be glad to help.

1. Role description - Currently, I'm a nephrology RN who does the rounding visits on 200 chronic hemodialysis units located in two areas. I have to see all 200 patients each week. I handle their medical needs: HTN, DM, etc..

2. Type of setting - outpatient chronic hemodialysis units, free-standing.

3. Hx of the role and plans for the future - this is strictly dictated by Medicare requirements. CUrrently the requirements mandate that the pts have one MD visit while on dialysis each month and then three other visits which can be from a mid-level practitioner. No change for the future unless Medicare changes.

4. Role conflicts - I actually am employed by the physician practice versus the actual dialysis company. I am usually able to get what I need but since the dialysis company is for-profit, there are sometimes challenges. For instance, I have a recently dx'd pt who has a documented heparin allergy (positive Factor 4) and he has a permacath. Normally, you would lock the Permacath (after dialysis) with heparin. However, 20% of the heparin leaches out of the system into the pt so that wasn't feasible. However, citric acid 4% is what is to be used and it is very expensive and the request ended up going up the change in the dialysis company which took two weeks. During this two week period, the permacath was locked with tPA. Not a biggie if its aspirated completely prior to dialysis. However, it was an accident waiting to happen. So, the permacath was labelled with bright orange labels stating that tPA was in place and must be aspirated. Not the best solution.

5. Barriers - the two main reasons folks go on dialysis are HTN and DM. Pts run a much higher risk of needing dialysis if they are noncompliant. Many of my patients are completely noncompliant: don't take meds, dont' come to dialysis, don't restrict fluids, etc.. Makes it very hard to care for them.

6. Special skills....hmmm having a hammer to whack some sense into these patients comes to mind - lol. Negotiation skills, ability to try to understand why some of the pts are noncompliant, ability to work with people from all walks of life.

Hope this helps...

Hello, michelle_icurn,

I sent you a private message.