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New grad FNP - Health Risk Assessments?

Specializes in ICU, Military.

I graduated in May 2020 and passed my ANCC boards the same month (FNP-BC).  The job market is slow here in eastern KY, and I really need to get my foot in the door but most jobs require at least a year of experience.  I have been contacted by recruiters about doing health risk assessments for a medicare companies (annual wellness exam) in the person's home.  Has anyone had any experience with these?  I am in KY and would not require a collaborating physician since no medications would be prescribed.  Would this count as "real" NP experience?   Also in KY you must be a practicing NP before you can apply for a DEA license (with proper collaboration agreement), so would this experience start the clock for that requirement as well?  I ask because alot of jobs around here require a DEA license, which I am not yet eligible for.  

Also - would I be looking at lots of liability with these exams?  The company does provide malpractice insurance with tail.  

Incidentally - I am in a position where I could do travel/locum assignments, however my new grad status is hindering this as well.  I can move pretty much anywhere (not married, no kids).

Any advice would be appreciated.

 

I did these assignments for about 6 months on my off weeks from the hospital. It was fine. I did have all the licensing from my primary job though but like you said I didn't prescribe or change treatment. Occasionally I'd find something screwed up and tell them to call their PCP.

I'd schedule about 8 visits a day for 3 days on my off week. The company I used was pretty flexible and my contact person was helpful. If I went far they'd give me a rental car and hotel. $40 per diem daily. I could get through the assessments really quick after awhile. Knew the questions by heart. No thinking whatsoever so it will make you money but be absolutely no help to you in the future and as a new NP I'd be concerned about that. Maybe the experience will help you get a job though.

Something you should know, I went into some shady places. Hoarder homes, massive fires hazards, and once I was bitten by a cat. Didn't even see it the thing just jumped out of a junk pile in the middle of the living room. I'm male and was hesitant about a few neighborhoods. I would be really concerned about my wife doing that job. I did see some really beautiful homes also. Now I just pick up OT at the hospital because although it's very busy it's at least safe.

anchorRN, BSN, MSN, RN, APRN

Specializes in ICU, Military.

8 hours ago, IMNP said:

I did these assignments for about 6 months on my off weeks from the hospital. It was fine. I did have all the licensing from my primary job though but like you said I didn't prescribe or change treatment. Occasionally I'd find something screwed up and tell them to call their PCP.

I'd schedule about 8 visits a day for 3 days on my off week. The company I used was pretty flexible and my contact person was helpful. If I went far they'd give me a rental car and hotel. $40 per diem daily. I could get through the assessments really quick after awhile. Knew the questions by heart. No thinking whatsoever so it will make you money but be absolutely no help to you in the future and as a new NP I'd be concerned about that. Maybe the experience will help you get a job though.

Something you should know, I went into some shady places. Hoarder homes, massive fires hazards, and once I was bitten by a cat. Didn't even see it the thing just jumped out of a junk pile in the middle of the living room. I'm male and was hesitant about a few neighborhoods. I would be really concerned about my wife doing that job. I did see some really beautiful homes also. Now I just pick up OT at the hospital because although it's very busy it's at least safe.

Awesome info man!  I'm also a guy and although the sketchiness of going into a person's home is still a concern, I'm a little less worried about my safety than others may be.  My main concern is to get some experience on my resume.  When I apply to jobs on Glassdoor, Indeed, etc., alot of the positions have a "pop up" that asks how many years of NP experience do I have and you have to answer that question (zero for me) before letting me submit the application.  I assume this sends it straight to someones trash LOL.  I'm a veteran and I'm going to apply for some jobs on USAJOBS and see if I get any responses because of veteran preference.  I'm more than willing to move away from here.

KatieMI, BSN, MSN, RN

Specializes in ICU, LTACH, Internal Medicine.

22 hours ago, anchorRN said:

Awesome info man!  I'm also a guy and although the sketchiness of going into a person's home is still a concern, I'm a little less worried about my safety than others may be.  My main concern is to get some experience on my resume.  When I apply to jobs on Glassdoor, Indeed, etc., alot of the positions have a "pop up" that asks how many years of NP experience do I have and you have to answer that question (zero for me) before letting me submit the application.  I assume this sends it straight to someones trash LOL.  I'm a veteran and I'm going to apply for some jobs on USAJOBS and see if I get any responses because of veteran preference.  I'm more than willing to move away from here.

I had to do it as part of my previous job (private practice), tolerated it for very short time. 

1). It will add nothing to your resume as everybody knows that the assessments pretty much excluded any clinical/critical thinking. You will learn questions by heart after a few times and then just mechanically ask them in prescribed order, that's it.

2). Safety is going to depend on where you do it but it can be a real biggie. It was the reason I said "no more" after a couple of dozens (I am female). Hoarders, really dirty houses and dogs were bad enough, but when one guy showed up with semi-authomatic gun in his hands while smoking a joint  to kill the characteristic "sour" aroma of kitchen meth processing, that was the end of it for me. 

3). Re. new job search: Google every private practice and hospice in your vicinity, especially rural ones if you live close enough and either look for their "careers" openings (if they have online site at all) or call directly. Private practices typically do not have time and money for ads, recruiting and such and pretty frequently just quietly go desperate for help till it happens to arrive. Also ask your PCP and ask everybody you know to ask their PCPs too. 

Private can be VERY hard, haphazard and challenging work with low pay but it almost universally gives an excellent exposure and more than plenty of practice. Honestly wishing you good luck! 🙂

DLS APRN CNP

Specializes in Nurse Practitioner.

There is a NP job saturation in my area, so taking a job conducting health risk assessments was my only choice. I have been doing it for 2 years. As a woman, I do not feel safe going into stranger's homes. I carry mace but honestly that's probably not going to help much. I've been in filthy homes with infestations, hoarding, drugs & drug paraphernalia, schizophrenic/mentally ill patients, guns, angry patients yelling at me, and last not but not least, dirty old men who hit on me (one guy tried to show me scantily clad photos of a woman he was "dating", I've been asked out so many times I cannot count, I've been offered the bed to sit on...). I don't mind seeing elderly Medicare patients. I've sent several to the ER who otherwise would not have gone...helped a domestic abuse victim...and got case managers involved when the elderly didn't have food/medication/transportation/etc. Unfortunately, my employer started having me do Medicaid assessments, which means my patient population has gotten younger and the neighborhoods I go to are not the safest. For example, I was stranded in a Medicaid patient's home because the police were doing a drug raid next door. Many of the neighborhoods I visit have memorials set up on street corners/telephone poles for murder victims. If you're a man and cannot find a NP position, I would say give it a try. If you're female, I would say stay away. Your safety isn't worth it. Thankfully, I now have experience under my belt and have been offered a new job, which I happily accepted. Best of luck!

As others have noted, Medicare wellness exams give you absolutely no clinical experience. At most you get adept at getting detailed histories. But those companies only goal is to make a quick buck while you do the leg work. They have very minimal overhead or need of facilities as technically no physical exam is necessary. It’s an annual “come to Jesus” so Medicare can better plan for the next year.  Ensuring the patient knows what preventative things they *should* be getting (whether they opt to actually do them or not). These companies are not vested in the long term outcomes as their only role is to ask the questions and document the needs. Meanwhile pcps never see those outcomes and basically are already doing the same thing. 

I don’t recommend this as a first job and only as a supplement should you need the extra cash. It will never get you in the door. 

KatieMI, BSN, MSN, RN

Specializes in ICU, LTACH, Internal Medicine.

12 minutes ago, djmatte said:

 

I don’t recommend this as a first job and only as a supplement should you need the extra cash. 

One job which is quite similar but better in so many senses is doing "face-to-face" for hospices. It is also about visiting homes whuch can be, er... different, but at least you perform real physical and use VERY real clinical knowledge. And most people realize how much you are needed and behave accordingly. 

You'll need DEA # as you are going to prescribe a heck of controls but you are paid per visit and get real experience. Plus that feeling of helping people at some of the most difficult momenrs of their lives. 

14 minutes ago, KatieMI said:

One job which is quite similar but better in so many senses is doing "face-to-face" for hospices. It is also about visiting homes whuch can be, er... different, but at least you perform real physical and use VERY real clinical knowledge. And most people realize how much you are needed and behave accordingly. 

 You'll need DEA # as you are going to prescribe a heck of controls but you are paid per visit and get real experience. Plus that feeling of helping people at some of the most difficult momenrs of their lives. 

Absolutely agree.  My wife was a hospice RN for years before she moved on to senior living.  It is an area in need of providers and while it is a tad niche, it will still get you some solid assessment skills.

Catherineann, BSN, MSN, APRN

Specializes in Sleep Medicine.

I have been doing HRA’s for about 6 weeks via telehealth. My hours at my FT job we’re cut due to covid and so thought HRA’s would be a nice supplement. I went into it with about 2 years of specialty NP experience and it’s been fine. The patients (Medicare) have been lovely. I’ve definitely enjoyed that part of it and I’ve definitely become a better history taker. Financially this job was just a mistake. It likely depends on the company but mine provided iPads to document with which has proven to be a PIA and takes far longer than it should. I’m constantly getting charts back requesting addendums for missing items which were not missing at all. We get graded on the accurateness of our charting and so these bogus addendums kill your score. The company created their own software and it often dumps info from the chart. There can be a TON of technical issues on the patients end which kills your time. Basically I’m making half of the hourly pay due to how long it takes to document after the visits.
it may be better with in-home visits, but I would steer clear of the outsourced telehealth ones. 

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