NP in Nursing Home/SNF

Specialties NP

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I've looked through and searched several pages but cannot quite find much about this topic with many good answers.

Does anybody here work as a NP in a SNF/nursing home/assisted living? There are many postings in my area through independent companies placing NP's in these facilities and was wondering how the work was, if pay any better or worse, what a typical day is and anything else that might be helpful.

I went rounding at a local SNF with one of my preceptors and it didn't seem like bad work.

Thanks in advance for any help!

On 4/7/2015 at 11:12 PM, Hi2Jenn said:

I just started doing this a month ago. It is not what I plan on doing long term, but for now it is working. I also had a background in home health. I love the autonomy and the freedom. I do more rehab patients than long term. My expectation is 15 to 20 daily. It is very doable. I set my own hours so long as my patients are seen.

I am expected to see at least 20 to 22 patients a day. Is that normal?

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I have been doing SNF for the last 10 years, at first parttime and full time for the last 3. I enjoy it, you can't beat the autonomy. You do have to look the other way sometimes because of poor staffing. I am a PMHNP, so my role is a little different.

I work for a company that expects you to see at least 12 patients a day. After that, we are paid by productivity.

I do average about 20 patients a day. Keep in mind, that is mostly revisits. It gets easier as you know your residents.

Finding the resident and charting are the 2 main downsides.

22 residents is definitely a full day. You are bringing in well over 300k in reimbursements.

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They want to pay 105k and then 50% of anything above the minimum amount of patients

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Specializes in NP.

Hi Laura, did you take the job? What is the minimum amount of patients/day that you need to meet to bonus?

thanks in advance

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Hello everyone! I’m a new grad and this will be my first job! I’m orienting first about 3 mos and will be taking over a new facility. I’m nervous as hell, but by orientation so far , it seems doable. Any recommended materials that was a help to you?

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Hello so an update: anyone else working in SNF setting? I have a few questions.... will really appreciate if you can dm me

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Specializes in ICU, LTACH, Internal Medicine.

I covered plenty of SNFs, ALFs, independent care facilities, etc.

Doing that was one of the reasons for me to leave this job. It is just not my cup of tea. The wast majority of the facilities are not fit for caring for patients with level of acuity they are sent from the hospital. Facilities are operating under policies/schmolisies which are definitely products of someone's deeply disturbed mind. Spontaneously increase a dose x2 times because "as per policy we cannot give half pills, only whole ones" - easy thing. Substitute one pill for another without telling provider as per "pharmacy request" - even easier (the med in question was immunosupressant for transplant scheme, mind you). Yes, autonomy (sometimes), and flexible hours (again, sometimes), but tons of paperwork, calls any time of the day and night for the silly "concerns" like mosquito flying around the patient ("but his roommate has hepC, can we order some blood test or something???"), endless notes for 20+ patients seen in a day, forced to "double prescribe" narks because "we always need TWO scripts" and heck with the fact that double scripting is illegal and endangers YOUR license, politics worse than in hospital, treating payients as "clients" and families as "guests", the said families pretty much run the place, etc., etc.

Maybe someone would like it. Not me, for any money.

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On 12/11/2014 at 3:28 PM, TakeTwoAspirin said:

I work for an independent company that places providers into facilities. I currently cover two facilities, around 140 patients, split between rehab., snf, and ltc. I really enjoy the variety of patients I see and I like the independence. My company really does not care what hours I work as long as I cover my patients and make the minimum numbers. If I need to go early one day I will make the time up later in the week. Depending on what is going on at the facility, I can see anywhere from 6 to 15 patients in a day. Because I am not employed by either of these facilities I don't get involved in too much drama or internal politics - I just do my rounds and move on. Not saying there are no frustrations with this kind of work, but on the whole I prefer it to being employed at one facility because of the kind of politics caliotter3 has mentioned.

I certainly think it is worth looking into if you are interested in this line of work. I am salaried with a production bonus that is well within my ability to maximize, and I have fully paid health benefits as well as the usual add on's - mileage, CME credits, 4 weeks vacation, 7 days paid education days, sick pay, etc.

Hi, I’m a new grad and have accepted this as my first job...what drew me in, as mentioned was flexibility. I started 2 mos ago and I feel like now I’m all alone. I don’t feel I was properly trained for this role. They always mention we’re a phone call away..but that doesn’t mean they are always available either. The min I need to see is 15...I’m not making that mark...I’m at a 190 bed facility with another experienced np doing the short term side and I’m doing long term. I think I’ve been taken advantaged off...she now has a 3 day weekend and has let me cover the whole facility twice in the last 3 weeks. I’m so not comfortable with doing that yet!!!!!!! I’m definitely in search for another job!!!! Another thing is As a new grad all this billing bs is driving me crazy!!!! What can I bill in a SNF setting?????? Obviously sick ones, but anything else? Hospice rec? Please helplpppp

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Technically any time you review labs, if you see the patient, you can bill. If you review a BMP, write a note. Any INRs, see the patient an write a note. Skin tears, note. Any adjustments to insulin, write a note. Any patients who fell, write a note. Write a note and bill for any controlled substance refills. If you do this, you should hit 15 a day.

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Thank you! The one who is supposedly orienting me said I couldn’t do Coumadin dosing and bill...how about recommendations from dietician or hospice?

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yes, as long as you see the patient yourself.

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I am in mental health, but I know what the PCPs do.

You talk to the nurse, you review the chart, you see the pt, however briefly. You can bill even if you don't write an order.

No need to document the 12 cranial nerves, strip the body naked for a full assessment ( it didn't really happen) which is the big rip off I see all the time.

Medicare values a simple visit where you don't write an order as 15 minutes. Total. Chart review, staff information. Absolutely not 15 minutes examining the pt.

I have never heard not being able to bill for coumadin dosing, dietitian recommendations, or hospice. Sounds like a ton of crap.

If you are in a 190 bed facility, you should be seeing 20 pts a day, or close to it.

If you are somehow not getting that many referrals, something is wrong.

And 20 pts a day should not usually take more than 8 hours. If it does, you are doing something wrong.

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