Nurse Practitioner Questions

[iheartqd]

Hello everybody!

First and foremost, I'd just like to introduce myself to the allnurse community. I am a new grad FNP, and currently work with an interventional cardiologist in both outpatient and inpatient setting. However, I do not have much cardiology experience. I have worked as a pediatric rn in med surg, and PACU rn for both adults and pediatrics. I would like to gain as much information and knowledge as possible! The dr I work with is very smart and great at what he does. However, I am his first NP and he doesn't have much time to teach and train me. He trusts me and says that with time and experience I will learn better that way. I am searching for learning opportunities, and would love your feedback on this issue. He also does not have standards or protocols for NP in the office. How would I go about obtaining these?

I have considered taking a post masters ACNP program, or NP fellowship in Cardiology (which is offered in Phoenix, AZ). I also have an interest in Alternative Medicine, and have contemplated the NP fellowship at University of Arizona. I am also interested in possibly pursuing a RNFA at UCLA, but would need a surgeon for my clinical hours. Cardiothoracic Surgery is interesting, but I know the job market is pretty slim right now!

Please let me know your suggestions! Thank you!!

[nomadcrna, DNP, CRNA, NP]

1. Practice evidence based medicine. It is time to make the transition from RN to practitioner. You don't have to practice according to "protocols".

Cardiology fellowship would be nice. It depends on your state laws btw. In the states I practice, an FNP can work pretty much anywhere. ACNP would also be great.

You also do not need to do a RNFA, unless it is just to learn fast. You can hire on with a surgeon and get OJT. There are a number of FNPs working for ortho and one neurosurgeon as first assist here in Montana.

Again, your mileage may vary depending on your state of practice.

[iheartqd]

1. Practice evidence based medicine. It is time to make the transition from RN to practitioner. You don't have to practice according to "protocols".

Cardiology fellowship would be nice. It depends on your state laws btw. In the states I practice, an FNP can work pretty much anywhere. ACNP would also be great.

You also do not need to do a RNFA, unless it is just to learn fast. You can hire on with a surgeon and get OJT. There are a number of FNPs working for ortho and one neurosurgeon as first assist here in Montana.

Again, your mileage may vary depending on your state of practice.

Thank you for your response. I thought that standards and protocols for procedures were needed at every office and hospital for Nurse Practitioners due to scope of practice?

What is "OJT"?? I believe it's according to the hospital procedures, and most in California require a RNFA certification to be in the OR with the physician.

[mammac5]

OJT = on the job training

[nomadcrna, DNP, CRNA, NP]

The protocols may be needed in California but in many states we practice independently.

An RNFA is for RNs to be able to act and bill as first assists. You do not need an RNFA if you are an NP.

It is very common in Montana for FNPs to work with ortho and 1 neuro surgeon I know utilizes an FNP as first assist as well as clinic and inpatient.

See below for the first assist question from ACNP

Q. Can a nurse practitioner bill as a first assistant at surgery? Are there specific educational requirements in order to qualify to be a first assist as an NP?

A. Medicare pays for assistant-at surgery services under both the hospital inpatient prospective payment system and the physician fee schedule. Payments under the physician fee schedule are limited to a few health professions. Nurse practitioners are permitted under Medicare to receive payment as first assistants in surgery.

Medicare makes a single payment to hospitals for all the services, including assistant-at-surgery services, that a hospital provides to a beneficiary while an inpatient. The inpatient PPS pays predetermined fixed amounts for groups, or bundles, of services, designed to provide incentives to control spending by rewarding efficiency. Medicare also makes payments under the Medicare physician fee schedule for assistant-at-surgery services performed by physicians and members of certain nonphysician health professions whose members assist. These nonphysician health professionals-primarily physician assistants, nurse practitioners, and clinical nurse specialists-are allowed to bill Medicare under the physician fee schedule.

There is no widely accepted set of uniform requirements for experience and education that the health professionals who serve as assistants-at-surgery are required to meet. The health professions whose members provide assistant-at-surgery services have varying educational requirements. No state licenses all the health professionals who serve as assistants-at-surgery.

For assistant at surgery services, payment equals 80 percent of the lesser of either the actual charge or 85 percent of the physician's fee schedule amount paid to a physician serving as an assistant at surgery. A physician serving as an assistant at surgery receives 16 percent of the physician fee schedule amount. The NP allowance is 85 percent of the 16 percent (13.6 percent of the physician fee schedule). The assistant surgery (AS modifier) must be submitted with the claim.

[nomadcrna, DNP, CRNA, NP]

Sorry, here is the link for the above info.

http://www.acnpweb.org/i4a/pages/index.cfm?pageid=3436