Dumb question--What do you NPs do?

Specialties NP

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My program attracts a lot of people interested in becoming NPs. I'm looking more towards the CNS role, as I'm looking for something more hospital-oriented and specialized. I've never wanted to do the kind of primary care my PCP does (and I'm not looking forward to yet more school).

But I really like and am good at basic physical assessment, which is something more associated with NPs (and is in fact taught by NPs for both the lab and lecture sections). So, I'm starting to wonder if I am right about the NP role.

So what is it that you all do?

Specializes in Nephrology, Cardiology, ER, ICU.

pinoyNP - I CAN be credentialled to do this. Since I will be working with the hospitalist in palliative care, I doubt I will get much of a chance to do many procedures. Anyway...just wanted to let folks know that APNs can and do do many different procedures.

Thank you.

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I was referring to Medicare and Medicaid,

"On March 26, the Health Care Financing Administration (HCFA), the Federal agency responsible for administering the Medicare and Medicaid programs, issued a much-waited program memorandum implementing direct Medicare reimbursement for nurse practitioners (NPs)"

"The memorandum makes clear that "services provided `incident to' physicians' services . . . are not affected" by the new law. Such services must continue to meet the current requirements for "incident to" services (i.e., provided by employees under direct physician supervision, etc.) They will continue to be paid at 100 percent of the physician rate."

For all NP practicing under in an MD's office, or a hospital setting.

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I was referring to Medicare and Medicaid,

"On March 26, the Health Care Financing Administration (HCFA), the Federal agency responsible for administering the Medicare and Medicaid programs, issued a much-waited program memorandum implementing direct Medicare reimbursement for nurse practitioners (NPs)"

"The memorandum makes clear that "services provided `incident to' physicians' services . . . are not affected" by the new law. Such services must continue to meet the current requirements for "incident to" services (i.e., provided by employees under direct physician supervision, etc.) They will continue to be paid at 100 percent of the physician rate."

For all NP practicing under in an MD's office, or a hospital setting.

Umm what you are quoting is exactly what I stated. The direct billing refers to the fact that NPs can directly bill for services provided. They are reimbursed at 85% of the physician fee. This did not change incident to billing which requires the physician to see the patient first for any problem and allows the NP to bill for services under the physicians NPI at 100% if the physician is physically present in the clinic when the patient is seen. In the hospital setting the NP can bill for the encounter at 85% or can co bill with the physician under the physicians NPI if the physician document participation in one portion of the encounter. Most NPs do not bill directly but assign the billing to the practice that employs them. To encapsulate there are three ways to bill if you are an NP:

1. directly at 85%

2. incident to at 100%

3. Cobilling 100%

David Carpenter, PA-C

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Trauma RN,

Did you find your MSN to be worth the time invested/money spent in school? Just curious about job opportunities with this as this degree path has been recommended to me. I'm contemplating it, however, want more patient contact and feel the NP role is what I'd rather pursue. I appreciate your feedback.

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Specializes in Nephrology, Cardiology, ER, ICU.

GirloftheSun - yes, definitely worth it. I personally identify more with the NP role than the TRUE CNS role. I do advanced nursing care: see patients, treat them, order and interpret labs/xrays and also prescribe.

In fact IL just got schedule II prescribing rights.

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Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.
I beg to differ with you n_g - NPs can't do EVERYTHING a FP MD can do. What the NP can do is strictly controlled by the state practice act.

IN New Mexico a Family Nurse Practitioner CAN do everything a FP MD/DO can do.

There are states that do not recognize Clinical Nurse Specialists as advanced practice nurses, so do check with the board of nurses. This is the issue that is currently under discussion due to the National Council of State Boards of Nursing Vision paper that recommends re-naming CNS's to NP's.

It does depend on geographic areas how each role is viewed/utilized/ accepted by other health care providers.

I teach at a university and there is an adult CNS program here but grads of this program currently can not get advanced practice license in Texas unless they return to take another course and Texas is just 45 miles away. Be sure the state/s you intend to practice in will accept your education.:uhoh3:

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Specializes in Nephrology, Cardiology, ER, ICU.

SailorNurse - May I ask your source of the info that an NP can do EVERYTHING an FP MD/DO can do?

Yes, I am very much aware that in some states CNS's aren't APNs. It does bear checking things out with your BON BEFORE you start your education. Fortunately for me, IL equates NP, CNM, CRNA and CNS all as APNs with no difference in the practice act.

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Specializes in Education, FP, LNC, Forensics, ED, OB.
IN New Mexico a Family Nurse Practitioner CAN do everything a FP MD/DO can do.

I would like to see where this is cited as well.

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APN's are just as good as MD/DO's. Studies have shown we have equal or superior results.

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Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.
SailorNurse - May I ask your source of the info that an NP can do EVERYTHING an FP MD/DO can do?

Yes, I am very much aware that in some states CNS's aren't APNs. It does bear checking things out with your BON BEFORE you start your education. Fortunately for me, IL equates NP, CNM, CRNA and CNS all as APNs with no difference in the practice act.

To reiterate: I said that in New Mexico, this is true. Before I replied, I thought about any procedures that a FP doc could do but FNP could not, still can not think of anything. Family practice is a broad area, we know some basics about lots of areas.

My source is the New Mexico Nurse Practice Act and the fact that I am a FNP.

Here in New Mexico, FNP's suture, interpret 12 leads, & basic xrays/ct scans. They are employed in ER's as fast track providers, some work in cardiology, others women's health, insert IUD's. New Mexico's practice act says you must get the education to perform skills/procedures.

Also, you had mentioned you were training to place PICC lines, that is something Rn's do locally in acute care hosptials, where other central lines are left to Acute Care NP's.

For the OP, it is the scope of practice for each state that determines what you can/can not do and your education/specialty regardless of whether the state does not differentiate amongst the various types of advance practice nurses.

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Specializes in Nephrology, Cardiology, ER, ICU.

I still stand behind the statement that FNPs are not the SAME as an MD. Sorry...just the facts: an MD has 4 years of college, 4 years of med school and 3-4 years of residency. An NP has 4 years of college and 2 years of grad school. Just because you can DO a procedure doesn't mean you are equal to an MD.

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some procedures that rural family practice docs in New Mexico can do that rural FNPs cannot do: from the university of new mexico FAQ for their FP residency.

  1. How do family practice physicians get training in performing procedures and which ones can they perform?

Training occurs informally by residents watching and doing procedures under supervision. Increasingly, residents in the UNM Program practice procedures such as central lines and intubation in the BAT CAVE before performing them on patients. There is a gamut of procedures FM doctors do from trigger point injections and laceration repair to C sections. Most FM doctors feel comfortable with typical inpatient procedures like lumbar punctures, circumcisions, paracenteses and thoracenteses, and outpatient procedures like laceration repairs, skin biopsy, toenail removal, endometrial biopsies and IUD placement. Some do nonoperative orthopedics including reducing some fractures and dislocations. Residents in some programs or some FM graduates take special training to perform colonoscopy, EGD, hernia repair, post- partum tubal ligation, D and Cs, chest tube placement and caesarean sections. Like other doctors, what procedures a family doctor performs can depend on where she practices and the availability of certain specialists in the local hospital or practice group.

http://hsc.unm.edu/som/fcm/FMIG/faqs.shtml

I highly doubt you will ever find an FNP doing a herniorapphy or C-Section, a colonoscopy, or EGD. Probably won't find them putting in chest tubes either. I just dont understand it.. Why is there a need to be an "independent" primary care provider or is it a want to be able to do whatever you want whether you were trained to do it or not?

The FAQ also addresses this question.

  1. I have heard some say FM will disappear as a specialty because nurse practitioners and physician assistants do the same thing only cheaper and they will therefore replace FM?

That more quickly trained, lower paid health providers may replace any specialty is a pervasive concern. However, we believe the concern is unjustified. Every specialty has its “cheaper, less trained competitor.” For example, anesthesiologists have nurse anesthetists, ophthalmologists have optometrists, emergency physicians have emergency medical technicians, hospitalists have in-patient mid-levels, psychiatrists have prescribing psychologists, cardiothoracic surgeons have cardiologists doing angioplasty, and so on. Our Family Medicine program welcomes the help of PAs and NPs, for the health needs of our population are growing much faster than the supply of physicians. In fact, our Department runs the School’s PA Program. Increasingly, FM physicians are managing healthcare teams. Mid-levels can make the FM far more efficient by caring for more routine problems, freeing the FM to devote more time to more complex cases and management decisions. FM graduates are so versatile, that they are highly desirable and have no problem finding work in any community, urban or rural. This is not the case with all specialties.

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