question for nephrology NPs

[celle507]

I am a new grad FNP (RN for 4 years in med/surg and home hospice) and have an interview with a nephrology practice next week. The practice is 5 MDs and this would be their first time hiring a mid-level provider. I have always been interested in nephrology but I have never worked in a dialysis clinic and have had no NP clinical experience in nephrology.

My questions are:

1. How much training should I expect? This position would primarily be rounding on dialysis patients with potential to do clinic if I wanted.

2. What are your daily duties? How independent are you in adjusting meds, etc. since you are really just working under the supervision of the docs.

Any advice or recommendations on other issues I should be thinking about would be much appreciated.

Thank you!

[traumaRUs, MSN, APRN]

I'm a CNS but have done dialysis rounding for five yrs.

We have 14 MD, 5 midlevel practice. My nursing background was ER and ICU. I had never seen oupt dialysis being done.

I had approx five months orientation. The dialysis units and hospitals were very slow with credentialing.

I am very independent and rarely see the docs though I always have someone for back up.

How far apart are these units? How many pts total?

I see about 240 pts week in four clinics. The closest one is 9 miles and the farthest is 62. It is a very flexible position.

[celle507]

hi traumaRUs,

Thank you for replying. I read your previous posts and hoped you would reply and give more information!

I haven't had my interview yet but am trying to gather information so I know how to negotiate. So you have your own set of patients that you follow? I was told that I was basically there to assist with the 4 provider visits that Medicare requires each month for dialysis patients and I would be put on the dialysis rounding schedule. I assumed that meant I would be working under direct supervision of physician and not have my own set of patients.

Do you think 240 patients/week is reasonable (approx 48 patients/day?)?

Do you feel like the patients are too complex for someone like me (a new FNP grad with only med/surg experience) to handle? I am most nervous about that. I know chronic kidney patients are extremely challenging and I hope that I will be able to take care of their needs. FNP programs really emphasize primary care rather than specialty care.

Thanks again for your reply and any other tips or info that you can suggest.

[traumaRUs, MSN, APRN]

Oh I think you would do fine. The way the 4 visit thing works is that (I can't remember the exact figures:)

Visit #1 (MD) you get $200

Visit #2 (you) you get $100

Visit #3 (you) you get $zero

Visit #4 (you) you get 75$

This is to encourage the practice to obtain all the visits. If you make all the visits than the doctor visit is paid at 85% per CMS(Medicare) guidelines.

The MD doesn't have to the first visit of the month, just ONE visit a month.

My pt load is heavy but since I know most of the pts, it goes quickly. I'm now at a unit 62 miles from my home - I started out this am at 0630, went to a unit 22 miles from my home, saw the first shift of pts there (9), then came over here - saw the first shift (5 pts) and then will see second shift (4 pts), then back to the first unit for second shift (9 pts) and then on into town (another 35 miles) for another second shift (32 pts). I will be done by 5pm.

Now, this is the first part of the month and my last week of the month is just catch up for the most part - picking up visits of those noncompliant pts or those who were in the hospital when I visited,

I'm also on call for about 5-10 units/day - sometimes the pager is dead and sometimes I'll get 20 pages/day. Just varies.

We also do call for all the dialysis units (approx 20 units in central IL) which consists of phone call on Saturdays/Sundays every 4th weekend.

It is not a bad schedule at all and like I said, there is a lot of flexibility.

You can't visit the same dialysis pts on the same day as the MD - that's a no no. So, that is why you don't see the docs often.

We have an electronic medical record also which helps tremendously. You do have the option of charting at home if you want to.

Can I ask what state you are in?

[globalRN]

I am a FNP with 9 yrs of NP experience, 3 in adult hem/onc, 5 in hospitalized family practice adult patients, 1 yr in internal medicine hospital care of adult patients. I have many years

of medical RN experience.

I can tell u that I would never apply to work in a specialized area like nephrology.

I know very little when all is told about dialysis.

When u r the NP, u are expected to know what to do....I think u would be way in over your head.

[traumaRUs, MSN, APRN]

I had absolutely no dialysis experience when I started. Its not important that I am able to canulate the pt, just know what's happening. I do the medical management of the pt, not the technical part. With 14 years of RN experience under my belt when I took this pt, after five months I was pretty good. It did take about two years to feel totally comfortable though.