preliminary questions for the np

Advanced Practice Columnist / Guide · Apr 24, 2007

Here's my take on your questions:

1. I love the fact that as an NP, I am able to do more in terms of patient management. Many times, when an RN becomes experienced enough to decipher medical pathologies and physiologic changes going on with patients, we tend to feel an itch to also figure out what the next step is going to be including medical management (drugs, further testing, etc). As an NP, I am able to go further and satisfy my curiosity by virtue of my advanced education and certification by being able to order the needed tests and the medications that I feel will help the patient. An RN role will not allow me to do that.

2. There are still barriers that prevent many of us from making full use of our advanced education. Total prescriptive authority without physician involvement is still an issue in my state as well as the ability to order ancillary services such as PT, OT, and home health care. There are pharmacies that still question our prescriptions for not only medications but medical supplies as well. These are being addressed by our state NP organization. In my current role, we had issues with some RN's in step-down units questioning the validity of our orders. These have been evened out and addressed appropriately. In short, as an NP, I still struggle with constant education of other professionals about my role and what I can do.

3. Not in my current role collaborating with an ICU intensivist. However, our team of NP's tend to be more vigilant regarding the role of nutrition and elimination in the wholistic management of patients in the ICU. A lot of the surgical residents we work with tend to forget to address nutritional supplementation and ensuring regular bowel elimination as factors contributing to success in patient management especially since we have a surgical patient population.

4. Advice, sure, in what specific area?

Trauma Columnist · Apr 24, 2007

okay, hope you don't mind a cns in the mix - lol. i'm an adult health cns who works in an np role as an apn in two chronic hemodialysis units:

1). what do you like about your position? i like the autonomy and the ability to pretty much completely care for my patients. the physicians that i work with (my collaborative agreement is with 15 mds) are wonderful and very mid-level friendly (there are 3 fnps, 4 pas and me). that helps to make a very collegial environment.

2). what are the disadvantages of being an np?very much the same issues as pinoynp. when i call in scripts, i'm asked for the doctor's name. when i call the hospital to give orders, i'm asked the md's name, when i place orders to nursing homes, i'm sometimes questioned also. however, the key to success with this issue is to be very polite and patient. it is very important that we keep a reputation of professionalism and competency so that we spread the word positively. some of my best moments has been explaining my role to other rns. oh and that brings up another subject - i still consider myself an rn and that helps with relations with other rns too.

3). are you able to implement complementary and alternative therapies into your practice?dialysis by its very existence is pretty high tech. i'll be honest that i am not too interested in the holistic aspect of care. my nursing experience has been in the er and icu and i really like the science behind the care we provide. this is not a big issue for me in my current practice setting.

4). if you have any advice to give, i am a willing listener/reader.my best piece of advice is to check your job market in your area prior to choosing an education path. while in clinicals, get your feet wet and explore things outside your area of comfort. prior to taking this job, i had never even seen dialysis performed. my other job offer was in a dermatology practice - again something i was not in the least comfortable with. then, once you graduate, make sure that you network with your state apn organization, take as many cme's and go to conferences too. this widens your scope of knowledge as well as makes you more valuable to your practice. and my last piece of advice is more to myself than you: if you realize that you made a mistake with your first job, don't be afraid to change jobs. good luck.

lunamar · Apr 25, 2007

Thank you very much, traumaRUs and pinoyNP for your insightful responses. I truly appreciate the advice that you have given to me. To specify "any advice" that I had previously asked for, I would ask if you ever had a moment (either in school or in practice) where you said to yourself, "I wish someone had told me this before." If nothing comes to mind, that's OK.

Thank you again and take care!

Trauma Columnist · Apr 25, 2007

For me, the big thing is the lack of training or education on what is billable and how to order and word your order in order to maximize reimbursement.