ehcaseyAPRN

If you are indeed a new nurse practitioner, the pay you've been offered may well be fair and reasonable. There are some other things to take into consideration. 1) Is the ~97K the cash portion alone or is it your entire package? Someti 2) Is your health insurance covered? Other insurance such as life, dental, disability, etc.? 3) Is there a retirement plan included? 401K with some level of matching? 4) What kind of paid time off is offered? Vacation? Sick days? 5) Is there payment for continuing education? I'd recommend going to Salary.com - Salary Calculator, Salary Comparison, Compensation Data and looking to see what the median salary is for nurse practitioners in your area. In my neck of the woods, the median salary for a nurse practitioner in primary care is ~95K. So as a new nurse practitioner, you'd expect to get lower pay than that; the 25th percentile is ~88K and the 75th percentile is ~103K. Someone with higher levels of experience would expect more than just 95K.

Sound of Music- on the whole it sounds like you are in a good practice setting despite some garden variety issues and that one staff member in particular is causing a problem. I do have some questions; they don't necessarily need to be answered here but they bear thinking about. First, you say you've been in this job for a bit over a year. What does your employment history look like? Do you tend to stay in jobs for the long haul or do you change jobs on a regular basis? Is this your first NP/PA job? Second, are the MAs assigned to individual providers or do they do tasks on a first-come, first-serve basis? (For example, any available MA checks in patients as they arrive and takes care of other tasks on a first-available basis?) Third, are the other MAs and staff easy to work with? Is it just the one who is causing a problem? Is she rude to just you or to everyone? Is she always abrasive or was it mainly that one incident? Aside from her being abrasive, what kind of job does she do? Does she get the things done that need doing? How does she get along with the patients? There's always gotta be that one difficult person. Don't let that one person stop you from enjoying what otherwise seems to be a good position. Perhaps having a sit-down with the practice manager and the MA in question will help sort things out. She may truly be clueless that she's out of line. Good luck!

I'm up in the air about going back for my DNP. I have my MSN (2004) and at this moment do not have a true need for it. The only way NOT having it could be an issue would be if I allowed my Florida NP license and/or my AANP certification to expire AND if the DNP were a requirement to get them reactivated. As long as everything remains current and is renewed in a timely manner it won't BE an issue. For me there are really not any compelling reasons to put out the effort. It would be more of an ego booster, and I am comfortable enough in my own skin not to need the boost in a game I have no interest in playing. In addition, it would involve adding more debt to what I already have and would take a lot of time and energy. Who knows, something might change to make me want it but I'd say don't do it unless you just want to.

In the practice that I am working at, each provider has their own dedicated MA. They get the patients checked into the room, do and document their vital signs, enter the chief complaint into the computer, and pull lab/diagnostic testing results. They also do lab draws when needed, vaccinations, ear lavages, etc. We have another staff member who is our referrals expert; she finds out what specialists are on a patient's insurance panel and sets up referrals. She also gets prior authorizations for and coordinates diagnostic imaging. Yet another staff member handles insurance prior authorization on medications and routine refill requests from the pharmacies. Our clinical coordinator answers patient calls and helps with whatever people need help with. The front office staff gets patients checked into the office and then checked out and makes their next appointments. So, on the whole there is one person with whom I work directly who gets to know how I like to have things done and then have 3+ people with whom I work indirectly. This keeps everything running smoothly most of the time. My previous practice was an entirely different situation. I worked in the office 2-3 days a week and rounded at nursing homes the remainder of the week. Part of the days I was in the office, it was me and the physician for whom I worked directly. We had a receptionist who took care of checking patients in and out and making subsequent appointments. We had 2 office nurses (both were LPNs who were hard-working and thoroughly capable.) They had to room the patients, get their vital signs, identify their chief complaint, and then check them out including any necessary vaccinations, ear lavages, etc. In addition to that, they ALSO had to answer patient phone calls, do prior authorizations on medications, set up referrals, handle refills, and a myriad of other tasks. Needless to say they stayed behind the curve the vast majority of the time. It could be slow getting patients checked in and out, and turning around all the appropriate paperwork and such was a challenge. We did not have a true EHR and did not have electronic prescribing capability. We were a hospital owned & operated facility so used their computer system to document in. It was ill designed for doing office notes and did not have electronic prescribing capability. The MD with whom I worked had to take a leave due to a personal emergency and the hospital did not find a replacement MD and closed it. Having a well-oiled infrastructure has made a huge difference in the way things flow and how easily things get accomplished. To be honest it is hard to judge whether it is because I DO have my own dedicated MA or is because the rest of the structure is so well coordinated.

I am a family NP in a family practice setting, and I have a dilemma. We have several families that we see both parents and the child(ren). The mom came in on Wed. and she is a victim of abuse. We had not noticed it previously. Previously, she & her husband came in together. He was not present this time. There is a restraining order in place on him. What do I/we do about caring for him? We are his primary care provider. It is likely that he will be back to see me. I found the arrest record. Obviously, I do not disclose anything about her health or otherwise to him. But what are the logistics of providing care to an abuser? Thanks for the insights.