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nbtw

nbtw

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Content by nbtw

  1. nbtw

    Self Employed

    Are there any self employed nurse practitioners out there? I'm a psych NP and thinking about working for myself. Does anyone else work for themselves? Any ideas on how to make this happen? What should I be aware of before taking this step? What business advice can you offer?
  2. I'm reaching out just for some guidance. I've tried to do some research on my own but have been unsuccessful. My former collaborative physician is refusing to complete credentialing paperwork related to my new job. I've never had any issues with this physician and there have never been any patient complaints against me. She doesn't have to recommend me but only speak regarding my work. I have a copy of the collaborative agreement we both signed which states that reviewing my work would be one of her duties. I don't know what my rights are here. I had a collaborative agreement because of the state practice laws but here the physician is not holding up their part of the bargain. I was wondering if any other APRNs have had to deal with a similar issue. Any guidance is appreciated.
  3. nbtw

    Collaborative Physician Issues

    I'm not sure where you work. I work in CT and this credentialing process is for the largest, research, teaching hospital in the state. They're notorious for asking you for everything except the toilet paper you use. I know every hospital has different credentialing requirements. I've never been credentialed with hospital before as I've only been outpatient. My credentialing process in the past never asked for collaborative physician references only peer references as you mention.
  4. nbtw

    Collaborative Physician Issues

    Yes, an evaluation is precise. The agreement we both signed specifically states that this was one of her duties. I've spoken to her. She wants the medical director to complete the evaluation. This makes no sense. First, the medical director is not the person listed on the collaborative agreement. Second, the medical director that works at that organization now is not the same person who was in place when I worked there (that medical director has also moved on). I guess my question was really to ask everyone if they have any knowledge about what the physicians legal obligations are when they sign a collaborative agreement. In my state collaborative agreements are required unless a nurse practitioner is practicing independently; this is written into our states nurse practice act. I just don't understand why there is a requirement if the physician doesn't actually have to adhere to the agreement or do they? I've looked at my states practice act and can't find any information about this or if I have any rights at all. That's my question. As nurse practitioners with collaborative agreements what are our legal rights? I'm not asking this person to evaluate my work from today. I was asking for their evaluation during the time I worked with them, a task they did or at least should have been doing the whole time the agreement was in place. I think this is important for us all to know. After all, malpractice cases can come up years later, credentialing (if you want to work in a joint commission hospital) is not going to go away, and state boards of nursing can decide to audit our practice any time.
  5. nbtw

    Having difficulty determining my next step

    Quote from InquisitiveAPN: You can find jobs that fund malpractice, licensing, and CEUs. I don't see any of that as a problem. I don't let patients leave my presence until I'm finished documenting. Why? Because by 10:00, I wouldn't have a clue what the 8:30 said or did. If you're making a lot of call, etc you need to block out admin time for your own wellbeing. You might lose $120-150 a day, but you could take a shorter lunch or just be present with your family. Sounds like more than anything you need a better job, sister! I've shared my personal experience as an FNP across 3 different employers. Thanks for sharing yours.
  6. nbtw

    New NP pay

    New grad FNP- Connecticut Outpatient primary care $90-100,000 per year salaried. 40 hours work week No bonuses 26 days PTO HMO/PPO plans LTD, vision, dental, dependants covered, etc 401K 1500 CME 1 month onboarding With 2 years of experience was offered $115k Make sure your orientation time is written into your contract or some employers will try to backpedal and baptize you by fire.
  7. nbtw

    New NP pay

    I would say if you've been an hourly paid RN in the Northeast for more than 8 years then becoming an FNP will very likely be a paycut for you and actually more of a headache. Once you punch out as a bedside RN your work is done. As an FNP you may very likely be taking work home with you and you won't see one red cent above than what you agreed to for salary.
  8. nbtw

    NP salary/job market

    To very directly answer your question: 1)What salaries do guys make/offered? As a new grad $90,000-100,000. With 2 years of experience $115,000. If you choose psych NP then very likely more than this. 2)what area are you in? Connecticut 3) was it hard to find work? It's very hard to find work as a new grad. Start looking months before you graduate. Consider asking your clinical rotation sites if they would consider employing you when your done (that is if you liked those rotations). Being an FNP is not easy work. Some people love it and others hate it. I know a lot of older FNPs who love it but the profession has changed a lot in just the past 5 years and these NPs are close to retirement. I know a lot of knew NPs with regrets. Do a lot of research before you make your choice. You want this to be an investment not a failed (or rather regrettable) venture.
  9. nbtw

    Having difficulty determining my next step

    I am an FNP. I won't recommend or bash the profession but I will tell you about my experience. I have only worked outpatient as an FNP. If you're outpatient you are scheduled anywhere from an 8-10 hour day. You are provided with an hour for lunch. You are scheduled acute visits every 15 minutes or 45 minute physicals. In the 15 minute visits you are expected to get history, do some type of physical, come up with a treatment plan which may include doing an in office procedure, prescribing medications, explaining medications, educating the patient and documenting everything that you did. This never happens of course, not if you're a thorough provider. So you end up working through lunch (just like your bedside days), documenting at home and missing out on what's going on with your family. In between your appointments, you're expected to call patients back about results, return patient calls, call other providers back that needed to get in touch with you, read and sign off on patient information. Of course you never have time in between appointments because 15 minutes is unrealistic so your appointments typically run into each other. You will likely be on call. So even when you're not physically in the office you still have to field calls from patients, hospitals, pharmacies, critical lab values. You are ultimately liable if you don't get back to a patient in a timely fashion (there's no guideline for what timely fashion means), if you don't explain every single side effect and the patient experiences one, if you don't give your drug addict patient more oxycontin but they stay in pain, if your diabetic patient has an A1C of 11 and eats a dozen donuts a day even though you've educated them multiple times, if you go through a depression screen with your patient, they deny being depressed but 2 days later try to kill themselves. Well you won't be liable but people will try to make you liable. The only thing that will save you is if you properly documented but many providers don't. So that they don't take so much work home, many providers use templates which they lack the time to modify and typically don't give the documentation that an insurance company or department of health would deem appropriate for the patients presentation. So I spend a lot of time documenting because I know other APRNs who have ended up with fines or probation from the department of health because their documentation couldn't back up their claims that they met the standards of care. Oh and there's the patients that want to see a "real" doctor, think that an NP is different from an APRN or that the PA is at a higher level than you just because you have nurse in your title. You'll work with physicians that are grateful to have you as a colleague because healthcare sucks and you need all the hands you can get. But you'll also work with physicians who are resentful towards you because you're stealing their piece of the pie (even though your not because no graduating residents want to do your job anyway, that's why they had to hire you in the first place). And lets not forget that you are likely not being paid 75% of what the physicians are making even though you're both doing the exact same job. All in all, I still get disrespected as an FNP, I work a lot of extra hours that I don't get paid for, my risk of malpractice and being sued is way higher than a bedside nurse, and you pay more for malpractice insurance, licenses, CEUs.
  10. nbtw

    Collaborative Physician Issues

    To reply to everyone's posts let me provide some clarification. I worked with this collaborative physician for almost a year in 2016. The collaborative agreement (required in my state) requires them to review your work. She in fact physically signed off on some of my encounters, such as preoperative clearances, because some of the hospitals in the area require a co-signature. If she had issues with my work, she certainly could have brought them up at the time and this never occurred even once, verbally or in writing. To answer Inquisitive APN, yes this provider is very flighty. She has a bad rep personality wise at the organization I used to work but she's an experienced and thorough provider. I'm going through credentialing at a new employer now. To answer IhflanurseNP, "Credentialing - also called medical, provider or physician credentialing - is a detailed process that reviews doctors' qualifications and career history including their education, training, residency and licenses, as well as any specialty certificates. Credentialing must be completed upon the hire or enrollment of a new doctor and regularly afterwards to abide by the standards set forth by regulatory and accreditation organizations such as the National Committee for Quality Assurance (NCQA) and The Joint Commission (TJC)." The collaborative agreement that I had with the physician in question specifically states her responsibilities to in reviewing my work. She won't do the paperwork at all. This is not professional. Credentialing like the process I'm talking about is not uncommon in the Northeast where I live. What is the point of these nursing boards requiring advance practice nurses to have collaborative agreements if the physician's have no obligation to hold up their part of the agreement? To answer kooky korky: I need to complete credentialing to remain employed. The organization I'm employed by is accredited by the joint commission so there is no way around this credentialing process. I just feel like this is some type of sabotage. I just wanted to know if any other APRNs have faced this and how you handled it.
  11. nbtw

    NP Salary

    I was motivated to start this post after I overheard a physician bragging to another physician about how they "bagged" a nurse practitioner for $76,000 a year. Here's some background information for you. I live in Connecticut. The physician in question hired for a community clinic in a large urban setting with a high volume of patients. I myself was offered positions from $90,000 to $100,000 as a new grad FNP. After 2 years of experience, I was offered $115,000. I have a friend who is a new grad psych NP and she was offered up to the $160k's. When one practitioner is low balled, taken advantage of, or mistreated it can have a domino effect. I hope this post will encourage everyone to share their experience. Knowledge is power or so I've heard.
  12. nbtw

    weight loss clinic?

    Hi, I have worked for a weight loss clinic. I was hired to do physicals, review labs, and address any health complaints that clients were associating with the program. Once employed there was increasing pressure to prescribe weight loss medication (even when not appropriate) and also to push the programs products. I also later found out that other staff members (people who are not licensed medical care providers, nutritionists, dieticians) were billing encounters under my name for clients I hadn't even seen on the days of billing. I told the own that this was insurance/healthcare fraud and that if it didn't stop I would quit. It didn't stop and I had no choice to leave. I worked so hard to be an NP, I just couldn't have this job jeopardizing my clinical decision making or legal standing.
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