Ohio NP

I worked for a number of years in renal transplant. Does not prepare someone to step in and be the frontline nurse for NICU. These are the most vulnerable, most fragile patients in healthcare. She has been on the unit for 8 weeks and is pushing to get more autonomy. Perhaps this nurse would benefit from backing up, asking questions observing these critical cases, asking questions again afterwards to learn from the experience and slowly build her knowledge base and the trust of her peers. NICU nursing is a very high stress, highly specialized area of nursing and quite frankly, you won’t survive there if you are thin skinned or looking to get your needs for validation met. Pump the brakes and learn slowly and gain the trust and acceptance by the unit through demonstrating that you realize how much you have to learn and respect the difficult nature of this area of medicine.

Agreed to the lack of leadership in nursing and that the nurse “leaders” are just administrative shills. The ones who aren’t, and I’ve worked with many, are pushed out by Administration and replaced with yes people who share their disdain for the nursing profession. I’m so disappointed with the entire healthcare experience I wish I had made other choices. On a positive note, I know that it’s just a numbers game so can make decisions regarding my healthcare and my loved ones healthcare with eyes wide open. The only upside to this miserable career path.

She belongs in a psych ward that is not a person who should be at the bedside.

Yep nurses are not allowed to prescribe. And in case anyone is wondering prescribing is not just writing a prescription on a pad or sending it to the pharmacy electronically. The definition of prescribing is the act of giving medication instructions to a patient, even recommending an OTC med to a patient is considered prescribing. Every single nurse making medication recommendations on line are completely and entirely outside their scope of practice and if any of the state boards wanted to they could sanction you just on that. When you post on facebook to take a certain medication that can entirely be interpreted as prescribing to everyone in your feed. Pump the brakes nurses and get back in your lane.

So I think the one main thing I picked up in your post that explains a lot of why you have this generalized distrust of public reputable sources is your comment, “yes liberals vaccine injuries do happen”. So if you truly want to understand your source of bewilderment you will need to do a very strong, objective assessment of your own biases related to every piece of information you receive. This one quote pretty much displays the lens through which you vet all incoming information. As a clinician that’s not a great approach to critical thinking. And FYI the anti-vaccine big pharma is trying to kill us all line of poorly supported “research” posited over the years by everyday lay people (who equate a Google search or reading their facebook feed as research) originated with wacky holly weird liberals so there is that. To answer your question where do you go when you don’t trust the main sources of reputable clinical information because your world view has become mired in paranoia secondary to a longstanding disinformation campaign carried out by the political faction you follow? To therapy, go to therapy to improve your boundaries and ability to discern information from manipulation.

Living and practicing in Ohio has been a never ending years long nightmare. I have lived in a number of areas in the country and never have I ever encountered a social system that celebrates ignorance and defames education so much. No wonder we have such an opioid epidemic this state is filled with a bunch of overgrown toddlers that have an inflated sense of their importance due to national politics pandering to their idiocy. On a side note, when my husband and I moved here 19 years ago, I heard, for the first time in my life, an individual at a group function(neighborhood cookout) use the N word casually with no fear of retribution. I was gobsmacked at the time and thought perhaps it was just this one idiot but 19 years later, nope it is an overwhelming portion of the state.

And he lied about his credentials. I watched his school board performance and he stated a number of things that were absolutely unequivocally wrong about immunology and virology yet he stated in his public grandstanding speech that he was a specialist in virology and immunology. He’s not, he’s not board certified in either of those specialties he’s just a general practitioner who runs a new age type clinic where he makes his money off skin de-ageing treatments and the like. I’m pretty tired of the doctors and nurses trying to make a name for themselves and get that social media buzz to parlay this nonsense into the talking heads and social “influencer” money that seems to be a big side hustle in healthcare right now. Everyone looking to be the next snake oil salesman in the vein of Dr. Oz, Drew Pinsky, etc. I called his performance just that, it was a performance, he had someone at the ready to record, and they started spreading that nonsense all over social media. He should lose his license I’m so over the quacks.

I do not introduce myself as doctor I introduce myself as a nurse practitioner. In Ohio we have to have a collaborative physician so I will usually say full name and then say I am the Doctors NP. I currently work for our medical director so I say I’m the medical directors NP. The issue with working as both an NP and an RN with the same patient in the same practice is multifaceted. 1. Scope of practice; an NP can diagnose, order diagnostics, admit to certain levels of care, prescribe, order equipment, order therapies etc. A nurse cannot do these things they are outside the nursing scope of practice. 2. Malpractice; many malpractice insurers will not cover an NP (or doctor or PA) who is working in a different lane clinically. Malpractice policies are very specific to the role you are performing. Further, if you are functioning as an RN and there is an issue with the orders or diagnosis etc that falls under Doctor or NP role and, as a nurse you cannot change it, in a court of law you could still be held to account for the orders/diagnosis of others as the courts will say you can’t unknow what you know 3. When practicing as an RN in the same setting where you are an NP there is role bleeding whether or not anyone wants to admit it. You may be there as a nurse, but you will have the knowledge of what should be ordered prescribed etc. so you can get in trouble with your nursing license for functioning as an NP when you were working as an RN. 4. CMS (Medicare and Medicaid); if you work with the same patients, in the same setting, at the same time (and they will consider on the same shift the same time) your organization cannot bill for both services. Now you might say well nursing isn’t coded and billed for it is part of the overall package but that is often not the case. And if you are on shift as an RN, switch over do some NP stuff (like intake admission) and then back to RN the place where the double billing will come in is when they bill for the services you provided as an NP. And double billing is Medicare fraud don’t for a second think it isn’t. Home health and home hospice NPs can get in a world of trouble in this way if they are coding in their payroll and documenting both an NP and nursing visit to the same patient on the same day. Just don’t do it, it’s legally sketchy, it’s role diminishment, it’s complicated for all involved and the only upside is it saves the employer a little bit of money when paying you at the RN rate. Why would anyone want to agree to that?

Yes and that psych diagnosis in on the DSM V Axis 2 disorders namely borderline personality disorder. It’s insane how many nurses have this issue, and of course that leads to the poor boundaries with patients (seriously why are you facebook friending you patients families hospice nurses!) and the emotionally toxic workplace environments. I also came from another field before, I couldn’t believe how ridiculous healthcare is. It’s like a never ending junior high school, I mean why keep living that? It wasn’t that great the first time around folks.

Right now, my employer has me filling my role ( the medical directors NP, I see almost all her patients) , the RN team manager role, and an RN case manager role. They give me the gaslighting hey the team needs you crap that they fall back on every time. When it’s something they need we’re all in it together but when it’s something we need, we are negative or not team players etc. Oh yeah and they sent me a lot of atta boy emails and gave me a recognition award. You want to know what my prize was? A stupid pin. A 25 cent garbage pin like I’m a freaking child looking for worthless trophies. Typical abuser behavior smack you across the face then lovebomb and gaslight with cheap grocery store flowers from the sale bin. Then on the team conference call they bragged about the extra money they are making from being so understaffed. If I was younger I would be out of this profession in a minute.

Exactly, this Sainted Selfless Nurse persona is how the administrations get away with the ongoing systemic abuse of the nursing profession. It’s time to stop with the empty platitudes about I’m not in it for the money, I just want to help people etc. It’s gaslighting and it’s manipulative. And every nurse I’ve ever worked with who walked around with their sainted halo attitude was a call off queen or a work shirker. Just stop it already.

Wow this speaks to me so hard and all the comments I’m just overwhelmed with how much anger welled up in me. I work in hospice, HOSPICE!, and our company runs us chronically short staffed in the clinical side. ( business and sales still living that charmed life). As our census declined during the assisted living facilities lockdowns I kept hearing from my GM that a program our size didn’t need a full time NP. He said it over 52 times over a four month span. Yet I was also covering two RN case manager assignments, encouraging the remaining staff and supporting and educating them and precepting the one team manager left (all the others left under mental health LOAs). Our DON? She would literally leave multiple thing’s unfinished at the end of the day that impacted the patients because quote “I’m over this day I’m going to go ride my horse”. I have four children and unlike past generations of nurses who encouraged their children to follow them into the profession I strongly encouraged them not to. My daughter just graduated law school and is starting out, at the age of 25 with zero years experience in her field at double my current salary. And I’m considered at the top of the pay scale for NPs in my region. Yeah mommas don’t let your babies grow up to be nurses.

You need to check with your state board. In Ohio the board greatly frowns upon having a dual RN and NP role with the same patients; because the patient will identify with your NP role and have expectations of receiving that level of care when clinically engaged with you and per the board, you can’t unknow what you know, so even if you are practicing as an RN your NP knowledge will slip into the practice. They encourage us to not practice below our full scope. The other issue is malpractice insurance coverage and claims, because the court may also hold you to the higher practice level even when you are working as an RN. It sounds to me like your employer is trying to nickel and dime you find a better gig. These people are cheap and could be putting both your licenses at unnecessary risk. On that third day do not flip flop between roles throughout the day. If you are there as an RN stay in that lane don’t let them pressure you into “ putting on a different hat” to do the intake then changing out the hat. My current employers DON kept trying to get me to do this to make up for her RN shortages. She also asked me on more than one occasion to go back and code in my payroll an RN code on the same visit I was seeing the patient as an NP. I refused on the grounds that I would not help her commit Medicare fraud. Which it is, it’s Medicare fraud to bill for two different service levels on the same visit. Move on or set better boundaries this employer does not have your best interests at heart. And they do not respect your role as an NP.