caldje

you almost surely have to explain the circumstances. without a doubt. Most licensure boards will require it, the certification exam elligibility might require it, malpractice insurance will want to know, and the credentialling comittee will want to know. IF you have a good explaination or if it was a long time ago it shouldnt be a big problem. Good luck.

thanks for sharing such a personal story. It always helps to hear these kinds of things.. Keeps us realizing what we are doing on a daily basis. Also remember, it doesn't have to be cancer to be important either. I hope I can always remember how significant the things that may seem 'little' to us really are to the patients and their families. I will let David answer your question about PA training cuz he can do it without making anyone mad. :nuke:

consulting physicians must see the patient every other day. admitting physician must see every 24 hours. Surgery is billed on a global fee that includes post op management. The surgeon does NOT bill for every post op visit. The only time he/she would bill for post op care is if it was on a modifier/etc. not included in the global fee. Hope this clears it up for you... Patients die, it is a shame. Truly sad, but there is not always someone to blame.

Yes, the hostility is out there. But for every place that doesn't want an NP there are plenty of others who do. Ignore the crap you hear and move on with what you want to do. The same goes with being a PA.

Yup. http://www.npinstitute.com http://www.npinstitute.com/Course.asp?pid=40&UID= has a basic and advanced course. Good Luck!

I would just like to make a point about this paragraph. While you obviously feel very (maybe overly) confident about your medicine skills. You yourself mention in your paragraph after this "if you are going to be doing what we are doing the more education the better." Keeping this in mind, I find the above quoted paragraph strangely contradicting your philosophy on the need for the "most education" to "do what we do." PAs PROUDLY submit to the strict regulation by board of medicine (the gold standard for regulation of those who diagnose and treat illnesses) and even more so PROUDLY support that the practice of medicine (meaning diagnosis and treatment of illnesses) should be overseen and directed by those with the most training/education/experience.. meaning physicians. This TEAM based practice is very important and regulatory oversight by physicians is what is best for the patient... even if it is at the sacrifice of our bank accounts. I very sincerely submit that maybe being 100% independent, being able to bill medicare independently, and disregarding those with the most education to do our job is not what everyone aspires to. Quality patient care requires team based practice and physician involvement at some level.. even if it means indirect oversight. Its what is best fpr the patient even if its not best for my porsche payment.

Do you see the logical error in this statement. You start by saying that the PA school has more clinicals in the PA program but doesn't require prior experience. (completely ignoring that most people in the program still DO have prior experience) However, when you list the hours of training in the FNP program (less than half that of the PA program) you put an * beside it and say but we are required to have a year of RN experience (whether it is applicable to FNP practice or not) and take the opportunity to say BUT most have more than that. It just seemed kind of slanted to me. The second portion of your post was very well put though.

Im sorry. Im not an NP and don't support confusing patients. BUT, its completely unfair to say they "don't know what they dont know." I have never seen an NP, and especially never seen an RN get 'over their head' without asking for help. That behavior has been the solitary realm of physicians and medical residents.

FYI, if you are working in a hospital it would be advisable that your review your medical staff bylaws to be sure the use of the title is not protected in there either. As I was going through mine I noticed it was prohibited.

I was about the say the exact SAME thing to the nurses I am having a problem with. If you review my post you will see this quote of mine... "I had never had an issue like I had read about (and dreaded) on here until very recently when I ran into a couple of nurses with chips on their shoulders." I have never had a problem, just read about them on here and other forums. Now I am experiencing the issue and would be happy to explore my own faults. I often do, and I have plenty of them. Please don't get stuck on the bedpan issue, because its not just about bedpans. We all have our jobs, sometimes we help eachother out because we are in it together/like eachother or whatever. In the end, though, we all have tasks we have to accomplish and if we don't accomplish our tasks because we are taking care of someone else's then that is not in the patient's best interest. Again, I know that for some people, no matter what I say, their opinions won't change but hopefully the people reading here that do have an open mind will understand my point. sincerely

No. I will be in surgery, and I am experiencing the same issue there. I cannot speak for the PA in the ER but I can speak for myself. I have no idea what is involved in using a bedpan and assisting a patient with a bedpan. For that very reason, it is a skill you have, that I don't. To me, a nurse is best at taking care of the day to day issues a patient faces. If you want to delegate that to a CNA, thats fine. But I myself, have no idea what each individual facility rules are (I will be practicing out of multiple hospitals) and for my own, my patients, and other professional's sakes I try to leave their part of the patient's care to them. I try to help out whenever I can, I enjoy helping. However, most of the time when I help I get yelled at by one or the other, a nurse or a doctor. Either the doctor says "you're supposed to be working (learning) with me not being a nurse" or the nurse says "that's not where that is supposed to go" or "didn't you know we recycle those scope biopsy instruments?" My answers? Well, if I don't help the nurses they get mad at me, and when I do help them I usually don't know enough about the workings of the specific unit/hospital to do things right. So I've learned to just do my job and move on, I can't keep everyone happy. I'm positive you can identify with that feeling. Honestly, I think it is a very few doctor's, nurses, and PAs that ruin it for all of us. They have chips on their shoulders, feel insecure, or whatever, and it makes those of us who are honestly just in it because we love medicine feel like we are walking on glass because everywhere we turn (especially as a PA) someone is taking a shot at us. I had never had an issue like I had read about (and dreaded) on here until very recently when I ran into a couple of nurses with chips on their shoulders. Otherwise, I have learned a lot from nurses, how to start IVs back when I was in emt school, how to pull a central line, insert a foley, etc. I have also had nurses save me from writing an incorrect order as a student. These are all important things the nurses around me do, as is taking a patient off of a bed pan and talking them down from their anxieties before I even show up to do a procedure. I know.. trust me I know. Anyways, I hope that helps you understand where I am coming from. It is just so dissapointing to come on here and see my colleagues talk about other health professionals the way I see nurses talk about PAs on here. Unfortunantly, I don't think there is anything I can type, or say to help the people who need to understand, understand. Best of luck, and I hope this was at least worth reading. Sincerely

exactly. be proud of the specialized skills and knowledge you have as an RN. It literally is a job nobody else could do without the training you have. Being offended when someone asks you to do something you are trained and good at makes it seem to me you may be the one who feels its beneath them. We all have different roles, yours' is as important as the PA's but they are also different and a PA doing a nurses job will fumble around to no end, unless they were a nurse before PA school.

If I may ask, what are you willing to do for a PA? To me, there seems to be an underlying confusion among the entire nursing profession as to the role of PAs. Would you guys agree with this? Nurses are trained to do what you do, PAs are not trained to do what nurses do. If PAs were doing other things they weren't trained to do that were say, a pharmacists job or a physician's job.. You would be outraged that they ARE doing them. Now, when they aren't doing things they weren't trained for you are outraged that they AREN'T doing them. I hope you see how frustrating this can be for PAs.

25 patients a day really isn't that much. It all depends on whether or not you are taking the urgent stuff like colds, coughs, etc. or are managing complicated patients with comorbidities, reviewing labs, consulted you doc, etc. Chances are you could do 25 a day after a month. I saw 10-20 in family practice as a student and had to present every one of them. Probably could have done 25 if I could have just treated the OMs, streps, pneumonias, and rashes without presenting. With regards to moving, they should be paying your moving expenses, period. I would not consider a job that doesn't. It will cost you close to 2 grand otherwise and you shouldn't have to spend a dime to get a new job. Good luck.

How would you evaluate them? Would you get a BP, temp, pulse, height, weight? Would you do a rapid strep? Send for cultures? Do you have complete medical records on the patient or just psych records? Can you evaluate all of their medical complaints to rule in/out other possible causes of a sore throat? Would you rule out mono before prescribing that amoxil? How often do you prescribe abx? Enough to be familiar with local resistance patterns? Can you write for the epi pen when the patient has an allergic reaction? There are a lot of questions the lawyers will ask you when the time comes.

Thanks David, sometimes I feel like Im speaking french. I do think that being knowledgable about GLBT issues includes knowledge of STDs. However, it is only a small part of the big picture and to allow it to remain the FOCUS of glbt health would be a disservice to the community. If I have come off as if I am against a GLBT clinic I'm sorry. I'm all for it and I would be proud to be a part off one. I am also not against an STD clinic. People with STDs also need a safe place to go where they won't be judged like they are at so many other clinics. However, the two are seperate entities and STDs and gay shouldn't always have to come one after another when we are talking medicine.

Let me give two examples. Patient #1 Comes in and says they have been using crystal meth and having unprotected sex. He is male, white, and heterosexual. Patient #2 comes in and says they have been using crystal met and having unprotected sex. He is male, white, and homosexual. Now, are you telling me that they will need different expertise on the part of the provider? Are you telling me they need different testing? I don't think so. I would like to make the point again. There ARE special considerations for the gay population that involve being accepting and welcoming and understanding the process of coming out and the unique social injustice faced by this population. However, a high risk individual is a high risk individual whether they are straight or gay. Both should have the same cautious and thorough approach to testing for the various diseases that they could have been exposed to. Yes, there is a place for clinics that are open to gay and lesbian clients. Other than that, the medicie that is practiced should be identical. The new CDC guidelines for HIV testing and their rationale for changing them are a perfect and validated (in case you want proof) example of the error in the ways of thinking being gay or straight puts someone at any specific risk that the other would not have.

There are gay friendly clinics across the US in small towns and large cities alike. Some are staffed with straight providers and some with gay providers. Their focus is on creating a welcoming environment at which the patient will not feel judged. It should not be to provide STD treatment and testing. Gay people have hypertension, dm, etc. and their total health should be the focus. The fact that what we think of first in our minds is STD testing/treatment is a consequence of the social environment in our country and not based on facts reguarding the many, many gays and lesbians in long term, commited relationships, some of them married and all of them monogamous and disease free! They need good care for their FAMILY in a place that will not judge them for adopting, getting married, etc. and request to test them for random STDs that they have absolutely no chance of having and had they been straight would have never been tested for. My concern is public perception of the glbt comunity, the whole reason this clinic needs to exist in the first place. By making the focus of the clinic STDs in the gay population you only worsten the current homophobia in society. To the OP.. If you are gay, or straight but still active in the gay community. You will get gay patients. There is little need to make it the focus. If your interest is in infectious disease, stds, and HIV (also an honorable pursuit but a seperate from gay and lesbian health) I suggest you look into getting certified by the AAHIVM as a midlevel. That will get you far in landing a job taking care of folks who have developed those conditions. Best of luck to you. Whichever you choose will be a great service to your community.

I find it offensive that homosexuality be so closely related to STDs. If you want gay patients, be a good NP that asks and appreciated your gay patients. They will tell their friends, you can get your name on the GLMA lists/websites start asking for referals from local glbt physicians etc. Acting like the thing gay people need most is treatment for STDs will not get you very far with this population. Good luck.

while there is little research with the only purpose being comparing pas and nps there is a substantial amount that did exactly that indirectly by comparing midlevels to physicians. i suspect this data set was chosen for cost as well as because it showed what they wanted to see. one could easily review the current literature (i have done so) and see that there have been well designed studies that indirectly showed little difference in outcomes between provider type. i suggest that if you have an interest in the comparisons between pas and nps productivity, outcomes, and practice patterns you do a critical review of the literature yourself and see if you can prove your preconceived notion that nps are better. i would share mine but i would prefer not to give you my full name and location.

like how to make a useless study with such a small number? or how to read a study without recognizing its limitations?

Very true. Can you imagine what would happen if everyone sat down, agreed on their differences, strengths, and weaknesses and looked to improve on them? Maybe someone should do that?

Good post but you miss one thing. If we took the best of both worlds and accepted our faults there wouldn't be anything to talk about on allnurses. Nobody would need to tell the world why they are better than everyone else!

I agree, its a personal decision. I just hope that it is a personal decision made on accurate information. I also hope that there will be a spread of more acurate information on this forum. I also have a question for the posters who mentioned generalist training as RNs. What daily activities did you perform as a student nurse that you perform as an NP on a daily basis? How many patients were you assigned as a student nurse?

my view, is that you cannot make a blanket statement that one is better trained than the other because there is no evidence. The evidence FOR my view IS the lack thereof. You dont HAVE to be better than anyone, just willing to better yourself.