MegRyanGirl

So does that mean you have to have 300 hours of CMEs? Or can you count most of the Adult NP CMEs towards the Family NP CME as well? In other words, can you use the same CME hours for both certifications if they are relevant?

I am currently a Primary Care Adult/Geri NP licensed in NJ and NY and would like to add a post-Master's FNP certification to expand my job options. I found a bunch of programs but not sure what's required to maintain the certification. Do I have to maintain separate CEs (150 hours x 2=300 CE hours) for Adult/Gero and Family NP even though the only difference is the Peds? Or can I just do the 150 hours for Family NP since it already includes the Adult/Geri NP requirements? I'm certified with ANCC. Do I have to take the Board exam to be able to see children and claim FNP status or is the graduation from the program sufficient? It's my understanding that in some states, you don't need a board certification to be able to practice as an NP. Also, what's the role of the State Nursing Board when it comes to adding a post-Master's certificate? Are they involved in anyway? Has anyone here gone through the process of adding the post-Master's certificate? Any information would be appreciated. :)

Thank you for your answers. Im not talking about my employer. Company A wants the NP to bill for 2 visits even if one of the visits is not medically necessary. They get paid a set amount per head regardless of number of visits made. How is it legal if Medicare rules don't allow for medically unnecessary visits? Does it become legal because the company gets paid from the insurance company and not directly from Medicare? Very confusing 🤔 What's the difference between an NP Forum and an APRN forum?

Is this legal or illegal? What would you do in this situation? Company A that you work for says that you have to see your nursing home patients a minimum of twice a month (including the monthly visit) even if there is no medical necessity for the second visit. Medicare guidelines say that nursing home patients should be seen for required monthly visits…. And other medically necessary visits.” Company A says there is no legal problem here because it does not get paid from Medicare. They say it has a contract with Insurance company B that pays them a set amount per patient each month regardless of number of visits. What would you do?

I wish I were better at that! :-) Have been working on it. Any tips on how to just let things go?

I think canceling a check for service provided is wrong. Just because you don't like the diagnosis you got doesn't mean you shouldn't pay for the work that was done. And no, no lawyer is going to call such an episode "malpractice." Lab test is not necessary for a URI unless strep throat is suspected. Obviously this is all theoretical since I didn't see you personally, but in general if the cold went away within 2 weeks (with or without antibiotics) it is safe to say it was a viral infection. That's what evidences show. So you can't attribute the fact that you got better when you took the antibiotics to the good work of antibiotics. You were on your way to getting better and you happened to take an antibiotic so you think that's what made it better. Again, that's if the whole thing lasted 2 weeks or less and all in theory.

I was looking for a place to release some work tension but didn't find the right topic. So here is a place for every NP out there to vent your frustrations that you come across as an NP :-) Advice, encouragement and support is what we are looking for! Share and sympathize Here goes mine. I've had a typical week at a primary care office. Saw about 40 patients with some form of URI. I'm very diligent about not prescribing antibiotics when it's clearly a viral case. With the new CDC recommendations and the antibiotic resistance epidemic, every one has to take a part. But I'm getting really frustrated with providers out there that have no problem prescribing abts to pts that had some cold for a few days. It really undermines providers like myself that diligently educate the patients on viral v.s. bacterial infections, not to mention bad medicine that goes against the most up to date evidence based practice. Patients can be quite frustrating as well. They all fall into one of 3 categories. 1) Those that I educate about the viral infection, understand it and follow instructions, 2) Those that seemed to have understood it but then second guess and start calling and asking for antibiotics when it's not necessary, 3) those that get annoyed that I didn't give them an antibiotic and just go to another place or urgent care and get what they want. ARRRRRRRRRRGGGGGGHHHHH What am I to do??? Another issue. I don't know how many people on this forum are from the U.S. or another country, but I was raised outside of the U.S. and the mind set is very different for that of the U.S. where I practice. I don't want to be judgmental or anything but American born patients seem to have a very low tolerance for anything that's a little uncomfortable. They can't deal with a little sore throat or a little cough here and there. I mean I have pts that come running to see me for some medicine after some sniffles or some sore throat or a little cough for even less than a day! Most common is someone with cold symptoms for 3-4 days. Where I come from, you just suck it up for a week or so. Back when I was younger I didn't know much about viral versus bacterial infections but now I understand that most of those sniffles were just viral anyway and went away on it's own. Here in the U.S., people take and demand so much antibiotics that they get sick much faster! It's really frustrating. Sometimes I just want to tell them to stop their whining!!!! Or have some cheese with it

I actually met with the Medical Director for the facility they are hiring. There was not enough time to go over practice standards or management techniques, but he expressed some frustration with the facility like the staff nurses not having good assessment skills and getting after hour calls over stupid stuff when it's not nothing urgent. I forgot to mention that the LTC has on call duties as well! :-( He did sound like he wanted me to call or email him at least in the beginning to update him on a daily basis. My previous job also went over my notes the first 3 months and I did find it a little intrusive but I didn't care so much cause I knew I was new and that they wanted to make sure I wasn't doing anything funny. I would rather have my charts reviewed than having to call/write the MD every day and update him on everything. That's just extra work and annoying.

I was leaning towards taking the LTC NP job after reading these comments, but now I feel a bit differently after shadowing an NP at one of their facilities the other day. I was taught that NPs are not assistants to MDs and we are not there to be supervised. At least not in the State I practice in. We have to have a collaborative agreement, not supervision, and we can order whatever we want including narcotics as we see fit. But the NP I shadowed at this LTC said we can't just do whatever we see fit. If I want to treat one way and the MD wants to treat another way, we have to go by what the MD says. And that NPs don't own patients. We share them with the primary MDs, and we assist in their care of their patients. So the MD has the ultimate say when it comes to patient care. I am starting to think this might not be the situation I want, since it would not allow me to practice to the full extent that I am trained. When I was in my previous NP position in an outpatient primary care office, I didn't have to ask for permissions on anything from an MD, nor did I have to check in to make sure that an MD agreed with something. If I saw the patient, I could do whatever I wanted that was reasonable practice. I could ask a question to an MD if I was unsure of something, but no one kept tabs on me. Well, I am sure they did, but no one said anything about how I practiced. But in this LTC, it was explained to me that I have to notify the primary MD what I did or was planning on doing on a daily basis or several times a day. Granted this is just in the beginning until I establish a relationship with the MD. Once the MD trusts me I don't have to update as much, but still the MD has to be made aware of a lot of stuff. So in a sense, I feel like the position I am being offered is just a glorified RN position. Agree? Disagree? What is your LTC setup like? I really wanted this position to be the one but I'm feeling disappointed. :-(

I am not sure I would call it "hung up on primary care." :-) I was trained to be a Primary Care NP. I was not trained to be an Acute Care NP nor do I enjoy doing acute care. I want to be in an office practice because I enjoy it. My question was whether it would be a problem getting back into an office practice after doing LTC, which you answered, so I thank you for that. :-) Personally, I would be bored if I saw only 4-6 patients a day, but the job I am being presented with gives me the freedom to see as many patients as I want, so that should not be an issue.

I have been an adult/gero NP for 7 months now. Just got laid off from my first primary care office job when they realized that they didn't have enough patients and it was no longer financially feasible to keep me. I worked there for 7 months and have good references from them. I immediately started looking for a new job, since I have a baby that's in daycare($$$) and it's hard to make ends meet with just one income from my husband. There are a lot of jobs out there but I don't want to just take any job that would pay the bills because it's my first year out of school and I don't want to be type-casted as "nursing home NP" or "homecare NP" or whatever that would get in the way of getting my ideal job in the future. I had this issue as an RN when I took a job in non-acute care position in my first year out of nursing school and couldn't even get an interview at a hospital after that. My question is, what's a good field to go into that would not impede my career in primary care office position? Ideally, I want the same type of position I had. But there are jobs for NPs in sub-acute/LTC centers, homevisit NPs, urgent care NPs(most likely I don't qualify cause usually they want family and not adult np), insurance company NPs, etc.... I have an offer from a sub-acute/LTC center but I am afraid that if I work there for 1-2 years I will not be able to get a job in a regular primary care office. What are your experiences and thoughts on this??

1)__ Do you take the flu vaccine yearly? If you do not, what is the reason you do not participate (if you don't mind answering this question)? No. I take it when I feel like it. The statistics for the effectiveness of the flue vaccine is inaccurate. It typically works only 60% of the time. Last year it was even less effective than that. It was even in the news. I don't take it because I don't see the point in getting an ineffective vaccine. I've worked with a doctor that has never taken it for the exact same reason, even though he always asks his patient whether they want a flu vaccine and has no problem giving one. I am with the camp that thinks that the drug companies are out there to push their drugs on the public to get the maximum amount of money. They have a lot of money to do the grassroots work and to affect the lawmakers for their own gain. Seen that too many times. But really, my biggest reason for not taking it most of the time is the vaccine's ineffectiveness. 2)__ Does your employer have a mandatory influenza vaccination policy as a condition of employment? If yes, where do you work? No. 3)__ What concerns do you have about the flu vaccine? That it's ineffective and that sometimes you get the flue even if you get a flue vaccine. So what's the point? No I'm not afraid of needles. 4)__ Do you know if anyone who has been released from their job because they did not get the flu vaccine? Not personally. Just from the news.

Congratulations Alta75! I also took the AANP about 2 weeks ago for the first time and did not pass. Needed 500 and got 486!!! Arrrrrggggghhhh!!! Honestly, it felt like an exam with one level above what I was prepared for. I had to guess many questions. Some questions seemed to have multiple correct answers. I have a baby so I am unable to study for long periods every day. I studied 2 months, 3 days a week a few hours at a time. That was the best I could do given my circumstances. Went through Barkely review CDs twice, did the Fitzgerald CDs, and took both of their practice tests as well as the AANP mock exam. I passed most of them although in the 70's. Alta75, how long did you wait to retake the AANP? I thought that you had to wait 3 months before retaking. I signed up for AANC since it seems they let you take the test quicker than having to wait and do the 15CEs for AANP. Also, has anyone heard of people appealing the test result?? Is it worth it or a waste of time? On what basis can you appeal?

My goal is to become an integrative/holistic NP. I saw some holistic programs for NPs (NYU has one for example), but they don't seem to provide you with knowledge to actually prescribe herbs. I am not sure which school is reliable for this. Whether it's homeopathy using traditional European herbs, or using Chinese herbs, they are all still considered herbs (in my humble opinion ). I want to be able to prescribe herbs or antibiotics depending on the situation and would like to find a program that teaches you about the interactions between the herbs and the conventional medication. That's the most important thing to me. University of Arizona's fellowship looks very good but I am not sure if it will provide the information that I am looking for that I just mentioned. It may very well be perfect for me. Does anyone know of a person that went to that program? The cost is definitely an issue. I've studied aromatherapy on my own and have been practicing it on friends and family for about 10 years now. Zenman, you should definitely "sniff it out." As for acupuncture, I would rather refer my patients to a practitioner than do it myself. The schools in NY seems to require you to be an acupuncturist before you learn Chinese herbs and the whole program comes out to 5 years, but I found a certificate program in NJ that doesn't have that requirement and is much shorter. Does anyone know of a reliable school for homeopathy?

I am trying to figure out what the scope of practice is for NPs in terms of various alternative medicine modalities (i.e. aromatherapy, acupuncture, prescribing Chinese herbs, prescribing vitamins, Reiki, Guided Imagery, meditation, etc). I would like some input from you all as I am having a hard time finding this information. I did some research online and it appears to me that you need a separate certification to do accupuncutre. Even an MD seems to need a separate certification. Am I right in this? Does one need a certificate to practice aromatherapy? Or does being an NP allow you to give aromatherapy recommendations without the certificate? Same question for the herbs and vitamins. I am especially curious about the legal requirements for prescribing Chinese herbs and whether an NP can do it. Any information is appreciated