imanubee

Hi pinkort-- I work at a different partner hospital that also has a partnership agreement w/ UTA. I applied in early October, had transcripts sent, etc and my "app status" still shows as "application received and completed but under review". So I called the academic partnership admissions person that had previously responded to my request for info. She wasn't sure why the above showed, but informed me that I had been accepted and that I would receive a "course map" in the mavs email system this coming week. To date I still have not received an official acceptace letter, but did receive something shortly after my initial app w/ my NetID and temp password. You also have to set-up your mavs email account that is shown on your profile, since this is where the course map, etc will be sent. Several co-workers are working on their ADN-BSN degree thru UTA and really like the pgm so far. I will also start in Jan 2010 and really looking forward to it!

If an NP were to open a clinic, would she be able to bill Medicare directly for services rendered if there weren't a physician on staff? Yes you can bill directly without a doc on staff. Would it be sufficient to have a collaborating physician or a physician as a consultant? Yes I read in my book here that in order to bill Medicare, the physician has to be in direct supervision of the NP. Only if the NP is employed by the group AND is billing "incident to" the physician's services. Also, realize that different Fiscal Intermediaries determine Medicare policy for their region. So Medicare policy in Texas may not be the same Medicare policy in California. Your book's authors may very well have obtained their info from an FI w/ that restriction, but most likely that info is just dated. An NP does NOT have to be employed by or supervised by an MD to bill Medicare. To be sure though, you could go to the FI's website for your state and obtain the info straight from the horse's mouth. This will be exactly what you do once you enter practice to find the billing guidelines that you'll have to follow. Or just hire an experienced practice administrator to guide you ;-) You would need a collaborative agreement in both practice setups---whether your own practice or whether employed by a group. This is not the same thing as a supervisory agreement. The billing details come into play once you decide HOW you are going to practice. If employed by a group, then initial decisions have to be made regarding the doc's and NP's expectations/roles, ie are you going to have you own patient panel and be just another provider in the group OR is the doc going to see the patient initially or for any new problems and then you take over care. This determines how Medicare is billed and also impacts reimbursement. HTH!

The Pearsonvue trick worked for me too. When I tried re-registering, it did not let me get to the payment page, but rather gave me a pop-up message. I still had my doubts up until I actually saw my "pass" results, but it did ease my mind a bit during the agonizing wait!

I just graduated too. The only other use of Mg++ (besides hypomag and pre-eclampsia) that I recall is for Vtach--Torsades de Pointe. Being in NCLEX mode, I too would have gone w/ the morphine answer, but thats the "theory" part thats been drilled into me. No practical experience to speak of.....yet anyway

Thanks for your reply! I'm wondering about the culture within the nursing units. Are new grads readily accepted and supported or does the "nurses eat their young" attitude apply? Do you know anything about the residency programs? I've been interested in finding one of these types of programs. In Houston for instance, the med center hospitals offer these twice a year and I've heard from previous classmates about their experiences with them---mostly good of course! Overall, I'm very interested and excited about the opportunity to work there, but wanted to fish for insight from someone with first-hand knowledge. Oh-what about parking? Can employees park for free? Thanks again!

Hi, Since you're looking at RN-BSN, have a look at UT Arlington. Completely online (RN-BSN) and they estimate tuition to be $4950 for the pgm. I'm not sure how they compare to the other two, but worth a look. And if you don't have pre-reqs completed, you can take them while in the program AND they have multiple start dates. Cheers!

Hi Lucky, I'm wondering what you might have found out about either of these hospitals? I just applied and was offered a new grad residency. They seem to have great benefits and a great work environment, but I'm looking for some first-hand insight. Thanks!

I recently took the exit Hesi as well. Fortunately, every question on the exam covered a topic that I'd seen before--whether in our texts or in the study guide. There was a question though that I STILL think was incorrectly scored. I answered it according to the information presented in the study guide where it specifically states a certain change that is to be expected in a certain population of patients. In reviewing the rationales at the end, it said something to the effect of, while this change may occur, it is not a uniform finding in this group. Grrrr...... But I passed it with a decent score, so in the end I'm just glad that its DONE!!!! After three attempts, there are about 13 of 90 classmates that did not pass and will not be graduating with us this week, so pinning will be bittersweet.

I've always heard that there are four. Its funny you say that about V3, b/c I heard that V2 was harder than 3, and that V3 was comparable to V1. But who really knows.....its all subjective in a sense. We had a Hesi Review at school w/ an Evolve person and this question was asked. Her response was that there are definitely 4 versions in use, but a school can always request an additional, which they will create from their test bank. In our class of 88, 50 students passed the first time, 39 didn't. On the second retake, approx half passed V2. With the grace of God, I was fortunate to pass the first time with a 1050. In all honesty, I really didn't think it was that bad. But of course its easy to say that in retrospect and from this side of the fence!

It is theoretically possible to offer "free" services, but in reality, something that is very difficult to accomplish. I have worked in agencies that have provided charity care to some patients, but not across the board for everyone. The most immediate problems that comes to mind with providing free services to patients is that many times, medical conditions are not "diagnosable" without studies such as lab work, x-rays, ultrasounds, mri's, cts, angiograms, etc. Now you are in a situation where a medical provider may suspect a condition, but there is an issue of payment for such diagnostic exams. And there are also medical liability issues involved if you suspect a serious condition but do not have the resources or referral arrangements to ensure the follow up and management of the patient. There is also the issue of treatment. How/who will pay for medications that the patient may need on a continued basis? If this is a clinic that is going to treat minor aches, URIs or something that requires a week's worth of antibiotics, its not such a big deal. But if there is a more extensive problem, its a tough position to be in. I worked for several yrs at a CHC, but prior to that I worked for several years in a cardiology transplant group. Frequently patients came in that needed transpantation or evaluation for such, but they were uninsured and financially challenged. It was a bad situation in that we were happy to provide the medical visits for free, but the costs of a heart cath, pul testing, echos, etc were out of reach as these involved procedures @ the hospital and w/ other specialists. On top of that, medications were unaffordable, the transplant itself approached 1 million dollars, plus the costs of immunosuppressives, and ongoing care put such an option out of reach. Also, if you provide free services, services have to free for everyone. If a pt is medicare/medicaid insured, you CAN NOT collect payment from them, even if the pt wants to pay and even if you are not participating in federal programs. The exceptions to this are in traditional medical models or CHCs as in my previous reply. This is all probably way more info than you wanted, but hopefully something in my reply has helped or given you food for thought. Cheers!

Hi CareerThree, What you are describing is a "Community Health Center". Healthcare centers such as these offer services at typical costs as well as a "sliding fee scale" for those who qualify based on income. Many times, the fees are waived depending on where the patient falls on the poverty scale. Documentation of income is essential to maintain. The center would set the fees and decide on the sliding fee scale. Another option for CHCs is FQHC certification---Federally Qualified Health Center. This is a federal certfication/designation that offers "enhanced reimbursement" to centers from Medicaid and Medicare on the order of 115-200% of the usual reimbursement. The rationale being that the center is a "safety net" provider and the additional $ will offset discounted and free services. Also paramount is a very aggressive strategy to maximize funding streams, as the center would have to demonstrate an ability to maintain financial viability to receive any kind of federal assistance. This can be accomplished via grants, fundraising, participation in managed care contracts, corporate sponsors, etc. Also, obtaining FQHC status qualifies the center to receive annual subsidies that can vary from 100-400K (depends on the center and many other factors) to help offset start-up costs and hire staff/providers. The center must operate as a non-profit with a Board of Directors that are active "users" (fed lingo) of the clinic. and must be in a "medically underserved or rural area" to qualify as an FQHC For more info, google "community health center" and "FQHC". Also, HRSA and NACHC (nat'l assoc of community health centers) are excellent places to start and obtain more info. HRSA is the fed branch that oversees these type of centers. This is a complex undertaking with many regulations and legalities, but very doable. rewarding and necessary. Hope this info helps some. Feel free to pm me if you have any questions. Cheers!

Audrey, I understand your concerns completely. I'm 36 yrs old and have been with my partner for 11 years and counting. People do regard our orientation as "sexual" unfortunately. I knew my entire life that I was gay, but never, ever allowed myself to admire a woman from afar in the way that heterosexual men and women gawk at each other---"whether checking out a package/bulge,rack, talking about how hot someone is, etc". I did try to conform and did not begin dating women until my early 20s, but even at this point in my life, I am "out" to very, very few people. And our lives are not about sex, any more than that of a straight person. Its really about connection, support, friendship and love. In fact, as I finish my last semester of nursing school, the last thing on my mind is sex! During my maternity rotation, I had a lot of the concerns that my patients would be uncomfortable if they knew. I knew that they would/could not know as I am very feminine in appearance, but those feelings were due to my own paranoia and stigma. The last thing that that I would ever want to do is make anyone uncomfortable, so I can respect someone's feelings as they are in a powerless and vulnerable position. Unfortunately, it may not be so easy for those gay women that are androgynous or "butch" in appearance. But my reasons for going in to nursing are not so that I can check out women, but rather because I know that I am capable, knowledgable and have a geniune desire to take care of people during their time of need. I do not expect to be asked in an interview if I am homosexual nor do I plan to out myself to coworkers/mgmt w/ an "I'm here and queer campaign", so from that perspective, no one would ever know. However I would like to feel like a part of the team/unit by being able to attend a happy hour function or party or being able to talk about my weekend or my vacation plans or the funny movie we saw without feeling like it will come back to bite me b/c of someone's homophobia. Socializing w/ coworkers that bring their husbands and always ask "where is your bf/husband?" gets old. Even now, I attend NS in Podunk, TX and have to endure homophobic comments from students AND instructors regarding "going to see all the faggots at the gay pride parade" or being warned by our instructors that "we WILL at some point have to take care of a gay pt and to be prepared to be hit on or groped and to know how to handle yourself". Unbelievable! I was in fact terminated from a job because of my orientation. I do not have proof or legal recourse, but am highly suspect given a rave review and $10,000 salary increase a month before I was laid off because the practice decided to go in a "different direction". What led up to that was the addition of my partner as a beneficiary in my life insurance plan 2 weeks before my layoff. Prior to this, everyone assumed that I had a boyfriend and that my partner was just a friend. So they did the math and low and behold I was no longer needed. The doc's friend was our agent and I was the Practice Manager. Whatever---they actually did me a favor as I found a fantastic and better paying job in a GLBT agency afterwards. Everything happens for a reason. Its just funny that I live in the 4th largest city in America and still see rampant discrimination and homophobia so often. Anyway, I've rambled on about this, but know that you are not alone in your concerns and kudos to you for being strong enough to be open about your partner when asked. Follow your heart and your dreams b/c life is too short to look back later and say "If only I had...." Good luck to you!!!

Probably not too much help with actual practice starting one, but if you go to youtube and search for IV, there are several how-to videos. I'm in my last semester of NS and doing a critical care rotation. I'm a little stressed, since in our level we're supposed to be able to assume total care. Well the problem with that is I have only started ONE IV and that was a year ago. Same with a foley. At least reviewing and watching with explanations helped a bit. But I want practice..... Good luck!

I think a lot depends on what you ultimately plan to do and your life circumstances. I returned to school at 34 to complete pre-reqs and was accepted into an ADN program shortly after. I will graduate in May 2009 at the ripe old age of 37. Nursing programs are extremely competitive--there were over 800 applications for 120 spots in our program. While a BSN degree is desirable for me, the ADN route was the shortest path to entering the workforce as an RN. This will allow me to gain experience and continue working towards a BSN (and after a period of time, obtain tuition assistance/reimbursement from an employer). Additionally, community college is certainly more affordable and after completing the program, there are several RN-BSN bridge programs, many online. If I were younger, I might have chosen the BSN route right away, but whats that saying about hindsight being 20/20? If you are interested in pursuing nursing, why not continue to work on additional pre-reqs for a BSN degree until you are accepted into nursing school? You'll need classes like stats, pathophys, nutrition, etc. Having additional course work under your belt can only add value to your application, help you while in nursing school and put you on your way towards a BSN degree. Good luck to you!!

Grayhunter- Check out the following link from Elsevier (makers of the Hesi): https://evolve.elsevier.com/EvolveWeb/services.link?uri=/SearchProduct&userType=Student&searchBy=DS&searchCriteria=1_74 There is an "Evolve Practice test 2009" that you can purchase access to with something like 1200 questions for additional practice. They also have a live tutor option and a live review course ($$$). I bought access to the practice test and use it in addition to the hesi rn book they sell. The cd that comes w/ the book just doesn't have enough questions for me, so I use the website too. We have to take a hesi during every rotation that counts as an exam grade. I have one Monday in OB that I am dreading. We also have to take an exit hesi at the end of the program to graduate. It blows, but at this point, we have to do whatever it takes. Keep trying---you've come too far and worked too hard!!!