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Riburn3 BSN, MSN, APRN, NP

Internal Medicine
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Riburn3 has 14 years experience as a BSN, MSN, APRN, NP and specializes in Internal Medicine.

I have been an RN since 2007, where I worked for almost 8 years in CVICU as a charge nurse. I graduated with my MSN-FNP in late 2014, my AGACNP in 2017, and work as a hospitalist.

Riburn3's Latest Activity

  1. Riburn3

    NP salary/pay let’s be transparent

    Thanks. I had to crawl through the muck before I got this job, working for a large volume practice, seeing 30+ patients a day all over a decently sized city, and barely was scratching 6 figures. It prepared me very well for my job, but it's proof that experience pays off. I would have never landed my current gig as a new NP, and it's important to remember for new NP's out there, that their starting pay out of school will most certainly not be what you are making down the road. Even in saturated markets, practice groups and larger companies will pay for experience.
  2. Riburn3

    Did you feel ready to practice upon graduation?

    I didn't feel uncomfortable (but also not really "ready"), but I also was very aware of my weaknesses and not afraid to look things up or ask questions. My first job was in a large IM practice that I did a huge chunk of my school clinical work in, so I already knew the charting and system well, so the tedious new job stuff was out of the way. Looking back now I can think of dumb things I did, or how I used to manage some things, and think to myself that I was really ignorant, but I wasn't dangerous. Nearly 7 years into my NP career, working in an inpatient environment, I always am still looking things up, asking questions, using my resources. There's not a day that goes by where I don't learn something. I think it's important to lay the groundwork of curiosity and know your limits. It is so crucial to get that first job in an environment where questions are encouraged. The worst providers to me are the ones that act like they know just about everything, and can never admit with they are wrong or don't know.
  3. Riburn3

    NP salary/pay let’s be transparent

    Hospitalist NP in Southern, NM employed by a large national physician practice. We work independently within our group and admit to ourselves with no physician oversite. NM is a very NP friendly state. -$171k base (have to give fourteen 12 hour shifts a month, at $85/hr). I typically work 15 or 16 shifts a month so haven't taken home less than 210k a year in the nearly 4 years I've been here. -RVU and Quality bonuses equal another $20-30k a year -4% matched 401k -Solid Healthcare -No PTO, but schedule is week on, week off, so I have over half the month off and can work the schedule between months for more time if necessary -Holiday differentials -2k CME (licensing can be covered under CME, as can scrubs and stethoscopes, supplies)
  4. Riburn3

    ANCC AGACNP Exam Tips

    Both of you sound like you’re putting in the effort and are on the right track. I scored all over the place on practice exams. The Barkley practice tests are in my opinion much harder than the real deal. Keep doing what youre doing and maintain a positive positive mental attitude and you’ll succeed.
  5. Riburn3

    NP Wikipedia Article

    Meh, our group did fire a physician because they were a giant dumpster fire and couldn’t punch their way out of a paper bag. They were a hangover of the previous hospitalist service. They never quit, but at least the NPs knew it wasn’t the right fit for them and didn’t need to be fired.
  6. Riburn3

    NP Wikipedia Article

    I think the issue is the person that edited the article is a preferred editor, sooverriding him/her is more difficult. The article also has a soft lock until November.
  7. Riburn3

    NP Wikipedia Article

    There are tons of discussions about this over the years on here. Youll see posters say that experience matters. You’ll have some that didn’t have any experience and say it didn’t hurt them. My personal belief is that its helpful in many ways. I felt very prepared in my program because I had 6 years of ICU/CCU when I started, and didn’t struggle in the program like some folks with less experience That experience also left me with better connections for employment, and my first job out of school was a direct result of having experience. Many in my class likewise.
  8. Riburn3

    NP Wikipedia Article

    To be honest I don’t know. It’s still not a very large sample size and it’s just now only being tried in other places I also mentioned earlier it was really tough finding the right NPs to fill the role. In the first year, 3 NPs essentially left only a few months in because they didn’t feel comfortable operating so independently in a state that already has had independent practice for a long time. As proud as I am, you don’t really experience that from physicians freaking out and quitting. Not that these NPs were bad, and some were already hospitalists before, they just weren’t quite ready.
  9. Riburn3

    NP Wikipedia Article

    Well it is True True, but I admit one of the program struggles initially was getting the right kind of NPs into the job as it requires a very high level of autonomy and critical thinking (we cover ICU as well). Once we found our core, it’s been smooth sailing, but we did burn through a couple folks quickly that weren’t ready for it. I also dont disagree with your comment about precepting. There are certain schools I won’t precept from, and I usually now only agree to take student that I know.
  10. Riburn3

    NP Wikipedia Article

    Hmmm you sure like to just make up a lot of bologna. My comment on consults was in regard to you saying they would run away at an NP run hospital. My point is lots of NPs isn’t scaring anyone away, we live in an underserved area so many consultants come here to finish their visas, then end up staying. You seem to live in the world and have a mentality that if you haven’t heard of something happening or seen it , then it must not be true. What’s it like being so omnitient?
  11. Riburn3

    NP Wikipedia Article

    It’s sort of funny you mention “an NP run hospital”. I work as a hospitalist in a group that is 50/50 physician and NP hospitalists. We are part of a pilot program by our company to determine if a larger pool of NPs in a group is effective and safe. Effectively our company wants to know if they can get away with this model because we are paid a lot less than the physicians, so it’s a big cost saver. We split the assignments, admissions, acuity, hours worked, committee memberships, and everything else evenly. It’s an independent practice state so there’s no co-signing. After two years, the NPs as a whole have a better satisfaction rating, lower readmission rate, equal length of stay, equal consultation frequency, fewer adverse outcomes, and fewer core metric fallouts. As a result, several of our sister hospitals are eliminating physician positions in favor of more NPs in the practice group. Since our group started this we surprisingly have more consultants that have moved to the area. No one has fled!
  12. Riburn3

    NP Wikipedia Article

    So because those are the only studies you’ve seen makes it definitive I guess? Many states have had independent practice for over 20 years. You’d think it would be all fire and brimstone there with how terrible NPs are. Look at a map of states that have independent practice, and they coincide with some of the healthiest states in the country. Look at the most restrictive practice states ( the south), and you have some of the most unhealthy states in the country. I’m not saying NPs are the cause of that either way, but it’s clearly not a detriment, and just perhaps patients that have greater access to more providers is a good thing, and a net positive. Lets not beat around the bush. Physicians against independent practice are worried about their bottom line. Plain and simple.
  13. Riburn3

    NP Wikipedia Article

    I agree most surgeons are adequate. Most I’ve met are fantastic. When you took a generalized shot at the NP profession and our personality not understanding shortcomings (which had you actually ever been on this site would know there’s literally hundreds of pages worth of NPs discussing the profession and our shortcomings), I decided to make a joke about surgeons. Surgeons are experts at deflecting their own mistakes and shortcomings onto others. Clearly not all of them are, but there’s a reason for the profession being associated with the term “God Complex”. At the end end of the day, comparing education has done nothing to enhance the physician lobby, and more and more states are granting NPs their independence, not the other way around. When I sat in a recent hearing where the government of New Mexico passed a law allowing all APRNs the ability to admit their own patients in a hospital without a physician, the senators asked point blank, if the physicians there fighting the bill had any proof that nurse practitioners, particularly in independent states like New Mexico, provided inferior care or their patients suffered worse outcomes, and they straight up said no proof exists, and spouted on again about education. They were promptly silenced. The bill passed easily and was signed by the governor just this month.
  14. Riburn3

    NP Wikipedia Article

    Clearly never met a surgeon.
  15. Riburn3

    NP Wikipedia Article

    I'll also add after doing some digging, that it appears since the end of march, an entity has taken over the page, and started making numerous edits, and now the page is semi locked. While some comments are fairly accurate, others are blatantly false or misleading, indeed fake news. Anyone with half a brain can read the edit history, check the IPs, and actually read the references cited and realize this is a hit job. The person editing it apparently knows a great deal about Pakistani cricket and Nurse Practitioners, no other medical articles. "NP training covers basic disease prevention, coordination of care, and health promotion, but does not provide the depth of expertise needed to recognize more complex cases in which multiple symptoms suggest more serious conditions" which is just blatantly false and cites nothing to back this up "Increased utilization of nurse practitioners is leading to increased cost of care through increased use of resources and unnecessary referrals". Check the references, they make absolutely no claim that we are leading to increased cost in healthcare and the difference in ordering practices in very small sample settings is 0.1%, not really statistically significant. Considering we bill at 85%, we are cheaper. "Nurse practitioners are more likely to prescribe antibiotics when they are not indicated". Only assessed providers in ambulatory care and the overall conclusion of the reference was that all providers over-prescribe and the study did not separate NP's or PA's, and even mentions in the studies limitations that the finding might no be representive of NP/PA practice because of the sampling methods used. "Although a few studies have shown that NPs provide similar quality care when compared physicians, these studies were found to have a medium to high potential for bias and had low to insufficient strength of evidence" This is my favorite as the article referenced so supposedly back this up states explicitly "The studies we reviewed did not demonstrate a difference between APRN care and physician care in primary and urgent care settings with regard to health status, quality of life, mortality, or hospitalizations" I think we can all agree there are ways to improve our profession and standards of entry, but this article is a biased pile of garbage and I can't believe it's allowed to exist.
  16. Riburn3

    NP Wikipedia Article

    Never said it was inaccurate in regard to what you just took the time to post, and even mentioned the part about clinical hours and education in my OP as being accurate. My larger issue is whoever edited it (foreign IP address), especially with regard to quality, presented a very narrow view of references and some of the “citations” are very poor quality. Their wording in general was also poorly done. It also failed to cite the many articles that do exist out there that prove our strengths. The intent was clearly biased in nature.