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djmatte ADN, MSN, RN, NP

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djmatte has 7 years experience as a ADN, MSN, RN, NP.

djmatte's Latest Activity

  1. djmatte

    Tips to increasing efficiency as an Outpatient NP?

    Epic is great. What I recommend is to come up with a smartphrase system. Use it for common things as you make your notes. Often I would use letters to guide the direction of the phrase such as using A in the phrase name for "assessment" and the P in some for "plan". For instance, shoulder pain. I had a smart phrase called .ashoulderpain which put the general assessments we do for shoulder pain and the option to put positive or negative for the specific tests (hawkins, empty can, etc). Equally, I had a plan for that as well called .pshoulderpain. This pulled up a list of the common things I discuss with a patient going forward. These lists were often broad enough to select which applied to each patient. Anytime I came up with a new diagnosis, I would create smart phrases around it. By the time I left, I had over 80 smart phrases that I had shared with my colleagues to make their notes easier and more through for billing purposes. Working in urology, you may have much less to deal with than I did. But you can still pull these ideas and mold them into your own practice.
  2. Any group worth their salt recognizes a new grad will need a ramp up and their initial salary may not reflect the actual revenue. Not to mention the complete lack of billing knowledge often lowers the amounts new grads tend to bill for (taken from my own personal experience of accidentally billing 75% 212s for my whole first quarter as a NP). Thanks EPIC magic wand tool. <,< But practices that are playing the long game for their employees will recognize that by year two and three, the profits should be rebounding. The hard part is not-so-hot practices can get burned in this practice. They have such a revolving door due to their business operations, they ultimately lose money if they pay a nominal salary for someone who is out in a year or less. They often don't or refuse to recognize their own shortcomings and this also can be where lower salaries tend to factor in (aside from NP degree glut). Realistically, new grads are in limited position to negotiate only because they don't know their own potential. They often fail to research or understand what exactly NPs bring in. Not to mention, RN positions generally aren't a negotiating job. They often fall under pay structures for time and degree level that is regulated on a hospital scale. So many come in from no history of negotiating a salary and accept the first thing they're offered. I negotiated up for my first job and for more PTO. I shudder to think of what my colleagues did, but knowing that one of them had at least 7 days less PTO than I did, I'm fairly certain many take whatever they were given.
  3. djmatte

    Tips to increasing efficiency as an Outpatient NP?

    Understand your EMR inside and out. Use automation to power through your notes. If there are smart phrases, have a series of common diagnoses, assessments, and plans to document the most likely things you will discuss or assess.
  4. djmatte

    Legally can I mix RN/NP roles?

    If anything, the best way to avoid a conflict is to perform one job at a completely different facility where you are not credentialed as an NP. that way you literally won’t be allowed to work to your full licensure. Either way I still find the idea ridiculous.
  5. djmatte

    How to educate spouse about what I do as an NP?

    The level of relationship aggression and self preservation I see here in this thread is eye opening and kind of disturbing. If you need to “check” your spouse, you made a wrong choice. If you need to educate your spouse or correct your spouse on your livelihood, you made the wrong choice. If you feel you need to compete for their respect or feel more dignified in their presence, you made the wrong choice.
  6. djmatte

    How to educate spouse about what I do as an NP?

    Sometimes we need to look into the mirror when communication with others isn’t working as well as we hope. First thing I noticed was your lead in topic. “How to educate spouse…”. You’re neither her teacher nor her provider. But you’re topic and statements indicate you feel some sense of condescending authority. You’re her partner at the end of the day and as such are failing to recognize what she’s clearly communicating to you. I’m gonna bet these responses are an escalation and not just occurring out of the blue. She may or may not understand your role or maybe she’s just growing more impatient with the topic of conversation and shutting it down more abruptly. My wife is a nurse and she doesn’t want to hear about my day when we’re home. I imagine the feelings much stronger for someone who can’t relate. As others pointed out, find a different topic conversation. Leave work at work.
  7. djmatte

    Air Force nursing FY2021

    After 2.5 years of trying to get back into the service, I officially swore in as a Captain in the USAF yesterday. We are in the process of going to my first duty station as we speak with the plan to attend OTS in the near future. Ready to get this chapter started!
  8. djmatte

    Medicare and Full Practice Authority

    Even in full practice states, many insurance companies still require a collaborator. I believe Medicare included. One of the biggest reasons I would opt for a direct primary care model of I ever went independent. No insurance. Pay a monthly fee of $50. See or interact with your provider as often as necessary. I won’t feel I need to hit a quota of patients per day to make money and I can more easily justify alternate forms of patient evaluation where insurance companies don’t always pay for.
  9. djmatte

    Continue as FNP or train in Cath lab?

    That’s not entirely accurate. You’re legally obligated to the level you’re credentialed. So long as she isn’t doing NP work she’s not credentialed for, then she has nothing to worry about.
  10. djmatte

    Continue as FNP or train in Cath lab?

    Sounds to me like you need a new job. You aren’t making anywhere near what you are likely billing for on those hours or volume. You need to either renegotiate your base or get a new job. This is the kind of situation we warn against for people who falsely claim oversaturation doesn’t hurt wages or our job opportunities. I don’t care what part of the country you work, these wages are garbage for the work expected.
  11. djmatte

    Secured a job on LinkedIn

    People recruit there. It’s good to have a solid profile. But never personally gotten s job through there despite lots of people reaching out.
  12. djmatte

    Happier being a NP than a RN? Right decision for me?

    Another consideration given your personal preferences. Consider pharmacy school. Lots of research and md level of care. Not so much on the patient interaction or crazy hours side.
  13. djmatte

    Happier being a NP than a RN? Right decision for me?

    Sometimes a change in function may be more appropriate than continuing on to role change. Not all nursing areas are the same and some might be a better fit. I might recommend PACU. While it’s task oriented, you will likely only have 1-2 patients at a time and typically they are gone in an hour ish. It’s technically a job you can coast in, but also a job you can transition into other areas. Another consideration is care management. The VA hires these RNs to reinforce their primary care teamlets. It’s a lot more patient monitoring with a pseudo provider idea; though technically exceptionally run by a physician. NP work isn’t without its drawbacks. In today’s climate, anyone who is not currently a working NP (outside of some specialties like psych) are going to find the job landscape difficult. You will still find yourself working five 8s and if you end up a hospitalist or doing other hospital work, expect just as wonky of a schedule. You can expect to also do many extra hours closing charts or researching conditions as you will frequently take work home with you. At least if you’re worth your salt in patient ownership. You will still deal with families, only on a different plane. You will be educating everyone in the room the ins and outs of everything you’re recommending for your patient. Patient interactions are not always one on one and while families may regard a provider higher than a nurse, they will also distinctly remember your name for any reason they don’t like you. It’s hard me to qualify happiness in a job. I feel good about my position and more involved in my patients. I know more and work harder to make important decisions for patients I never had to worry about before My pacu, pain management, and care management background definitely aren’t as fulfilling job wise. But those roles also had their benefits. But as I stated earlier, I feel anyone taking on more debt now will be hurting in the job market in the next few years.
  14. djmatte

    Total Number of Nurse Practitioners Hits 325,000

    Though an MSN there can be everything from FNP to education to management.
  15. djmatte

    Total Number of Nurse Practitioners Hits 325,000

    Another thing to consider is the USnews ranking. They have 574 total masters nursing schools and 330 DNP schools which to my understanding has some online and brick and mortar schools. I only presume this because FNU has placement in both their overall list and their online only list where others aren’t. I guess FNU is more hybrid given their in person requirements. Their online school list is at 173 schools. Also note Walden is unranked in any of these lists. Probably for good reason. Most brick and mortar are going to have smaller cohorts. Maybe a graduation of 20-40 if not smaller per degree program. Especially since they typically have an annual start. Frontier has a new cohort quarterly and typically is about 30-50 per degree program. Without knowing how many of those ranked schools are brick and mortar for sure, I’d argue the ranked brick and mortar and hybrid schools probably account for half the 35000 new NPs and the other half toward the online only list.
  16. djmatte

    Total Number of Nurse Practitioners Hits 325,000

    Online environments definitely allow a school to get more students. The question is really at what point do outcomes suffer. My school FNU awards about 800 degrees a year spread across MSN FNP, WHNP, PMHNP, and their DNP students. They publicly display their statistics to include graduation and retention rates and board pass rates. Places like Walden don’t which is a good sign of a school that has a questionable curriculum or business model. But if in one year, we’ve added at least 35000 new NPs, it’s a good sign some of these schools are pumping out much more. My school accounts for only 2% of the totals and has a fairly stellar track record of prepared NPs. https://frontier.edu/about-frontier/frontier-statistics/