NPmimzy75

Thanks for all the comments! I agree that it is mostly a billing issue. In practice, I am seeing the patient in the ER for the cardiologist (who is likely in the cath lab) assessing the patient including interpreting the EKG. I'm making the decision about the treatment course including going to the cath lab at that time. The EKG is "signed" by one of the cardiologists the following day. I don't go back and use that signed EKG for anything. It stays in the computer system. My decisions are made by the real time EKGs in the chart that I've ordered. The question I'm wondering about is, do anyone's priviledges specifically mention interpreting EKGs? I think the bigger issue in the situation that this has stemmed from was an isolated incident, maybe with an individual that may need closer monitoring or a system that needs scrutiny. My facility is trying to turn it into a broader issue involving all NPs (and PAs) in our organization in general. I plan to express that this is not appropriate or necessary. It is within our scope to interpret and treat based on these tests. If they want a physician to do the "official read" for billing and liability purposes, it really doesn't change our day to day.

Hi all, I'm looking for some feedback about different facilities and specifically EKG reading by NPs. I am having trouble finding anything concrete that states that this specific skill is within our scope of practice. Most wording I find is quite vague like "ordering and interpreting diagnostic tests". How does your facility's credentialing committee handle this? Is it mentioned specifically? It is considered an "advanced privilege" that you need to apply for specifically? If so how do you display competency and maintenance of competency. Just a bit of background: I work at a fairly small, fairly rural hospital that is a bit of a "good old boys club". We are very behind the times as far as incorporating NPs into hospital practice and allowing us to work to the top of our scope. I'm afraid this recent issue that has come up is really a slippery slope that will just lead to more barriers to practice. Thoughts and advice are much appreciated!

Hi all, I'm planning on working with my office manager to help restructure how our clinic is running. I'd love some examples of models that work well to take to our group meeting. We are a growing specialty practice with physicians and NPs / 1 PA that work mostly in pairs (the busiest physicians have a NP/PA assigned to them). While it is a hospital based "group" most of these pairs function rather independently and very differently. My personal work load involves admitting, discharging, doing consults and rounding in the hospital on days when my doc is on call. He is a very busy interventionalist so is in the cath lab or reading tests all day. He rounds behind me at the end of the day. Post call is the same. We have 1 clinic day a week where we see patients simultaneously all day. We are now adding some days where I will be there myself seeing mostly routine follow ups, recent hospitalization followups and work-in urgent issues (not needing an ER visit). I feel that the workload between all the providers is not equal. I'm wondering how I prove (in order to be compensated for it) that I am doing more work than my peers. Right now, our salary is based on a national average with a raise each year which really isn't based on anything other than "cost of living increase" or something like that. I am always there late. My doc accepts new patients and consults (that I need to see) even when he's not on call. And my weekends (1 per month) are always full days with my doc doing procedures where the others mainly get in, round and get out. We have just obtained our Medicare/caid number to start billing under ourselves which I think should make things easy to track. So I guess my questions are: 1. how does your specialty clinic (doing both outpatient and hospital work) utilize NPs? 2. how are you compensated for the work you do? 3. is the workload in your group "fair" and how do you even it out? 4. Do you think I'm being abused ha, ha? I actually love how I'm functioning. I'm only 3 years out of school (still feel new!) so I'm happy with the independence level which is: making my own decisions, initiating workup and treatment, but not feeling out on my own to flounder. While I may not see my doc all day, he's always available. We always discuss our patients at the beginning and end of each day. BUT I think I've spoiled him because he expects *someone* to do all his "hospital work" for him when I'm not there. My peers don't like it and also have other stuff to do for/with their docs. 5. related to #4, how independently do you function? Do you have "your own" panel in the clinic. I feel like, being a specialty, the patients should remain under the MD specialist, even if he only sees them himself every few visits. 6. Would you send out a letter to all the clinic patients and give to new patients explaining how the model works... explaining who I am, what my qualifications are, what an NP is and can do? I'm getting tired of hearing "oh I'm not going to see the doctor today?" when I walk in the room (another whole topic!) thanks for replies or comments on any of the above! I plan to present *something* to my whole group so I need to get prepared!

So I'm 2 years into my first job and I'm worried that I'm being taken advantage of. How do I know what I am worth, financially? I feel like I should be getting paid more. Background: I am an ACNP working in cardiology. I do all my billing under my physician so I have no way to really know what I am bringing in. I work both clinic and hospital, doing rounds- basically seeing all the hospital patients including admits and consults while my doc is in the cath lab all day doing procedures. It's actually my dream job, exactly what my job description would be if I wrote it myself! My only complaint is that I am frequently over 80 hours a pay period, sometimes working 12 hour days- (and it's hard to go from hourly with overtime to salary and working overtime for free) and that weekend rounding once a month has now been added to my duties. I don't mind working hard and staying until the work is done, but at what point should I expect extra compensation for what I feel is extra work. I have no contract, which I know see is a big problem because things just keep changing on me. Is anyone else in a similar situation? How do I figure out if I'm being compensated adequately? Thanks!

I had the same problem, I was worried that something might be important but I just couldn't see that yet, so wouldn't want to leave anything out! I didn't know yet, what was important and what wasn't. I'm 2 years into practice and just now starting to get comfortable with a quick presentation. When you're getting together what you're going to say, try working backwards from your diagnoses or conclusions and think about what supports them- those will be the important things. The first sentence should give you a clear picture of what kind of patient it is- "a 57 year old uncontrolled diabetic smoker presenting with exertional chest pain" gets their attention right from the beginning.

I'm wondering how common it is to have an NP job without a formal contract? Myself and another NP were hired by the same organization, by the same person, with the same package offered at about the same time. There was no contract offered and I did not think to ask for one. The person who did the hiring has since left the company and there has been some restructuring. I am up for my 1 year evaluation and raise and it has brought to light that I am not receiving all the benefits I was offered in my interview. I have the salary I was offered, and that is the only thing in writing. I was told my licenses and certifications would be paid for and now they are taking them out of my "education / CME money". I was told my annual raise would be a certain percent and it is lower. They are small things but adding them up amounts to something to me. Is this just my mistake for not asking for a contract and oh well? Should I fight it? In this time of cut backs I hate to rock the boat as I love my job otherwise (it is my first NP job). But part of me feels like I should stand up for myself and what I was promised. What do you see as the pros and cons of having a contract or not? Should I fight for the verbal offer I was given during my interview (there are two of us to corroborate), or just get what I have now in writing so it is safe from any future cut backs? Thanks!

zenman, I can't find anything on the NM BON website that tells me how I must sign my name. I'm having prescription pads made up for me and not sure if I should use CNP or ACNP-BC. I thought the latter was the nationally recognized title from my certifying body and so I should use that. Can you direct me somewhere that clarifies what title to use when? Thanks! (I'm in N.M. and certified by ANCC)

I think someone hinted at this in their post, but why not just alter the test to include more geriatric questions, thus proving our competency. I know my program included geriatric material, does this mean I may be eligible for the new exam? It sounds like the requirements are not even laid out yet, so how are schools adjusting to be ready? I think I have PTSD from taking my ACNP boards just weeks ago and I don't EVER want to do that again! Nor can I afford to go back to school...probably ever by the time I get my loans paid off! I also can't believe that I graduated in August and did not hear anything about this during school.

Well I passed!!!!! I think over half of the test was on "therapeutic communication". I had no idea how I was doing the entire time, it was very nerve racking. I could narrow those questions down to 2 good choices then it was a guessing game. It's hard to know what you would say to a patient that you only know by 2 sentences of information. I'm kind of offended by these questions. I think at this level of practice most of us are able to communicate "therapeutically" or we probably would be here. Especially for the acute care test, how about find out if we can keep them from dying then we'll focus on talking to them about their situation. Just glad it's over and never want to do it again! Time to turn my brain off for a few weeks then start my new job! :beer:

Any clues on how to study for the billing and coding section listed in the content outline. I get the levels of exam (focused vs comprehensive) but what about the section on Health Care Policy- health care financing (billing, coding, reimbursement, third party payors). I'm guessing there would be no specific ICD9 code questions, but what about CMS codes (99231, 99232) and the exam requirements in each level...or am I getting too deep? DRG's maybe? Any help on this portion of the test would be great, I don't know what to study or where to look for information! So scared this non-clinical section is going to cause me to fail.

So I read over this consenus model during a break in studying for my soon to be retired certification (ACNP) and the way I see it is that I'm OK as long as I don't ever let my certification lapse? It sounds like, if something happened and I wasn't practicing for a while, didn't have the practice hours to re-certify, I'd have to go back to school and take classes to be eligible for the new certification? I know my school was in the process of reworking the curriculum, I wonder if it meets the new eligibility criteria already.

Yes, prepare yourself now for a wait financially and mentally! I graduated in August and won't test until December. My job will start "hopefully" beginning of January. The earliest I could have was end of October. At this point it feels like it will never end! Everyone keeps asking me why I'm STILL studying, I graduated already! I did start the interview process over the summer though (I didn't search much, I had work and clinical rotation connections and knew it was the job I wanted).

I just graduated this summer and towards the end my instructors were telling us that they were adding certain amounts of geriatric information to the existing curriculum to meet the new requirements. I'm assuming this won't affect re-certification for those of us with certifications that will be retired?

It is my understanding that the AACN cert is not accepted everywhere (VA, IHS facilities...) so I haven't heard much about it. I'll email you too.

I'm signed up for ANCC, any idea why you think you might have failed? What did you find to be challenging about the test? I shouldn't even be on here reading these kinds of posts!!!