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ghillbert MSN, NP

CTICU

Content by ghillbert

  1. ghillbert

    Examples of Nursing Leadership

    Sounds awfully like a homework question.
  2. ghillbert

    Where are NPs most/least in demand?

    I am in Pittsburgh and it depends on the type - we can't hire enough AG-ACNPs, although FNPs are having a harder time.
  3. ghillbert

    Defense date set

    Congratulations, TiffyRN, PhD!
  4. ghillbert

    Will you get your DNP

    Nah, I think I'll get a PhD. The DNP is too variable between institutions.
  5. ghillbert

    Question re APP billing

    Question re critical care. Since critical care time provided by a PA/NP should not be attested/billed under collaborating physician but under the provider who did the work - what happens with critical care procedures at other places? I have always billed my own critical care procedures, but now we have APP 'fellows' coming through and I was told to have them sent to the collaborating physician to bill ... is this permitted and it's just critical care time that can't be split/shared? I can't find any CMS guidance on the separately billable procedures done in critical care.
  6. ghillbert

    Question re APP billing

    I knew you'd know, you're the best. Thanks David!
  7. ghillbert

    ACNP - Will I be missing out?

    If I knew I wanted to work trauma/ED, even if I was a nurse, I would apply to PA school. As an NP, you are reliant on either being adult or pediatric, acute or primary care etc. There are some dual programs aimed at ED but PA would give you more clinical time. It really depends where you live and intend to work - some places prefer NPs and some prefer PAs. Know your market.
  8. ghillbert

    Is 6 weeks too long to give resignation notice?

    I would give the minimum required. I have given more in a previous job, and lived to regret it as they were mad about it and made my life miserable for the 6 weeks - I would never do it again.
  9. ghillbert

    Question re APP billing

    Is there any CMS/legal guidance as to the fact that licensed/credentialed NP/PAs cannot bill procedures under the collaborating doc? I think I will need cold facts to address this internally. I hate to just lose the revenue.
  10. ghillbert

    Australian degree nurse wants to work in the US

    First look at NY state licensing requirements and go from there.
  11. ghillbert

    Australian nurse wanting to work in America

    I am an Australian-trained BN RN who now works as a nurse practitioner in the US. I went to Deakin initially for my nursing degree. Deakin did offer standalone units for Paeds and OBGYN nursing but it is over ten years ago that I came over so I don't know if they still do. I applied for the CES from CGFNS and my education was found equivalent so I didn't end up having to do extra courses or clinicals. On the good news front, once you have managed to pass the NCLEX exam and get licensed in the US, it is fairly easy now with the E3 work visa to get authorization to work once you find an employer.
  12. ghillbert

    Can't get ACNP job

    UPenn is a well regarded program. This baffles me, because I am in Pittsburgh and I can't hire enough ACNPs. I have FNPs applying to my critical care jobs often. Are you getting interviews and not being hired? Or not getting interviewed? Are your salary expectations too high? Or not even getting to that point?
  13. ghillbert

    Fulltime or part time PhD? Share experiences please

    Depends - what do you want to do with your PhD when done?
  14. ghillbert

    First job woes

    I hire ACNPs for critical care. HR controls the pay offer, based on experience, but I ALWAYS tell candidates to negotiate! Never accept the first offer! There is always a range, and room to move with hours etc. All bonuses and raises are based on salary so go for the highest you can. They can only say no and give you the change to accept or decline. Always ask about signing bonus - they won't offer if you don't ask! I have had candidates in same position with a $15K/yr pay difference, merely based on their negotiation, or not. It's also smart to go to the physician in charge and thank them for the interview opportunity and mention that you are interested in the position but may not be able to agree on terms. They can often put pressure on HR/admin if they really want you.
  15. ghillbert

    Terminal diagnosis

    I probably would have told the patient, because I usually think about how it would feel to find out "accidentally" with a less-tactful clinician reading off a chart - because I have seen it happen. You don't need to get into the specifics, it's okay to say that you felt they should know so they can start to deal with it, and that the specialist will follow up with further information. It's good to reflect and learn for the future, so you're doing a good job.
  16. Why do DNP at all if you arent interested in further clinicals?
  17. ghillbert

    Intubation turning into a code blue

    - Inadequate paralytic dose or time - Inadequate bagging/mask seal - Need for jaw thrust Multiple reasons it could be that you weren't able to oxygenate patient adequately with BVM. Was it an experienced provider attempting the intubation? Probably could have grabbed the Glidescope or bougie with the first difficulty. Your best shot at intubating is the first one.
  18. ghillbert

    Confidence issues in ICU

    You sound like your confidence is pretty well intact.
  19. Why are you committing to a PhD program if you don't know what you want to do when you grow up? That is a lot of time and money.
  20. ghillbert

    ICU Nurse Practitioners in teaching hospitals

    I work in a SICU which is primarily cardiothoracic. I am an ACNP. "Autonomy" is in the eye of the beholder, and is a limited thing when cardiac surgeons are involved; its an open ICU. I have my own patient load (I see half the patients and the residents see the other half), then round with the ICU attending then multidisciplinary team and present my patients, my assessment and my plan. Attending may have input or agree with my plan. I do procedures independently such as limited bronchoscopy, intubation, central lines, arterial lines, pigtails. Attending is present on the unit for intubations. I bill for my own procedures and for my critical care time under my NPI.
  21. ghillbert

    Quit my job

    This seems extremely impulsive and unprofessional to me. You didn't get a reply so quit without notice although you have no evidence of incorrect billing because... well... you didnt give them a chance to reply. Very odd.
  22. ghillbert

    NP contract? salary with no holiday pay?

    Do not even consider accepting a job working for this person! If he's googling the FLSA now and working out ways to screw you over, do you really think he's going to do the right thing by you once you're hired? Run.
  23. ghillbert

    Disposable Bronchoscopes

    We use them in the ICU. I am not a fan. It's decent for airway placement or quick issues but not too useful for significant pulmonary secretions or lavages/BALs. It gets stuck in the swivel adapter half the time and needs jammed down the tube super hard (yes even with adequate lubricant). I might not have used them enough yet, we've only had them a few months but so far I prefer the "real bronch".
  24. ghillbert

    SICU Patients?

    My unit is called "SICU" but is mostly cardiothoracic surgical ICU. We get: - cardiac surgery (VAD, ECMO, CABG, valves, aortic surgery) - thoracic surgery (VATs, esophagectomies, bronchopleural fistulas) - vascular surgery (EVAR, TEVAR, bypasses) - organ transplant surgery: heart, liver, some kidney, pancreas
  25. ghillbert

    Anyone disliked ICU?

    Consider surgical ICU if you have med/surg experience. I hate medical ICU but love cardiothoracic surgical ICU. I much prefer 3 x 12's than 5x8 schedule, and like having days off during the week to get things done.
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