livingkennedy

I have joined the AANP and and LANP for my state and thus far it has helped by giving me a lot of contacts, but it has not helped that none of those contacts are responding.

So my school requires us to find our own preceptors, which I didn't think would be too much of an issue until I found out that they require the majority of them to be ACNPs, as I'm in the AG-ACNP track. I had plenty of MDs lined up and willing to precept me, but now this obviously must change. The city I live in is a good size, but AG-ACNPs are not utilized here or anywhere near here. In fact, there is only 1 between the 4 hospitals in the area, and I can't use them because their role is less about patient care and more about setting up a trauma program. I don't know any other ACNP's, and I must find some that function as an internist as well as in the specialties of cardiology, pulmonary medicine, nephrology, ID, Hem/Onc, ED, neurology, endocrinology, gastroenterology, and endocrinology. I am considering paying a third party to arrange these clinical experiences as I literally have no connections, and the efforts I have been making have been fruitless. If any of you function in these areas and are willing to precept or if any of you know someone who is willing to precept, let me know. I have 12.5 years of ICU experience and I'm pretty knowledgeable and love to learn, but I am just not finding any opportunities to actually learn!

I have started an agency and have been looking to get assignments but it seems that every single hospital uses VMS/MSP for supplemental staffing. Not only do they use it, but they require it. I have talked to about 20 different hospitals and they don't even entertain going outside of their VMS/MSP. I thought that I would solve the problem by asking which VMS/MSP they use and then signing up with them...I got about 5 different answers and called each of them, and exactly zero are accepting more agencies. I'm stuck. I have tried rural hospitals as well as big city hospitals and I keep running into this problem. I tried going through the unit manager of nearly all places and I'm still not getting bites thanks to not belonging to these entities. It's hard for me to understand why none of the MSPs will add a new nurse who's ready to take an assignment immediately, considering they take a percentage of earnings. Does anyone know of hospitals that don't use this ****? I can't tell if it hinders a hospital's prospects or helps them, given my experience.

While it may not make you like your job any more, perhaps it will reduce stress: Much of what you might be scared about in the ICU is taken care of by fundamental things. 9 out of 10 problems a patient encounters in the ICU can be dealt with by fluid/blood, pressors/inotropes/vasodilators, and alternate modes of ventilation (bipap/vent). It really is as simple as that. It's recognizing problems and intervening appropriately that is more difficult, but most of the problems really do boil down to the above.

How much do you pay for your general liability if you don't mind me asking? I am getting some crazy quotes from companies in the 3k range just for general liability + worker's comp (which I haven't yet figured out a way to get out of the worker's comp).

I got a quote for professional as well as business insurance through NSO which includes the general liability required by a lot of hospitals. I read that back in 2004 it was around 265 per year. I am getting quotes for over $900 now. What do any of you ICs pay now?

Thanks Ned. I didn't know if there were ways to get the money forwarded to the payroll service. Kinda like direct depositing from business to payroll service. On a somewhat different but related note: When you invoice a hospital - how often do you do this and how much time do you give them to pay? I understand many hospitals pay out quarterly, so I would assume you wont be getting anything if you invoice at the beginning of the quarter and give 30 days, so the hospital would not agree to those billing terms. Is this true about the quarterly payments? How do you do it?

I have been looking into the payroll process, and it seems most ICs use a payroll service. I can't for the life of me find out how that works - the payroll websites give generic information. What I want to know is: Do you get a check directly from the hospital that you then deposit in a payroll service account, then pay from there? Can you have the hospital just send the check to your payroll service? How does the money actually change hands from hospital to business to payroll service to employee?

I have experienced a bit of both. After years of experience even the sickest don't bring as much joy or intensity. I do like those patients more, but often I feel like what those hospitals do to some of those people is just not even humane and a huge drain on the system. In that aspect it is almost depressing. It's like taking a 19 year old dog that would normally die or be put to sleep and prevent that from happening. Hook it up to feeding tube, breathing machine, CVVHD, LVAD, blah blah blah just to supplement each organ. Yea it's cool that you're operating all that and it can be intense and a great learning experience, but at the end of the day you're essentially paid to be torturing some person's body. I'm not trying to sound dark, but the reality often is dark. So what you gain in learning/intense environment, you might lose in your own sense of humanity. That's my experience at teaching facilities.

This is a question for you IC nurses (Ned!): What items do you have to provide as your agency to HR? I have read I need drug screen, ACLS, BLS, PALS, background check?? Immunizations, TB test, physical...but then I have seen your FAQ and it mentions things like the OSHA and JACHO standards, but not really sure what those items are as I haven't received something like that. edit: I had finally found your FAQ that I remembered seeing long ago after I posted this. I know you're tired of repeating yourself. Thanks!

Wolf where do you get these quotes? Every time I google some of the text you send, I get a dead link.

This is mainly for my research into IC nursing. Let's say you form a contract with a hospital - you move there, sign a short term lease on an apartment, work zero shifts or only a few and then they cancel the contract - how do you protect yourself from this financially? It seems that all the contracts I've read can be cancelled for any reason. Is this just a risk you have to live with? Many of the contracts require 30 days written notice - does that cover you for anything? It seems to me they can still cancel without paying anything (if you didn't work a shift) or very little of your supposed guaranteed hours. It seems many hospitals might be hesitant to sign contracts that have anything that might protect you.

Damn, I typed this huge thing out and submitted and it never actually submitted. Here goes again: Basically the reason I am asking is that I want to be an IC for my own agency once I get my hands on some decent contracts. I wanted to get a little more creative with the staffing solutions in my area because we often run into the problem of PRN and per diem nurses not able to work when we have the need and travelers working on slow days and then happen to be off when we get slammed. What I would like to do is charge a bit more than the standard agency billing rates for short ~ 4 week contracts where I can guarantee them an ICU nurse (me) within 90 minutes of call for a particular shift (night or day) for the duration of the contract. I will guarantee myself anywhere from 96 to 144 hours that can be used at any time, including all days in a row if the need were to arise that way. With my lifestyle here, I am totally able to fulfill these "on-call" obligations. When I told my coworker this, he said the hospital would have to pay my agency time and a half, which I don't believe is true. I think you ultimately answered the question that they can pay anything they want, including zero dollars. Is this correct? I am not sure that I would have to pay myself time and a half or any bonuses whatsoever if I own the company. However, since the company is a separate entity that I work for and happen to own, maybe the company has to depending on state labor laws??? I don't think for tax purposes it matters in the end, but I'm curious on that. It may matter if i traveled and didn't take max tax free money I suppose. Thanks for all of the info you provide Ned.

PS if you've seen a hundred agency to hospital contracts, can you send me like 5% of those? OKAY THANKS! (the ones I have are nearly 20 years old if not older, and not complete).

I was told by some people that if a travel agency supplies a nurse for more than full time hours in a week, the hospital has to pay the agency at 1.5x bill rate. Is this true? I would think they could charge the hospital a flat bill rate no matter how many hours, but the agency would be obligated to pay time and a half to the nurses. Does this vary by state? Frankly I'm skeptical of this persons info but just wanted to confirm.