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Acute Care - Cardiology
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DaisyRN, ACNP has 5 years experience and specializes in Acute Care - Cardiology.

DaisyRN, ACNP's Latest Activity

  1. DaisyRN, ACNP

    Help! Case log!

    Hey all! I am applying for a new job and they want a case log... of procedures I have done over the last two years. I have not been keeping up with them... honestly, because I didn't think about it. But now, I wish I had! How do you guys think I should go about back tracking this and what all should I include? For example... I know I supervised over 1000 stress tests... can I include a general statement like that as I would in a resume? Like From Dec 2007 - Dec 2008, Supervised over 1000 treadmill and pharmacologic stress tests? (Including because they will want me doing stress tests) And then for the procedures I have done less of, like arterial lines, central lines, chest tubes, thoracentesis, etc... I can individualize these. What all do I need to include? The date... patient identifier... procedure... anything else?
  2. DaisyRN, ACNP

    Advice on how to locate preceptors for NP clinics

    http://www.npfinder.com is another resource...
  3. DaisyRN, ACNP

    Stupid question re: orders from NP's

    the nurses that take verbal orders from me often write, "rbto daisy, np" and then when i come to round on that patient the next day, i will initial it. the doctor's do not have to be listed in the verbal order. everywhere my initials or name is has to be cosigned by my supervising doc, per the hospital's bylaws so... the docs are going to end up with their name on it eventually. i don't know of any hospital that doesnt require some signature by the docs, per their bylaws. it is not a nursing issue, its a medical records issue. some nurses have done it both ways... my name or my docs name. rarely both. we are legal to give verbal orders and you are legal to receive them from us. i think you are safe either way... but to be sure, you could ask your medical stffing office.
  4. DaisyRN, ACNP

    NPs/PAs: How do you split overhead costs with MD?

    hmm. well someone's lying to me. the upper admin even says, "she will never make money as long as she's in the hospital..." and to be honest, i would rather be in the hospital! i just dont know how to make it better... i talked to the billing person yesterday... and the way that our office does it, i turn in charge cards for each patient that i see, indicating the days i see the patient, specifying the level of visit as well. they are uncomfortable with billing a shared visit (i understand there is no "incident to" in hospital)... the doctor also turns in a charge card, and some of the days may overlap my days (because he went behind me and indicated "seen and examined" so it could be billed at the higher level)... the billing clerks look at each card and for the overlapping days, they give the visit to me. for the days that are only indicated by me seeing the patient, i get the charge at 85%. so... is this not right? i generally do not do consults or admits. well... i do do consults, for "free"... which sucks. so, this is on the agenda to discuss with my supervising next week. i actually perform the consult, gather the information, develop a plan and i know it should go under me... but because of the smalltown mentality... the referring physician wants a "physician" to see the patient, so my supervising comes behind me, sees the patient and adds to the note... taking the credit. i know this is not appropriate. i am losing moolah on this one, and this will change.
  5. DaisyRN, ACNP

    NPs/PAs: How do you split overhead costs with MD?

    well, most of them are level 2's. i guess i should clarify... the reimbursement problem stems from self-pay, no pay patients... plus the hospital write off, which i really don't understand all that much. but what the office writes off versus what the hospital writes off is way different. therefore, when compared to my colleague pa who is primarily only in the office, his reimbursement numbers are way better.
  6. DaisyRN, ACNP

    NPs/PAs: How do you split overhead costs with MD?

    okay... so i got some answers. they tally my hospital charges and office charges... then calculate my reimbursement (which from the hospital is crap)... then add in "ancillary" profit which comes from echos, nuclear lab, and lab. from that, they will be pulling three different expense categories... 1. administrative costs which will be roughly $1500 per month (3/4 of a share) 2. business costs which will be roughly $2000 per month (3/4 of a share) 3. site specific costs (utilities, rent, medical assistant costs, etc. of our practicie) (1 whole share) 4. my salary will come out of my revenue each month whatever is left at the end of the quarter, will be split 50/50 with me and my supervising doc. issues: i am in the hospital every day (and i am the only npp in the hospital every day)... so my reimbursement numbers are not so great. i didnt realize how much the hospital writes off... and plus, with me supervising all of the stress tests in the hospital, i only get the stress interpretation fee (which is low)... and the hospital gets the big bucks technical fee. because i have doubled the hospitals productivity and expedite the mobility of patients in and out of the hospital, the ceo of my company and the ceo of the hospital have agreed that the hospital needs to supplement my salary (due to lost reimbursement and benefit of me doing the tests). so they are going to "subsidize?" i kinda know what that means, but we dont know the details yet. unfortunately, they just work it out and let me know... or i accidentally find out. oh well... at least they are doing something about it.
  7. DaisyRN, ACNP

    Managing school and finances: how did you do it?

    if you are able to cut back at all, or able to work an extra shift, or whatever to avoid student loans. do. it. i use to be one of these "you are investing in yourself" thinkers with regard for student loans. i am paying $800/month in student loans... it hurts. when i took my current np job, i did not negotiate a high enough salary to cover the $800/month and give me a little extra to feel like i actually did something with my career. (meaning, if you don't negotiate a high enough salary to cover your student loans, you will end up feeling like you are making less than an rn.) welcome to my world. now, if you have to take on student loans, like i did... just keep this other information in mind. i wouldn't have been able to do it any other way, but i certainly didn't think it was going to be this much of a burden. ideally, find someone or a company to repay your student loan... that is what i would love to do!
  8. DaisyRN, ACNP

    NPs/PAs: How do you split overhead costs with MD?

    i'm meeting with the cfo about what all the numbers mean and how they come up with the numbers on friday... i'll update everybody with more details about the whole situation then. thanks ya'll...
  9. hey all, i think i pay a ridiculous amount of overhead costs for our cardiology practice... i am expected to pay half a share (the mds are a whole share). i just don't see how i can even begin to compete with that. not that it's a competition, but how can they expect us to even reach half of what the docs generate in revenue when they are doing $20,000 caths and thousands and thousands of dollars for devices? i just think that half a share is not reasonable... the reason i care is because if i don't reach that "half a share" amount, i don't get productivity bonuses... despite what my charges are. any thoughts?
  10. DaisyRN, ACNP


    describe the # of years/ type of educational experience i graduated from an associate of science degree in nursing program in 2003 which took me 2 years to complete, rn-bachelor's of science in nursing program (online) in 2006 which took me 2 semesters to complete because i already had many prereqs complete when i started, and a master's of science degree in nursing with an acute care nurse practitioner certification in dec 2007 which took me 18 months. describe the different roles in which the individual has worked in health care i have been an acute care nurse practitioner in cardiology, both inpatient and outpatient roles, for 1 year. before that, i had been an rn in the emergency room setting for 4 years. before that, i worked in the er as a nurse tech, unit clerk, and nurse extern to get experience in the health care field, which i highly recommend. explore how professionalism is incorporated in their role asw a nurse for me, professionalism is expressed in everything i do. i have to maintain professional attire each day; i have to speak and act professionally at all times at work (yes, even when i'm around friends) because you are held to a greater degree of accountability and responsibility as an apn. you never know who may hear/see you. with colleagues, i want to be respected as a 'professional' in the medical community, so i must uphold all of the expectations that go along with a highly educated individual. you also must form relationships with people that you may not even like, i.e. referring doctors, supervising doctors, etc. because you are all in this journey for the patients' wellbeing. in building these relationships, you have to know when to bite your tongue, when to speak up, and be cognizant of your own personality in dealing with difficult people to maintain professionalism. when documenting in the patient's chart, you must also be tact... especially if you are suggesting the internal medicine doctor did something wrong in adjusting the patients' meds. determine what advice each would offer to a person beginning in the nursing profession i would suggest that a beginner get as much exposure as you can. take every experience seriously, whether you like it or not! it will stay with you a long time. you need to get variety in your roles and explore what makes you happiest. there is nothing worse than a nurse that hates his or her job. how stupid is that? there is enough need for nurses that there is no excuse to hate your job. there are plenty of opportunities. don't sell yourself short. be assertive. discuss the advice each would offer for the nursing student as they work toward the completion of their degree see above. take critism constructively. i cried. i admit. but, looking back, i know that all the hard times helped shape me into what i am now. and be patient with yourself. i tried to learn too much too fast and was so disappointed when i didn't know everything at once. it takes time and experience to learn how to be a nurse. no matter what they teach you in school, you will never be fully prepared once you are on your own. don't rush school. learn as much as you can. soak it in. ask questions, especially of your preceptors. listen. set yourself up for success; get experience before you are a nurse as a unit clerk, medical assistant, cna, whatever. just do it. there is much much much more to being a nurse than just "being a nurse." you have to build patient rapport, deal with difficult doctors, interpret foreign language - both written and verbal, and expect personal internal conflict and emotion with situations. pre-nursing experience in the workplace will help prepare you for these aspects of nursing that cannot be "taught." it will be one of the most rewarding things you do with your life... enjoy it.
  11. DaisyRN, ACNP

    Hey Cardiac NP - talk to me!!!

    i posted this in a few other messages, but i copy/pasted here for you... i'm an adult (ages 12 and up) acute care np in cardiology. my days go like this: m-f 7:30a-10:30 (give or take) - supervision of stress testing at hospital m-f 11-whenever (usually 2-5pm) - i see clinic patients (hospital follow ups, chf patients, etc.) and because i'm still in this "orientation window," i'm not seeing a whole lot of patients on my schedule yet. today, i saw 8 which was higher than average for me, but i was seeing another physician's clinic patients because he was tied up at hospital today. i am usually the go-to person for someone that calls in having problems because my schedule is more open than most of the mds. the docs like that aspect of my being there. plus, the patients like knowing they dont have to rush to the er for every little thing if someone is available to them in the office. mixed in during the day, but usually isolated to the mornings, i follow our inpatients with my supervising physician. he normally splits up his list patients for me to see and he sees the rest... then we discuss at clinic (sooner if i have questions/problems) and i write orders, discharge planning, interpret testing, etc. the new thing for us is weekend call, where i don't take actually nurse or er calls, but i am in the hospital doing rounds on all the patients left from the previous week so the on-call doctors don't have to do it, usually around 10-12 patients max. i love my job. i get lots of variety in clinic and hospital... love it.
  12. DaisyRN, ACNP

    family NP or Acute/crital care NP

    as pinoy stated, there are 3 types of "acute care" nps including adult, pediatric, and neonatal... with adult, i am only allowed to see ages 12 and up. pediatric acnp is what it sounds like you would want (to do kids in the hospital)... but then after reading your job listing, it sounds like you'd rather do neonatal. the problem with apn programs is that you have to choose. i sacrificed caring for children to do adult acnp. i do not know the specifics regarding ages, etc. for neonatal vs. pediatric. perhaps you could post a new thread to talk to pnps/p-acnps/nnps. as for the experience required, sometimes your rn experience is sufficient... but sometimes it's not. you'd have to ask them. i gotta get to the clinic, but i'll try to post again later. hope you are finding some answers...
  13. DaisyRN, ACNP

    family NP or Acute/crital care NP

    what is it that you are looking for exactly and i will try to help. there is no site that i know of to tell you where each type of specialties flourish. the classifieds are a good source... but you need to take them with a grain of salt. just because it says "fnp wanted," but its a hospital setting, theres an opportunity for you to contact that employer and offer yourself as an acnp or ask them if they would consider it. as for the perks/drawbacks of each, i'll try to get back to you later today. do you have any specific questions? good luck with your decision making!
  14. DaisyRN, ACNP

    family NP or Acute/crital care NP

    hi there, not to sound completely like i do not care, because i do. :) but there are exhaustive posts on this site, this this forum, regarding this issue. the most recent is the following: https://allnurses.com/forums/f34/tell-me-again-why-i-should-choose-fnp-over-anp-324095.html basically, it boils down to your location (state, mostly)... and also what your ultimate goals are. i am not going to repeat all that we have said in the other posts, but as a general rule, fnps are not trained in hospital medicine, therefore, should not be practicing in the hospital. however, some states are not as strict on this (i do not know about ma), and only use fnps in the hospital setting because acnps are not as prevalent, or whatever. as an acnp, i was trained in adult internal med outpt and hospital medicine. i could work in an internal med clinic as an acnp and i can also work in the hospital. currently, i work for a cardiology clinic and do both. all within my scope.
  15. DaisyRN, ACNP

    Tell me again why I should choose FNP over ANP

    that is exactly my point... and i guess i forgot to mention it. *lol* if you can show you have had training in that particular setting (e.g. hospital) during your np program (rn experience does not count), then you are covered. some people will say that as an acnp, i should not be in the outpatient setting at all... well, i had a clinical rotation through adult internal med... so likewise, i can justify my outpt exposure. thanks...
  16. DaisyRN, ACNP

    Tell me again why I should choose FNP over ANP

    jd... as an rn first... i "thought" i was making decisions regarding my patients in the hospital too. sure, low bp... give some fluid. fever... give some tylenol. whatever. those are "protocols" most of the time, which give you permission to make those "decisions". as an acnp now, i realized those were not really medical decisions that are being discussed here. there is soooooo much more involved than just superficial orders or needs. an rn is not capable nor legally able to make necessary medical decisions, as a general rule. i am not saying that an rn does not know what to expect to do for treating a certain illness. it comes back down to legalities. the bons would have a fit and revoke an rn license if they knew about a "doctors' nurse making rounds/decisions." that is not safe for the patient, nor is it within his or her scope. why in the world would there be any nps if that were the case? like others have said and we have all exhausted before, fnps and acnps have very different scopes... and just because there arent any acnps in georgia and just because your state does it that way, does not make it "right." in giving advice to others, you should consider what is legal and safest for the patients. now... back to the original poster... :) my suggestion to you is to call around to some of the places advertising for an fnp or whatever and see if they'd consider hiring you as an anp. most of the time places just say "fnp" because that's all they know. it's not that they are against other specialties... especially if it is in your scope of practice. best wishes to you!