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Pachinko's Latest Activity

  1. THANK YOU. Posting this was very generous because my head is spinning with conflicting information. This helps. So I am supposed to submit my application to renew first with a "no" for completing the fingerprint requirement, then submit the Livescan paper after? And, did you fax the LIvescan form? Thank you
  2. Pachinko

    Would you be willing to walk away?

    The question is too vague to answer well, but I would be hesitant to leave a profession that requires giving up a license. Renewing your NP requires a certain number of direct patient care hours per annum I believe. At least now, that license entitles you to a job with a better chance of good pay, security, and personal reward than many others.
  3. Pachinko

    Full Practice Authority

    Very true. And yet, multiple studies show that NPs provide quality primary care. Why is that? It’s an interesting question. I used to work bedside in a unit with lots of NPs. In that setting, roles were sharply demarcated, with MDs directing the care and NPs doing so-called “scut work” like writing routine prescriptions and simpler procedures. I would not want to be under the care of an NP in a cardiac unit. But a primary care office is not a cardiac unit. Perhaps MDs are working below their potential in the primary care role? The system itself may be to blame. MDs who choose a primary care track go through lots of training, including rotations in the hospital and learning surgeries. But in primary care, where you have to see a new patient every 15 minutes, how can they utilize that knowledge? I think that is why, at least in my experience, primary care NPs and MDs provide almost identical care. We all work under the same constraints, with the same goals, and we all refer on to specialists at about the same point. Add to this that education can take you only so far. For most people, a few years in the field whittles your knowledge base down to the specifics of your population. An MD may have more schooling, but much of that recedes with time and experience. We are all left with the same patients and the same standards. I have big concerns about low standards for NP schools at present, but I don’t think that’s something that we can depend on physicians to correct. If oversight needs to happen, I don’t see why another NP with a certain amount of experience can’t be the one to oversee new grads and pick out the ones that are incompetent. In any event, I think that NPs should have the option of becoming independent after a certain number of years of practice without incident.
  4. Everyone is different in terms of learning needs, but I would strongly recommend working in a hospital before doing FNP. ICU is the best because so much happens at bedside; you get to see diagnostics done and resulted and see how medications and interventions impact patients directly. I learned a lot about treatment of specific conditions in nursing school, but my ability to triage and prioritize came from hospital nursing, and that is just as important (and can't be taught in a classroom). A possible exception could be if you wanted to work for a specialist, where you are dealing with a narrower range of issues...but I'm just guessing about that.
  5. Pachinko

    RPRs driving me crazy

    I have a patient with a positive RPR, titer 1:4, and a negative confirmatory test (FTA-ABS). I do not think that it needs follow up. One of my colleagues does, as does another, but they do not agree on the follow up. Pt is asymptomatic. What would you do?
  6. I say, no problem! I will offer to see the patient for this appointment only or to simply schedule with MD. I would rather know up front if a patient has a problem with NPs so we are both spared problems.
  7. Pachinko

    Low Salary @ the VA as NP

    I looked at pay for LA and not only are NP jobs insanely low, but I make more as an NP than their starting physicians do! Sorry, but you're not going to attract talent that way. It's crazy, and a bummer--I would like that population.
  8. Pachinko

    Oversupply of Nurse Practitioners

    Sorry, I would edit my post above to include this but don't see an edit button The majority of my real education came from bedside. The hospital is also where MDs receive their real, experiential education. I worked in different ICUs for about 8 years, including a general med-surg and a cardiothoracic. You get to see procedures done and participate, you have to interpret labs and diagnostic reports, and you have to know about medications. You end up learning whether you want to or not. What I learned in NP school was building on that base. I guess that there are some brilliant students who can be competent in the NP role with only a year or so of med-surg or tele experience, but that certainly was not me. I will say though that, in my experience, MDs and NPs work at about the same level at some point. My MD colleagues tend to work up a patient to the same point I would and refer on at the same point as well. I sometimes run into a MD who chooses to manage complex conditions on his or her own, but that can go either way--they're doing it either because they're very smart, or they're overestimating their abilities. Law is experiencing something very similar to advanced practice nursing right now. There is very poor regulation of law schools by the ABA, and tons of for-profits have opened. It flooded the job market, depressed wages, and made findings jobs difficult to impossible. The days of attorneys having a guaranteed six figure income are long gone--their pay can be below that of an RN now.
  9. Pachinko

    Oversupply of Nurse Practitioners

    In this climate, I would not become an NP unless I got into a school with name recognition. It gives you an edge not only because of reputation, but because those programs are more likely to set you up with clinicals instead of making you find your own. You make contacts that way, and you benefit from the alumni network. I would also bet that the education is better, but I'm not sure about that. Going to a for-profit where you take your classes online, find (or don't) your own clinicals, etc., seems like fool's errand. So much money with so much risk of poor return.
  10. I have a 60 yo Indian male experiencing chronic itching in his ears, recurrent angular cheilitis, hair loss, eye watering, and scalloped tongue. All of this has developed within the last year. All B vitamins and thyroid are normal. He is a controlled diabetic without much other history. I stopped his statin for a month but the symptoms are not really resolving. Sent him to ENT for his ear itching (it was driving him crazy) and they were not much help. Any thoughts about what might be going on?
  11. Pachinko

    Metal worker needs MRI

    All very helpful, thanks.
  12. Pachinko

    Metal worker needs MRI

    Thanks. What about metal embedded in skin? Is that a concern?
  13. Pachinko

    "Noctor?" Offensive title?

    It's better tham "midlevel," which I find extremely offensive. Because, you know, MD=high level, NP/PA= mid level, and RN= low level. It's a political term. Noctor as a combined nurse/doctor is kind of cute, but I've only heard it referenced as a contraction of "not a doctor," which is derogatory.
  14. Pachinko

    Metal worker needs MRI

    I have a metal worker with severe radiculopathy. Has undergone CT, EMG and is being told by both neuro and ortho that he needs an MRI. Ortho apparently told him that he could undergo a simple eye exam and that this would be sufficient for clearing him for MRI, but it's up to me to order it. Does anyone have experience with this and can recommend how I go about evaluating him for MRI safety? I've looked around but can't find a good guideline. thanks
  15. Pachinko

    I quit the PA rat race.

    Non Sequitir, you would look much better with some soft curls, and lay off the neck exercises. Your rationale for NP school is good. Working bedside is where you will receive your real education. Start with whatever unit interests you most and will hire you, but shoot for ICU at some point, especialy cardiothoracic if possible. This will teach you to think critically and prepare you for the advanced practitioner role. It will also help you determine which kind of NP you want to be. I would only add that one of your main reasons for not pursuing your PA, market saturation, is also an issue for NPs in some areas. It's hard to know where it will be in 5-6 years, but NPs are not necessarily better positioned than PAs in that regard. ETA: yes, NPs do have more freedom than PAs. We can practice independently in some states. I don't think that there is much difference in pay, I recall salary surveys showing a difference of 2-3K in annual income, with PAs having the slight advantage. In my experience (underserved primary care), there is no different between what PAs, NPs, and MDs do. What makes the better practitioner is how dedicated and interested in helping the provider is, not education level. Have seen this repeatedly. I will say that MDs are less likely to miss major issues, though. That's why you need solid hospital experience before you practice. Nurses also have a lot of good will from the public, which is nice.
  16. I recently heard from a colleague that a hospital here in the LA area makes new grads sign contracts prior to orientation. The new grads agree to pay back the cost of their training if they do not complete the orientation period, and it can result in bills of up to $5000. They will be billed if they are not found to be a good fit for the facility, and several of this hospital's most recent cohort have been let go and billed. I was so shocked by this that I emailed the hospital's HR department, and they confirmed that it's true. Is this the new norm for hiring new grads?! It is outrageous and shameful to bill new grads, who are likely in debt and who are certainly unemployed, because the job did not work out.