Pachinko

I’ve been an FNP for about 8 years. Love my job, decent pay, stable as of now. But with the over-saturation of NPs here and the possibility of lower wages and worsening working conditions, I have to keep open the possibility of transitioning back to bedside at some point. I just don’t know how I’d pull that off when I’ll have not done bedside in years. Has anyone transitioned back to bedside care after years in an non-acute provider position? How did you do it?

This thread is not about debating the merits or risks of single payer/socialized medicine in the US. It is about impact on pay for providers. I was reading a thread about this topic on another site, and a poster suggested searching federal NP jobs to see what pay might look like under single payer. At Federal Bureau of Prisons (BOP), I noted that the pay range for NPs was around $58-$90K. MDs, by the way, started around 107K. VA starts around $80K. This is substantially lower than other NP jobs in my area—I live in a big, expensive metro area. For those who work in federal jobs, are these pay ranges reality, or are they adjusted up (or down) depending in the area? More generally, do people with more insight into policy and administration (read: people who know more about this than me) think that these pay figures would be likely under single payer? Again, this is not about whether socialized medicine or target pay for NPs under single payer would be good or bad. I’d like to anticipate and plan since a mass reduction in income across most advanced practice positions would necessarily change lots of peoples’ lived.

Veganurse, I spoke to ***** at the number you provided and it helped a lot. I answered my own question as well, so, for others' reference...she advised completing the fingerprint requirement before renewing. You request the Livescan paperwork from the BON (which was identical to the one posted above), they email it to you, then you fax the completed form to the number listed on the form itself. If you do that, you have fulfilled your obligation and can say that you are compliant with the fingerprint requirement. You do NOT need any further feedback or clearance. Also, 2014 is the cutoff; if your last Livescan was before that time, you need to repeat it. ETA: this is for people who already have licenses in California. If you are getting a new license, the process may be different, and I recommend contacting the board at the number Veganurse listed above.

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? I cannot see a place on BREEZE where you can upload the Livescan form. Thank you

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.

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.

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.

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.

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.

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.

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.

Apparently there is a new Quantiferon test that is less time intensive to perform (not cheaper though). It's new to our clinic system at least. I am not able to find guidelines for determining whether to use PPD or Quantiferon with patients. Quant is best for the immunosuppressed, but are there any other populations where it is preferred over PPD? TIA.

If I buy malpractice insurance today, will it cover me if I'm sued in the future for something that happened before I had the insurance? I'm not talking about buying insurance when you are under investigation or a lawsuit has been filed. I mean buyimg insurance and then, maybe a couple of years down the road, being sued for something that happened before you had the policy. thanks

Is tuition for this program $135K total?

Dranger is correct. You might find something cheaper if you scour Craigslist, but a 1 bedroom in a decent area will be around 2k, a 2 bedroom 2.5k. S/he's also correct about salaries of 120-140k. If you decide to rent, try to find a rent-controlled building, which applies to all buildings built before a certain year. Otherwise your rent can be raised with impudence. Buying is insanely expensive. People are moving further and further out of LA in order to own and are now localizing around Palmdale/ Lancaster, which are 45-60 min away. I work primary care so can't recommend employers based on NP experience. I worked bedside at UCLA for ten years before becoming an NP and the experience was very positive, excellent standards of care, good benefits, etc.