Dembitz

Breast self exams are not evidence based. I don't teach them or encourage them. https://www.aafp.org/patient-care/clinical-recommendations/all/breast-cancer-self-bse.html Screening exams for testicular cancer are also not evidence based. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/testicular-cancer-screening The undescended testicle mentioned in a different story should have been caught at a much, much younger age.

I look things up all the time. And if a patient has an unusual set of symptoms, I talk them through my diagnosis. "Well, I'm sure it's not <XYZ emergency> because <ABC>, but I'm not really sure what this is. I'm going to do some research and follow up with you in a few weeks. In the meantime, keep me posted if <PDQ bad thing> happens." Patients seem to appreciate the honesty.

Pre-op assessments for anesthesia? From what I understand, it's mostly a one-and-done type encounter with no ongoing care.

Our nurses have standing orders to triage UTIs, and if low risk, treat with antibiotics per protocol. They let the provider know after the fact. We're maybe working on a standing order for nurses to see patients with sore throats, do rapid test, and send antibiotics per protocol.

Dual cert as a WHNP/ANP. I interviewed at a fertility practice in a high cost of living area, salary was GARBAGE with pretty minimal autonomy. They justified the salary because the NP scope was so limited, at least in their practice. I do have a former classmate who did per diem IUIs in addition to her primary position and was pretty happy with that.

Some onsite workplace clinics can be lower stress, particularly the ones for white collar. Mostly rashes and colds, the occasional injury due to ergonomics. Manufacturing sites are more difficult.

Assess for PID (CBC, cervical motion tenderness, wet prep or swab for BV/yeast) and UTI/pyelonephritis due to flank pain (urinalysis with culture). Maybe ultrasound depending on exam and institutional availability. Treat according to CDC guidelines and culture results. Any suspicion for TSS or vomiting and can't hold down oral abx would warrant admission for IV antibiotics.

You can and should apply for your license before your get a job. You won't be able to get a MA controlled substance registration until you are hired.

Know the guidelines for common conditions (HTN, CAD w/PCI or CABG, DM, OSA, vision, hearing) COLD. Pay attention during the training class. I had to take this when they were rolling out the requirement, and everyone in my facility (MDs, NPs, PAs) scored mid 80s. We had the advantage that we'd been doing DOT physicals for a while as this was before certification became mandatory. It's really a memorization based test, which is what makes it harder in some senses than board exams.

If you're unsure about a procedure, there should be someone there to back you up or you need to refer out. That being said, sometimes you just need to go for it. I learned digital blocks (admittedly more straightforward than some other procedures) by watching YouTube videos. You sort of have to do a few to learn how skin and tissue move and behave. Give good follow up instructions, ALWAYS. Remember, most people will actually get better regardless of what we do. Look for procedural continuing ed -- it's still on a pig's foot, but it will give you more hands on experience and you'll get to talk to experts about the typical challenges they face.

Full time for any MD/DO/APRN/PA where I work is 32 contact hours. We work 4 days per week, 8 hour days, lunch does not count towards hours. I rarely take work home. The doctor I work with stays an extra 15-30 minutes a few days per week.

I'm rural, but we have weirdly good access to derm due to a derm NP opening a practice in the area. Psych is impossible, as it is in so many areas, but getting a patient in to endo takes almost as long as pysch.

If you're opening your own practice, you'll likely have a ramp up period where business, and hence your schedule, is a bit slower. Depending on your area, it could take a while to ramp up to a full patient panel. Why not contact one of the nursing schools in the area and ask to precept a final semester student? You can essentially use it as a semester-long interview. You may be able to do this for a few semesters before your practice is big enough to support two providers.

Are you really responsible for arranging PT and getting all prior auths? Generally there should be nurses or MAs who take care of most of that, only involving the provider if a peer to peer review is needed. And all images should have a formal read by radiology. Depending on the situation you might be in a position to make treatment decisions before radiology can complete the read, but there's nothing wrong with saying, "nothing immediately pops out to me on this xray, but we need to wait for the radiologist to formally review your xrays." There's a reason radiology is its own specialty.

I live in a high cost of living area. Dual certified as WHNP and ANP. My first job as a new grad in a non-women's health field paid $85,000 in a somewhat lower income part of the state. I interviewed for a WHNP position closer to home in a much higher income part of the state (New England states are small, cost of living varies dramatically in a small radius!) and was told they NEVER pay NPs more than $75,000. For whatever reason, women's health jobs do pay less. (Didn't take the job, currently making well over 6 figures but not in a women's health position.)

I used the Kelsey purple book and felt well prepared. There's also an online test available for purchase somewhere, but that was 3 years ago so I don't have the link anymore.

Not offensive at all. I introduce myself by my first name, but many of my patients call me Dr. LastName anyway. I correct them the first few times, then give up. I've been called much, much worse. :)

I wonder if this is an issue of lack of experience rather than micromanaging. How long has the nurse been on your unit or working in a similar environment? Is it possible that she asks for all this information because she doesn't yet have the experience to know what information will be relevant for her shift? My thought would be to have her immediately at the end of each shift determine how much of report was relevant to her clinically that shift and how much was not, but this might be a better task for someone in management to take on.

My employer specifies 3 month notice for all providers. My experience is that most credentialing processes take about that long.

I can really only speak to the ortho-type imaging. In the system I use, I choose the body part I want xrays of and it comes with certain standard views. For knees you need to decide weight bearing or non-weight bearing (hint: always weight bearing if possible). For wrists, if you suspect a scaphoid fracture you need to ask for additional scaphoid views. Most ankle injuries should get foot images as well to r/o metatarsal fracture. I very rarely (once maybe?) order CT scans for musculoskeletal injuries. I order MRIs if I suspect any ligament/tendon damage or disc injuries, almost always after at least a month of conservative treatment. Shoulders can be done with our without contrast (arthrogram -- dye injected directly into joint space, very painful), and I've heard lots of arguments for both (dye better for labral tears and possibly small RTC tears, but advances in MRI technology now show that non-contrast is pretty comparable to contrast). If I'm not sure, I refer to Ortho and let them make the decision.

Just to argue for the sake of arguing, I had to refer a patient to a wound clinic this week for a burn I probably could have managed in office with more wound care experience (and dressing supplies). I don't think any particular RN experience is essential to being an NP (possible exception for inpatient NP care, which I've never done), but I think you can make any RN experience useful.

Not certain they'll only take ANCC, but all our NPs in my group are ANCC so it hasn't come up. It's possible other NPs at the hospital are AANP, but as this isn't an issue for me I didn't really check. I took the exam a year and a half ago, never really even thought about taking AANP.

ANP/WHNP here. Couldn't find a WHNP job, working as an ANP with no OB/GYN at all. I miss it and want to get back into the field, but I'm not sure I would advise doing WHNP alone to anyone as the job opportunities really are so limited.

It's not the science prereqs, it's the 4 years of med school + residency. Most of medicine is routine. I think it's a great distribution of resources if I, for example, manage the knee sprain myself and send the guy with the torn ACL to see an orthopedist after he's already had an MRI done. I actually think advanced practitioners (NPs and PAs) should outnumber MDs in an ideal situation.

And I saw a patient recently who refused to see a particular MD (one known nationally as a thought leader in his field) because previously, the MD had told the patient repeatedly that he had a strain when he in fact had a major musculoskeletal injury that required surgery. I've been an NP for one year. I saw the patient for another injury, listened and did a thorough exam, ordered appropriate imaging and got him in to see the right specialist to fix the problem. And I still think that MD is brilliant academically, just not with people. There are good and bad apples in every field.