allennp

I used to go to the ACEP conferences and pick up some skills, and the consensus was if you were trained then sure do them and bill for it.

C19 will hit you guys one day, this is not going away, Seattle where I am has been on fairly tight lockdown since the first of March. I compare it to a wet tarp over a hot fire full of coals. Start lifting that tarp up and the flames will rip again. Our ICU's are full and folks are going WOW!, they stay on vents a longgggggg time. Look at the UW studies 60% mortality in a very limited review when you end up on a vent with this. But everyone is running out of money and we need to start up electives and help all the folks we have pushed to the side as well. There are still folks having glioblastoma's, need liver/kidney transplants, having Cranial facial injuries, getting burned, et et et... the world can not stop for this....or should it? That being said it is in the communities and we are just going to have to let this ripple gently and not overwhelm us, as I know folks here know. It will not be pretty. Your wife? HA, let her live with that view of innocence, sadly she will have to reconcile its a real issue. We can be so influenced by input. I have such a fear of getting it and concern for the country. Yet a friend today told me about a 70 yr old friend with lymphoma who infected four other folks and they are did well, no big deal. All we here see is that 2-5% of dreadfulness, much of the country and people does not see it in the same visceral sense. Tough issue.

well here is another take, at a large hospital in Seattle they have sent out a group email that we are PA/ARNP are subject to be redeployed in a position other than what we work as, within scope as phrased, I.e PA can be redeployed as a MA helper and the NP's can be forced to work as a RN. It has been portrayed that if asked and you decline you will be subject to dismissal.... all that being said I have not yet heard of them forcing the issue.

I think it might be for some. I have a hard time seeing where the differentation of the ARNP role is going to end. If I was 30 yrs younger going in to this I would struggle to decide, I am currently inpatient working at a level one center as a FNP. Sort of grandfathered in, now we hire mostly ACNP's for inpatient. Thing is I take care of kids as well. Both clinic, inpatient and ED/ICU. What cert would be best? I guess ACNP, FNP. Ironically I lecture and precept ACNP and FNP students, and have previously served as expert content source for the initial ACNP workup and planning(though in reality contributed little). My current position needs the pediatric component that the ACNP would not cover. The current consensus model has few advocates, but its water under the bridge and one must live with it.

I am aware of several FNP’s who have gone back to get ACNP certification so they could work acute care/inpatient roles.

Where I am we/us prefer NP’s for billing and independent licensure.

My experience after 10 yrs, no difference. Reimbursements based on position, place of employment and experience.

as a current FNP and previous medic I do not see a lot of usefulness in a NP working prehospital. A focused prehospital EMS program gives in my opinion a much better clinical and didactic program for managing issues in the field, vs a ACNP or FNP, the benefit of prescriptive authority is minimal with the guidelines and protocols that have been developed. Plus who the *ell wants to work 24 hr shifts in the field hauling backboards and intoxicated folks.

Well said.

For years I have listened to HIPPO rap, podcast that is certified for my CE. I am now signed up for their primary care. Its a excellent CME. Research, esoteric facts, reviews and opinions really well down. I seriously enjoy them and its well worth the money.

This has a great point I have not reflected on much, I am a advanced practice nurse hence I suppose?? I practice nursing.... yet in reality we are in the same healthcare role as our colleagues DO's, MD's and PA's. We are share expertise and consult our expert colleagues when appropriate, and they us depending on specialty. It is a curious twist to consider who manages me, and I do not much care as long as they are professional and provide me the ability to provide the best care at the most efficient cost to my/our patients. I have seen some horrid physician/ARNP managers and superb RN managers. I do not want to get to caught up in the letters behind a name, just as my patients do not get caught up with the letters behind our name, but rather consider the product and outcome perhaps?

Good comments here, and to answer the OP. I worked in a large academic center ED and the NP/PA's were managed by the RN director of the ED. Medical control by the EM director. The manager had a remarkable control including excluding NP's from having NP students, yet of course their were medical students in the ED. Also input over hiring and schedules. So it does happen. I never felt comfortable with it. I am still in the same system and have my administrator being a NP with my Medical director a MD which for me is comfortable.

Oh my, no you misunderstand. I took a inpatient position trauma services to many advantages to describe. I also love what I do!!

HA! I love that Truth is there, I have been in both, in ED fair amount of expected supervisor just as the residents and interns get though of course I am not one! UC on my own. Truth be I think as I am a FNP that the UC is more in my scope of practice it might be argued and I could go a couple of ways on it. I di find it a bit err.... I say carefully boring, though one had to always keep your eyes open and always work things up as I encountered many sick folks that did not think they were that sick hence presenting to the UC with...its just a cough. Left it all to work nice hrs and make some reasonable money at the same time...to have a life its all good A

seems to me the more you focus/narrow the more you restrict your options? Why not FNP and focus with post doc work on Gero. I know a number of practices with heavy Gero load but would not hire a Gero specific provider. I however am far from being aware of everything and I may be misreading the market. Lots of NP's coming into the market now. I am curious to what the future holds. Yes I am in Seattle.