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.

We need MD's we need NP's, we need RN's we are all spokes on the wheel, different overlapping supporting roles.

"Mar 17 by fathertod, BSN, RN Your best training and career bet is to go to Harborview. You will not regret it" Harborview is a great place no doubt. However if you wish to be a NP/PA and do a lot of procedures that is not the place. One of its mission statements is to train MD's and interns/residents will do 98% of all procedures for some aspect of their training. If there is any issue is that there is concern there is not enough OR/procedure time for interns/residents. NP/PA's or healthcare specialists as they are called round on floors, run clinics, discharge and do the grind of heavy day to day lifting there of daily provider work to allow higher level training options for the interns/residents. Its a great place with super staff with a real sense of mission but not a procedure rich environment for NP's. Very limited involvement with the critically ill. Interestingly/sadly they do not even allow NP students in the ED anymore...all teaching spots are for MD students. Just FYI.

well if you love your staff nurse position and hours why change? Nothing wrong with that! Its all a balance, spokes on the wheel, all points of life should be smooth for a easier ride.... that being said for me I feel I can impact patients lives in a different way as a NP, better hours, better pay, more headaches in a vague sort of way but thats life. I have never looked back... Its what that works for you. A

This and I like it also, good combo. I know a similar NP in the same system who is salaried and makes a touch more than me who would argue she has a preferred system. YMMV depending on your personality a

generally speaking in academic centers, short coats are for students whether you are a pharmacy, medical or NP student. Wearing a tie shows respect for the patient and institution. Long coats are for licensed folks, never seen any real rules. Though I have a coat rack of them I wear them only occasionally. My chief tells all the interns and residents that they are expected to wear them as they are "doctors" and need to look the part and helps the patients tell who their "doctor" is. I am bemused by the "doctor" bit, but do agree with helping the patient identify roles. I am gray with a goatee and bad humor, so once my patients meet me they always know who I am. I do not like wearing coats, but they do allow me to carry stuff, like stethoscope, small flashlight, pens, my iPhone, and patient lists with my to do lists. I carry a iPad mini sometimes that can access my EMT so if I am in a meeting I can check labs or charts.. When I have students I have them wear scrubs when inpatient with a short white coat. When in clinic I have them wear nice business casual with short white coat. - When in my private practice and when I had students I had the wear a short white coat and scrubs. I have seen a wide range when visiting practices and students in the community here in the Pacific Northwest. YMMV a

to the OP Work at a level one and am with the Burn service; my attendings are Burn/Trauma surgeons. I manage the floor patients for acute issues as well as just regular day to day stuff. Many of my patients are on service for a couple of weeks with wound care and such so lots of management of their baseline medical issues DM, HTN CAD.... as well as the acute stuff. I also have a out pt clinic twice a week (4hrclinics) where I see new and followup pts that have been discharged. For us increasingly burn patients are being managed on a out pt basis. I go to the OR on rare occasions just to see whats going on and say hello to my team. We have a robust residency program and we keep the interns and residents in the OR. They watch the floor pts on night/weekends and holidays, hence I have a nice schedule! I myself have no interest in the OR, my partner on service is a PA and she does of course. We are supposed to be getting trained up to do laser therapies the next year, either in the OR or in clinic. I am as independent as I need want to be/it is a large team so we are always running lists and giving each other signoffs on what is going on. Very few PA's in the OR. not any NP's, not really our training or at least mine. a

Sounds like he wants you to do a non paid orientation

I am a FNP in WA state, both private and university. No we do not need a collaborating partner/MD. Many independent NP's here in the state with their practice.

You need to learn how to be a NP first. Then maybe find another NP job that fits. I question why you are a NP as well. Two different jobs you are discussing NP vs RN.

I would if I was young..less than 50? and starting a program, just seems to make sense though I agree with all the above posts. Doesn't though the university of Washington allow a person to obtain a MSN mid school track? And exit if they wish? I seem to recall someone one doing that.