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mangopeach's Latest Activity

  1. Patients who are taking stimulants in combination with benzos and sometimes. Ambien. Or Seroquel, Gabapentin or Lyrica in the mix. I would never start a patient on this kind of regimen. I have acquired some patients recently who had previous providers within the practice who have left. Recently was asked by office manager to see a patient whose provider left and he was assigned to another provider who looked at his med list and said Nope, not seeing him. Office manager wanted to know if I would be willing to prescribe those meds. I responded in kind that I would not prescribe that combination either. When I have new patients that are brand new to the clinic, and have this complex med list. I tell them at the initial eval that I don't think their med regimen is safe long term. I let them know that we will work to simplify their regimen and I will help them wean off some of these meds and we will work to find alternative solutions. Some are agreeable, others not. From an ethical standpoint, is it ever OK to refuse to see these patients? I seem to recall reading somewhere, that checking PDMP and then refusing to see a patient because they are on a long list of controlled substances is a no no.?? Thoughts??
  2. mangopeach

    Manager threatening patient abandonment

    I was tempted to resign immediately from my currently employment. Things have gone downhill over the last few months. I tried to do some research on this matter and I am still not clear what does and does not constitute patient abandonment. I had a lot more clarity on this matter as a bedside RN. I need to be more educated about it as an NP. As a result I gave them 30 day notice. I read some information similar to what Neuroguy posted. I also read info on this site. The writer here seems to think reporting the provider (MD) to board was appropriate https://www.jucm.com/the-consequences-of-a-medical-provider-quitting-without-notice/
  3. mangopeach

    Psych NPs Patient Schedules - Is this the norm?

    The benefits offered at my current job are excellent indeed. I suppose that is probably the main reason some people stay. The health care plan aIone is unheard of anywhere else that I've worked. I contribute very little to my healthcare plan. It's paid for mostly by my employer. I have decided to move on to private practice though. Well, don't want to count my chickens before they hatch. I have a 2nd interview next week so hoping it all goes well. I am a bit disappointed to be going back to my home state. Almost feels like a loss, that I didn't make this work but looking forward to the next opportunity.
  4. I'm a psych NP. Had an interview this morning. I have a little over a year's experience as an NP. Towards the end of the interview, they asked me what salary I was looking for. I gave them my salary range with the lowest number being what I currently make to the highest number - my current salary plus 10K - Thinking that there would be room to negotiate somewhere in between. The look they gave me was kind of " are you serious, look". They asked me if I would be willing to negotiate. Negotiate as in lower. I don't think I responded well. I told them I am not willing to go lower than what I am currently making. Program director said, "well you wouldn't be on call or anything, nobody would be bothering you after 5pm and its 4 days a week.". The way she said it, I sensed that she was not happy with the salary range I was looking for. I'd be going to 2 different locations, which I don't mind. Its in my home state and the cost of living is higher than where I am now, so it doesn't make sense to take a lower salary to live in a more expensive state. Seems like they were really interested until salary came up. Was there a better way that I should have handled this? They haven't said no. They said they are still interviewing and would get back to me. However I sense that I won't hear back because they are not willing to pay what I am looking for. They have never used an NP. I would be the only NP and there's one MD.
  5. Psych Eval is 1 hr and Med management is 20 mins - I get that this is standard at most places. However is every bit of your time booked to see patients? So 8:00 am, 8:20 am, 8:40 am, 9:00 am and so forth. No time in between? I've been practicing for one year and some days I feel like I am being taken advantaged of. If patient A is supposed to get 20 mins that ends at 8:20 - By the time they are out of the office and patient B is in the office its 8:22 or 8:23. We are still working remotely but things can sometimes get even worse with doing things remotely because some patients have technical issues that can put us behind. Am I being petty here, or is this the norm?
  6. mangopeach

    Inpatient or outpatient PMHNP?

    I've been a working NP in an outpatient community mental health clinic for a little over a year now and some days I really dislike it. I worked in a hospital my entire RN career. I'm at a cross roads to be honest about where to go from here. I miss being in the hospital and I miss working 3 days a week. Every now and then I picked up an extra shift but to to go from working 3 days a week to 5 days has been challenging. I find working 5 days a week really draining. The documentation is never ending. It's not a 40 hr/week job. Its a good thing I am single with no young kids. I don't have a healthy work life balance. I relocated for this job so I don't want to throw the towel in just yet. Trying to stick it out for another year. But I keep looking. Recently considered a hospital position with a 7 on 7 off schedule. I procrastinated and did not apply for it.
  7. mangopeach

    Do Black Nurses Have a Different Experience?

    I posted this on another forum that I frequent 2 years ago. So today I was reminded that I am not an equal Rumors have been swirling at work that the new guy (he's white) I am training was being paid more than many of us are being paid. I've been brushing those rumors off. He's a new grad. I was thinking no way. Sure enough, I went HR, just for the hell of it. They wouldn't confirm, but they didn't deny it- But they said, " you need to talk to your manager about your own pay rate". - which pretty much confirmed the rumors for me. Anyhoo, HR guy contacts my manager - who then calls me with some BS excuse saying " oh looks like we made a mistake when we did our numbers in Jan and you got left off, I don't know how that happened, I'll make sure that gets fixed". So now they will give me a raise. - But it felt like a kick in the gut. How insulting to think it was OK for me to train someone who was getting paid more than I was? I am his superior - how can he make more than I do? This has ticked off a bunch of other nurses on the unit that are now thinking about leaving after finding out how much this guy is making fresh out of school with no experience. I guess thats white privilege at its finest. Walk out of nursing school and make the same pay rate as nurses with several years of experience.
  8. mangopeach

    Psych NPs working in hospitals. What are your hours?

    Thank you for all the responses, Verene, I can't afford to reduce my hours. I really just want a balance in my life. I worked 40 hrs in 3 days for most of my career as an RN, so long work days don't bother me. It's doing it every day, and now even on weekends as I find working from home, even more time consuming. The EHR we use has its own template for psych evals and med management and its awful and cumbersome. They are supposed to be replacing it with something better soon so we shall see. Never thought about dictation software. I am not sure if I can use it though. I would have to get IT to install it. Before Covid, I would sometimes be able to document as I was seeing a patient. Now that we are working from home, Its hard to do that now with Zoom since I am on a totally different screen with Zoom and would have to switch screens for documentation. Landolakes, I would love to go back to working 3 12s! Hi Erin, Good luck in your job search for 4 10s. I think I am going to polish up my resume and start looking. It's too early in my career to feel this burned out. Thanks again for all your replies.
  9. I am approaching the end of my first full year as a psych NP. I am not sure I want to renew my contract. I work at a FHQC mental health clinic. I was hoping to stay here for awhile and perhaps get loan forgiveness. But I am finding myself overwhelmed these last few months. I knew the transition from RN to provider would be challenging but I don't like feeling burned out this early! Things have gotten worse since Covid19 and we have been working from home. At first, I thought I would enjoy working from home, but I have found it more time consuming and we have not gotten any more time in between patients. I feel like I am always working. Even before the shutdown, I never left the clinic at 5. I was there till 6-7 pm. I start seeing patients at 8:00 am. I miss working 3 days a week! I find the slog of working 5 days a week draining. Maybe if I left the office on time, it wouldn't be so bad, but that never happens. I even spend my lunch hour doing documentation. I just knew when I started working as an NP that I would only work outpatient. Now I find that I miss working in the hospital setting. I was looking forward to never having to work holidays and weekends ever again. But I think I would prefer that if I could have some semblance of balance in my life again. I have seen some positions posted, though not many for positions with 10 days on, 10 days off, or 15 days on and 15 days off. Does anyone work a schedule like that? I think I would prefer that schedule than 8:00 am to 5 pm (which is more like 8am-6 or 7pm) 5 days a week. Maybe things would be different in private practice. I don't think an NP in private practice has to do all the things we have to do - So maybe working in private practice would be an option, but like I said, I just find working 5 days a week such a drag. Thanks for reading.
  10. mangopeach

    PMHNP practice

    I work in community mental health. I've seen as many as 19 patients in a day. Though my average is around 15. Med management is 20 mins. New patient 60 mins. I am salaried so get paid the same if only half of my patients show up or all of them show up. We have a lot of no shows. We do walk ins to compensate for the no shows. Which makes your day really unpredictable! I've been a working NP for less than a year so things take me longer than some of my co-workers. Its very rare the person that comes in that is psych med naive. Many have tried "everything and nothing works" so sometimes coming up with a regimen takes more time and goes over 20 mins. I used to dislike walk ins, but I am warming up to the notion now. While I am salaried, we do get production bonuses so having walk ins help. As we have gone telemed due to coronavirus, I am liking that option more as well. We have a contract with the local county jail so I was already doing telemed with jail patients 2hrs, once a week. Now that we are strictly telemed, I like that option more as well. So many clients ask for late evening or weekend appts. We close at 5. Many of our clients don't have PTO, so asking them to come in when they have to work, is really difficult. Looking to ask the powers that be if they will add late evening and weekend tele-med service. But I'm waiting till its time for me to renew my contract and ask not to be salaried at that time. Maybe those ideas may be helpful to you. Consider walk ins and tele med.
  11. mangopeach

    New Grad NP - Experiences with Relocation

    I relocated a few months ago and I don't regret it one bit. I didn't get as much as some others posted for relocation though. I got $3000 for relocation. They paid for my hotel, flight, rental car when I came for the interview. When I first started working with recruiters I considered some places that were not ideal at first. I love the city I'm in now. Great weather, beautiful beaches, its not in the middle of nowhere, still not a big city but only 2 hrs away from the closest big city. And its only a 8.5 hr drive from my home state so not too bad. I think I lucked out with this one. I'm getting some good experience here. Not sure if I will stay after 2 years. I am thinking of moving west, but who knows. I may end up staying here. I'm glad I took a chance on moving though. I had to sell my home, but you know not being a home owner, feels a bit "freeing" right now. My son is grown and out of the house so I can pick up and go wherever I want to.
  12. mangopeach

    Interview Questions and strategies for first NP job

    Not unreasonable to ask about mentoring and having a lower patient load while you get up to speed IMO. This is my first psych NP job. I work for a community mental health center. To be honest, I would have liked more time before getting a full patient load but it is what it is. The first month I did not have a full patient load. I was not paid less during the time I did not have a full patient load. I don't think you should expect to be paid less. But someone with a lot more experience may have some more light to shed on this. The documenting in the allotted time is what I struggle with so I am no help there. I don't have to deal with any of the insurance details where I work.
  13. So I've been on the job now for 2 months. This is my first real NP job since graduating last December. I was supposed to start another position in June but that did not work out. In any event, I work at a community mental health center. Overall, I love the job. It is a super busy clinic. We service a lot of people in the county. My issue is I work through my lunch break often and I'm at work an hour sometimes 2 after the clinic is closed! finishing up documentation. I see a lot of new patients. I get an hour for new patients. Med management is 20 mins. I find the EMR, burdensome, so that's one reason. The form is not exactly user friendly IMO. Of course I've gotten better with using it since I first started. So maybe this is a silly thing that I carried over from my days of being a floor RN that just will not work as a working NP. Whenever I did my assessment as an RN , I always wrote my notes on paper then typed them up. I never liked talking to the patient and typing at the same time. I see, that will not work for me as a working NP. Way too many patients to see. When I look at the initial psych eval and med management notes for the patients I have inherited, they tend to be a lot more concise than mine. Sometimes in a good way and sometimes not. Maybe its newbie jitters. I took over the patient load of a doc that recently left. I'm actually shocked at the brevity of her documentation. I'm just afraid if I don't have it all down, that I will miss something. Which of course leads me to be at work for an hour extra. Help! Any pointers for improving to documentation to make sure you get all you need while being concise?
  14. This all day every day. I'm a new grad NP. I spent over 7 years in patient psych. It is my opinion that anyone that wants to be a psych NP should be a psych nurse prior to becoming a psych NP. Just my opinion. I was always gobsmacked at some of the things some of my cohorts that never worked psych would say. Rest assured that I would run the other way if I took my loved one to an appointment and walked into an office and saw one of them sitting in that chair. In time, I suppose they will be great clinicians , but I think there are things you learn when you are exposed to actual psych patients that you don't learn in a book. I can't imagine being a cardiac NP without ever setting foot on a cardiology unit. Again, JMO. We didn't give IV meds on my unit but I gave levothyroxine, insulin, metformin, you name it blood pressure meds, coumadin, anti, biotics, nebulizer treatments, on my unit, made sure chest x-rays got done, etc. Psych patients do not check their medical issues at the door. In fact, just as they do not take their psych meds, they do not take their medical meds so they come in with uncontrolled blood sugar, blood pressure etc. Psych patients tend to have shorter life spans. They tend not take care of themselves.
  15. mangopeach

    Angry and need to vent

    Hugs to you. I am a new grad NP. I have been a detox/psych nurse for over 7 years prior to becoming an NP. I plan to continue my work in psych/addiction medicine. I've lost clients over the years. Some have been successful at being able to stay sober. But the battle for their sobriety is hard fought. The crisis was there for me on my unit- long before the media was talking about the crisis on tv. There is not enough money for long term treatment. There are not enough providers. I am relocating from my state to another state for my first NP job. I am still getting calls from clinics in far flung places desperate for providers that have experience with addiction. I was delighted to read an article recently that some medical students were choosing Addiction as a specialty. It is its own beast under the umbrella of psychiatry. I don't want to get on my soap box here because I believe that there is a lot that we can do to stem this crisis. Its like a lot of other things in this country. Its a matter of what our govt prioritizes. Our politicians, make wonderful speeches but never put money where their mouth is.
  16. mangopeach

    Interview Tips

    I'm a new grad NP - I just went through a whirl wind series of interviews and phone calls. So glad all that's done! So I had some varied experiences- The job I eventually took- First contact was a phone interview - This was with the Community outreach program president Then I was told to fill out an application online -then HR manager contacted me and had a 2nd phone mini interview - Then they offered to fly me in for interview ( This is in another state) Day of interview - I met with the MD in charge of the the out patient clinic, practice manager, HR manager and Community outreach program manager -All separately. Total of a 3 hr interview It was a pretty laid back interview though. It really was more about what the organization was about and seeing if I was going to be a good fit. I sent everyone a thank you email after the interview. They sent me an offer letter by email a week later. On other interviews Job#1 I interviewed with only the practice manager - that one disturbed me - but hey I'm a new grad so what do I know? I figured I should be meeting with an MD or NP as well. So I was turned off by that. I asked who would be my direct supervisor and she said me. I found it all Strange. Job#2 Interviewed with HR manager and Medical Director - this was the job I almost said yes to. HR manager contacted me first. I had a phone interview with HR manager then 1 week later went in for in person interview. HR manager asked the usual Tell me about yourself, Greatest strengths, weaknesses, etc questions. Medical director asked me clinical questions - /diagnosis/meds. This was the only time I was ever asked those questions in an interview. Job#3 Interviewed with a solo practitioner- I knew I was not going to take that position- He bad mouthed his current NP during our interview. Her contract was expiring and she did not want to renew. I wonder why? Anyway - we talked on the phone a few times before I went in for the actual in person interview. Our conversations were really friendly prior to me going in person. I was just really turned off about the way he spoke about his current NP. As far as Thank you emails - I would send it to everyone you have been in contact with through out this process, including the people that interviewed you over the phone. Good luck!