juschillin

I too am looking at locums work as a psych NP and hope you find something that works for you. I don't have too much to say but will share that I'm working with locumtenens.com and have done one assignment with them, it went fine, had no issues. Now I'm back to do it again 2 yrs later but they have yet to come through on anything. Lots of back and forth, have presented me to various places, but nothing has come of it particularly. I've reconnected with Staffcare who has a psych-specific employee who talks a great talk... just waiting to see what comes of it. I've had difficulty connecting at all with CompHealth. I'm looking for outpatient primarily.

Thank you for these thoughts. I think every community mental health and/or outpt clinic has different levels of acuity and there isn't one method that will work for them all. I have a lot of clients that need higher levels of care, such as ACTT or CST and it's not available. Lots of them don't have primary care and haven't seen a PCP in years. I recall seeing a post on here not long ago and a NP had a form that each client filled out before being seen that had them list their meds, how much sleep they're getting, appetite, mood, all that stuff, and so when they were being seen they focused on that only, and it was much quicker. I'm going to try and do that this week coming up and see how it goes. I try not to get into side stuff with them and rarely do anything but a little bit of support counseling. We're very short on therapists and they're lucky if they see someone every 3 months. I know there are NPs that are able to get 'em in and out quickly, I just haven't found that sweet spot.

I'm back in my old role as a psych np, this time in community mental health. I put all I have into the job, trying to provide the best care I can. I have 20 min. for follow-ups and 45-60 mins for new clients. I have found it to be impossible to see these clients in that amount of time. They are a pretty sick bunch, with a lot of complex trauma and substance abuse. Because of turnover with NPs and therapists, they have had little consistency in care over the last couple of years, which of course has impacted them negatively. I work incredibly hard. But I feel that it's never enough for the bean counters, who constantly tell me "more more more". I cry often because of the work load and know something has to give. In June, one of my coworkers was violently assaulted in the early evening hours while working late (he survived); someone tried to break into the office via a back door, believing no one was inside, most likely looking for drugs. It's common for staff to work late because we're short staffed and horribly over worked. I've been trying my best not to work such late hours, and finally had to put my foot down. They have done very little to improve safety since that incident, despite repeated requests to do so by myself and other staff (that location is one of 4 that I work in every week, so I'm there physically only once a week, thankfully). Just yesterday I had to call the police re: a client that I felt was too threatening. It's the end of the day at the end of the work week, and I'm exhausted. But I wanted to write this for a few reasons. For one, those of us in mental health (all of healthcare, really) need to have safe work environments. OSHA has a guideline about this, particularly in the mental health setting. Google that website and read it. I think it's called "Universal Precautions for Violence", or something. LOTS of good info. Of course, my company has broken every rule in OSHA's book. But I just needed to vent, I guess, too. I cannot seem to find a place to work that has a good balance, one where I feel truly supported as a healthcare worker. I also know that this theme, compassion fatigue and burn-out, is a main one on this site and other forums like it. Whoohooo! I'm not alone! That doesn't make me feel any better, though. I don't want to quit this particular job, but I don't know how to make it work. I don't know how to survive in this field. Can anyone offer suggestions about how to hang in when you're not feeling supported by the administrators, aka, the bean counters? Does it ALWAYS have to be "us (nurses) vs. them (bean counters)"? This was way long and I ought to edit it but I'm too tired to edit. Thanks for reading/listening. Have a great weekend. jc

BabyNP, I've never heard of that. Glad you feel good about what you're getting, so that's awesome. That's like this job for me, I thought it was an amount I was comfortable with, so I didn't feel the need to ask for more. Congratulations on your new career!

NRSKaren, and everyone else, great information! Boy do I wish I had access to all this before I accepted. I don't think I am far off at all, but still can't help but kick myself a little for not at least trying. I am in the process of making peace with it and I know it will be OK. I never imagined I would make this much money, I'm in 6 figures, so I'm way more than happy for that. I feel like I'm being greedy if I asked for more, seriously. The national average according to 2015 Advanced Practice (?) magazine is about 95k. It sounds like everyone that posted here is doing an awesome job of self-advocating. You're all excellent role models for those of us short on the skill of self-advocating.

Hello, I just needed to vent a little... Today I accepted a psych NP position without countering on their salary offer. All I asked for was annual CME conference allowance, separate personal malpractice allowance, and up-front payment for my DEA number, all of which they immediately had no problem with. I hung up think, UGH I should have countered on the pay! I just lost 10,000! It's a full-time position with standard benefits, including 5 weeks vacation. At least I had the nerve to ask for those three extra items. The last RN position I had was the first (and only) time I ever counter-offered on pay. I must have been feeling especially bold that day, because I earned 7500.00 in only a couple of hours. I thought to myself that never again will I accept the first amount... oops! I guess I wasn't feeling very bold today. I don't think I'm far off on the pay with this job, but I definitely could have gotten at least another 5k. I think employers EXPECT us to counter. When we don't, we're the ones that lose. If you don't counter on pay, certainly ask for things like malpractice pay, extra vacation, a doctor's parking space at the hospital, etc. (I know one person on here asked for that parking space and got it!) I want to encourage everyone to JUST ASK! They expect it. I'm sure the PAs and MDs do it, and probably more nurses do it now than in the past. If you need a buddy to stand with you in your kitchen for extra courage while you're on the phone, do it! I didn't have anyone, just my dog... she was helpful afterwards, always accepting me with my many limitations! We're a power force to reckon with, especially when we stand our ground. So DO IT. Onward and upward. JC

Thank you Jeremy, and Psychcns for your information. Yesterday I was reading about "incident to", and SBIRT, and it seems like there are services that can be billed. I don't know if other states have the designation "Qualified Mental Health Professional" like NC does, but I'm also wondering if that designation allows billing of services that a RN without a master's could do.

Hello, Does anyone know if there are any outpatient (or inpatient) behavioral health codes that nurses with master's degrees can bill? My situation is that I am a RN with a master's that used to be a psychiatric NP. I left NP practice for 5 years, and now I'm going through the process of obtaining it again, but it will take many months. I'm not employed as a RN, one big reason being that I have had a hard time finding employment because I'm always questioned about why I left my NP work, and they're concerned that after spending money to train me, I will leave the RN position to resume NP work. That is accurate, but it could be a year before I'm eligible to work as a NP. I have to complete 400 clinical precept hours, and was recently given the opportunity by a large behavioral health agency to complete all of the hours, on a fast-track, at the pace of 40 hour/week, and a full-time NP job upon completion. Where I live there is a shortage of NPs. This is a great offer, but I need income to supplement cost of living expenses in the meantime. They asked me if there are any billable services I can provide during this time, to help offset expenses, and I said I didn't think so. This is a long post to ask this question, but I needed to provide the background. I have a NPI number and was eligible to bill CMS at one time, even as a RN I believe. I live in NC and my license is compact, RN, NC. Any suggestions or info will be greatly appreciated! Thanks and have a great day.

KRSKaren, Thank you and I will certainly investigate and help spread the word.

Just this week I met a gal who was preparing for graduation from Frontier's NP program and she had lots of positives to report about the program... just commenting on that since you just mentioned it. I was just accepted into a post grad certificate program for nurse education. I will be applying for the faculty loan repayment via the government to cover that one. So now I just need to find a HRSA site to pay off my graduate loan. Slightly humorous note to all this -- I spoke with the student loan dept recently and asked them "what will happen to my loans if I die before they're paid?" The answer: it's forgiven! Til death do us part. At least my kids won't have to fork over any inheritance money to pay for my nursing school loans (should they be so fortunate).

While networking today, I spoke with a local pediatric NP who said that her office gets DAILY requests from NP's needing clinical hours and preceptor time. She said that there is just not enough time to do it, plain and simple, and there is no amount of incentives one could offer in exchange. She said that "back in the day" this was not an issue for students (finding clinical sites) because the schools were providing them. Now, she said, schools are making the students find their own preceptors. With the rise in number of online programs, I think schools are taking in students (that is, taking their money), promising a lucrative salary upon graduation, but not providing the clinical sites. There is clearly something wrong with this picture. At least I already have my degree, so I feel fortunate in that respect. But I'm still in need of the hours, and without that, I can't practice. Thank you, Psychcns and BeautynBrains_Rn, for your responses to this post.

Thanks UNCNP. It's an issue of time, yes. One of my colleagues in SC precepts at the VA and is already so slammed with her regular job duties... chillnurse, you're correct in that some people just don't want the bother of helping someone. I'm glad to see you are receptive to the concept of lending a helping hand.

I'm renewing PMHNP certification (following a few years away from practice for family leave) and need 400 clinical hours. When I graduated in 2003 the only enticement for a preceptor to have someone tagging along was their ability to use the time for continuing education hours. What are some ideas on what can be offered to a potential preceptor in exchange for hours? How are NP's finding preceptors? I'll network as much as I can, e.g., via professional organizations, LinkedIn, and universities. Thanks.

I agree. I'm not pursuing this one anymore. Thanks for your thoughts.

Focus Cares, Inc is advertising on Craigslist again in my area, NC, advertising for RN Care Managers. The position if for doing short health in-home assessments for Medicare recipients. He said they are contracted by Humana for this. I received an email following the initial phone conversation to discuss the job and they are asking me to submit a photo (for my ID, they say), copies of drivers license, ss card, BLS, PPD, etc. Sending my drivers license and social security care copies, along with my photo, makes me skeptical. From a Google search I can't find a whole lot of info so I thought perhaps someone on here may be familiar with them. Thanks.

Thank you, and I will look further into their program.

Thanks for your reply. How was the job search following graduation? Was it an online program? I'm glad it was positive for you.

Thanks so much for your thoughtful reply. I have a MSN and used to have APRN certification. I elected not to renew because at the time I was in the midst of caregiving for my mother who has Alzheimer's. My specialty was psych/mental health and to be honest I didn't enjoy prescribing those medications. Nurses with a master's either work in admin, NP, or they teach. Admin is of no interest to me. NP will take a long time to renew. That leaves teaching, which I've always wanted to do. I just turned 50 and there in lies the/a rub. By the time I finish a PhD I'll be 56-57. That's not far out from "retirement" age. My life took the turn it did, with regards to my mom's illness, for whatever reason. If I were 10 years younger I'd dive into getting a PhD. But at this point I want to ride with loose reins... off into the sunset! The deadline to apply for this fall is fast approaching and I need to decide. My first choice is Duke but that's the most costly I've seen. I'm applying there anyway, in case I can get enough grant money, plus another school near where I live. The schools are all online. So going with a top-notch program may not be so important. Or maybe the opposite? Thanks again.

Hello Nurses, I'm trying to choose a post master's certificate in nursing education and there are so many. I'm looking for institution recommendations. My goal is to teach at nursing schools (as opposed to nurse educator at a healthcare facility). I've considered the PhD approach but for numerous reasons I've ruled that option out, for now at least. Suggestions? Recommendations? Advise? Thanks!

I'd love to read any updates on how this is going.

Sparker, That is an incredibly good synopsis of a home health nurses work and it sounds like you enjoy it and are good at it. This specialty can be really rewarding and it's always been my favorite. However the last stint I did I was in a really toxic work environment and was putting massive, I mean massive, amounts of miles on my car. I had to give it up. There are pros/cons to everything.

The 20-somethings that you've seen coming in for care -- how great is that! It's going to be really interesting to see what happens, for our profession and our patients/clients. It's exciting. Today's New York Times has a couple of interesting stories about the ACA rolling out and I'll put the links in this post. The first one talks about a study being done in Oregon that's showing more people are using the ER than was thought which is the opposite of what was hoped. There will be a big learning curve for those who've gone without primary care for so long, who are so used to going straight to the ER. http://nyti.ms/19MlzXo "Access to Healthcare May Increase ER Visits" http://nyti.ms/1cJhMi5 "Consumers Start Using Coverage Under Health Law"

Happy New Year fellow RNs! I believe we're going to see an increase in RN job availability with the Affordable Care Act kicking into place this year. Already on job boards I'm seeing a lot of postings. It seems only natural because there will be more people getting care they've put off. CM jobs should increase, IMHO, because this is all about dollars and cents, more so now than ever, as the ACA has to "prove itself". What's everyone's take on this? What are you seeing out there?

Very good to know, thank you. I'll try and keep you posted.

Funnygirl -- general case management job description plus what I mentioned in my post. Grntea -- I agree, never give any personal info out. They didn't ask me for anything. A staffing company (not this one) in a city I used to live in had a skills test that was done on this same site, Prove It!. I looked them up on glassdoor and seemed Ok. Didn't look them up on the Better Biz Bureau though. I'll try to keep this updated on how it goes. Thanks for sharing.