CardiacNP01

Our team of NPs place PICCS, central lines, a-lines, quintons, etc for our hospital. For PICCs, I believe it's around $420 per line.

This is just a guess.... Since the hospital has a contract with the agency, they would probably have to adhere to their agreement (to pay the full housing stipend, etc).... the agency may need throw some perks your way and/or maybe you can start your new job early?

Just remember...whatever they promise or whatever you agree upon, get it in writing...EVERYTIME.

And they mean EVERYTHING.... phone interviews are useless with regard to promises. Remember, if it's worth discussing, it's worth getting it in writing.

Suzanne wrote: "If you one does not have a tax home in another area, and they are getting the per diem, then it is not tax deductable and they will have to pay taxes on it as well as penalties and we are seeing more and more of this. Agencies promise anything and then people get caught in the middle. Also depends on how the agency sets up the housing payments as far as stipends." You are sooooooooo right about this Suzsanne.... I have a friend who has become a traveling nurse in recent months...prior to that she lived with her mother. Correct me if I'm wrong, but a tax home is one that you are paying a mortgage on (vs. living with your mother in her home free of rent)....am I wrong? The agency recruiter assured her that since she is living "in a home" (with her mother cost free) then her per diem is tax deductable. The assignment is out of state. I told her that the recruiter is either grossly misinformed or is lying to get her to sign on.... am I wrong about that? I'll gladly stand corrected if I am, but I would hate to have my friend get stuck with huge penalties. Thanks!

A quick example to support the advice of this excellent post. In Jan of 1999, I had accepted my 2nd travel assignment with a "heart institute" in Miami Beach. (I'd be happy to tell you the name of the nationally known hospital organization if that's permitted...the company has changed their name since then) I was a CVICU nurse but of course agreed to float to any ICU...yet, I did not have the organzational skills for the floor...thus I was assured that their needs were in the ICU. My second night at work I was pulled to the floor....I promise, the following is absolutely true. The hospital's floor staff (we were told) had "walked out" or something along those lines. Thus, we had 4 travel RNs to provide total care for 48 pts per shift. No LPNs, No PCAs, No unit secretaries.... No joke. It gets better... although we were contracted to work 3 12hr shifts/week, we had two options. 1.) Work four shifts per week (and of course be paid). Two 16hr alternating with 2 12hr shifts OR 2.) Work every other night..split shifts. I couldn't do the latter because my girlfriend was in Lakeland, Fl then on a travel assignment, which was about 4hrs from Miami Beach....(I was too stupid then to figure out the distance between the two cities before accepting the contract). Furthermore, even my young body then couldn't adjust to an every other night schedule...uuhhhh.. Now....what about the person who, over the phone, agreed to not being pulled to the floors?? Well, she was no longer employed there once I arrived. As she said...GET IT IN WRITING. That experience on that assignment is the sole reason I was enrolled in graduate school the next spring.... and I LOVE being an NP!! P.S. Excellent advice on the housing as well!

There are job shortages across the state and the country...critical shortages in the larger areas. If you are considering advanced practice, I strongly suggest that you obtain your BSN (meaning forgo the LPN or ADN programs) and then get the critical care experience you need for a couple of years. It would be particuarly helpful if you could obtain experience within a high volume CVICU or SICU. Good luck.

While I haven't had a chance to respond before now, I feel that RuralNP stated it beautifully. Additionally, I've had experiences similar to that of RNMARTINNC. With all due respect to Tenesma, I've had to correct dozens of overzealous interns (with greater than three months experience) and R1s from making potentially fatal med errors within a CVICU in Memphis. Additionally, the thought of an intern with three months experience providing greater quality of care versus an NP or PA with 15 to 20 years experience is implausible at best. At worst, this thinking could prove to be very dangerous for an unsuspecting patient. Granted, the education of an M.D. vastly differs from that of an NP. Certainly no one can argue that point. Yet, the aforementioned post by RuralNP addresses this issue very well. It seems that we all agree that the quality of care provided is the most important issue for the patient, regardless of their title. That's good to know.

i believe it's a fundamental difference in the genders (i.e. men are from mars, women are from venus, or vice versa). regardless of the reason, this is without question one of core problems that has plagued nursing for years (or even decades). the dissension among nurses is in large part the reason i chose to pursue advanced practice. while i could make close to $100/hr in overtime as an rn in an icu, i simply am not strong enough to withstand the *****ing, moaning, groaning, whining, etc that spews from many of my female colleagues on a regular basis. (yes, female...the men, in general, don't partake in this crap). it's a problem of epidemic proportions that tarnishes the integrity of our profession. luckily, i escaped before they were able to completely suck out the life out of me. :rotfl:

It seems (to me anyway) that this discussion may have become more about the "status" and "recognition" versus quality of care. There are a couple of points I'd like to make. 1.) I somewhat agree with the first post. However, as a nurse practitioner, I've never been caught up in the "recognition game" (for lack of a better term). I don't view NPs as being better or lesser qualified than any other health care provider. I do agree that it can be frustrating to have to acquire a physician's signature in order for certain services to be provided to the patient. Yet, it's only frustrating from the viewpoint that efficiency in providing care is compromised by unnecessary steps. For instance, to order supplemental oxygen (considered a medication) for a patient with severe COPD, a physician's signature is required. Yet, in most cases, the patient (often times with cardiomyopathy) should have been placed on O2 long ago. Many times it was an oversight by the physician who didn't take the time to order pulmonary function tests or even a SaO2 at rest and with exertion. This is only one example, which brings me to my next point. 2. Regarding the issue of NPs acquiring expanded privileges and/or being considered "a wanna-be doctor", I suggest that much of the public (and many physicians) are grossly informed and/or unaware of the scope of practice of NPs. Additionally, far too many people "pigeon hole" a person based on their credentials and educational background. For example, let's say you have numerous comorbidities (i.e., cardiomyopathy, NIDDM, HTN, COPD, renal insufficiency, and major depression). You are given the choice of seeing a general practitioner versus a nurse practitioner within the same practice. Each person has roughly15 years of experience. The knee jerk reaction for those not very familiar with NPs would be to choose the physician simply because he has a degree in medicine. Yet, the fact remains that there are tens of thousands of physicians within this country who have been deemed grossly incompetent. I have manytimes corrected physicians who inadvertently prescribed potentially lethal medicines to patients. Additionally, I have many times discontinued and/or changed medicines and even cancelled potentially dangerous diagnostic tests because of their poor judgment. Thus, while there need to be certain standards, a "degree" certainly doesn't define the quality of care you will receive. With that, NPs should indeed share most of the same privileges of primary care physicians. Yet, they clearly should not have the same privileges as a surgeon, cardiologist, neurologist, etc. (and the first post didn't suggest they should either). However, an internist certainly should not be attempting to perform a cholecystectomy or even a cardiac catheterization. I've enjoyed the other posts. Great comments.