amandarez

I am a NP working in a private practice. One part of my job is to go to the hospital and see new Consults. I exam the patient, write up the note, and initiate care. My physician is available as needed for me to discuss with the patient. I have my own medicare number for billing. I was recently approached by a NP working for the hospitalist group who told me that per medicare rules, I could not develop a plan nor initiate care for the new consults. However, I have reviewed the Non-Physician Practitioners Manual and I cannot find anything that indicates that; nor have the billing specialists in our practice. I have sent a note to my state's NP board and the AANP to see if they know. But I thought I would put a note out and see if anyone knows anything about it. thanks

Hi all - just finished my np program (thank god - it seemed to go on forever). I have been working on my resume but have hit a bump. Can anyone give me any suggestions about how to say that I have been a preceptor to new nurses and also that I have acted as charge nurse (we don't have a single charge nurse on evenings - it just kind of rotates between 3 or 4 of us). Thanks for any help! Amanda:lol2:

We have pre-printed order sheets for the post op joints and spinal surgeries that also list drain orders. The MD just checks them off. If drains put out more than 240 cc (this is off hand and might be a bit higher) in one 8 hour period, uncharge them for 8 hours. If drains put out less than 30cc, then pull on POD 1; otherwise all drains are to be removed on POD 2. JP drains are usually stitched in. Hemovacs usually aren't (some of our md's do stitch in hemovacs for hips). UNCHARGE before you pull it.

I work on an ortho unit and the patients who are going to be getting any kind of joint surgery have to go to a class a couple weeks prior - they learn all about hip precautions, types of pain control, etc..... In addition, all of our patients have care management consults to arrange for either home health/pt or rehab. In general (at least at our hospital), unless the patient is fairly young, most hip replacements go to rehab after staying with us, they use walkers and are taught to navigate steps before leaving us. I would tell your surgeon that you are concerned about your home environment and ask for a consult for rehab. I absolutatly disagree with using your seat to move up and down steps. It flexes your hip more than 90 degrees which is a huge risk for it to dislocate. Again, tell your doctor and tell physical therapy that you have steps to navigate, they will teach you. I understand you don't want to be away from your husband if in rehab, but you have to put your safety first. If you aren't safe to be at home then you shouldn't be there. And believe me, at rehab you won't have much time to miss him - our patients have activities for about 6 hours a day.

Just the location and look of lesions is not enough to dx it. When did the lesions start, where did they first appear, do they hurt, burn, etc.., have the lesions changed, does anything make it worse/better, what has she used on it, any travel or contact with animals, co-morbid conditions, medications, family hx, etc.... This would need a full work up. The best I can advise, is that your friend needs to make an appoitnemtn with a dermatologist.

This is posted on the UNOS website (that is the group that runs the transplant national lists that match pts with donors): "For any death where organ donation is a possibility and consent is given, there will be a medical assessment of what organs can be recovered. There are no absolute age limits to organ donation. A handful of medical conditions will rule out organ donation, such as HIV-positive status, actively spreading cancer (except for primary brain tumors that have not spread beyond the brain stem), or certain severe, current infections. However, for most other diseases or chronic medical conditions, organ donation remains possible." So unless the pt was HIV + or had cancer there was absolutely NO REASON to exclude him from being a partial donor of something. I believe they are also required to do HIV testing on the donor. It sounds like someone's personal feelings became involved and resulted in the death or continued suffering of someone on the transplant list.

Well, I am a RN and I don't agree with you. I think RNs are amazing but the impression I get from all of your posts is that you are experienced and so know best about a job that you don't do and are not trained to do.

i was trying to get through the entire list of responses but couldn't. i wanted to respond to a couple points. i am a bsn prepared rn who is working towards her master's. what i am learning in my master's program is completely different from what i do as a rn. the only thing that really crosses the line is critical thinking. why is it that many of the rns posting feel that tons of experience as a rn is necessary to becoming a good np? second to didirn vbmenu_register("postmenu_1057391", true); who wrote: "i admire anyone with high ambitions, but please do not ignore folks who have been in this business for a long time who question this way of training. that is a very unwise thing to do. the op may have come rather caustic to you and insulted you, but others completely agree with the bottom line message of it. that to me gives it tremendous validity." so basically you are saying that since experienced rns say it is so then it is so???? well, everyone used to believe that the earth was flat and the sun revolved around it. i thought we were taught critical thinking and not just accepting things as they are. when the people who have been posting (who mostly seem to be rns and not apns) actually have experience with a np program and what goes into it, then they can make those statements. and fyi, np programs do weed out the people who aren't qualified and who can't handle it. and lastly, maybe there are so many new grads who are quitting because of the attitudes of the "older" "experienced" nurses towards them. as a new grad i run ins with a couple "experienced" nurses who constantly made me feel stupid for asking questions. however, i was lucky that my preceptor and my unit was supportive.

You should call the Board of Nursing in your state and ask their advice about what to do. You don't have to give any details about you or the nurse but explain the situation without having to make a complaint. In my state (Virginia), they get calls everyday from other nurses, managers, etc.... with questions about what to do about anything that pertains to nursing. My other concern is that you know now and if you do nothing and a patient is hurt or god forbid, killed by this nurse while she is under the influence, you could get in a lot of trouble. She is an addict and if caught may blame you --- Lori knew I was doing it and did nothing! Good luck and let us know what you decide

I am a first year nursing student at Virginia Commonwealth University. While we are learning about caring for our patients, we haven't heard much about caring for the needs of the families of adult patients. I have seen in my clinicals, different ways that nurses care for the families of patients - but there doesn't seem to be any agreement on how to deal with families. I am working on a project trying to put together a lists of hints and advice from other nurses on things to remember when dealing with the families of patients. Any advice or comments from your experiences would be greatly appreciated. Thanks!