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myoglobin ASN, BSN, MSN

ICU, trauma, neuro
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myoglobin has 13 years experience as a ASN, BSN, MSN and specializes in ICU, trauma, neuro.

"When the mob and the press and the whole world tell you to move, your job is to plant yourself like a tree by the river of truth, and tell the whole world "No you Move"...

myoglobin's Latest Activity

  1. myoglobin

    How much do you owe in student loans?

    Well, I intend to keep working as a Psych NP well into my 80's. Given that I'm currently 52 it is not entirely unreasonable that I might go back to school and earn an advanced degree such as a PhD that would let me also consider teaching (maybe in my 70's or 80's). Given that many of my instructors were NP's with only a Masters (at major state universities) it is not unreasonable to assume that I might be able to gain such a position. Also, even as a new grad NP's I had two job offers paying around 80K per year to teach online NP and RN content from major online schools. You may not believe that this is appropriate, but if it is possible as a new grad it is not unlikely that with several more decades of experience that I might be able to obtain a similar position (with possibly additional education at that time).
  2. myoglobin

    Is doing therapy as a psych NP realistic?

    All digressions aside this was the original post/ question"Im considering pursuing my psych NP but I know most psych NPs are med management focused and I would really want to incorporate a lot of therapy into my practice, I was wondering if this is a realistic goal? " The answer is a definitive YES at least in the state where I practice ie Washington. Essentially, every NP in my practice (well over 40) bills add on therapy codes and earns an income well above 300K (of those that work full time) in part for doing so. Many of done so for more than a decade. Thus, I submit that it is beyond reasonable argument that therapy can be part of a successful practice. Also, in almost every case the clients see a dedicated therapist on a weekly basis on top of the PMHNP.
  3. myoglobin

    Oversupply of Nurse Practitioners

    I went to the University of Southern Indiana and had to find my own preceptor. He was willing to work around my hours in such a way that I could continue to work part time in the ICU. The cost per hour was around $300.00. My income went from 60K in the ICU with no benefits to around 300K 1099 (distance telehealth). Had I been forced to attend a school that required preceptors there is simply no way that I could have gone back to school (indeed I did the MSN program over about 5.5 years part time). Thus I am grateful for the diversity in opportunity that the current structure provides.
  4. myoglobin

    Psychiatric NP

    My first job out of school started in person and transitioned to online after about a month due to Covid. Once Covid is over I will travel to Seattle once per month for a week to see my clients on schedule II medications (ADHD). The law that currently requires this is suspended. I can't say that I exactly enjoy my work but it is definitely less stressful than neuro trauma ICU ( also I don't get hit or yelled at by surgeons who want me to override medications on patients just moved from the ER who are not even in our system Pixus, yet) and it is somewhat better to earn around 300K rather than 60K.
  5. myoglobin

    I Really Do Not Want the COVID Vaccine 😞

    Self interest will always be a primary motivating factor in a free society. While my degree is only a Master's it was earned mainly online (except for clinical) and it took me from a 60K non benefitted ICU job to the one I currently have earning between 25 and 30K per month (working online). I am grateful for the opportunity to have been able to further my education while working full time (except for the last two semesters then part time). This would have not been possible with traditional modalities.
  6. myoglobin

    I Really Do Not Want the COVID Vaccine 😞

    If this is true (that you need people to take the vaccine for you to be safe) then you are unlikely to be safe anytime soon given that their isn't enough vaccine available to reach herd immunity (probably 70-90% will need to take depending upon who you listen to) and well over that amount of people are intent upon not taking the vaccine even if it is required by law. It would probably be more effective for you to focus on what actions that you can take to keep yourself safe. Things like taking the vaccine, taking certain supplements like vitamin D-3 and Zinc, and wearing an N-95 face mask when in public and consider adding a face shield (or at least glasses) to better protect your eyes and mucous membranes.
  7. myoglobin

    I Really Do Not Want the COVID Vaccine 😞

    No one wants covid, but it isn't required that we get it in order to keep our jobs. Indeed, I think one of the reasons for "concern" is that because so many health professionals have been infected with Covid that we fear this high level of "covid antigen" in our system may make us even more likely to have a negative reaction. I remember a fellow RN once who has received the BCG vaccine in their home country who did not realize (or fogot) that they should not get a TB test. Their entire arm swelled up and they experienced tissue necrosis around the TB test site. Still, I believe that for most people the benefits far out weigh the risks. One can respect each individuals right to choose without agreeing with their decision.
  8. myoglobin

    NP Hates from Physicians?

    I have great respect and even love for MD's. However, in my experience pay and working conditions for NP's have been vastly superior in groups owned by NP's or by therapists. That is not a love or hate perspective, but one rooted in the best interests of my fellow RN's/NP's. Usually, the pay differences have been dramatic on the order of 50%. Also, given that this is an RN/NP board is is reasonable to expect a bias towards NP's in the same manner that I would expect a bias (and indeed find) a bias towards MD's on sites like StudentDoctor.net.
  9. myoglobin

    I Really Do Not Want the COVID Vaccine 😞

    Also in addition to seeing your PCP and reporting you should do the things that often help reduce inflammation such as getting at least 7.0 -9.0 hours sleep, daily exercise, and a diet low in high glycemic index, especially processed foods. From a natural standpoint certain things like turmeric, omega three fatty acids EPA/DHA , green tea, and ginger can be helpful.
  10. myoglobin

    The economics of PA vs. NP

    My assertion for NP quality equivalence is limited to primary care. I believe that the data (even for Psych where I practice) is limited and lacking overall. However, in any case without regard to the data IP practice (or de facto IP practice where the supervision is effectively paying a fee to an MD and maybe having a conversation once a month) is the effective rule in essentially every state. Also, states like Washington where I practice have had IP for NP's for many, many years. This train has left the station and even new higher standards are likely to "grandfather" in people who met the older, lower thresholds. For example I know several NP's who have a Masters in "nursing education" (didn't have to take the three P's) but they took the boards back when they could (I believe until the late 1990's early 2000's) and they do not have to meet the new higher standards (having programs that require a certain number of clinical hours and the so called advanced 3 P's courses).
  11. myoglobin

    The economics of PA vs. NP

    Well, in Washington state where I practice IP I advertise CAM approaches and lifestyle interventions. One could not be much more outside the mainstream unless I started doing energy field manipulation or something. Probably, 70% of my clients balk when I even suggest an intervention that requires an RX.
  12. myoglobin

    The economics of PA vs. NP

    Again, even in non IP states like Florida (well we technically just became IP) even as a first year NP I found no less than four MD's willing to "sign my charts" for anywhere from 5-10% of gross revenues (they wouldn't have signed my charts just been my collaborator per state law). Thus, even in non IP states supervised practice is largely a fallacy since it is in essence a "fee" for service arrangement where the NP pays a fee and gets to "check off the box" so they can practice with little or no actual supervision. Note, even for a job in New York State where I interviewed the Psychiatrist said we would "chat" for about an hour per month. The same was true in Mass and for a different job in Rhode Island.
  13. myoglobin

    The economics of PA vs. NP

    We can argue studies all day. Bottom line NP IP is growing and is unlikely to slow let alone reverse. Thus, we are winning and that is a good thing for NP's and probably also for patients.
  14. myoglobin

    NP Hates from Physicians?

    Yes, but with tele health you don't necessarily have to live where you work. Thus, my clients are in Washington state and my house in Florida. Thus, I have the advantage of my 28K per month in earnings integrated with the cost of living of Florida. There is no reason that "NP" owned businesses could not propagate this dynamic and offer partners the option of 1099, PLLC, or W-2 (obviously at different percentage levels to reflect the differences in cost/benefits, and taxes paid by the company). However, with such a company the emphasis would be on maximizing the pay/benefits of the workers rather than enriching the owner. Thus, at "Dr. C's" in Florida (the place that offered me 100K with benefits) she lives in a 10 Million dollar home in Florida and has other homes in Puerto Rico and elsewhere. Indeed, at her practice even the MD psychiatrists still only earned about 160-180K (still alot more than the NP's) and were expected to see about 25-30 patients per day. My approach would even pay many MD's more than they earn in typical Florida (and other states in the South) MD owned practices.
  15. myoglobin

    NP Hates from Physicians?

    Also a "typical" Florida based scenario would be Dr. C (where I did clinical for about a year). There I was offered around 100K with benefits. I would have been expected to see from 25-32 patients per day and she would have "grossed" on average around $150 per patent. Thus we get $150.00 X 25 X 5 X 48 (week per year) or around $900,000. Even assuming my figures are a bit optimistic (My company grosses about $190.00 per patient visit) you can see that the percentage at 100k is at best around 20% even with every benefit (and they were modest) that can be imagined.
  16. myoglobin

    NP Hates from Physicians?

    Yes, but I was replying to a particular individual who may or may not be in California. In all likelihood one of the jobs that you reference that pays 200K with benefits in California would generate 300K plus on a 70% split such as I outline. Again my "theme" isn't so much "work for a percentage" (although that certainly is one of my main points) as it is "NP's need to take control of practices" so that more are owned by and for the benefit of the employees with a larger percentage of the revenues going toward the NP owners/practitioners.