BlueDevil,DNP

Blue Devil, DNP, ARNP

I agree with the last post. Make them verbalize the issue. If it is significant enough to warrant honest regret, I might apologize. If it is petty customer service crap, I'd say something like: "thank you for sharing your observations with us. We here at HappyFlowerKittyLand Hospital feel it is important to hear the patients out regarding concerns. I'll make sure your comments get their due attention." Then I'd get on with business and not mention it again. I would not be likely to utter the words "I am sorry" and certainly not "I apologize" unless 1) the complaint was legitimate and 2) I was directly at fault.

Generally speaking, I would not be in favor of AD entry levels, but I do think you are over reacting. "I hope she doesn't get in" is a terrible thing to say. Shame on you. I take it you would not be interested in attending such a program, but why would you actively hope for a negative outcome for someone to whom you are close and presumably love or at least hold in high regard with great affection? If the program is accredited, I don't have a problem with it. As she is related to you, she cannot ethically treat you; you are off the hook so far as that is concerned and cannot be expected to establish as a patient. Support your loved one. And never use the pejorative term "midlevel" if you want to be taken seriously.

Say what? I am absolutely a "medical authority" and I absolutely present myself as such. Where do you get this stuff? I don't have, have never had, will never have, a supervising or collaborating physician. I tell you what, NPs or NP wannabes practicing apologetics actually do irritate me, whereas all the rest just amuse. I think you are going into the wrong line of work. SMH.

Do I think religion can be changed? This is where we acknowledge that as an atheist, I am not the right person to ask for a personal opinion on that matter. Religion is a legally protected class. To my understanding, religion is not considered a malleable personality characteristic, but something sacrosanct. Rationally, I cannot even begin to grasp that concept, but I accept it for what it is. But that was not a serious question in the first place, was it? Obesity is not a legally protected class, nor should it be. There have been legions of studies supporting the hypothesis that more attractive candidates are hired and promoted faster and earn more money than less attractive candidates. Since obesity is not considered an attractive physical attribute in our culture, it stands to reason obese people would suffer the same unfortunate bias as other applicants deemed less attractive. This is neither new nor surprising. The interesting point is that if obesity is the only or the major disadvantage a candidate is facing, it is so easily addressed that it could be a non-issue for many within just a few months time. A lof less time than it would take to convert to a new Religion or go through gender reassignment surgery.

"How bad does the discrimination have to get before people will begin to recognize it for what it truly is, and take action to stop it?" Speaking for myself, it would have to be so bad as to include class discrimination based on race/ethnicity, gender (including gender identification), sexual orientation, disability or religion. Modifiable health risk factors as a basis for making hiring decisions are not bothersome to me. I would not knowingly hire an alcoholic, even though alcohol consumption is legal and I consume alcohol occasionally myself. I don't hire tobacco users. I don't consciously discriminate against obese people, but I hired a slim, highly physically fit woman. She could still have a genetic triglyeridemia or be BRCA+for all I know. Those of us in a position to hire make the best decisions we can based on the data available. In this case, even if my Nurse had been BRCA+, I'd still have hired her because she was a good fit for me and for the office. I would not have hired her if she smoked, because she would not have been a good fit. Capiche? I would not have hired her if we knew for a fact she was an alcoholic because, well do I really need to explain, lol? I don't care if an employee has a diagnosis of major depression (outside of the fact that I generally do care about them as people) unless it causes them to miss unacceptable amounts of work. That is usually easily checked into by the background investigation. People with excessive call-ins are typically "not for rehire" at previous jobs. Otherwise great employees who have a behavioral health diagnosis and needed FMLA a few years ago, took it, recovered and came back to work at their former level of excellence are worth investing in, so I don't think their diagnosis is any more significant than someone with an elevated LDL. The fact of the matter is, most of the things you chicken littles are worried about can be changed. If you are worried about it, change it; lose weight, stop smoking, whatever. If you don't take steps to help yourself, you have no one else to blame.

My focus is exactly the same as my physician colleagues, so I have no idea to what the above post is referring. I am a PCP that happens to be a NP vs a MD/DO, but we do the same job. Our educational paths differ, and you can all argue about which path is superior. My path was optimal for me and for my family and my patients are not suffering for it, I assure you, lol. The job "focus" is the same. I was independent on day 1 after graduation, as are all other other NPs in this state and 16 other states in the US. Don't like it, move to one of the other 33 and get active in your state legislature to keep it that way. I don't think you will be successful, but if you want it that way- quit yer bitchin, get off the internet and do something about it. Otherwise, stuff a sock in it. 9/10 posters in this thread have no idea what they are talking about, lol. I won't point you out, I'll just let each of you believe you are the one that has it right. Go see whomever you like for your medical care. My panel is full, and I'm not accepting new patients anyway. I have a few I'd sometimes like to get rid of because they can be a PITA, but by and large I enjoy the patients I work with and have no desire to "prove myself" to anyone. Everyone whould be happy with their PCP. PCPs have a right to be happy too, and I would not be happy having to put up with the 'tude, so I'd prefer individuals with a chip on their shoulder move on down the hall and be a boil on the butt of my colleagues instead, lol. Equal practice rights mean we have to share the PITB patients equally too. Pursue whatever you like for your career. Stop trying to justify yourselves to ignorants on the interwebs and just do it, whenever you want to do it. You don't need a nod from any of us, you just need to be accepted into a program. Apply when the time is right for you, regardless of when SusieQ or Joe Schmoe thinks you ought to apply. My only advice is to apply to a top rated program. I would never recommend anyone go to one of those (ahem) questionable schools that operate for profit and do not have a tradition of excellence and an outstanding and accomplished faculty with strong research backgrounds that match your own interests. Mediocrity is never acceptable when it comes to education. Don't settle there. But bedside experience, pffttt. That is up to you. It won't do much, if anything for you a a NP. If you want to do it and it works into the master plan, beautiful. If not, don't fret. That's all I have to say about that. Carry on. P.S. Neither my wife nor I have ever worked FT, and we have always had at least one Nanny or au pair living in. We have 7 kids, and it takes a village! You youngins are clueless.

I don't have a problem with this. The amounts are pitifully low, considering the volumes of work involved. Patients should be embarrassed about what we are paid on their behalf by Medicare.

I have a pt that has several severe mental health diagnoses. She has long been dangerous to herself and others. She is constantly in and out of behavioral health units and jails/prison, and then back in our office again. I don't treat her psych disorders, but do treat asthma and a few sundry medical conditions. I have to deal with her psych issues, as does the rest of the community. A few months ago she had to be removed from our office for making threats (off her meds, obviously). We were surprised to see her back a few weeks later, having been "stabilized" in the BH unit at the Univ hospital for about 10 days and released. She was off her meds, again, and in the front office making threats, again. She left of her own accord but then assaulted another patient in the parking lot. She was arrested. There were other warrants out for her and she had prior convictions, so she went to county lock up for a few months. Then she was back and we went through the same scenarios all over again. Until she killed her mother. I think they will keep her a little while this time. The saddest part- her mother was the one caring for her 6 children (fathers unknown). What happens to them now?

Why doesn't he just buy his own coverage?

Oh for Pete's sake, you're right. I never check the dates. doh. I hate when that happens!

Most practices have a provider on call 24/7. That person is authorized to make decisions, relay them to the MA, who then returns the call to deliver the message to patients. This is how we do it in my practice. I do not typically speak directly to patients on the phone, but I get electronic messages about their issues. I answer them electronically, and the MAs call the patient back with my response. When I am on call, I also address issues for patients of other providers from whom I am covering. I suspect this practice has a similar arrangement and I think it is highly unlikely a medical assistant just made an independent decision such as this. Don't assume the worst without all the facts. Why not just ask before going off the rails and lodging unfounded complaints?

Well apparently you don't own anything suitable for a job interview, so IIWY I'd spend some time looking for something appropriate and getting it tailored so that next time you don't have to run around at the last minute. A good tailor will do at least 2 fittings (at least for a man's suit, I don't know about women) and these things take time. Use this time to get prepared. Did you call the recruiter I referred?

I've never been. No member of my immediate family has ever been. One the one hand, we have all been lucky never to have had any serious accidents or injuries. On the other, we are not stupid and know how to do conservative management of routine illnesses at home. We don't go running off to the PCP for nausea, vomiting, diarrhea, coughs or sniffles either. Everything goes away in 7-10 days, lol. Come on people, man up.

The only part of the poll result that I find surprising is that there are still people who would deny anyone the right to end their own life when they see fit. It is their own business and it doesn't matter what the reasons are, terminal illness, running out of money, 90 years old, lonely and just plain tired-whatever. It is their life to do with whatever they choose. Who are we to make them live another day if they don't want to? There really are people that don't have anything left to live for, let them end it. It really isn't that big a tragedy you know. The part I object to is when selfish people commit suicide and leave a body in horrid condition for someone else to happen upon in surprise. That is inexcusable. They need to make arrangements in advance so that doesn't happen, which is one reason why an organized, well planned, assisted suicide is the best approach. Say goodbye, get your things in order and make sure the necessities are addressed. One can die with dignity and show a modicum of respect for others at the same time. Leaving behind a maggot infested corpse for your kids to find when you don't answer the phone for two weeks, or for the neighbors to sniff out, is just plain rude.

I'm curious as to why the OP thinks assisted suicide is OK for a physician but outside the scope of practice for a NP? In my state FNPs and MDs have the exact same scope of practice, so I find that statement silly. I have no problem with PAS and if it were legal here and I had patients that asked/met criteria, I would help them. That is my job.

Agree. A suit is a must; tailored to fit perfectly will go a long way to making anyone look great regardless of body type. I'd avoid black, but navy or gray would be fine. Stay conservative. I would spend some money on this, consider it an investment in your future. Good shoes, no scuffs, but I don't think heel height is an issue. I'm a guy, so I would not care about your heel height. I'd notice if you wore cheap or scuffed shoes, though. I'd expect an interviewee who flew cross the country to make an effort. I wouldn't really expect to see a woman with bobby pins in her hair, but I am not sure that is what you meant. I guess I'd suggest a chic haircut. Go for something sporty, maybe you can project youthful vitality. NM is a very ourdoorsy state. You want to look like you will like it and fit in, not go running for home first chance you get. I am no help with make-up. My wife takes our daughters to a make up artist to learn how to apply the stuff when they get old enough. If you have time before you go, give that a try. Can't hurt, might be fun. My girls always have a blast, but it is a little mysterious to me. If time is running short, I think it is better spent obtaining a proper suit, shoes, haircut and practicing interview skills. good luck.

How is this even a suitable question for debate in a NP program? It's offensive.

I'd answer them for you, but I don't have a collaborative relationship- I'm in a state that doesn't require anything like that. I agree that you would benefit from meeting with someone local and doing some networking.

We most certainly do. Psych pts are my most difficult and least rewarding. A little venlafaxine here, or some escitaloram there and they either get better or they don't. It's a crap shoot.

I went to Duke. I took most of my classes on the ground, i.e. in person -on campus, but I did take a few online if the course I needed wasn't being offered at an hour/day that could be worked into our schedules. I didn't observe any difference in quality/substance. At least insofar as Duke goes, I'd say there is no difference in the quality of education between the online and B&M approach to the NP programs and it genuinely is, "what you put into it." I agree that some programs are just better than others. I've always said, attend the very best one that accepts you.

I am not going to swing at pitches in the dirt, I suggest the rest of you refuse to do so as well. The focus here is on the fact that APRNs with unrestricted practice do not endanger patients. The proof is in the pudding. See the seventeen states with unrestricted practice. AANP - State Practice Environment "To exist is to change, to change is to mature, to mature is to go on creating oneself endlessly. " – Henri Bergson

I don't identify where I live on the internet, except to say it is one of the independent practice states. AANP - State Practice Environment. Not red or blue, but a "green" state, lol. I was a new graduate NP when I came here. I did do a one year unpaid Family Practice NP Residency, but that was my choice and not formally part of my educational program. I was not yet a DNP, nor had I yet attained my orthopedic NP certification. Strictly a FNP with a strong CV. We moved out of NC because I refused to work in a state with restricted or reduced practice. When choosing from the remaining states, the priority was where my partner could advance her career and where our children still in secondary school could enjoy the opportunities they were seeking. Once my partner found an opportunity in an otherwise acceptable locale, ,we just moved. I didn't even begin looking for work until I had been here another year. I spent a long time looking for a job that I really wanted, turning down several in the process. When I accepted this job, the pay was somewhat low, but I appreciated the support for my DNP goals and the respect with which the physicians treated their NP colleagues, and vice versa. Money was not a motivator to take the job, else wise I'd have taken one of the more lucrative offers. I'd been here a few years when the changes to the pay structure came about. I did nothing to affect them, they just happened. So the only advice I have is take a job that you love and perform it passionately, and the rewards will be abundant. Do not take or stay in any position to which you don't desperately want to devote yourself. Do not allow peers to regard you as "less than." That is what we have always lived by, and what we tell our kids. I do't have any other secret approach to NP parity or happiness in this world. Good luck.

No, I'm sure it isn't the norm. There was no NP "movement" or demand, if that is what you are asking. The BOD came to that decision independently. I cannot say what led them to it other than to echo what they said at the time, which was that they felt it was the right step to take for the group. If I had to hazard a guess, I'd venture that retention was one of the primary goals, as much as making the public statement of support for parity among all providers.

Now, returning to the actual thread topic, that being the article by Dr. Gorski. I thought the article was perspicacious in the way that he recognized the differences between NPs and physicians and deftly described the systems problems that really get in the way of progress. The article has been picked up and reposted in several venues. There are more and more of these pieces in the media all the time, and if you read the comments, fewer and fewer of them are derogatory. NP independence in coming to all 50 states, an inexorable march of numbers. They will start falling like dominoes soon enough. The naysayers can grumble all they like, and seek out the few remaining MD/DP providers in primary care as is their right. So let them grumble and go about your work, your education if you are a student. Your success will be their undoing. Go about it with quiet dignity and don't give haters the honor of a response.