automotiveRN67

I guess my advice would be. 1) Don't post misinformation. Proof-read your work. People who stumble onto this and don't do due dilligence may believe what you have said. Misinformation will never help our cause. You may want to edit your post for accuracy. 2) Your writing style comes across as whiny, and without substance. I know you received a lot of likes, but if I handed this to physicians I work with, they would still say, "not seeing a need for change". Legislators will ask the same thing. Just because you want it, doesn't mean it's convincing to someone else. 3) Your information is kind of scattered and hard to understand. You may want to start with an outline next time. Remember those papers you wrote to get your degree? This reads like it was written by someone with a high-school education. 4) In my personal opinion, I am really afraid of your last statement. While there are many reasons why I feel NP's should be allowed more scope and less supervision, responding to a perceived need by making the regulatory requirements easier has never been a good idea, historically. In the article below, a Minnesota community started piloting a program to send paramedics to see the area's "sickest patients who might otherwise end up in the ER". Basically doing a house call. You read that right. There goal was to see sick patients, and try to keep them out of the ER. This would save money. And another article popped up in the WSJ this week on the same topic. I don't know about you, but I am not convinced this is a good idea. "specialized training", does not equate to experience managing complex illness, and an advanced degree. I frequently see patients after home health nurses have been following them for weeks, or months, and find myself saying, "man, I sure wish they had called me and told me his BS has been 250 or more every day for the past six weeks". So you have to think about this from the other side. What do we need to do to convince physicians we deserve a broader scope of practice. Even as an NP, I am concerned about opening the floodgates on patient care. Instead of the ER: Paramedics making house calls to chronic patients - NBC News Paramedics Aren't Just for Emergencies - WSJ

Can you clarify the part about DME for medicare patients? I was under the impression that the restriction came in 2012 according to this rule, and was applicable to all medicare reimbursement: In a November 16, 2012 final rule titled Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, DME Face-to-Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Part B for CY 2013” we established a face-to-face encounter requirement and new requirements for written orders prior to delivery for certain items of DME (77 Federal Register 68892). These requirements may be found in the Code of Federal Regulations at 42 CFR § 410.38(g). The law requires that a physician must document that a physician, nurse practitioner, physician assistant or clinical nurse specialist has had a face-to-face encounter with the patient. The encounter must occur within the 6 months before the order is written for the DME.. However, on April 16, 2015 this law became effective: n April 16, President Obama signed into to law H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015. The law replaces the flawed Medicare Sustainable Growth Rate (SGR) formula for provider reimbursement with an improved payment system that rewards quality, efficiency, and innovation. Include nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists in the new Merit-Based Incentive Payment System. Lastly, it removes the barrier to practice in Medicare, allowing APRNs to order durable medical equipment and document the required face to face encounter. I know I have ordered DME in Florida, and I don't know if the supplier isn't doing due dilligence, or my note is good enough. I've been told it just has to include DME requested and detailed description of need with diagnosis.

Can you post a copy of the law and the linK? That seems like a really weird law, wondering what the intent would be. Here is a discussion that may be helpful to you. https://allnurses.com/nurse-practitioners-np/hiring-np-in-390234.html

Thanks for all of the responses. I use my cell phone every day to contact patients, and have never had one abuse it. My cell phone is on my card, so they already have it. I do tell them "If you have a question, and it is a reasonable time during the week, I will probably answer. But don't take that as a guarantee. At night, we share call, so use our main number if your question can't wait." Patients are always respectful. I do text some of my most common patients, but not medical information. Only vague discussions. If it gets too detailed, I ask them to wait until I can call them. I will text things like "OK, called in your refill". Or "Got your message, I will call you when I get a chance."

As the title states. It is difficult to understand rules, regulations, and the impact of modern technology. I am wondering how many NP's text their patients, and what they think is appropriate, vs when to use the phone.

In part, this depends on whether your hospital job affords flexibility. CRNA generally get paid by the hour, and their charting consists of a few check boxes and scrawls on their anesthesia record. In some facilities, a hired NP may be expected to be in the facility the entire scheduled time. Although, I have known many hospital NP's who round in the hospital, and see some clinic patients, and are afforded the flexibility to schedule as they choose. So getting the work done is on your own time. Not sure if this helps.

I have. Also, I have had colleagues fill scripts for me without issue. This thread has certainly been worthwile, I think.

The variety of opinions is the reason I brought this discussion to this forum. One of the common suggestions is to have someone call a script for you. To paraphrase, "Just have someone you know call it in." Even my PCP (a nurse practitioner), tells me she does this. I wonder if people who suggest that are willing to call in scripts for other colleagues?

Wouldn't any ARNP who is working as an RN hold themselves to the higher standard anyway?

But isn't that violating the first rule for physicians and practitioners? By calling it in under someone else's name, you are directly violating the "must examine to prescribe" rule, thereby, putting that person at risk. I think you could make a better case for prescribing for your family or yourself, which is only a "should not", because it is very likely you have seen and examined your family, and you have absolutely examined yourself.

I'm the same. My protocol says "what" I can prescribe, but it doesn't dictate to "whom" or "where".

I remember a lady who brought her three children (the oldest about 5 years old) to a heart cath with her. She thought we could sit them in the corner of the waiting room and give them coloring sheets. I can't tell you how many people would be greeted after their heart cath by a room full of family and a pizza. Or, how about the moms who plunked their baby on the bed next to grandma on a venilator, to change their diaper? I learned long ago, you can't live their lives for them. :)

Yes, but in this case he was prescribing controlled substances to himself and his girlfriend. He was not real smart.

Well, again I have to say "use common sense". It seems this case was really about the supervising physician not standing up for her in this case. Obviously, she examined her son and used due-diligence when deciding on prescribing the antibiotic. But, what you have said certainly serves as a warning.

So here is one article with some common-sense guidelines: http://www.currentpsychiatry.com/home/article/should-you-prescribe-medications-for-family-and-friends/a1eba6baba36081fe00579a4482aaa41.html And one where a psychiatrist almost kills her sister with Septra DS (very emotional). Treating Friends and Family | Physicians Practice So, moving on to the real risk. An article in Jail Medicine warns "You might think, I'm OK! These are my co-workers and friends! They would never sue me!” Well, you might think this but you would be wrong. The annals of malpractice are filled with such lawsuits.". But the only article I could find with an actual lawsuit was this one. Legal risks for giving free medical advice - amednews.com But this article is really a case of medical negligence, not casual prescribing. The physician already knew the patient well, and would not have been protected for his advice if he had given the same advice during an actual visit.