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automotiveRN67

automotiveRN67

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20 years RN, currently working as ARNP in Hospice.

automotiveRN67's Latest Activity

  1. automotiveRN67

    Nurse Practitioner Restrictions

    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
  2. automotiveRN67

    Nurse Practitioner Restrictions

    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.
  3. automotiveRN67

    Any NPs partners/part-owners w/ physician?

    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
  4. automotiveRN67

    Do you text your patients?

    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."
  5. automotiveRN67

    Do you text your patients?

    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.
  6. automotiveRN67

    CRNA/NP Outside of work Hospital Setting Question

    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.
  7. automotiveRN67

    Who prescribes for themselves or family

    I have. Also, I have had colleagues fill scripts for me without issue. This thread has certainly been worthwile, I think.
  8. automotiveRN67

    The Overly UN-zealous Hospitalist

    A few posts back, a nurse makes this statement, which speaks volumes about his/her attitude towards the written order. "Low BP with a systolic of 102? I might or might not give a beta blocker at this number dependent on the diastolic. If the diastolic is 38, making the MAP 58, the patient could be having problems with end-organ perfusion d/t hypotension and giving a beta blocker would make the problem worse. " A nurse is not allowed this kind of judgement. Withholding beta blockers is risky. And the risk increases if a patient is on higher doses, and longer periods of time. That nurse should call for clarification on this. That's why I find this statement very disturbing, and unfortunately, all too common. As far as trust, I don't operate in a vacuum. I work with a large group that is respected, and share rounding on all of our patients. I will say that some facilities are worse than others, and some days (shifts) are worse than others. Too difficult to fix, but frustrating, nonetheless.
  9. automotiveRN67

    The Overly UN-zealous Hospitalist

    And I see it as the education paradox. Years ago, nurses were encouraged to pursue higher degrees, with the hope that they would improve patient care through their advanced degree. Problem is, the job is still the same menial job it always has been. This article is a personal attack, by a nurse, on a hospitalist. She then extrapolates this to this overwhelming sense of hyperbole, and dramatic presentation that ends up being all about how menial she thinks her job really is. But, the main theme of this article, is a personal quibble between this nurse and the way she feels perceived. I can tell you the reason why most providers don't stop and "educate", or even discuss patients with nurses, is because there just isn't time. And it doesn't make a difference. It is not uncommon for me to see 10 patients in the morning, go to the office for 2 or 3 hours, for 12 more patients, then to another hospital for 10 or 12 more. That is a lot of nurses to appease in a day. So most providers, as you guys probably see, jam into the dictation room, pop-in a few orders, and leave out the back stairwell. It's not bad medicine, its efficient.
  10. automotiveRN67

    The Overly UN-zealous Hospitalist

    I knew someone was going to say this. In the case of the nitro, and frequently what I would find when I talked to my patient, was that they never actually said that. They would have nitro paste from the ER, but no one ever came in to put anymore on. Charted it though, Hmm. I see this way too often to think every patient is lying, and every nurse is charting correctly. When my beta blocker order is written, hold for SBP
  11. automotiveRN67

    The Overly UN-zealous Hospitalist

    That's not how I manage my patients at all. Most of my patients do much better outside the hospital than in, because they don't overthink things. I can't tell you how many times the MAR shows something like "patient refused -causes headache" for nitropaste when I admit somebody for CP rule-out. Or beta blockers held for "low BP", and the documented BP is 102. To me, this is usually the work of an "un-zealous" nurse.
  12. automotiveRN67

    The Overly UN-zealous Hospitalist

    She didn't give a polite, well reasoned anything. I have been working in healthcare almost 30 years, and I have seen nurses like this come and go. They are generally one of two types. 1) They quietly sit and stew about everything they perceive is wrong, or 2) They go after everybody, all the time, for anything they perceive is wrong. They are never good team players. Now if she had said to the hospitalist, "Did you mean to restart Mr. Bill Board's metformin today, or hold it for a full 48 hours after his cardiac cath?". Or "Mr. John Jumpingjack's Lantus is still on hold from surgery, but he ate all of his meals yesterday, do you want to restart that for tonight?" Neither of the examples she gave would or should be concerns. And I imagine she feels that physicians don't listen to her because she warns of things that aren't concerns. So it would be pretty hard to take her suggestions seriously.
  13. automotiveRN67

    Who prescribes for themselves or family

    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?
  14. automotiveRN67

    Can an APRN practice as an RN

    Wouldn't any ARNP who is working as an RN hold themselves to the higher standard anyway?
  15. automotiveRN67

    Who prescribes for themselves or family

    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.
  16. automotiveRN67

    The Overly UN-zealous Hospitalist

    I bet people love working with you.