CNogues

It is definitely a hospital culture thing. It is a community hospital. The intensivist program just started 3 years ago. I have been working with the group for 2 years. Most physicians are using ultrasound guidance. Its frustrating because I moved from NH for this job. New Hampshire is the most autonomous state for Nurse practitioners!!!! I am now in a hospital that doesn't allow me to work to my full potential, but I love the area, and can't imagine living anywhere else, and of course there are no other hospitals in the area with mid levels managing their ICUs. I just have to keep pushing, and like you said provide the data nationally regarding ICU NPs.

Hi All, Thanks for the responses. To clarify billing. The H&P is dictated under the physician and they see every patient and do an assessment of their own. Also this is the hospitals rules, not the physicians. If they had a saw, we would be more autonomous . Also,are most critical care NP's doing procedures. I just convinced them to start letting us be competent to intubate and place picc lines, but they are reluctant to let us place central lines. My thoughts are most other ICU NPs are doing central lines, and chest tubes. If I ever leave this job for another critical care job, I will be at a disadvantage not knowing how to place a line or chest tube. Is that accurate? thanks!

Hi all, I am interested in the following for ICU and or in patient practitioners please. Type of NP: Years experience in current role: Area of Care: (critical care team, hospitalist, etc) really looking for ICU only. Size of ICU/ICU's: Bill independently or for supervising physician? Do you do procedures? what? (chest tube insertion, central lines, intubation, LP) How were procedure competencies done? How are you staffed? (24/7 nurse practitioner coverage, 12 hour days, how many full time NPs work for your program) Do you have weekend/night requirements? if so, are you paid extra? paid hourly or salary? overtime? monthly take home pay? Yearly pre taxed income? orientation process for new NP's in ICU role/length ? benefits: typical week day in your shoes? I am asking the above questions to reexamine my current critical care program which is failing and we are unable to keep employees in this role. I Have been with the program for 2 years and we have been through 5 full time employees in that time frame. I will answer the above questions in regards to myself to give you a better idea of what I am looking for. Thank you for all responses and even suggestions. Type of NP: FNP Years experience in current role: 2 years Area of Care: (critical care team, hospitalist, etc) really looking for ICU only. ICU Size of ICU/ICU's: 18 bed SICU, 8 bed CICU, 12 bed CVICU Bill independently or for supervising physician? bill for physicians. nothing is billed independently. require a supervising physician in this state Do you do procedures? what? (chest tube insertion, central lines, intubation, LP) Just started doing intubations and central lines with 2 of the 6 physicians. How were procedure competencies done? no formal format. we need one! How are you staffed? (24/7 nurse practitioner coverage, 12 hour days, how many full time NPs work for your program) When we are fully staffed our icus are covered with an NP/PA 24/7. We do 12 hour shifts 7-7 Do you have weekend/night requirements? if so, are you paid extra? We must work 1 Saturday and 2 sundays a month. no extra pay for these days or differential. We have full time night NPs who get a $10/hour differential. they also need to pick up 1 Saturday and 2 sundays a month. paid hourly or salary? overtime? Salary, typically work 40hrs/wk. no overtime, just recently got approved for a bonus shift since we were so short. This is paid for working a 12 hour shift only and is $400 for the 12 hours (this is less then my regular pay) monthly take home pay? 4000 Yearly pre taxed income?84000 orientation process for new NP's in ICU role/length ? 2 weeks with NP, then on your own Benefits: We get $400 education. We accrue sick/vacation time at the same rate/fashion as the RNs in the entire hospital. I believe it is 7 hours a pay period (biweekly) no bonuses, no overtime, no raises this year (the whole hospital didn't get a raise) everyone did get a $500 bonus (all full time hospital employees) . medical/dental, 403B, etc typical week day in your shoes? come in at 7am, get sign out from night NP. We have progress notes that all the data and medications are filled out by the night NP every night. I go through these and check labs and abgs and make sure nothing needs to be urgently addressed. Multidisciplinary rounds start at 830. RN presents patient. I will interject any information that was left out. During rounds we (NPs) work as a scribe by writing orders. The MD writes the exam, assessment and plan. once rounds are done, I input billing for all the patients (for the MD) into IMBILLS. If a new admit comes, the process depends on the MD working. some like to see and workup the patient together, do orders together, and I am left to dictate. Some will have me see the patient and call them with my assess/plan, and I do orders/dictate. The critical care team must dictate a transfer summery for our hospitalist team if a patient has been in icu >72 hours, I always do these. I typically discharge patients to LTACs. We must track family conferences for the physicians, and make sure they are completed within 3 days of icu admission (with a special progress note filled out that I typically have to fill out for them) Night shift NPs are required to input all patients into apache (this is timely) and complete all the data/medications/labs/I/Os on daily progress notes on all patients by 7 am. This (typical day in my shoes) is why I am inquiring about other critical care teams, and how their day flows. I feel like a secretary most days, and am seeking to revamp the program. All input and help is greatly appreciated.