Hi2Jenn

So, I have been considering getting my DNP because I really want that terminal degree. However, I haven't found a curriculum that appeals to me. I enjoy patient interaction, but I think as I get older I'd like to move more into education. I already teach on the side now. My question is, should I go with the DNP looking at the business angle? I just have no real experience with the EdD so I'm not sure how respected it is in academia. I also know that the PhD is more research driven. I enjoy research, but I'm not sure if that is where I want to head. Any input would be appreciated. Note: I do not want any input from the usual suspects regarding how crap the DNP is.

I have 19 years experience, including management, as a RN. I found it much more difficult to break into the field than I thought I would. I'm in Tampa, so I know we are definitely saturated here. That being said, while you should research so you don't get taken advantage of, realize that your first job might not be your dream job. Let everyone know you are in school, particularly the physicians you work with.

I am getting ready to renegotiate my contract. Having dealt with the office manager, I can tell you this...I would discuss it directly with the physicians. They know how much you work and how much you bring into the practice. They will not want to lose you over dissatisfaction with pay. The office manager does not have the same compulsion. I would have to google, but there are sites where you can compare your cpt codes with billing and a formula to calculate for costs, etc. I think if you go in with a better idea of what you are bringing in to the practice then you can negotiate better. I don't know your salary, but your benefits are bare bones.

I have found that many physicians see NPs as simply a way for them to make more money. The provider probably isn't providing the quality of care that you are. That being said...interruptions from the nurses? Stop them now. I would create a sign in sheet. If it isn't urgent (i.e. coding) then they write down the patient and concern and you deal with it when you get a chance. 20 a day isn't unrealistic, but you need to find ways to make it flow smoother. If she isn't willing to help you with that then you need to find a new job. When I was struggling with time management and what I felt were unrealistic demands, one of the partners came on his day off and shadowed me around a facility. He made notes on what worked and what didn't work. He gave me a lot of good tips. If your boss can't do that, then run.

I have a 1 year. The physician I work with has a 2. I would only do a 1 year. I would definitely run if they want that long of a commitment with no budging on anything else. I understand the feeling of running out of money. Maybe try a prn RN position so you don't rush into the wrong thing.

I'm getting ripped off, lol. When I take call for the weekend, it's 7a - 11p for $150/day. We get approximately 20-30 calls a day. No matter where you work on call, there is a liability in ordering without the benefit of a physical exam.

I work in acute care rehab. My expectation is 20 a day. I am on a RVU basis. I get bonused for anything over 460 RVUs a month. I found the bonus fairly easy to make some months, more difficult in others. However, it is based on how hard I work. The rest of the issues you mentioned are 100% correct. The nursing staff does not have the knowledge. I find the facilities are expecting me to provide more complex care in the facility in order to reduce their return to hospitalization rate. The fact that you had a contract that provided for the raise and you were just given a new contract without that clause without input says volumes to me about how the company values your contribution.

What sort of fires are they expecting you to put out? I would request a meeting with your collaborating physician and the DON. I would set up some protocols of when and how you want to be notified of issues and which issues you will see patients for versus just giving orders.

Delerium, yes. Not slight confusion. That's the problem. In the ER they do it all the time. I feel like it's throw it at the wall and see what sticks. Im having a hard time getting past that training. Confusion = UTI

I work in acute rehab, but I don't think that makes a big difference. That being said, I was taught that you do not check for a UA C&S if a patient is NOT having s/s of a UTI. However, every facility wants to check a urine everytime a patient is slightly more confused. I tried to discuss this with the psychiatrist the other day. She basically said that if she is not allowed to check a urine on her patients and treat them then she risks misdiagnosing them. I found a concensus paper from the Infectious disease society of america stating that it is not recommended to treat, but doesn't say about testing. However, I am meeting resistance at every turn. So the facility waits until I am not on call and gets my on call to give the order. They are all hospitalists so they do urines routinely and think nothing of it. I guess I just want to vent, but does anyone have any other resources or suggestions?

Tampa is definitely a very saturated market. I can't say that I'm surprised. It took me 7 months. Can't say that I am thrilled with my job, but the salary is decent. Absolutely do not take a low ball offer. Even as a new grad here you should make 80K. I too understand the can't move thing. Really sucks. I've heard several people say Tampa Family Health is horrible and one say not bad. You might want to branch out to Pinellas or Pasco. Join the West Coast NP association and the Tampa one. It's like 30 a year. Network is the number one way. Also, check United Health. They are expanding.

I had heard that unlike travel RNs, that locum tenems tended to not get paid a housing stipend? 1099 leaves you having to pay for SS tax, etc, not just income tax. I would talk to a tax professional to see which is better.

I went to a brick and morter school that set up our clinicals. It was not always the best, let me tell you. We didn't do ob/gyn (As a FNP) because they didn't have enough preceptors. My own pediatrician who had agreed to precept me backed out saying he was just too busy to take on a student. Unfortunately, when our programs rely on individual providers to provide this service without recompense, it can be a problem. That being said, check ENP network. I know the professional associations in my area provide a list of preceptors.

If you don't have dips in patient levels, i.e. in the summer only 10 a day, then 80K is definitely low ball. You are better off with per patient's seen. However, that can be done per RVU (Each CPT code has an RVU) or percentage of patient's billed. Find out if you're paid when you do the visits or when they get paid by insurance. If percentage billed, what is their average payment? Two weeks is not enough time off. Trust me on this one. Definitely have them pay all licenses, renewals, and certifications. Mine even pays my membership in professional organizations. CEU - 5 days and $1500 is standard. FYI.

I think what most posters are missing is a context. There are many things that occur on the nightshift that by regulation must be reported to the provider. However, I don't think you're going to call them at 3 am to say, Ms.Smith fell out of bed. The only injury was a skin tear. I believe those are the situations she is speaking about. I would also further say, that you should not document "MD aware" You should specify WHO you spoke to. Name and credentials. Just FYI.