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MikeFNPC

MikeFNPC

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Reputation Activity by MikeFNPC

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  1. Like
    MikeFNPC reacted to Neuro Guy NP, DNP, PhD, APRN in Starting own NP practice   
    You're in an independent practice state so go for it! Check out bank of America, they have a program designed for providers looking to start their own practice! After I finish my neuroscience PhD I plan on working with them. I did some preliminary discussions with them and I think it checks out pretty well so I give my endorsement fwiw.
    I think consulting a lawyer or other business professional who is familiar with such matters is wise. Remember too that it may take 2 years to really turn a profit and get things off the ground with growing pains, etc. Take into account unexpected business expenses. I'm sorry I can't give you advice from the perspective of a practice owner but I do wish you luck.
    Go NPs!
  2. Like
    MikeFNPC got a reaction from traumaRUs, MSN, APRN in Passed AANP on Monday...I Have Questions!   
    Congratulations!  I would only add to above comments with, join your local APRN professional organization, there you would be able to meet others who could turn you on to community opportunities that may fit your schedule/life.  Good luck, and welcome to an amazing profession. 
  3. Like
    MikeFNPC got a reaction from traumaRUs, MSN, APRN in Passed AANP on Monday...I Have Questions!   
    Congratulations!  I would only add to above comments with, join your local APRN professional organization, there you would be able to meet others who could turn you on to community opportunities that may fit your schedule/life.  Good luck, and welcome to an amazing profession. 
  4. Like
    MikeFNPC reacted to fizzlepop in Passed AANP on Monday...I Have Questions!   
    Congrats on passing your exam! I'm an AGNP, but I can take a stab at some of these questions.
    1. I started my job hunt with my NP license in process, but my DEA was covered by my employer.  Renewal of my RN and NP licenses were covered by my employer as well. Licensing fee coverage was written into my contract.
    2. Unfortunately, I never found a great website for NP resumes.  I just did a Google search and worked off of examples. 
    3.  General things I negotiated on included: salary, sign-on bonus, relocation fees, and vacation/ holidays.
    4. My guess would be urgent care or minute clinics would provide the most flexibility in schedule. However, I have never worked in these settings, so I don't know for sure. 
    Good luck!
  5. Like
    MikeFNPC got a reaction from NRSKarenRN, BSN in What did you wish you knew as a new grad NP?   
    UpToDate, a must have. 
  6. Like
    MikeFNPC reacted to djmatte, ADN, MSN, RN, NP in Ok TEXAS NP's, wake up and smell the coffee!!!   
    Looks good, but I would proof read some of it for grammar before sending.
  7. Like
    MikeFNPC got a reaction from LibraSunCNM in Texas Medical Board Attempting to Limit Scope of Practice   
    I hope doing what's safe for the patient is what we all strive for.  This has nothing to do with the patient.  It has everything to do with control.  If we stand by and allow the door to open for medical boards to control NP's that door will be impossible to close.  I find it hard to believe that this topic has only attracted the attention of a few of us.  I've sent messages to the Texas Board of Nursing, and several elected officials expressing my opposition to this rule with logical and practical examples of how this rule is part of the problem with access to care, not part of the solution.  My question to NP's of every state is, should we do something, or nothing?
  8. Like
    MikeFNPC got a reaction from traumaRUs, MSN, APRN in Ok TEXAS NP's, wake up and smell the coffee!!!   
    Example letter that anyone (MD, DO, PA, NP, person in general from any state) can send to rules.development@tmb.state.tx.us.  
     
     
    Texas Medical Board,
     
    I am licensed as a nurse practitioner (APRN) in Texas, and I oppose the Texas Medical Board adopting rule 193.21 as published in the Texas Register on January 25, 2019.
     
    This rule would severely limit the practice of APRNs who have safely and regularly read and interpreted radiologic studies, and also diagnose and treat patients based upon these radiologic studies.  It also unfairly restricts physicians who wish to delegate this ability to APRNs they trust and work with daily in order to provide the best team-based care possible.  For example, in my practice, the clinic is in a rural community, it’s myself and an MD.  Regularly, the MD takes 2 weeks off for CME and vacation.  During that 2 weeks, this is a sole NP clinic.  We have x-ray at the clinic, and do several a week.  Not only does this ability prevent unnecessary hospital and ER visits, but it provides urgent/emergent treatment to be initiated without delay.  If this rule passes, then I can assure the TMB that the Texas residence of this community will suffer not only delay of care but feasibly even death especially in the case of acute heart failure, bowel obstruction, and pneumonia. 
     
    There is no evidence that APRNs who read, interpret and diagnose medical conditions based upon radiologic studies has resulted in increased danger to Texas patients.  Imposing arbitrary and punitive regulatory restrictions on the physicians I work with and at the same time restricting my role on the health care team will disrupt the lives of the patients I care for every day.
     
    I beseech the Texas Medical Board to reject rule 193.21 for the good of all Texas patients.
     
    Respectfully,
    Michael Ryan MSN, APRN, FNP-C
     
  9. Like
    MikeFNPC got a reaction from traumaRUs, MSN, APRN in Ok TEXAS NP's, wake up and smell the coffee!!!   
    TMB Proposes Harmful Radiology Rule
    Monday, February 4, 2019   (3 Comments) 
    Posted by: Erin Cusack
    Share|
    The Texas Medical Board (TMB) recently proposed a new rule that could dramatically impact the practice of APRNs in Texas across all settings – from hospitals in urban areas to the most remote rural clinics.

    The rule proposal says:
    §193.21.Delegation Related to Radiological Services...

    (d) The following acts have been determined to be the practice of medicine under the authority of the Act, §157.001(b)(1), and cannot be delegated to a midlevel provider, certified radiological technologist (MRT and LMRT), or non-certified radiological technologist (NCT):

    (1) the reading and interpretation of the radiological studies; and
    (2) rendering a diagnosis based on the radiological studies.

    Nurse Practitioners and Clinical Nurse Specialists regularly use x-ray and other imaging for everything from mammograms to broken bones. Certified Registered Nurse Anesthetists use fluoroscopy for central line placement and other procedures. Certified Nurse Midwives use ultrasound to ensure the health of mother and baby during pregnancy. By adopting this rule, physicians on the TMB are prohibiting an essential part of APRN practice and forcing their competition to practice blindfolded.

    While almost all APRNs would be affected, APRNs who own or work in small and micro businesses will no longer be able to provide certain treatments. Rural communities that do not have a physician to read and interpret these studies will have to seek care elsewhere.

    TNP Members received a call to action on Friday. If you are a TNP member, be sure to check your email. If you didn’t receive it, feel free to email admin@texasnp.org. If you are not a TNP member and are interested in receiving these important updates that impact your profession, join TNP today.
    Comments on Rule §193.21 can be emailed to rules.development@tmb.state.tx.us or mailed to Ms. Rita Chapin to P.O. Box 2018, Austin,Texas, 78768-2018. Comments are effectively due on February 22. Earliest date of adoption of this rule is February 24. 
     
    https://www.texasnp.org/news/news.asp?id=436888
     
    It's coming because we aren't paying attention.  Please make comments on the site, and send an email to the TMB, the link is on the site.  
     
    (Admin comment - I added the contents of the link as well as the contact info)
  10. Like
    MikeFNPC got a reaction from LibraSunCNM in Texas Medical Board Attempting to Limit Scope of Practice   
    I hope doing what's safe for the patient is what we all strive for.  This has nothing to do with the patient.  It has everything to do with control.  If we stand by and allow the door to open for medical boards to control NP's that door will be impossible to close.  I find it hard to believe that this topic has only attracted the attention of a few of us.  I've sent messages to the Texas Board of Nursing, and several elected officials expressing my opposition to this rule with logical and practical examples of how this rule is part of the problem with access to care, not part of the solution.  My question to NP's of every state is, should we do something, or nothing?
  11. Like
    MikeFNPC reacted to Eydyey, NP in Texas Medical Board Attempting to Limit Scope of Practice   
    I also get where you're coming from. I understand that not all the situation fits it and have the resources available for them and this blanket policy potentially adversely affecting practice for NPs/PAs practicing at your level. You might be perfectly capable of doing that yourself but what about the thousand others who are entry-level into their careers as NPs. Oh no, I didn't say anything about restricting our practice at all. I'm all about collaboration for safer care to my patients, and IN THIS PARTICULAR situation, I would prefer to OFFICIALLY get a read from someone who does this better than I do. As I said, I often tell my patients, "I don't think you have this, so I'll treat you for this, but If I miss anything that the radiologist see, I'll give you a call." Also, don't get me wrong I am all about standardizing and improving education for NP programs. I will go out of my way to contribute to making the NP education better, but that's completely another topic which I think we both are on the same page about. But this does not solve the CURRENT issue, and the CURRENT issue is that most NPs who are in school and have recently graduated were not trained like MDs/radiologists. I am all for the progression of our profession, but I think we should not compromise patient safety in the process because of our ego. It is only my opinion though for this CERTAIN issue. Now, If It was any other issue such as EKG interpretation or any other ridiculous issue proposed against our profession then I'd be against it.  I don't mean to attack/offend anybody. I apologize if I have. At the end of the day, I'll do what's safe for my patient, if it means not waiting for the radiologist and relying on my wet read, then so be it, but I'd be the first to call the patient if they see anything I didn't.
  12. Like
    MikeFNPC reacted to Dodongo, APRN, NP in Texas Medical Board Attempting to Limit Scope of Practice   
    Do you practice in a hospital?  I make diagnosis and treatment decisions all the time based on a wet read that can't wait for the radiologist to post their final reading.  
     
    Further, you think restricting our practice is the answer? Rather than NPs in Texas spamming the CCNE with proposals like this and demanding that radiologic interpretation being included in all NP programs?  It's better to just stay ignorant and be forever under the thumb of physicians.
     
    Don't for a second think this will be the last we'll see of proposed legislation such as this.  
  13. Like
    MikeFNPC reacted to Eydyey, NP in Texas Medical Board Attempting to Limit Scope of Practice   
    I don't mean to be the debby-downer of our profession but I would always wait for the reading of a radiologist for a proper/official diagnosis. I might have some background and knowledge to say to the patient "I don't think you have a fracture, or pneumonia, etc. but I am still waiting on the radiologist's read to confirm it." I think it's fair for them to put it out there and I understand where they're coming from. I believe this is better for our profession if anything because one NP might have had formal training when it comes to radiology but I'm 100% sure most of the programs don't. This is potentially saving our profession the way I see it.
    What's not clear on that short section is the Section 193.21(d) number 2 where it states "rendering a diagnosis based on the radiological studies." can't be delegated. Do they mean even after the radiologist has read and interpreted it, we still can't diagnose a patient? Now that's different. But in any event, I don't find it offensive, but that's just me.
  14. Like
    MikeFNPC reacted to missdeevah in Texas Medical Board Attempting to Limit Scope of Practice   
    Those of us in TX have got to make our voices heard by the TMB. We can't take steps back, we're already behind. We need to write them and get them to see the light.
  15. Like
    MikeFNPC reacted to Wuzzie in Texas Medical Board Attempting to Limit Scope of Practice   
    This will hamstring all of your flight programs as well. 
  16. Like
    MikeFNPC got a reaction from Dodongo, APRN, NP in Texas Medical Board Attempting to Limit Scope of Practice   
    I think that the TMB may be shooting themselves in the foot with this one.  I just don't see how this rule can pass.  There are too many independent NP clinics doing xrays.  How many patients would suffer and even die waiting for an MD/DO to read an xray?  
    I agree with the TMB when it works to get along with APRN's, not when they aggressively attack. 
    The rural clinic I work at has two providers, myself and an MD, each of us have a panel.  We have xray and use it frequently.  Sometimes the MD is off for 2 weeks at a time or more.  We don't have anywhere close by for patients to go for imaging.  I wonder how many lives it would take for the TMB to wake up, or do they even care.  
    Hey Texas Docs, it really isn't about the money, it's about the patient.  
  17. Like
    MikeFNPC got a reaction from Dodongo, APRN, NP in Texas Medical Board Attempting to Limit Scope of Practice   
    The problem we have here in Texas is with the occupation code.  
    https://statutes.capitol.texas.gov/Docs/SDocs/OCCUPATIONSCODE.pdf
    In chapter 151, it says that to practice medicine in Texas you have to have gone to medical school.  Therefore, NP's cannot practice medicine in Texas.  And now, it would seem, that the TMB is saying in the same section that you quoted, that reading xrays and making a diagnosis is practicing medicine.  
    https://www.sos.texas.gov/texreg/pdf/backview/0125/0125is.pdf
    What I think should happen is we need to change the occupation code to include APRN's in being able to practice medicine.  
  18. Like
    MikeFNPC got a reaction from Dodongo, APRN, NP in Texas Medical Board Attempting to Limit Scope of Practice   
    I think that the TMB may be shooting themselves in the foot with this one.  I just don't see how this rule can pass.  There are too many independent NP clinics doing xrays.  How many patients would suffer and even die waiting for an MD/DO to read an xray?  
    I agree with the TMB when it works to get along with APRN's, not when they aggressively attack. 
    The rural clinic I work at has two providers, myself and an MD, each of us have a panel.  We have xray and use it frequently.  Sometimes the MD is off for 2 weeks at a time or more.  We don't have anywhere close by for patients to go for imaging.  I wonder how many lives it would take for the TMB to wake up, or do they even care.  
    Hey Texas Docs, it really isn't about the money, it's about the patient.  
  19. Like
    MikeFNPC got a reaction from Dodongo, APRN, NP in Texas Medical Board Attempting to Limit Scope of Practice   
    Another interesting item.  In the report from the Texas Register, it also says, "Any physician authorizing standing delegation orders or standing medical orders which authorize the exercise of independent medical judgment or treatment shall be subject to having his or her license to practice medicine in the State of Texas revoked or suspended under §§164.001, 164.052, and 164.053 of the Act."
    So, the TMB isn't just attacking NP's they're attacking other MD/DO's who are willing to sign delegation agreements with NP's.  Thanks to the OP for bringing this to light, Texas, take notice of the kind of care that the TMB is proposing for the general public.  
  20. Like
    MikeFNPC reacted to Dodongo, APRN, NP in Texas Medical Board Attempting to Limit Scope of Practice   
    I think we should all be aware of proposed rules by the Texas Medical Board, as published in the Texas Register on January 25, 2019.  The proposed rules are found on this website, under the hyperlink "Proposed Rules": https://www.sos.state.tx.us/texreg/pdf/currview/index.shtml

    In short, Section 193.21(d) states that there are certain acts that cannot be delegated to a "mid-level provider" (their words): "The reading and interpreting of radiological studies, and rendering a diagnosis based upon radiological studies".  
    This has the potential to adversely impact the practice of NPs in Texas.  Further, if legislation like this is passed, it endangers the future practice of NPs in other states as well.
    The Texas Medical Board is currently soliciting public comment on these proposed rules and have provided an email address for contact.  Texas Medical Board: rules.development@tmb.state.tx.us.  You can also send a formal letter to the following address:

    Texas Medical Board
    ATTN: Rita Chapin
    PO Box 2018
    Austin, TX 78768-2018
  21. Like
    MikeFNPC got a reaction from NRSKarenRN, BSN in What did you wish you knew as a new grad NP?   
    UpToDate, a must have. 
  22. Like
    MikeFNPC got a reaction from NRSKarenRN, BSN in What did you wish you knew as a new grad NP?   
    UpToDate, a must have. 
  23. Like
    MikeFNPC got a reaction from NRSKarenRN, BSN in What did you wish you knew as a new grad NP?   
    UpToDate, a must have. 
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