Purrsx2

I started working in the end of February for an outpatient ENT clinic of a large teaching facility. It is mid-May and I am still waiting to be credentialed... I am seeing patients, diagnosing, prescribing and referring, but I pend all prescriptions to be signed by MD and he puts attestation on every SOAP note of mine and all services are billed under his name. I was explained that I cannot see patients and bill until the credentialing process is completed. I am not sure if it means credentialed by that large teaching facility or by Medicare, Medicaid and every major and minor insurance company out there, but I am still patiently waiting. While the surgeon was on vacations, I was not allowed to see patients since those visits could not have been billed under his name. So I just sat in the office for 2 days and read ENT books and did some research for a couple of complicated medical cases he told me to figure out (did a good job on that, so when he came back we changed their Tx plan based on my recommendations). I still got paid for those 2 days, which was nice, but it was kind of weird just sitting there in an empty office full of support stuff (2 LPNs, receptionist, surgical scheduler and office manager).

Question for all working NPs: if Glassdor gives NP salary range for a particular employer as 41 to 45 per hour, and the offer states 41.02 for a new graduate NP (38400 for 18 hours), is it worth to try and negotiate, or is it really non-negotiable because this corporation is using pay grade rates (grade 1 through 30)? Is it possible to renegotiate the rate after you get 1 year of experience? As a side note, this employer is a non-profit organization and a great name to have on the resume for the future. I graduated back in May 2016 and could not land a job, no one wants a new grad with no relevant experience, so am absolutely taking this offer. However, is it too late to try and negotiate after I said yes, but before I sign the contract? I am making this much as an operating room nurse (6 years of experience) currently. Any advice is greatly appreciated.

BCgradnurse, Thanks for the response. I am expected to start allergy testing program in the office. They have 2 LPNs there, I don't know if the surgeons (they have 3 of them there) expect me to do the testing and then analyze the results, talk to the patient and come up with the treatment plan, or LPN will be doing the technical part of it (would need to be trained to do it, I guess) and I will be doing the rest. I will get more info on that.

Thanks, BostonFNP and BCgradnurse! Since I work in OR, I have seen my fair share of intubations with glidescope (it has a monitor that shows the trachea and vocal cords to assist with difficult airway), EGDs, Bronchs and FESS, so I have a very good idea of normal versus abnormal looking structures. The surgeon also mentioned that he will provide me with a book that he uses for his ENT residents. As for allergy testing - I am totally new to that, so I don't even know where to start...

Thanks for advice, BostonFNP! How difficult was it to learn how to do fiber-optic endoscopy?

Anyone with ANY experience in the above procedures? I am a new grad and I am offered a part-time position in ENT office. I was wondering if these procedures are something that a new grad can be trained to do in the office setting by the hiring MD (surgeon) or I will need some kind of official training. I am also expected to do allergy testing and the only provider who knew how to do it left a while ago, so "on-the-job" training is not even an option for that one... Any advice is greatly appreciated!

You can also contact your local Labor Department. If you are not being paid your earned wages, Labor Department will get involved and you will receive all your back pay pretty quickly.

When applying for DEA license the form requires to state the address of the practice where you are prescribing. What do you put there if you are not working/prescribing yet?

Is there anyone who currently works or worked as Nurse Practitioner in an ENT office? Have you done the following procedures: 1) Nasal bleed cauterization; 2) Scoping with flexible fiber-optic scope (visualizing throat and vocal cords); 3) Salivary stone removal; 4) FNA for neck mass; 5) Peritonsillar abscess aspiration; 6) Myringotomy / ear tubes placement; 7) Allergy testing (in-office) and allergy shots. Thanks!

It is a known fact that Andrew Wakefield, a British former gastroenterologist and medical researcher, published a fraudulent 1998 research paper in the world-known peer-reviewed medical journal Lancet, claiming the link between the administration of the MMR vaccine and appearance of autism/bowel disease. This claim was consequently refuted by his peers in the same journal. Shall we believe Dr. Wakefield's claim on the basis on the fact that his paper was published in Lancet and OP's personal belief that ?Shall we consequently ban MMR vaccine on the basis on the above "evidence"? Anyone can write an article with false claims, "supported" with non-existent sources or references to non-existent data from those sources, and that article will be published... until peers who know how to read research come up and refute the claim that is based on nothing but "wishful thinking". This is what happened in J. Pereira's case (the article OP keeps posting again and again) - he posted lies that suited his agenda/bias, and got publicly "whipped" in the same peer-reviewed journal by his own peers. I guess, OP somehow conveniently continues to overlook this and cite false data to prove own personal agenda. Or, perhaps, OP does not know how to read research articles and separate "wishful thinking" from scientific evidence (especially if this scientific evidence does not support OP's personal agenda/bias). That is exactly how people lose credibility in the eyes of the community.

I would really appreciate if you provide your source for this statement (reliable one).

Thank you for the provided article, written by J. Pereira . I read it and looked up the sources that were quoted in this article. Some of them were not listed, and others did not have information that he referred to. No wonder, this ERRATUM IN was posted in the same journal with regards to his article: Curr Oncol. 2012 Jun;19(3):133-8. doi: 10.3747/co.19.1063. [h=1]Pereira's attack on legalizing euthanasia or assisted suicide: smoke and mirrors.[/h]Downie J1, Chambaere K, Bernheim JL. [h=3]Author information[/h] [h=3]Erratum in[/h] Curr Oncol. 2012 Jun;19(3):e227. [h=3]Abstract[/h][h=4]OBJECTIVE:[/h]To review the empirical claims made in: Pereira J. Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls. Curr Oncol 2011;18:e38-45. [h=4]DESIGN:[/h]We collected all of the empirical claims made by Jose Pereira in "Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls." We then collected all reference sources provided for those claims. We compared the claims with the sources (where sources were provided) and evaluated the level of support, if any, the sources provide for the claims. We also reviewed other available literature to assess the veracity of the empirical claims made in the paper. We then wrote the present paper using examples from the review. [h=4]RESULTS:[/h]Pereira makes a number of factual statements without providing any sources. Pereira also makes a number of factual statements with sources, where the sources do not, in fact, provide support for the statements he made. Pereira also makes a number of false statements about the law and practice in jurisdictions that have legalized euthanasia or assisted suicide. [h=4]CONCLUSIONS:[/h]Pereira's conclusions are not supported by the evidence he provided. His paper should not be given any credence in the public policy debate about the legal status of assisted suicide and euthanasia in Canada and around the world. [h=4]KEYWORDS:[/h]Belgium; Canada; Euthanasia; Netherlands; assisted suicide; evidence; slippery slopes https://www.ncbi.nlm.nih.gov/pubmed/22670091 Quite embarrassing, eh?

Thank you for the googled links. I carefully read all the information provided on those links, but still did not find any cases where "patients and children have been euthanized without their consent or knowledge". Here is the quote from the article: "Belgian parliament on Thursday agreed with the doctors who argued that in rare cases of unbearable and irreversible suffering, children should have the same right as an adult to ask to die with dignity. Under the amendments to the country's 2002 euthanasia law, a child of any age can be helped to die, but only under strict conditions. He or she must be terminally ill, close to death, and deemed to be suffering beyond any medical help. The child must be able to request euthanasia themselves and demonstrate they fully understand their choice. The request will then be assessed by teams of doctors, psychologists and other care-givers before a final decision is made with approval of the parents." Provided links did not support your statement that "patients and children have been euthanized without their consent or knowledge".

I would be very interested to see your source of this information. Thanks in advance.

Thanks to everyone who actually answered my questions. I agree that president can't change state regulations. Is he able to appoint a healthcare "Czar" who will initiate changes in Medicare/Medicaid rules, since these are federal entities? If Medicare, for example, would mandate that NPs can only work under the supervision of MDs to be able to get reimbursement, than it is only a matter of time when the rest of major insurers will follow the suit, regardless of what state scope of practice is. Can it possibly happen? Also if Medicare decides to change the reimbursement to NPs from 85% to 60% as a cost cutting matter, without affecting reimbursement to MDs, the rest of the major insurers might also follow the suit. Can this happen? Is it true that conservative states have the most restrictions on NP practice, which is reflected in reimbursements to NPs in those states being much lower that the rest of the country?

These are my concerns: 1) Can he federally legislate supervision for all NPs by physicians regardless of how long NP had been practicing? 2) Can he change Medicare/Medicaid rules to exclude NPs from reimbursement unless care is provided "under the supervision" of MDs? Basically, my questions is: can he turn NPs into PAs on the federal level?

On BoardVitals it was around 80, their test questions, IMHO, are much harder than the real AANP test. I took FNP test.

Thanks!

Two of my preceptors were MDs and I have seen Abx prescribed right and left for just about everything... whether it was needed or not (even to a healthy 19 y.o. with runny nose, fever of 99.9 x 1 day and no other signs/symptoms). Adherence to the recommended treatment guidelines and EBP does not depend on the length of education.

Woo-hoo! I passed AANP test with a score of 725 out of 800! Test was not difficult, it only took me 1.5 hours instead of 3 hours to finish my 150 questions, including a bathroom break. This was my study plan: 1) Took the entire APEA Q-bank (over 3200 questions), found couple of errors in a few questions, otherwise it is a pretty good resource if you read rationales and copy them into word document for studying later (I bought the Q-bank in April of 2016 and paid $219 for 4 month access). When working with the Q-bank, you will see that there are 2 separate sets of questions - Management and Assessment. I was choosing option "tutor" (which shows explanations) and option "questions never seen" for both areas. When no "questions never seen" are left, go for the option "missed questions". 2) Leik review book and questions in the end of the book - it has a few typos and inconsistencies, but it is a great resource for the test, a lot of questions on actual exam were written exactly in the format presented in her book. She also gives excellent tips on which answers NOT to chose (obscure exotic diseases/disorders, etc.) 3) Took complimentary practice tests on BoardsVitals, AANP certification and other review websites. 4) Watched videos for USMLE step I (cardiac murmurs, respiratory, etc.), Stanford Medicine 25 videos and orthopedic and neuro exam videos. Helps to understand material rather than memorizations/mnemonics. 5) Re-read Fitzgerald review book with questions (I used it throughout my last 2 semesters in school).

Anyone here working as hospital cardiac APRN? What are your duties - taking care of patients on telemetry? CCU? Cath Lab patients post-angioplasty? Or something else? Is it procedure-heavy (stress test, pace-maker interrogation, assisting with angios, etc.) or mostly admitting/rounding/discharging patients?

Do guys buy "more purses/make-up" or it was a reference to females? Advice on reading "neuroscience topics" on males buying shoes, coupled with advice to improve my logic and assumptions on my voting preferences... hmm. I shall pass on that one. Yes, that is true, males in US are hired more often than females and males are paid higher wages than females for exact same jobs, "glass ceiling" does exist, too, and that is due to overt and covert bias, which your post, IMHO, is very representative of. People should be measured by their actions and contributions to society, not by their gender, race, nationality or background, IMHO.

I have seen a couple of occasions where the orthopedic PA did the surgery in its entirety (with the ortho surgeon in OR). One was short TFN, and PA did the entire procedure, from incision to closing, surgeon was scrubbed, was holding retractors and giving advice (this particular older ortho surgeon does not operate a lot, only when on call (very rarely), and is not comfortable doing TFNs. He used to do DHS, but we got rid of DHS instrumentation a while ago and had none at the time he was called-in on off-shift for a trocanteric hip fx). Ortho PA did the surgery very quick (25 min from incision to the beginning of the closure), some ortho MDs take much longer, I asked ortho PA where he learned to do TFN on his own, he told me that in another hospital ortho PAs often did TFNs by themselves while surgeons were in OR dictating their previous cases (not even scrubbed in). Another time it was a different ortho PA, but the same surgeon, ortho PA pretty much did an I&D of the shoulder by himself, surgeon was scrubbed, held the retractors, after lavage he scrubbed out and left the OR to dictate and talk to the family, ortho PA finished the surgery alone. Also our ortho PAs fix the dislocations in ER by themselves (no MD present), do minor I&Ds, etc.

If I understood your post correctly, you are blasting women that go through MSN program with the goal of "wearing white coat and buying more purses/shoes" (I guess you think that you know better than them what motivated them to go to graduate school). Your post sounds somewhat sexist to me. Are all men that go to MSN program, exceptionally smart, and go there with the only shining goal of advancing science just by the virtue of being male? Have you seen male "monkeys with stethoscopes that make the profession look bad" or it just happen to be women in your opinion? I have seen exceptionally bright women enrolled into MSN program and average men, who also went into the same program (and I am not even going to guess what their motivation was, because it is irrelevant to the topic). I have seen in MSN program exceptionally bright men and women of average ability as well. Nature did not create everyone equal. Speaking of intellect, not everyone is born a genius, some people are average, some are high average, and some are below average, this is a normal variation. Unfortunately, I have seen some very average providers with stethoscopes and MD after their name (both males and females), who often misdiagnosed their patients (AOM when patient had TMJ; RA when patient had PMR, etc.). The biggest pitfall of those providers was not listening to their patient's story (HPI/ROS) and rushing through the visit. Going through medical/nursing school does not magically turn someone's intellect they are born with, into a genius intellect. Going through medical/nursing school does not mightily improve someone's logic and analytical skills, they are born with, either. School pretty much gives the knowledge to pass the boards, but in 5 to 10 years later most people won't remember that entire school knowledge anymore, they will retain mostly the knowledge they apply on everyday basis. That's why constant self-education after school (beyond required CMEs) gives a great advantage over the lack of thereof. Also, learning good questioning and listening skills might actually improve diagnostic outcomes of some providers. It is a good idea, IMHO, not to make sweeping generalizations based on gender, age, race, educational level, etc.

I have two questions for the community: 1) Is orthopedic surgeon allowed to sign off on EKG strip just because he is an "MD"? 2) Who has more exposure to reading EKG - psychiatrist, pediatrician, plastic surgeon or FNP/PA/primary care doctor?