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  1. nursetim

    Any NPs have scribes?

    Do any NPs have scribes assigned to them. I am slow, but thorough adult NP. Cranking out high volume is not my forte. If I had a scribe, I imagine I could see the requisite 80 Pt.s a day (just kidding), seriously 30 Pt.s/day.
  2. FLOATnureCO

    Nurse Practitioner- Job Outlook

    Hi, Assuming I get accepted, I will start FNP School in a few months. We all know how expensive it can be and I have a family...and well, a lot of questions that I'm having a hard time finding the answer to. For one, I don't see myself as a primary care provider and I feel like this is the most common job for FNP graduates. I chose FNP to be more versatile than specializing... but I would rather work someone like a cardiology office/heart failure clinic/ in-patient cardiology/ derm NP/ trauma surgery NP... Like do these things even exist for an NP? I've tried searching for jobs but the market around here is a bit saturated at the moment and I see mostly primary care jobs. Another thing I've been thinking about is how I would want to be part- time until my kids are a bit older. I kinda suspect this will be difficult but I'm not sure? Insight, anyone? I live in Colorado if that makes a difference. Thanks!
  3. Hello I'm looking for some feedback. I got accepted into 2 online (Maryville & Walden) and 1 brick and mortar (La Salle) Adult-Gerontology Primary Care NP programs starting soon. I plan on working on call at night and was looking for a program that will have flexible clinical hours. Can anyone give me feedback about their experiences with Maryville, Walden or La Salle University?
  4. Chestes123#

    Regis college online NP

    Anyone starting the nurse practitioner program at Regis College online in January? I start the pmhnp program and was wondering if anybody has started the program previously and what their thoughts are on it.
  5. Hi everyone! I was just accepted to maryville university's adult gerontology acute care np program, anyone recently been in this program that can give some insight/advice/encouragement? Anything to help? I'm so nervous and excited!
  6. House Bill 793 passed in the state of Virginia in 2018 and went into effect in January of this year. The legislation allows nurse practitioners (NP) in specialty practices to open a private practice and work without the oversight of a medical doctor. Since nearly half of the states across the country have similar legislation, this appears to be a win, but also possibly just part of the natural progression for NPs. Marsha Stonehill, a psychiatric NP recently opened her own practice, Melt the Ice. Her doors opened in March, just a few months after the bill went into effect. She described her practice and why she decided to go out on her own in a recent Fredericksburg.com article. Stonehill has previously worked in large health systems that required her to see many patients in a day and even cut sessions short. Today, she truly is a one-woman show who answers her own phone and emails and even set her times directly with her clients. She leaves extra time between patients in case there are emergencies or care issues that need further discussion beyond the scheduled appointment limits. She has chosen to be a private pay practice to avoid some of the limitations set by health insurance plans. While Stonehill is enjoying the freedoms of her practice, not everyone in Virginia or even across the nation agrees that nurse practitioners should be allowed to practice alone. The Debate Virginia’s law requires NPs to have a minimum of five years of full-time clinical practice. They must submit documentation from a physician who can attest that there was collaboration between the two during that time. If an NP wants to go out on their own but doesn’t meet this qualification, they must provide a plan to the state detailing how they will refer complex cases and emergencies to a doctor or other provider. Some doctors, like Dr. Davis Liu, who practices in California and runs a start-up called Lemonaid Health doesn’t feel that nurse practitioners should be allowed to practice on their own. He was quoted saying, “It boils down to training. Primary care is a cognitively challenging specialty. The amount of training doctors receive is far greater than that of nurse practitioners.” However, Lui might be in the minority for a few reasons. And, it’s not just nurses who question if his opinions are correct. Understanding the State Practice Environment According to the American Association of Nurse Practitioners, across the U.S., there are three categories of practice that governs the care provided by NPs. Full practice states allow the clinician to evaluate, diagnose, order and interpret diagnostic tests and start and manage treatments. They can also prescribe medications, including controlled substances under their license. This model of care is supported by the National Academy of Medicine and the National Council of State Boards of Nursing. States in this category include Washington, Hawaii, and Iowa. Reduced practice states include Ohio, Utah, and New Jersey. NPs in these states have a reduced ability to engage in at least one element of the NP practice. They must have career-long collaboration with a provider under a set agreement. The final category is restricted practice in which the NP have a restricted ability to engage in at least one element of the NP practice. They also must maintain career-long supervision, delegation, or team management by another provider. States who continue to restrict NP practice to the fullest include California, Texas, and North Carolina. What’s Next? Using NPs as an integral part of the healthcare team has been proven successful many times over the years. They’re a cost-effective solution to the shortage of physicians, and many patients prefer the care they provide. As more states adopt similar laws to Virginia will the naysayers finally believe in the value of NPs at work? What’s your opinion?
  7. The number of people over the age of 65 in America is projected to reach 98 million by 2060. This is more than double of this population today. An aging population taxes healthcare resources. It’s no secret that nurses are in demand, but you might be surprised to learn that physicians are another group of healthcare professionals experiencing a shortage. The Association of American Medical Colleges estimates that the shortage of physicians in the United States could reach 120,000 vacancies by 2030. The healthcare industry has turned to nurses in advanced practice roles to strengthen the workforce and deliver comprehensive, direct patient care. However, the care delivery system varies from one state to the next, leaving care gaps that impact the access to care for some patients. As nurses continue to step up to the plate to offer an innovative solution to cost-effective care, we must embrace the issues and rally together as nurses of various education levels to support this unique group of nursing professionals. Advanced Practice Roles Explained APRNs are registered nurses who have gone back to school to receive additional training. They work as nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs), nurse midwives, and clinical nurse specialists. Nurses in these roles hold a master’s or doctorate degrees and are trained to be independent practitioners. Many people consider these roles to be a modern advancement of the nursing profession. However, the role of the nurse anesthetist dates back to the 19th century during the Civil War when nurses were called upon to administer anesthetics. The first credential CRNA was established in 1956. Certified Nurse Specialists were the next APRNs to arrive on the scene in the 19th century when nursing specialists were needed. Midwives started with home deliveries in the 20th century and began assisting with hospital births during the baby boom. The first NP program began in 1965 at the University of Colorado, as Medicare and Medicaid expanded their coverage to patients of all ages who met income requirements or had specific disabilities. According to the American Association of Nurse Practitioners, there are over 248,000 NPs licensed to practice in the U.S. today. NPs work in primary care or specialty practices caring for patients across the age spectrum. They are permitted to diagnose and treat acute and chronic conditions. CRNAs deliver anesthesia before, during, and after diagnostic, surgical, and obstetrical procedures. Nurse midwives provide primary care services to women such as gynecological exams, prenatal care, labor and delivery, and family planning services. Clinical nurse specialists work in specialties such as critical care, women's health, or wound care services delivering advanced care and expert advice. Scope of Practice Issues Because APRNs fill a variety of roles, the issues around their scope of practice are just as varied. Some states provide a structure that gives APRNs autonomy, while others mandate direct relationships with physicians that range from supervision to collaboration. All APRNs collaborate or consult with physicians regardless of the state in which they practice. The difference is where they can practice without mandated oversight. According to the National Council of State Boards of Nursing 22 states and the District of Columbia allow NPs to diagnose and treat without physician involvement. However, 24 states require a formal, in-writing relationship between all NPs and a physician. Other issues around the scope of practice pertain to prescriptive authorities, with only 13 states allowing NPs to prescribe medications without the direct involvement of a doctor. This issue is similar for nurse midwives, with only 18 states allowing them to diagnose and treat without physician oversight. CRNAs are provided the ability to practice without direct supervision of a physician due to the autonomous role they must play in the operating room. Because the role of the clinical nurse specialist spans a wide range of activities, there isn’t a unified scope of practice. Improving Access to Care In 2008, the APRN Consensus Work Group developed The Consensus Model to standardize regulations. The model, which included education, certification, licensure, and accreditation was endorsed by 48 regulatory and professional groups. It allowed for increased access to care by increasing state-to-state mobility for practitioners and culminated in 23 states removing practice barriers and implementing this model. However more than half of all states continue to have practice barriers for APRNs to deliver a full range of primary care services. APRNs and the Patient These care limitations don’t just affect the APRN practitioner. Limiting the scope of practice for clinicians trained to be autonomous deeply impacts the ability of patients to access needed care. Several literature reviews have drawn support for giving APRNs the ability to work to their full practice authority. Multiple studies have shown care outcomes between APRNs and physicians to be similar, and some APRN measures are superior. One study examined patient satisfaction in the critical care setting and found that nurses performed better in categories such as listening, teaching, pain management, and answering questions when compared with physicians. At their core, APRNs are nurses. It’s not surprising that nurses continue to top the list as the most trusted profession in America. It seems that when innovative, comprehensive care is needed, the industry turns to nurses to fill care gaps. APRNs are in a unique position to increase access and minimize disparities in care over the next few decades. Where do you see the role of the APRN in 20 or 30 years?
  8. Is anyone applying to USA's dual FNP/ACNP program for summer 2019? I'm a little worried about my GPA since cumulatively it's only a 3.49 and that doesn't sound very competitive when I say it out loud. I have 4 years of total nursing experience with 3 years in the ED and 1.5 as a traveler in the ED. I'm really hoping that I can put together a decent essay and that combined with my experience will outweigh my GPA. Anyone have experience with this program or is anyone applying for the same track?
  9. traumaRUs

    Nurse Practitioner Week 2016

    The first nurse practitioner program was established at the University of Colorado. There are currently more than 222,000 NPs in the US and 20,000 NPs join the ranks each year. One of the focuses of National NP Week is to make patients, their families and also legislators aware of the care provided by NPs. Whether it is an Urgent Care, ICU, medical-surgical unit, primary care office, or specialty office, you will often find an NP caring for patients with a variety of needs and complaints. They work in the hospital, in outpatient clinics, nursing homes, prisons, schools and most places that provide health care. The quality of NPs has been proven time and again via research: Quality and Care Provided by Nurse Practitioners from the Journal of Nurse Practitioners: 9 Things to Know About Nurse Practitioners from US News and World Report: NPs provide advanced nursing care in the primary, specialty, inpatient and outpatient realms. NPs are now educated at the master's level and many today are pursuing a terminal degree, Doctorate of Nursing Practice. There are many avenues to becoming an NP: ADN to BSN to MSN BSN to MSN Direct Entry programs BSN to DNP Post-MSN certificates And there are several tracks one can take to achieve this goal (certifications available from ANCC Nurse Practitioner Certifications Acute Care NP Adult Nurse NP Adult-Gerontology Acute Care NP Adult-Gerontology Primary Care NP Adult Psychiatric-Mental Health NP Family NP Gerontological NP Pediatric Primary Care NP Psychiatric-Mental Health NP School NP Other organizations offer certification exams as well. NPs have to complete their education and obtain licensure as an APRN in order to practice. Here are some articles on how to pass the certification exam once your education is complete: Passed AANP FNP Today: Passed ANCC FNP: And after you pass the certification exam, it's off to the job search. Here is an excellent thread about how to answer the difficult interview question of, "Where else are you interviewing?" Nurse Practitioners have come a long way since their inception many years ago. However, they have a long way to go to gain independent practice in all 50 states. NPs in political office as well as all NPs need to be aware of legislation and how it affects their practice. Happy Nurse Practitioner's Week!
  10. You're on the road to success. Accepted to a nurse practitioner program. The program looks doable. All you need to do is buckle down and study. But is it? For many programs this is true but some programs have less visible challenges that are not transparent on admission. One such challenge are clinicals associated with the program. Depending on the program and specialty, clinical training consists of about 600 hours which amounts to 75 - eight hour days or 2.5 months. In pre-licensed nursing programs, the college arranges clinical placements and provides clinical instructors. However, some nurse practitioner programs require you - the student - to find the clinical placement and the clinical instructor. And this is a factor that some admission representatives might gloss over. The college requires that the clinical site and the college sign an affiliate agreement, which the college is usually willing to discuss with the clinical site. Your clinical supervisor (instructor) too must sign an agreement with the college. The challenge is finding the clinical site and clinical supervisor who will sign the affiliate agreement. Success on finding a clinical site and clinical supervisor usually depends on your specialty and the availability of the specialty in your area. Students specializing in family, adults, and geriatrics probably have a better success since clinicals can take place in a practitioner's office. Students specializing in other areas such as neonatal and psychiatric nursing may have more of a challenge in finding a clinical site. Further complicating matters is that different clinical sites might be require for each course. A case in point is a psychiatric nursing program offered by a reputable university located in the north east. Child and adolescent psychiatry is a course required for graduation - and requires a clinical site that focuses on child and adolescent psychiatry. The reality is that there are few such clinical sites even in this highly populated area. Some of those sites refused to take nurse practitioner students and others are overwhelmed by requests. Only a few students are accepted. This is one of those programs where students find clinical sites without help from the college. As a result, students who don't find a clinical site are unable to complete the child and adolescent psychiatry course, which is a prerequisite for other courses in the program and as a result might have to skip semesters until the course is offered again - and a clinical site is found. There are a number of reasons why some nurse practitioner clinical sites and clinical supervisors are difficult to find. The clinical site and the clinical supervisor may not agree to terms in the affiliate agreement. There are legal liabilities related to a student nurse practitioner's practice and the liabilities are one of many items outlined in the affiliate agreement. Compensation is another concern. Will the clinical supervisor be compensated by the college? The compensation may be little or none offered by the college. And then there is the paperwork. The clinical supervisor must review and counter sign all the nurse practitioner's documentation plus complete and sign the paperwork required for the program. Prospective nurse practitioner students may presume that they can use their current employer as a clinical site. Well not so fast. Some medical centers and practices don't want employees to use their facility as the employee's clinical site. There are sound rationales for such a policy. First they don't want to blur the lines between the employee's official duties and clinical education. This was illustrated in an old ER TV episode when an ER nurse becomes a medical student and uses the emergency department as a clinical site. She was still an ER nurse in the emergency department and was constantly reminding everyone of her role - sometimes an ER nurse and sometimes a medical student. And some employers feel that going to a different facility broadens the experience because they see how other facilities work. Make sure that you know what is really involved in a nurse practitioner program before you start the program. Don't make assumptions only to discover there will be challenges you can't meet when completing the program. You'll probably meet those challenges head on - if you plan in advance. And you may forgo nurse practitioner programs that are too challenging. Tips To Help Explore Nurse Practitioner Programs: Who selects clinical sites? If you, then identify the criteria and terms in the affiliation agreement then try to find sites before you sign up for the program. Who selects the clinical supervisor? If you, then get the details. What credentials are required? What is the compensation? When is the compensation paid? What are the college's expectations of the clinical supervisor? Will the college help you find clinical sites or a clinical supervisor? If yes, then ask the admissions representative to specify the help they will provide - and get this in writing. Don't accept a list of possible clinical sites. You want a list of clinical sites/clinical supervisors that have already signed an affiliation agreement with the college and have continuously accept nurse practitioner students. Speak with current students Current students and recent graduates are a good source of information about the realities of a nurse practitioner program. Furthermore, they may help to identify clinical sites and clinical supervisors for you. Will your employer provide a clinical site? Find out your employer's policy on employees using it as a clinical site. Some employers have such a policy and others decide on a case-by-case basis. Identify the ground rules if your employer can be used as a clinical site. For example, you might be able to use an outpatient clinic as a clinical site if you are an inpatient nurse. This prevents blurring of responsibilities. Maintain a sense of reality You will have at least 2.5 months of clinicals. Within that time you are expected to develop clinical skills necessary to become a healthcare provider. You are diagnosing the patient and prescribing treatments to resolve the patient's problems when you graduate and are licensed. Consistency is the secret of success. Plan to attend clinicals in a block of time (weeks not random days). Some nurses alter their schedule so they can focus a consistent amount of time for clinicals.
  11. Jul 1 - apply to AANP, transcript + RN license Dec 10 - get AANP letter stating eligible to test Dec 12 - last day of semester Dec 13 - graduation Dec 15 - get ATT, schedule exam for Dec 30 Dec 30 - PASSED AANP EXAM! I studied throughout my clinical courses but really got down to the nitty gritty my last semester and ESPECIALLY after I finished my clinical hours in early November. When it came to the actual test I am not gonna say it was easy because it wasn't. There were a few questions I really wasn't sure about. Some I had a faint thought about. Many that I got down to 2 answers. And several that I knew I nailed. STUDY MATERIALS Leik - Intensive Review Very to the point. Easy to get a lot of good information quickly. Some typos and inconsistencies (since when does vitamin K prolong bleeding time on a Coumadin patient??) as others have stated but overall a good $30-40 to spend. 600+ test questions in back also. I scored around 80% on those AFTER I finished my program (read book throughout semester and after) Hollier/APEA 2014 Review CD's LOVED these. She made information so easy to remember and I finally mastered the murmurs. I listened to them 3-4 times through (depending on that particular CD's content). Sometimes I used the syllabus too. Often times I just listened in the car. I hated to spend the $420 on these but man...I think they are worth it. Plus you can always sell them to a classmate afterwards and make a bit of the money back. ANCC Book I bought this a year or so before graduation. It is pretty good but I liked and used other materials more. This one has some wasted space as some of the information is repeated (symptoms and findings often just repeated each other). If you're taking ANCC this may be of more use but I didn't really use it and wish I hadn't spent the money (I didn't realize AANP existed when I bought this). Familynpexams.com I bought a 20 test bundle. They were ok and helped me realize the subjects I was weaker in but some of the questions had typos, weren't clear, repeated, had blatantly obvious wrong answers ("airway" is NOT something that may happen after a lung injury), etc. So these are cheaper than any other practice exams and again they do help you in some ways. But they could use improvement. I scored 60-low 70's in the beginning but by the end was scoring mid 70's consistently. Also even though I chose AANP I still got several non clinical questions each exam I took. It also asked several questions about nursing diagnoses which we never even discussed in my MSN program... Lastly an issue I found with these is that they may only give you a brand name of a med. I'm sorry I don't know the several brands of lisinopril but I do know LISINOPRIL. Everything I have read about the exams is that they give you a brand name and generic so sometimes I'd totally look up the brand name to give myself a dang chance with the question. My exam did have brand AND generic thank goodness. APEA practice exam I used the Black Friday code so took the practice exam for about $27. I did like the variety of questions and the breakdown at the end. I scored 79% at the end of my last semester. Physician Assistant Exam Review podcast This guy gives fairly short podcasts (15-30 minutes) giving brief reviews of topics on the PA exam. He doesn't go into a lot of detail but does go over symptoms, brief etiology at times, diagnostics, and some treatment options. It is meant to be brief as he reminds listeners but I really enjoyed it. It helped me better understand some topics by getting to the point. Sometimes his intros are kind of long on older episodes so I just fast forward through those. Dunphy and Brown practice questions book THIRD edition I went with an older edition to save money. I could tell by some of the "correct" answers. Some of these questions were very small details of knowledge also so didn't seem exactly "entry level" in some ways. Wasn't bad. Just wasn't great. On these questions I scored low to mid 60's. IF I COULD REWIND: I would get practice CD's my last semester and listen to them repeatedly. All of the CD sets out there have their fans and I'm sure much of the material overlaps. Personally I would not hesitate to recommend Hollier. Even though I listened to the CD's 4 times through I didn't get bored enough to want to dig out my eardrums....not gonna miss them though lol. I would also get Leik again despite some of the issues her book has. Overall it's an awesome value and had some topics I didn't even remember from my program but I DID see on exam. I would listen to the PA Review podcast because it is absolutely free and did help me differentiate some processes. The last couple of months before my exam I'd get Q Bank. I liked the APEA practice test and considering the Q Bank has thousands of questions that's a pretty dang good deal. A couple of months of that = $60. Not bad. Then counting the 600+ questions in Leik you're doing pretty well. I'd also maybe get another good practice question book when I start clinical courses because it is nice to practice questions as you go through each body system in class. I'd be happy to answer questions the best I can and good luck to all future test takers! We will survive!!!!
  12. 8mpg

    Is Becoming A NP Worth It?

    My reasons why I question going for a Nurse Practitioner license. Working with some seasoned nurses in the ER over the last couple of years, they make more than starting NP's do. Two doctors and a nurse who did recruit and hiring for a couple of years all stated that it was not worth it. If I don't jump on the bandwagon right away...the rumors of the dreaded 2015 DNP may come true The DRAWBACKS: Increased liability without enough pay Overworked and underpaid for their work. In our ER, the PA's do most of the work while the physicians kick back PA's are preferred in hospital settings (which is my major interest...though I'm sure an office setting will be great later in life) Again...financial. They did not agree that 2.5 years of schooling was worth a mediocre increase in salary (even long term). They collectively felt that working a 4th 12hr shift each week was better than spending another 2.5 years an lots of money for an NP degree. The POSITIVES: Increased autonomy I can do a full time NP program and still work There are 2 great NP programs near me (TWU and UTA) I believe I can get in without to much hassle In state tuition is affordable Self satisfaction I understand that financial compensation is not all there is to a job thought it is a necessity. Increased autonomy is very important to me and the main reason I would like an advanced practice degree. Med school would be great, but being hundreds of thousands of dollars in debt and taking 4 years off is not appealing to me. So to the current NP's... would you NOT get your degree if you had to do it again. Was it worth it more than just personal satisfaction? Do you enjoy your setting?
  13. One of the major symptoms of a midsemster crisis is FNP school induced delirium. Unfortunately, when it strikes there's no quick fix! If you're in the midst of a midsemester crisis, I highly recommend that you: Take a deep breath Remind yourself why you decided to go on this journey to become a Family Nurse Practitioner. Trust me, your determination is bigger than your current obstacle. Reassess your situation Things can often seem worse in our head. In grad school it's important to have a reliable support system. At a time like this, a good sounding board and a hug can go a long way. Often just talking it out, and getting a different perspective can help alleviate your anxiety. Find the strength to push through A pre-semester, midsemester and/or post semester crisis is bound to happen at least once (most likely multiple times) throughout your time in FNP school. If you're having one, try to remember you have a bigger goal in mind, and that this too will pass (even though it feels like it never will)! FNP school is not for the faint of heart or mind. It will challenge you in ways you had never thought possible. Couple grad school with balancing one's day-to-day challenges, it's no wonder midsemester crises are so prevalent in grad school. In this week's vlog you get to see my midsemester crisis in full swing! Some highlights include Why am I having a midsemester crisis? I'm one step closer to clinicals. Submitting clinical compliance paperwork. What's required? How do some programs decide if an examination question is fair? How I plan to deal with my midsemster crisis. I hope you enjoy Follow Me Through Grad School (#FMTGS) Episode 207: I'm Having A Midsemester Crisis! Have you ever had a midsemester crisis? If so, how did you deal with it? Please comment below! Also don't forget to LIKE, SUBSCRIBE, and SHARE! You can always catch up with my journey from the beginning here. Never miss another episode of Bizzy Bee Nursing: Bizzy Bee Nursing
  14. shibaowner

    Nurse Practitioners: Shortage or Surplus?

    This controversial topic has been hotly debated, and is of great interest to current and future NPs, so I conducted some research to help our community. So, is there a surplus or a shortage? It depends. (Note: this article is not in perfect APA format). The Case for an NP Surplus In 2014, Edward Salsberg published an analysis of the NP pipeline in Health Affairs. Based on data provided by AACN and the National Organization of Nurse Practitioner Faculties (NONPF), Salsberg reported new NP graduation rates had "increased from 6,611 in 2003 to 16,031 in 2013, an increase of 142 percent (Salsberg, 2014)." [He also noted that not all of these graduates would actually become practicing NPs - so estimates of new NPs entering the workforce have been rounded to 15,000 in some analyses], In addition, "the number of newly certified PAs went from 4,337 in 2003 to 6,607 in 2013, an increase of 52 percent. The annual number of new PAs will certainly continue to grow (Salsberg, 2014)." Salsberg reports that while there is currently a shortage of NPs, he is concerned that the high growth rates in NPs and PAs could lead to a large surplus by 2020. He gives two examples of similar phenomenon: the nurse shortage and the MD shortage. "In the early 1980s and 1990s, the nursing job market became saturated and new RNs had a very difficult time finding jobs; as a result, applicants and enrollment plummeted significantly over a 5 to 7 year period. Some programs ended up closing. This in turn contributed to new rounds of [RN] shortages." There was also a boom and bust cycle in physician supply. There was an MD shortage from 1950-1980, then an MD surplus from 1980-2000, and then another shortage persisting to the present. "However, [these cycles do] not necessarily mean that the forecasters got it wrong: in some cases, the educational community not only responded, but over-responded (Salsberg, 2014)." A 2013 HRSA projection, updated in 2016, also raised fears of an NP surplus by 2020 (note the HRSA projections are only for primary care The supply of primary care NPs is projected to increase by 30 percent, from 55,400 in 2010 to 72,100 in 2020. The supply of primary care PAs is projected to increase by 58 percent, from 27,700 to 43,900 over the same period. Assuming that NPs and PAs provide the same proportion of services in 2020 that they did in 2010, the combined demand for NPs and PAs would increase by only 17 percent (HRSA, 2016a). HRSA also published state-level projections of the primary care provider workforce in 2016. This report indicates a current shortage of NPs and PAs, but also projects a possible future surplus of primary care NPs and PAs by 2025. The surplus or shortage would vary by state. "In 2025, no state is projected to have a shortage of primary care NPs. Projected surpluses range from less than 100 FTE NPs (4 states and the District of Columbia) to 5,350 FTE NPs (Texas). Thirteen states are projected to have a primary care NP surplus in excess of 1,000 FTEs in 2025 (HRSA, 2016b)." A less dire situation is projected for primary care PAs: "Differences between each state's 2025 primary care PA supply and its 2025 PA demand range from a projected shortage of 560 FTE primary care PAs in Ohio to a projected surplus of 2,260 FTE PAs in California. A total of nine states are projected to have a primary care PA shortage in 2025, while five states are projected to have a surplus in excess of 1,000 FTEs (HRSA, 2016b). After reading these reports, it is reasonable to conclude that there is cause for concern over an NP surplus in the near future. The Case for an NP Shortage Currently, there is high demand for NPs on a national level. In a 2017 report on healthcare recruiting, Merritt Hawkins found that PAs and NPs (combined) "represent Merritt Hawkins' third most requested search in the 2017 Review, up from fifth in 2016. This is the highest position PAs and NPs have held on the list, though neither was in the top 20 singly or combined six years ago. PAs and NPs are playing a growing role in team-based care (many were trained in this model), in some cases handling 80 percent or more of the duties physicians perform, allowing doctors to focus on the most complex patients and procedures . . . PAs and NPs provide the bulk of care at the growing number of urgent care and retail centers and also have been a fixture at FQHCs for years. Given these considerations and the continued physician shortage, demand for PAs and NPs can be expected to accelerate. A significant recruiting challenge is arising in this area as many PAs and NPs are choosing to specialize though demand remains pronounced in primary care (Merritt Hawkins, 2017)." All of the projections reviewed in the NP surplus section above indicated a current shortage of NPs and PA, especially in primary care and in locations such as inner cities, smaller cities and town, and rural areas, but raised concerns over possible future surpluses. However, all of these sources included important caveats and limitations to their surplus projections, which can be grouped into the following categories: Inability to predict full impact of ACA and any future healthcare policy changes Inability to predict future changes in scope of practice for NPs and PAs (more states are likely to authorize full practice authority for NPs) Estimates of an NP and PA surplus did not factor in greater utilization of NPs and PAs to offset the primary care MD shortage For example, while projecting a future NP surplus, Salsberg concluded: "If these practitioners [NPs and PAs] are fully integrated into the delivery system and allowed to practice consistent with their education and training, this growth can help assure access to cost effective care across the nation." The 2013/2016 HRSA and 2016 HRSA reports, while raising concerns over a future NP and PA surplus, also points out that "If today's system for delivering primary care remained fundamentally the same in 2020, there will be a projected shortage of 20,400 primary care physicians." The report concludes Under a scenario in which the rapidly growing NP and PA supply can effectively be integrated, the shortage of 20,400 physicians in 2020 could be reduced to 6,400 PCPs. If fully utilized, the percent of primary care services provided by NPs and PAs will grow from 23 percent in 2010 to 28 percent in 2020. Physicians would remain the dominant providers of primary care, only decreasing from 77 percent of the primary care services in 2010 to 72 percent in 2020 (HRSA, 2016a). A 2013 Rand study hypothesized the future NP and PA surplus will help offset MD shortage: New roles for nurse practitioners and physician assistants may cut a predicted shortage of physicians by about 50%, according to a new study released Monday. The surge in new patients covered by health insurance that will be sparked by the Affordable Care Act has led to predictions that there will be a shortage of 45,000 primary care physicians by 2025, about 20% less than the predicted demand, said David Auerbach, a policy researcher at the Rand Corp., a non-profit policy think tank that conducted the study published Monday in the journal Health Affairs (Kennedy,2103). A new report presented at a 2017 American Association of Medical Colleges provides additional insight from a different perspective. Instead of numbers of providers, the researchers analyzed labor supply and demand in terms of visits and full-time equivalent hours because many NPs and PAs are currently handling work typically assigned to doctors. "Researchers applied the FutureDocs Forecasting Tool, showing a 15% increase in physician FTE labor from 2013-2030 and 18% increase in number of physicians. They found an 11% increase in demand for visits per 10,000 and -- evaluating physicians only -- a shortage of 4,700 visits per 10,000 by 2030 (based on an average 2,500 visits entertained per each physicians). The authors concluded: "The continuation of recent surges in nurse practitioner and physician assistant workforces could alleviate much of the potential overall physician shortage in the U.S., [but] . . . the researchers' projections still forecast shortages of primary care labor in rural areas and too few available provider hours to treat conditions such as those in the nervous system (a shortage of 21 million visits overall)." Conclusion Studies agree that there is currently an NP shortage at a national level (this may not be true of all locations), but that we may be heading into an NP surplus period. However, these same studies agree this could change if NPs were successfully integrated into the medical environments and utilized at a greater level. Other projections indicate that NPs and PAs could successfully be used to offset the primary care MD shortage, thus reducing or eliminating any NP/PA surplus. In other words, we don't know for sure if there will be an NP surplus in the future, due to countervailing factors. My personal advice to NP students and new grads is to be flexible with regard to location. Research the areas with the greatest demand for NPs and don't overlook a job search on these locations and populations. "Prime" areas like the major cities also have NP opportunities, but there will be more competition for these positions. Of course, top notch candidates will still get jobs in such areas. References (not in perfect APA format) NP, PA Workforce Growth Could Address Physician Shortage | Medpage Today Projecting the Supply and Demand for Primary Care Practitioners Through 22 | Bureau of Health Workforce State-level projections of supply and demand for primary care practitioners: 2013-2025. Doctor shortage may not be as bad as feared, study says Physician Salary Surveys and Articles: Average Salaries by Specialty, Physician Compensation and Physician Practice Data Sharp Increases In The Clinician Pipeline: Opportunity And Danger Bibliography Interesting Forbes article: Nurse practitioners are more in demand than most physicians as states allow direct access to patients for these increasingly popular health professionals. This is the Merrit Hawkins report referenced in the Forbes article. It is provides a wealth of information on MD, NP, and PA compensation. Use this link and then select "2017 Review of Physician and Advanced Practitioner Recruiting Incentives" Physician Salary Surveys and Articles: Average Salaries by Specialty, Physician Compensation and Physician Practice Data This is an excellent resource to identify areas with a primary care or mental health provider shortage. HPSA Find This a good resource for California NPs - you can find shortage areas in the state Best states for NPs Fascinating article on how there can seem to be both a shortage and surplus of labor in an industry, based on queuing theory, in STEM professions: STEM Crisis or Surplus
  15. Today I passed my AANP FNP exam, two days after graduation. I used this website constantly to read tips and stories about people that both failed and passed, and can't be more thankful a forum like this exists. This is going to be long, but I would like to contribute my 2 cents for others like me that can't get enough info. I loved reading peoples in depth study tips. Here are some useful bits of info I think are important to success: Attend a live review in person or online a month or 2 before you plan to test, or at the very least, buy CD's I don't think the company matters much. I went to a Fitzgerald live review at the beginning of November, and thought it was great for condensing and focusing all the information I learned over the last few years. Although I didn't care much for Fitzgerald herself (thought she was dry and arrogant), the content was great. I also went dutch with a classmate and bought Barkley CD's, which I LOVED. Whenever I heard his voice on the CD's I imagined Mr. Garrison from South Park and thought he was hilarious. Several classmates went to Hollier and Barkley live reviews and also found them to be completely worth it. The point is, they all advertise over 99% pass rates, so they're all good. If you want to eliminate any doubt, do it. Get the APEA Q bank a month or 2 before you plan to test You get over 1000 questions available to you and the rationales are the most in depth of any practice question resource available. I found them to be much more difficult than the actual exam, and I thought there were several similar questions on the exam, although not nearly as complex. These questions help you retain why something is relevant or why it isn't. It also is very light on the non-clinical stuff, which the AANP has none of. Don't be discouraged when you start doing these questions in 10-20 question quizzes and absolutely bomb them. They're hard, and you'll get better. Leik Fast Facts Some of her Mnemonics (like for heart murmurs), saved me on the exam. I mostly just read the Fast Facts and Exam Tips in each chapter, and didn't focus much on the content since I already had the Fitzgerald and Barkley review manuals. Barkley tells you straight up that his review manual is all you need to study for the exam in terms of content, and he's right. The Fitzgerald manual is great, but has way more than you need and lots of sections that send you online to review additional content. ExamEdge Practice tests for AANP Reviews on this site are mixed for them, but I found them to be pretty useful even if they're not perfect. Take the tests on explanation mode to get rationales. This also helps you just bypass the theory and medicare/caid questions that trickle into the practice tests, and are not on the AANP. When I first started doing these exams I was scoring in the low 60's, and by the end was getting low 70's to low 80's. They are the most affordable practice exams for the money, and are a great way to track your progress over time despite some dumb questions that aren't on the AANP (like rarely asking you drug dosages, insurance, billing, and theory). I bought a couple practice exams from APEA and Barkley, but don't really think they were worth it for the money. Take the AANP Practice Exam I know it's expensive at $50, but the questions on this are similar wording and structure to the real thing, and I had at least 4 questions from it that were word for word identical on the real thing. I actually took it twice, once at the beginning, and once at the end of my studies. I first scored a 64 back in August at the start of my last semester, and last week got an 87. Stay positive When you read this website and see lots of people saying they failed, it can freak you out, which can be a good thing if it motivates you to study, but too much stress is a bad thing. They are also a small minority of test takers. Remember, in 2013, 88% of people passed the AANP exam (some years over 90% pass). This isn't an exam that's out to screw with you. It's an honest exam. Yes there are questions that you will not know and be pretty clueless, but that's normal. As I went through the exam I marked on my scratch paper questions I was sure I got right, questions I had at least 50/50 chance, and questions I had no clue. When I submitted, I had a little over 100 questions I thought I knew, 35 questions I thought were 50/50, and about 15 I was clueless. You only need about 87 questions right to pass. When you are able to think of an answer before you have finished reading the question on a lot of the content, you're ready. Good luck to everyone that will be taking the test soon. If you have any questions about study materials or want more tips, please don't hesitate to ask here, or just PM. I am absolutely happy to answer and give back.
  16. So...you've decided to advance your education and obtain a masters degree in nursing (MSN) or a terminal doctoral degree. Which route will you travel? What is your ultimate goal? Where do you see your nursing career in 5 years, 10 years, 20 years? In this article, we will explore the four options for advanced practice careers. Nurse Practitioner (NP) According to the American Association of Nurse Practitioners, NPs are: "...clinicians that blend clinical expertise in diagnosing and treating health conditions with an added emphasis on disease prevention and health management, NPs bring a comprehensive perspective to health care." NPs fulfill many roles both in the hospital, in private practices, nursing homes, correctional institutions, home care and in management positions. NPs are sought after for their clinical expertise and ability to provide cost-effective medical care in our ever-changing world of nursing. They perform their duties professionally and compassionately. Outcomes from NP care are economical and have been proven to be on par with professional medical standards. Today, many NPs function as the primary gatekeeper to US medical care. Many patients have an NP as a primary care provider. The Advanced Practice forum has many threads and articles about NP practice, duties and responsibilities. We also have a Student NP forum where students can discuss issues about schools, classes, obtaining preceptors and the new-grad job market. Certified Registered Nurse Anesthetist (CRNA) Nurse anesthetists have been providing anesthesia care for more than 150 years. The certification CRNA was developed in 1956. From the American Association of Nurse Anesthetists: "CRNAs are anesthesia professionals who safely administer approximately 43 million anesthetics to patients each year in the United States, according to the American Association of Nurse Anesthetists (AANA) 2016 Practice Profile Survey." In the CRNA forum, discussions range from new grad job offers to practice pearls to how to develop an independent practice. We also have a very active student CRNA forum where members discuss shadowing experiences, interviews with schools, and the life of a SRNA. Frequent discussions focus on how to blend the student role with the practicing CRNA role. The military has long used CRNAs in field hospitals on battlefields on the front lines. CRNAs first provided care to wounded in the Civil War. Nowadays, the military continues to utilize CRNAs in active duty environments as well as the Veterans Administration facilities. Cost-containment is another aspect of nursing care where CRNAs excel. They provide high-quality anesthesia care in an efficient manner with reduced expenses to patients and insurance companies. This makes this career choice very lucrative. Clinical Nurse Specialist (CNS) The National Association of Clinical Nurse Specialists says that CNS's are expert clinicians who care for a specific population. In most states they are recognized as APRNs and able to examine, diagnose, and treat patients as well as to bill for this care. They function in a wide variety of settings including hospital, clinics, nursing homes, home care, and hospices. There are a myriad of roles for the CNS and depending on the facility, the CNS might be a change agent, educator, manager, or provide bedside APRN care. Certified Nurse Midwives (CNM) The American College of Nurse Midwives is the organization devoted to supporting and providing cutting-edge information to CNMs. For many women in the US, CNM care is the routine for their pregnancy. These nurses care for the pregnant woman and child during pregnancy and labor. They have a much lower rate of operative births. And the rate of labor interventions is often less also with CNM care.
  17. DidiRN

    What is a Nurse Practitioner?

    Nurse Practitioners (NP) are registered nurses (RN) with graduate level degrees and are considered advanced practice nurses. They are able to provide health care services to patients in a variety of different settings. Some responsibilities include: assessing, diagnosing, and managing acute and chronic conditions. They are also responsible for prescribing medications as needed as well as health promotion and disease management. Salary Salaries vary quite a bit from state and specialty. NPs who specialize in acute care or work with surgeons can usually command a higher salary than ones who work in a family practice office. The mean salary according to the Bureau of Labor Statistics in May 2012 is $91,450/year. It is important for new NPs to understand the negotiating process during the interview and hiring process. Not only is salary negotiable but benefits, loans repayments, vacations and bonuses can be negotiated as well. Knowing how much revenue you bring to the practice can help serve as a point of reference if this is possible to discover this ahead of time. Many websites can give tips on how to negotiate as well as local salary information. Educational Requirements The minimum educational requirements for an NP is a masters in science of nursing. Some programs require some RN experience while others do not. Some colleges offer a route for individuals without a nursing degree; they are generally known as direct entry programs. These types of programs usually require a bachelor's degree in another field as a prerequisite for admission. The American Association of Colleges of Nursing (AACN) recommends (not requires) a minimum of a doctor of nursing practice (DNP) by 2015. However many colleges and universities are moving forward with the DNP requirement and no longer offer the MSN approach. These typically take three to four years to complete, while the MSN requires 2 years of study for individuals who already are RNs. There are different types of specializations for the NP which include: family nurse practitioner, adult geriatric nurse practitioner, acute care nurse practitioner, pediatric nurse practitioner, psychiatric-mental health nurse practitioner, neonatal nurse practitioner and women's health nurse practitioner. A few programs offer dual degrees such as Vanderbilt University's dual Family Nurse Practitioner/Adult Gerontological Nursing with an Emergency Care focus or Case Western Reserve's Adult-Gerontology Acute Care NP with a focus on Flight Nursing, Cardiovascular Nursing and Oncology/Palliative Care NP focus. Certification is required in order for NPs to practice is most states. The American Academy of Nurse Practitioner (AANP) is one organization that offers a certification exam. The American Nurses Credentialing Center (ANCC), which is affiliated with the American Nurses Association, also offers a certification exam. There are only small differences between the two. For example, the ANCC allows NPs to earn CEU's by precepting NP students. The AANP exam can actually be taken prior to graduation. Most NP positions require one certification or the other; a few organizations may prefer to hire NPs with a specific certification. It is imperative that each NP know and understand the requirements of their practicing state. Almost all states require certification from either AANP or ANCC before a license is issued. Prescriptive authority are requirements that must be met in order to legally prescribe medications. To prescribe controlled substances, NPs must apply for a DEA (Drug Enforcement Agency) number. This number is also used to track the number of controlled substances the NP may write as well as for identification purposes by the DEA. Most states require a NP to have a current collaboration agreement with a physician. These are written agreements in which the physician agrees to oversee a NP's practice. The requirements of these agreements vary from state to state. Some may only require physician agreement in order to prescribe medications only while others may require it for the NP to a diagnose and treat. Some may require the agreement to include written treatment protocols, periodic physician review of the NPs charts, patient referral and consultation, or resolutions of disagreements between the NP and the physician. States where this agreement is not required are considered independent practice states. Work Environment NP's work in many areas within health care organizations such as hospitals, mental health facilities, community health centers, physician offices, long term care, urgent care, and hospice. New areas are opening up such as telehealth and home health. In independent practice states, NP's can even open their own clinics and treat patients. Duties / Responsibilities Diagnosis and manage patient all types of health conditions Detailed physical examinations (history and physicals) Orders diagnostic and/or laboratory tests and interprets results Orders treatments and monitors effectiveness Collaborates with other members of the health care team Performs procedures dependent on area of specialization Patient and family education and counseling on health conditions Projected Vacancies The Bureau of Labor Statistics (BLS) does not differentiate between projected vacancies for nurse practitioners and registered nurses. Many do foresee an explosion of opportunities in many areas of the US due to the current health care climate and shortage of primary health care providers. There may be areas that have few opportunities while others areas may have a high demand. Understanding the Practice Doctorate in Nursing [video=youtube_share;k1ULRWGVeog] Resources The American Association of Nurse Practitioners Medline Plus article on NPs National Association for Pediatric Nurse Practitioners FAQ About Psychiatric Mental Health Nurses from the American Psychiatric Nurses Assoc. ANCC Certifications AANP APRN Prescribing Law - State by State (MEDSCAPE 2018) Bureau of Labor Statistics NP Occupational Employment and Wages (5/2012)
  18. Michael M. Heuninckx

    9 Tips For Surviving Nurse Practitioner School

    1. My go-to apps UpToDate- I live in UpToDate. Any question I have, UpToDate is my go-to resource for the most current information and guidelines. Everything can be found there, in one, easy to use place. Also, if you are researching a possible diagnosis, it also offers you a list of differential diagnoses that can help aid in your clinical decision process. The best part is, this is a resource that should be free through your university or workplace. Check first before you buy a subscription. Medscape- I use the Medscape app mostly when I am looking up medication: indications, dosages, compatibility and side effects. The app also offers current news in healthcare, a calculator for medical formulas and is a reference for medical conditions. GoodRx- GoodRx is a unique tool allowing you to search for medication costs at multiple local pharmacies. A good habit to get into is to see how much you will be costing your patients and the overall healthcare system. Also, you will be surprised how many first-line medications are available to treat the same condition, but one could cost a lot more than the other. 2. Find a solid group of NP student colleagues Much like nursing school, in a nurse practitioner program, you will develop friendships that will last a lifetime. This will be the group that you study with, look forward to seeing in class, send out friendly reminders to, bounce ideas off of, work together in group projects, vent your frustrations, and have your back when you are in a pinch or when you need a place to sleep and take a quiz that is due at midnight because your power is out 3. Take A Vacation To be able to do this, first, know the calendar of the University you are attending. Find the dates of when one semester is ending and another is beginning. This is the time when it is the safest to travel. Also, it will give you something to focus on and look forward to when the semester is becoming unbearable. 4. Don't get behind in logging your clinical hours As much as this is "busy" work, it really is important that you do not fall behind in logging your hours for two reasons. First, once you get behind, forget it. You will only continue to get further behind and you will be spending countless hours trying to log them all in one sitting. Second, take the time to turn logging your hours into a learning experience. Use this time to fully understand billing and diagnosis codes, what they mean and when it is appropriate to use which one. Doing the leg work now will only help you down the road. 5. Make an appointment with the writing center A resource that is frequently underutilized is your University's writing center. I learned this lesson very early as an undergraduate student. In one or two appointments, my grade could go from a B to an A. Also, they are APA wizards, something that will help keep you from losing easy points. 6. Be on top of your schedule Your schedule is everything. This takes time, strategy, organization and double checking your work. Do not forget to place all quizzes and assignment due dates in your schedule as well. Classes are not designed with a ton of points to fall back on and if you forget to take a quiz or turn in an assignment, you can forget the entire semester. You will not pass the class if you forget to do one of the above and in graduate school, there are no redos. As a soon to be NP, it will be expected that you will be able to manage and handle your schedule with no excuses. 7. Eat right and exercise Nurse practitioner school is no excuse to let yourself go in the diet and exercise department. Your body will need the fuel to make it through the program. Eating fast food/highly processed foods will only make you feel worse and slow you down. Also, taking the time to get in your exercise will help you clear your head and relieve some stress. 8. Find your clinical sites yesterday Not all NP programs find clinical sites for you. If your school requires you to find your sites, do this ASAP. This is something that you think you might be able to do last minute, but this process can be like a full-time job. It would be terrible to get this far in the program and not be able to move forward because you do not have a clinical site. 9. Get involved with Nurse Practitioner professional organizations Meeting nursing colleagues that are currently practicing and who were once in your shoes is very comforting and exciting at the same time. You will meet people who you currently look up to and will be one day. Also, you will be able to gain knowledge from experienced practitioners about their current practice and what lessons they have learned that will prevent you from making the same mistakes. Only one semester left! Good luck to all of my soon to be Nurse Practitioner friends! Michael M. Heuninckx RN-BSN If you like this article then you might want to check out Michael's new book for nurses... Code Blue! Now What? Learn What To Do When Your Patients Need You The Most!
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