Why bother?

Specialties NP

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I have been a NP for over 10 years and am ready to throw in the towel. THe frustration and anger I feel cannot be expressed.

Over the last few years I have seen increasing numbers of physicians hiring RNs to help with their practice.

Theses nurses are functioning as physician extenders and perform all of the functions that a PA or NP would normally perform.

THey are able to do this because the MDs cover and sign for them. Yes the nurses are practicing outside their scope of practice. No one seems to care about the legality, much less the moral or ethical issues. THe physician is the big winner here. He can bill for his services on a daily basis in the office or hospital and then have his nurse provide the service.

He can then pay the nurse a fraction of what he would have to pay a NP. Imagine going to the hospital and seeing the MDs nurse for your initial encounter, who then performs your history and physical exam, writes all admitting orders, including medications and diagnostic studies. THen when you get the bill, it is for the MDs service ! This way he is able to get much more done in a day and continue to make money.

I think the bottom line is $$$$$ and that the future for those considering going back to school for an advanced practice role is in serious jeopardy.

Olympiad,

In response to your question I think you will see this practice mainly with surgeons, as they are paid per procedure and do not bill for daily visits. If they did bill for daily visits and the RN saw the patient without the MD ever laying eyes on the patient, that is fraud. (Surgeons do see the patient at least once......) However, some docs try and get by this by having the RN write the note and he co-signs. Many months later if the chart is audited he can say that he indeed saw the patient because he co-signed her note and then it becomes a case of his word against yours (or whoever tried to blow the whistle..)

WHy are so many docs getting away with this? Not sure, maybe Medicare/Medicaid systems already overloaded with not enough money to go after MD's who have much more money to fight with?? Maybe patients who dont know better are not complaining?? Maybe too many people saying this is the way its always been and it's just too big a problem to tackle???

If they paid you to blow the whistle on these docs would you do it??

Lalaxton,

No I would not blow the whistle on anyone for money. I am considering reporting them if I can be assured anonymity because it is ethically and legally wrong for patients to recieve care from a nurse and be billed a physician fee, for the medical plan of care to be made by a nurse, and for nurses without prescriptive authority to be ordering medicines and tests. It is ironic that physicians have tried for years to prevent APNs from having access to becoming providers of care, having prescriptive authority, and reimbursement priviledges arguing that we are less trained, educated and provide lower quality of care. But when it comes to saving them a few $$$ they are more than willing to hire a RN for half the salary, much less education and allow them to practice as an APN. Just goes to show you that for many of them quality of care is just lip service.

Olympiad,

I agree, sad isn't it?

I could not agree with you more. From my point of veiw (RN) advanced degrees mean a lot more work for the SAME amount of money. Check it out, I have worked side by side with Nurse Practitioners and PA's for years for the SAME amount of money. They work twice as hard, have lots higher insurance, make the same. Go figure. Sorry, bad for them good for us. It is great being an RN in this day and time.

;) Texman,

Well I will have to say that I and all of the NPs and PAs I know make at least twice the salary that those RNs are making, and no we don't work horrendous hours, I never work more than 40-42 and if I do I take pay back time. None of us work evenings or nights or weekend. Some do come in for an on call weekend every 4-5 weeks. So I guess there is some reason to feel we are recognized for our worth. It's too bad though that those RNs don't see how they are being used to further the MDs salary yet not being paid to do the work!

Okay, reading this discussion really makes me lean toward the CRNA thing. It sort of confirms some suspicions I have had about the profession. Additionally, I have seen more and more ads cropping up that want a "physician extender". I see this may be a way around hiring np's who may be threatening the $$ from GNP's practices. Unless the nursing lobby/unions start to crack down on this issue, both the NP's and the patients will be the ones that loose. However, I would not put my money on the nursing group. Although they make up the largest group of healthcare professionals, they haven't ever seemed to be able to make many political gains in their favor. Indeed this is frustrating. Now they are being walked on again, surprise, surprise.

I had been considering the accelerated entry to nursing program, but over the last few months had decided it wasn't for me.

The fact that I was just unsure about nursing as a whole and also the facts that you have all given here only supported my decision against it.

Anyway, my question is this:

I am wondering about a possible case of fraud.

I know someone who went to a dermatologist for laser hair removal. The first visit was a consultation(about 10 min) with the doc and on that day the nurse (LPN) performed the surgery.

They said it would take about 4-5 visits for total removal.

The following visit, the doctor was not seen and the LPN performed the surgery again.

Now is this fraud because the patient did not see the Doc, yet was billed $400 for a 15 min procedure, insurance clearly not covering it???

Please give me your thoughts.

Thanks

Greetings all!

Just to add in, on the topic.

How would you feel about a NON-NURSE writing meds, giving test results, and even going as far as perscribing... yes, perscribing meds for abnormal tests (exp... hyperlipidemia) per a formulary by the MD.

I work with one of the most brilliant MD's I've come accross, and while I would really like to terminate him on some days, and most all other MD's EVERY day; when I arrived, MEDICAL ASSISTANTS were doing just this.

Needless to say, it doesn't happen anymore, but it WAS happening, and this brilliant MD was in favor of it.

-David Adams, ACNP, FNP

P.S. Who thinks Lipitor 10mg +PO Qd is adquate for >600 cholestrol? I actually, during chart review found this was perscribed!

Wouldn't that be passing these people off as NP's?. I worked for a cardiologist as a nurse clinician. I made rounds for her but the hospital didn't let me make notes for her just to sign. I was not at that level and never intended to be. I am in the process right now going back to grad school to get into acute care. I will say something though and I don't mean for this to bed critical. Who is making the choices for people right now? How come states will require a doctorate degree in the near future to work as a NP when they are getting paid less than what nurses make in hospitals? Isn't it time for the ANA to start standing up for nurses and nurses wages out there?

But in the long run I will tell you something. I don't know how old people are out there but when you are turning 58 and there aren't jobs to be had anymore for RN's because they are too old to work at the bedside, it takes too long to get their degree to teach and everyone working in a doctors office are MA's it gives one a time to pause. Why can't NP's go it alone and be hired on contract and not be hired by MD's? Why aren't hospitals paying them more money than their regular nurses?

Beth

I have been a NP for over 10 years and am ready to throw in the towel. THe frustration and anger I feel cannot be expressed.

Over the last few years I have seen increasing numbers of physicians hiring RNs to help with their practice.

Theses nurses are functioning as physician extenders and perform all of the functions that a PA or NP would normally perform.

THey are able to do this because the MDs cover and sign for them. Yes the nurses are practicing outside their scope of practice. No one seems to care about the legality, much less the moral or ethical issues. THe physician is the big winner here. He can bill for his services on a daily basis in the office or hospital and then have his nurse provide the service.

He can then pay the nurse a fraction of what he would have to pay a NP. Imagine going to the hospital and seeing the MDs nurse for your initial encounter, who then performs your history and physical exam, writes all admitting orders, including medications and diagnostic studies. THen when you get the bill, it is for the MDs service ! This way he is able to get much more done in a day and continue to make money.

I think the bottom line is $$$$$ and that the future for those considering going back to school for an advanced practice role is in serious jeopardy.

Where are you practicing?

Specializes in Nephrology, Cardiology, ER, ICU.

This post is 7 years old - the practice act may have changed now.

Hi,

I am sorry that I didn't know that this posting was so old.

Thank you,

Beth

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