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Everything posted by EMNP

  1. Good morning everyone- I will be starting to precept a new NP student, I work Internal Medicine, this is first rotation for the student as well as me. For those who have experience precepting students, what is your approach to make the best experience both for me and the student? What is the best approach to prevent getting behind and overwhelmed? What do you usually do on the first day and thereafter (other days)? Thanks in a lot for your support.
  2. Good morning- I started working at an IM outpatient place a few months ago 2-3 times a week. All my previous hx is inpatient. Things in general are going great, the only issue is my charting. I find myself charting at home sometimes because I have a hard time structuring patient time when going into the room. Acute visits are pretty good, the issue is with follow ups as patients talk about many other things and drift off a lot from the pertinent things we are following up.. It is difficult to chart some in the room due to the same issue. I don't want to come off as rude, so I need some help. As my number of patients keeps increasing, I keep finding this more difficult at times. I am seeing around 20-22 patients a day, but at times it can be around 25. 1- What is the average time you spend with a follow up patient? DM/HTN/Hyperlipidemia, etc.. 2- What is your routine when you go into the room. 3- What is the average time you spend in the room for an acute vs a follow up visit? 4- What techniques do you have/use to keep patients on topic and have the pertinent conversation/exam and then get out of the room? Any other advice/input is greatly appreciated.
  3. I just started an outpatient IM gig; have been there for a month; it’s part time. All of my career had been inpatient, so transitioning to this has been a learning curve in regards to patient flow and timing; very different than inpatient. i have been there a month and currently am seeing 14 patients, it’s been slowly moving up since 10 when I started. I am sure the increase will continue and this is where I need your help: I get a mix of everything, physicals, AWVs, follow ups, new patients, Acute visits. My biggest issue is keeping the appointment focused to the CC/reason as patients like to wonder into other things or simply start taking about other things. I feel bad cutting them off; not sure what approach to use in regards to this as I don’t want patients complaining because of this. I feel that if I can keep them focused into their reason for the appointment this can make a huge difference with my documenting. How do you guys approach this? i have tried to do some charting in the room, but I feel uncomfortable as I feel the patient may feel ignored, how do you guys do this? How long do your usual/average yearly physicals, AWVs and follow ups take? What is an appropriate number of patients for me to see in an outpatient IM practice? I work 8 hr days twice a week; I am the only other provider apart from him. Thanks in advance!
  4. Hello everyone! Just started an outpatient IM PT job where DrChrono is what we use for charting; never used this program before. Any one have experience with this and had tips/tricks on how to move faster through charting to balance time between documenting and patient? Any input is greatly appreciated!
  5. First of all I want to thank you all for the numerous times you guys have offered insight and advice to my questions; thank you for that. I am asking the following question for a friend whom is feeling pretty “shi**y” to say it in an honest way. He completed a Nurse Practitioner program back in 2016 and started working right after as a hospice NP with no other forms of experience. Because of all these pandemic he has been dealing with a lot of end of life issues and it’s gotten to a point where he says it’s affecting him emotionally. He wants to start looking for new opportunities doing “real medicine/management” like he said but feels that because his only experience has been in hospice he will have a difficult time being considered for family practice, internal medicine, ER/UC, or hospital medicine. His second concern is that he feels “everything” that he learned he forgot because he has just been focusing on hospice care. This situation has him all bummed out and feeling hopeless and asked me for advice. I honestly felt that I had no good advice/guidance and asked him if he was ok exposing his situation here and go from here. what do you guys he should do to regain some Confidence in his knowledge given his background? Should he study any specific books, online review? What would be the best approach from your experience and perspective? Thanks in advance and wishing you all a good new year!
  6. I am in California, Central area and is internal medicine (outpatient). The dollar amount I said is just figurative with the range of $20, example $20-40. Let’s change this number to 50-70 and me currently making 55 as an example. Sent from my iPhone using Tapatalk
  7. Hi everyone- I need your advice/perspective. I received a call today for a job I had applied for and the physician is offering the position. We talked about a few things briefly over the phone and conversation came about salary. He mentioned that he was looking to pay $20-$40 per hour (just using numbers, not actual pay lol ). On the original job position it said 10-40 per hour. He asked how much I was making at my current hourly pay and I mentioned $25 and that was that and continued staring to talk about other things. He then asked when I would be able to start etc and how him and his team were looking forward to my addition. He said that they interviewed several candidates but that I really stood out. He said they were going to start working at n a contract and he would then send it to me and see what I thought about it. I am going to email him in the next two days to let him know of a couple things we talked about. These are my questions: Should I mention to him that I am looking to get paid between $30-$40 per hour or should I wait to see what the contract says? At my current job I am due for my annual review in the next couple days which will bring my salary up from what I told him, so Gould I mention in this email that I am looking to get paid in the 30-40 range as I will received an increase in my annual review? Or should I simply wait and see how much he offers in the contract and then mention if they can increase the hourly pay if it’s not what I am looking for? I also am bilingual (Spanish) and it would be a benefit for the practice. Thanks in advance for your advice! Sent from my iPhone using Tapatalk
  8. A friend of mine will be starting working for a general Surgery group, mostly following post surgical patients inpatient and outpatient; not first assist. His experience is 3 years of psych so a bootcamp like program or anything you guys may recommend could help him prep for this. Thanks for recommendations. Sent from my iPhone using Tapatalk
  9. Any of you have favorite apps/pocket books that you use in UC or EM that help you with a quick look/assurance with dosing, treatment guidelines etc. Thanks! Sent from my iPhone using Tapatalk
  10. Thank you for such insightful advice, I appreciate it. Sent from my iPhone using Tapatalk
  11. Hello everyone- How would you respond via email after an interview for X organization where a job was offered in Y specialty but you feel this specialty is not a good fit for you, but you love the organization and the APP director and CMO and you want to be considered for other positions within the organization? That’s the honest truth, I don’t feel this epically would be a good fit, but I would love to be considered for other positions within the organization. How would I word something like this to not burn Bridgestone keep doors open? I am just being honest and will email them in the next couple days. Thanks! Sent from my iPhone using Tapatalk
  12. Anyone? Sent from my iPhone using Tapatalk
  13. Bump.... Sent from my iPhone using Tapatalk
  14. Hi everyone, I was wondering if any of you would feel comfortable enough to share a template of your resume/cover letter. I feel like mine are very old and not up to date and just trying to obtain some ideas on how to best design/prepare and update my resume/cover letter. Some examples I have seen are colored as opposed to just black and white, some contain a personal picture. Thanks in advance, Sent from my iPhone using Tapatalk
  15. Do you guys have any recommendations on any emergency medicine books I can purchase to study? As mentioned in earlier posts; I am interested in working at an UC or ER. My background is inpatient cardiology and inpatient palliative medicine. Thanks in advance! Sent from my iPhone using Tapatalk
  16. Hello everyone- I am looking for some general advice on books/webinars that you guys have used to have better communication at the workplace with your managers. I feel that often times managers don’t look into who you really are and how hard you work and because of things like things we find roadblocks in opportunities to move up the ladder or get the highest raise, etc. I see that there is a lot of favoritism and some of these favoritism goes to people that simply know how to behave and what things to say as oppose to how hard they work. Are there any books on leadership or emotional intelligence that you guys recommend to better understand how to behave and move ahead in the workplace? How to be tactical I suppose? Thanks in advance! Sent from my iPhone using Tapatalk
  17. Have been an AAP for two years, working Inpatient Cardiology and Palliative Medicine. I would like to start working some urgent care, walk in clinics to start moving my career to other specialties. Any recommendation on which book(s) would be good to read/study before starting to apply to these kind of jobs? Thanks in advance! Sent from my iPhone using Tapatalk
  18. Hello everyone- Hope you all are doing well. Need your advise. I am 38 years old, have been an NP for two years exactly in October; completed a dual NP/PA program. Previous to becoming an NP; I was an ICU RN for 6 years. The big question is: Is it worth for me to go back and obtain my CRNA? The reason I didn’t do CRNA instead of NP was because at that time 1) finances didn’t permit it , 2) I wasn’t sure if I wanted to do it; I was 50/50 3) I knew I wanted to become an NP/PA because it’s a great profession. Why am I thinking about CRNA school? 1) I miss critical care and being in full control of your patient. 2) CRNAs have more respect and are treated much better than NPs/PAs, 3) The financial compensation is amazing! My wife will be completing her RN degree in May and we have some great savings in the bank that could allow me to go back to school as she could take over our bills. I have a 3 and a 9 year old. I currently make around $140K/year and we have some great savings in the bank, I would use around 50K of those savings to go towards CRNA school. Most programs are 3 year programs now, a few are still two. I would have to retake 2-3 classes and then apply. Given this information: Do you think it’s worth it and would you do it if you were in my situation? I would probably start the program at age 39 or 40 and be done by age 42-43. If I do it, i would be doing it for personal satisfaction, career advancement, opportunities and finances of course. What are your thoughts? Thanks! Eduardo Sent from my iPhone using Tapatalk
  19. I would have gone to Medical School or Engineering/Business field. Sent from my iPhone using Tapatalk
  20. Thanks for the reply! Ideally I would love to stay and if they could make an adjustment I am more than willing to stay. I guess I just want to know how to approach it without them feeling threatened, rather making them aware of that offer and my desire to stay. Sent from my iPhone using Tapatalk
  21. Hello everyone- As you may recall a few weeks ago I posted this question looking for some advice/guidance on how to request an increase in salary/compensation as part of my ability to see more patients, increase flow due to being bilingual. I was actually getting ready to go talk to my manager about it this week when I got a call from a recruiter on Friday asking me if I was interested in a position (same specialty I’m doing) at a hospital 45 minutes away. ( They dar my resume online). They are offering me $10 more per hour than what I make right now. I love the facility where I am at, love what I do, but this offer is very tempting. How can I make my manager/supervisor aware of this call from the recruiter and that offer they made me? The recruiter did mention that they are looking for someone bilingual and someone with the interests I have. I have a few projects that I am working on with my current job to make it better. What would be the right approach to my current facility to see if they can match or at least give a substantial increase compared to the new offer from the recruiter? Thanks in advance everyone. Sent from my iPhone using Tapatalk
  22. Anyone here at the AAPA Adult Hospital Medicine Boot Camp conference in Orlando? Let me know! Sent from my iPhone using Tapatalk
  23. Medic25, please do share the specifics of this as I want to start one for my hospital as well. Sent from my iPhone using Tapatalk
  24. Thanks for the reply and guidance; I highly appreciate it. I found out how much the interpreters that work for my hospital make per hour. They start at $17/hr for someone with 1 year experience. I have been an advanced clinical interpreter for my hospital district since I started working here 6 years ago; same certification these interpreters gave. I guess my approach should be that rather than waiting for an interpreter I can get to it and this will increase patient flow/productivity as well as better patient outcomes because of the one to one communication rather than using an interpreter. I am just somewhat nervous to approach my manager or director and really need your input to make it flow nicely and not mess it up lol. Thanks in advance again! Sent from my iPhone using Tapatalk
  25. I have been working for the same hospital and under the same manager for almost a year; first job after school. In short, I would like to be compensated extra on top of my base pay for being bilingual (Spanish) and using my language continuously when interacting with patients/families. I am certified as an advanced clinical interpreter through this same hospital; basically the same certification hired interpreters have. I could simply call an interpreter when dealing with this patient population and I have in the past, but I have found that the outcomes are better when I’m communicating with the patients directly than using an interpreter. I don’t mind doing this, I actually enjoy it, but I feel that I would like to be compensated for this some how. There is a form I can fill out every time I translate that states that for every 15 minutes of translation I will be compensated 50 cents; this is too much work as I have to include a summary of the interaction and patient information. I need assistance and advice on how to approach my manager or my managers director. Advice and guidance are highly appreciated. Thanks! Sent from my iPhone using Tapatalk
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