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Tips for New Nurse Practitioners

Monday February 7, 2000
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As a new graduate from nurse practitioner (NP) school, I was thrilled to be free from the daily grind of writing papers, studying for exams, and completing clinicals. Little did I know that the work was only beginning.
Beginning a career as an NP is an extension of your many years as a nurse, regardless of what setting you worked in. You must, however, keep certain topics in mind. These include -
· medicare, medical assistance, and DEA numbers
· collaborative agreements
· your role as a team member
· resources
· marketing yourself
· your financial worth
· being a mentor
· NP organizations
Medicare/Medical Assistance Billing Numbers. Apply for these numbers as soon as you begin your position. Ask if someone in the billing department will assist you in completing the appropriate forms. Also file for your state and then federal DEA numbers.
Collaborative Agreements. Not all states require collaborative agreements. Call your state board of nursing to determine what is required to practice as an NP. In Maryland, the state board of nursing provides information explaining what is required in the agreement.
Role as a Team Member. You are still a nurse, and therefore able to perform nursing functions. You need to evaluate your role as a leader and as a team member, providing advanced practice knowledge, along with basic nursing care and skills. If a patient needs to use the bedpan during an examination, there really isn't any reason why you can't assist that patient. By assisting the patient, you will encourage the staff to look at you in your expanded position, while viewing you as a team player.
Resources. Become familiar with the resources available to you. Clinical nurse specialists (in wound care, infection control, and psychiatry, for example), physicians, pharmacists, dietitians, and billing associates enable you to provide the highest level of care to your patients. Medical supply and pharmaceutical companies frequently provide free samples and educational materials to distribute to your patients.
Marketing Yourself. Know what your role is as an NP, and be prepared to explain it to patients, insurance personnel, physicians, and other medical staff members. Be familiar with the scope of your practice.
With a new physician, you may need to call and review even minor findings until he or she is comfortable with your level of expertise. Over time this same physician will come to acknowledge and appreciate the high level of care you provide. There may be, however, those physicians who choose not to work with an NP. Do not take it personally or feel that it is the result of something that you have done.
Make sure your curriculum vitae (CV) is complete, including clinical experiences obtained in your NP program. Have a professional review your CV.
Financial Worth. Each day, I record the name, diagnosis, and billing code for each patient I evaluate. The billing representative at my hospital helps me to determine a dollar amount for each specific code. It is imperative that you know the appropriate documentation needed for each billing code. This information enables me to monitor the numbers of patients and dollars generated over the course of the year. You can use this information to show how much revenue you can generate for a practice.
Remember that Medicare reimbursement for a nurse practitioner is 85% of the physician fee. In Maryland, private insurers bill under the physician's name and do not issue nurse practitioner numbers. Familiarize yourself with the insurers in your state.
When asking for a raise or estimating a desired salary for a new position, you must take into account your benefits, which include continuing education (CE) reimbursement, sick and vacation time, licensure fees, and malpractice and life insurance.
Being a Mentor. You probably have had a mentor in the past. Now it's your turn to be a mentor to another nurse or nursing student. For our profession to continue succeeding, we must help each other attain the highest potential.
NP Organizations. Participating in local, state, and national organizations is an excellent way to network with other NPs, obtain CE credits, become more familiar with legislative issues relating to NPs, and find out about job opportunities. We must be proactive about our profession and take nothing for granted.