Hello all,

I am a newly graduated Adult ARNP and have just started a job with a hospitalist program with 7 MDs and now 2 ARNPs. I have 12 years of experience as a nurse in CV medicine and the hospitalist will be running a Chest Pain Center and will be using me extensivly there. They are also going to utilize me for new H&P admits, post op consults, and then fu with previously seen pts on my list until discharge. I am really enjoying the new practice and they have plans to teach me how to do procedures; chest tubes, central lines, intubation, art-lines, pericentesis, etc.

I just wanted to see how others run their hospital based practice and get some opinions. I enjoyed the article in the Sept addition but wish it had some other comparisons in practice.

David

I work in a hospitalist program currently staffed with 3 M.D. hospitalists and 3 N.P.'s.  We work 7 on/7 off and rotate the night rotation (1 week out of 6).  We also have one internist and one family practice M.D. joining us weekly, who only work day shift.  Each provider, including the N.P.'s, has his/her own caseload they follow throughout the hospitalization, and we share admissions/consults as we get them.  We (meaning N.P.'s) have the same number of patients as each M.D. on the team.  We are treated no differently but have the benefit of a back-up M.D. should questions/problems arise.

David,

Sounds like a great role David.  I have been a part of a Hospitalist group for the last 2 years.  I was the first NP hired by the group.  I am an ACNP-BS.  Sounds like your group must also do a lot of critical care type rounds as well.  My group turns over all patients in the ICU setting to the critical/pulm MD group.  So, I occassionally see patients there if they are "overflow" from a bed crunch stand point.  I admit, round and discharge patients for our group.  I see patients in the intermediate and Neuro special care unit (Neuro ICU but no vents).  I see between 7-10 patients per day depending on admissions, discharges and critically ill patients I have been following. 

 As far as procedures, I have done some splinting, suturing, art lines, LPs and joint taps.  But, unless it is a code or a rapid response, not much in the lines of Central lines or intubations.  Our service sees aprox 60-75 or 1/3 of the inpatients at the hospital.  We typically don't have a whole lot of time to "play" with procedures.  We will usually have Interventional radiology complete it.  

A great resource is the SHM.  (Society of Hospitalist Medicine)  They have a good selection of resources for NPP or what they refer to as non physician providers.  I belong to the organization, have been to several chapter and regional seminars.  Most of the semiars and conferences are very well put together.  They bring to gether current trends, evidence and new guidelines for treatments.  They are also setting new best practices for several disease processes.  The SHM did a podcast a year or so ago talking about using NPP in a Hospitalist practice.  Not a bad idea.  Several articles were also placed in the Hospitals Journal the last few months.  I don't remember which ones, I will have to look.

What state are you practicing in?  A couple things about billing, Consults are a little tricky.  If a provider is asking for a consult of an Hospitalist or Internal Medicine MD, but, you are the one consulting, the legality as described by our coder is that it is our expert opinion and the MD is not allowed to bill as a shared visit.  If your hospital and provider group is "ok" with this, no big deal. 

If you have any other questions, would be glad to hear from you.  My work email is Jkobernusz@meriter.com.