Ntry to Practice Analysis for the Family Nurse Practitioner

Guidelines: Entry to Practice Analysis N5660, Summer, 2010

Maximum pages permitted 20. All papers are to be submitted in Microsoft Word format.
The preparation of this paper will provide the student with the opportunity to carefully analyze numerous aspects of her or his anticipated work setting as a certified nurse practitioner. The content is to reflect the students careful thinking and reflection upon researched information. The student is to address the issues identified below from the perspective of the anticipated work setting or the work setting desired as a certified nurse practitioner.

Working arrangements are typically one of the following:
The nurse practitioner will work as a/an -
Employee of a hospital, clinic, or multi-physician group practice or HMO
Solo practitioner
Employee of one physician
Partner with one or more physicians and/or nurse practitioners

I based my information on the clinic where I am completing my clinical hours because it is in my opinion, the ideal set up for a rural health practice and the providers are stellar. Beside each question, I provided some information specific to the clinic or my situation or feelings. There is much more to each question than what I have provided, and needs to come from research on the topic. Some of the information I provided might not really pertain specifically to the question, but serves as insight. One resource that must be utilized for this assignment is information in the book Nurse Practitioneras Business Practice and Legal Guide by Carolyn Buppert3rd or 4th ed. This practice will be in Texas so the professional associations specific to Texas need to be addressed such as The Texas Board of Nurse Examiners ( there are bylaws and information specific to the Advanced Practice Nurse. a Remember this is not an assignment for a Registered Nurse entering the nursing profession a it is for a Family Nurse Practitioner, which is an Advanced Practice Nurse. The American Academy of Nurse Practitioners is probably a good resource, as well. I put that it should have 10 resources but thereas not a specified #. The book must be used, other than that, however many it takes, but not fewer than 5. The 20 page limit does not include the reference page/pages. It does not have to be 20 pages long. I need to be able to go directly to the references cited. APA 6th ed. The references should not be greater than 7 yrs old, preferably 5 or newer.

1. In addition to identifying which of the above working arrangements reflects the anticipated (or desired) working arrangement, describe the practice: location, description of the community or practice, e.g., rural, urban (size), private practice, health department, etc., population(s) served, current or projected personnel, resources available, and physical site. (5 points) I choose the setting of a rural clinic with multiple physicians, located in a rural medically underserved area a the clinic is part of the same system as the hospital, but is not the hospital a the clinic shares the same tax ID# as the hospital. It is a Provider based health clinic ( family practice ) The clinic is government funded. Falls under health provider shortage and medically underserved umbrella a can use one or both depending on the need, so thatas an advantage. It would be a small community, < 20,000 people but would probably serve more than one county. The type of small town where everyone knows one another. Each provider has a LVN. The clinic has a clinic manager to act as liason between clinic and hospital CEO, intake coordinator, staff for scheduling, billing, referrals ( probably more but itas a start ). 2. Analyze the pros and cons of working in the identified arrangement. (10 points) Prossome pros would be a The provider would get to really know their patients and the circumstances in the patientas life and this would help the provider administer the best care for the individual patient. Itas a small place so the provider would know the available resources and would more than likely know the people who have access to the resources. The clinic brings in outside specialists at various times each month so that the patient doesnat always have to travel to see a specialist a also, this allows for greater continuity of care, if the provider is able to refer to a specialist coming to the clinic. Cons a some cons would be a Not everyone prefers to live in a medically underserved rural area, so location could be a con. High level services/procedures would be limited a although the providers at the clinic where I precept do many procedures. They are highly skilled. You have to be a jack of all trades if you want to practice in a rural setting. You never know whatas coming through the door and you have to be able to treat , stabilize, or treat until you can refer. There arenat as many positions available to practitioners wanting to practice in rural communities. The pay scale is usually a bit lower, but the cost of living is usually a bit lower, as well. 3. Discuss the essential elements of your Employment contractwith your anticipated employer. (If you choose Solo practitioner", discuss the legal issues you must establish prior to starting such a practice). (5 points) This isnat solo practice. I would have a specific physician to collaborate with, and this physician would have to sign off on 10% of my patient charts every month. The clinic pays the supervising physician a separate salary for this service. I would expect the beginning salary to be in the low $90,000as. Salary divided by 2080 # of hours the yearly wage is figured on. There would also be an incentive bonus plan a a threshold is set and the practitioner receives a specified dollar amount for every patient above the threshold. However, I have noticed that some practitioners have a higher bonus than others because they choose not to do procedures that take a lot of time. The practitioner can see 3 or 4 patients in the amount of time required to perform a procedure. I will provide care according to my patientas needs and this could actually kick me in the teeth for a job well done. So, there needs to be some sort of a plan in place to compensate for this. 4. Describe the financial basis of the practice: Sources of funding. Include types of payment e.g. third-party payers (Medicare, Medicaid, and/or private insurance), capitated payments, fee for service, sliding scale, etc., and sources of expensesa . State amount you expect to be paid annually for your services. (10 points) The clinic is government funded. There is a large Medicaid and Medicare population. Private pay and self pay, but no capitated payments or sliding scale. 5. Develop a financial plan to identify a Break even pointa i.e. determine the number of individuals and the nature of their varied payer sources that you must see in one day to cover your salary for that day. (10 points) I know that reimbursement in this setting is $300 per Medicaid & $180 per Medicare service or patient ( which one ?) because of the medically underserved rural area. Have to be aware of what procedures/services cost. If itas going to cost a lot more than what the clinic will be reimbursed, refer to outpatient. 6. Illustrate the collaborative arrangements that are (or will be) necessary to implement the practice. Note: Collaborative arrangementsmeans formal and/or informal a required by law and those that are important in terms of ones practice, but not necessarily required by law. For example, in Texas, the law requires the nurse practitioner to have a formal collaborative relationship with a physician (MD or DO). This is not true in New Mexico. Should one have a collaborative relationship with a physician ONLY when mandated by state law? Dont forget, also, that collaborative arrangements may include those that provide lab, x-ray, and other services. (10 points) Does not have in house radiologist and canat do complicate