How my master’s program is going


Photo taken from here.

I have a 4.0 still.  I just started my 4th class, Issues in Advanced Practice.  It’s a class on the politics of health care as they affect patients and nurse practitioners. This is a dangerous class for me; I’ve been one who tries very hard to walk the walk on those issues I feel strongly about.  I am not perfect, of course, but I try unbelievably hard.  So hard, in fact, that I had a meltdown of sorts due to the difference between what I was doing, what I was seeing, and what I know is right.  So how is it dangerous?  Well, I have tried very hard to just walk away from politics, from engaging in activities that frustrate me, and cause emotional distress.  This class is bound to require me to engage in all three.

Already I have learned that, even though I have no desire to get my doctorate, that it will probably be necessary in the near future due to the simple fact that I may not be able to be paid unless I have one.  I have learned that I really hate nursing research, and simply cannot overcome my disdain for qualitative research in the nursing arena – there’s a lot of money being wasted on research that applies to no one but the group studied.  I have learned that because American medicine/nursing is completely profit driven, there’s very little research being done here because it’s viewed as a waste of time.  I’ve learned that doctors feel that nurse practitioners with no actual experience in nursing make much better primary care providers because they follow the medical model better (this is based on one study, so it may not be applicable everywhere but I found it fascinating none the less).  The irony in that study does not escape me…if I wanted to be a doctor, I would have kept on my path 20 years ago when I was a student at the University of Arizona. The fact that I want to be able to provide care to my community does not mean I want to be a doctor.  It means I want to provide what doctors don’t want to, haven’t been trained to, and can’t.

I’ve learned that, while doctors are running from primary care/family practice in droves, nurse practitioners are setting up in that same area in droves.  Which totally threatens doctors, according to the AMA.  So they are lobbying hard to take away prescribing privileges, denigrating the care nurse practitioners provide, and working with officials at Medicare to eliminate reimbursement or recognition for nurse practitioners.  In some ways they have been very successful – a nurse practitioner can no longer write home care orders.  Plus, while here in Arizona a nurse practitioner *can* get privileges at hospitals, I am unaware of any who have been granted them.  So if an NP’s patient goes into the hospital, he/she is unable to see them while they are there, and the follow up will most likely be with the hospitalist or specialist who sees that patient while they are in the hospital. Which further fragments care.

I’ve learned that only about half of all insurance companies even offer recognition and reimbursement for nurse practitioners, and that many insurance company administrators don’t even understand what a nurse practitioner IS.  I’ve learned that when reimbursement *is* given, it’s at a rate that is about 57% of what a primary care doctor is given, even though the care is the same.

I’ve learned that if an NP counsels a patient for emotional or psychological issues, that is not reimbursable (which is why so many people are on psych meds – doctors don’t get reimbursed for that either, so they just write a script to make the person go away).

That’s what I’ve learned so far.  Oh, and how to make movies with Xtranormal, which is really fun and much more engaging than yet ANOTHER PowerPoint presentation.

Garden in shambles still, no time thanks to my (thankfully) just completed nursing research class. I’m hoping to get out there this week.  New chicks in the coop, two blonde bombshell Buff Orpington beauties, and two scrappy Rhode Island Reds.  That’s it for now, hope your gardens are going better!