Where do I start?

When someone asks me "where do I start?", I tell them with your credentials. Now "credentials" are much more than the letters after your name. Although they help, you must put together a professional level marketing plan for yourself and your services. You should also be prepared to invest in yourself. I'll explain this in a few minutes.

Let's start with the basics, you need to be certified as a nurse practitioner. Your certification (family, adult, peds, acute care, etc) will dictate where you can practice. Many states are getting very strict on making sure you practice within the "scope of your training". As far as "which" certifying exam to sit for, it depends on which state you want to practice in. If you look at the license applications from the various states, you will see that some specify "certification from a nationally recognized body", some say "ANCC", and some say "AANP". Now if you are AANP and the application specifies ANCC, don't have a come apart. So far, every state I have applied to has accepted either certification. When I called the board of nursing, they informed me that the wording on the application "just hasn't been updated", they actually accept either certification. You will find a more familiarity with a specific certifying body geographically. For instance, if the certifying body's office is in Texas, guess which certification the Texas board of nursing and facilities in Texas are most familiar with?

Now that you are a NP, you need current American Heart BLS, ACLS, and PALS at a minimum. But wait, there are many online companies that provide these classes, so why am I pushing AHA? AHA is the "gold standard" and is universally accepted. The "online, no mega code" courses all have a disclaimer that if your facility does not accept their BLS, ACLS, PALS, etc they will refund your money. From personal experience, facilities require AHA courses. If you are going to spend the time and money for a class, you should at least invest in one that is universally accepted. Trust me, it will save you grief in the future.

If you are planning on working in a rural/remote area you will definitely need ATLS as well. Now ATLS is a creature in itself. Only within the past few years was the class open to anyone who wasn't a physician. The first ATLS class I took would not allow PAs to take the final test and practical exam. It is intimidating to be surrounded by physicians staring at you while you attempt to perform a pericardial centesis on a pigs beating heart. Especially when the instructor at your station is the head of trauma surgery at Tulane, but that is another blog in itself.

I also recommend the Fundamental Critical Care Support course put on by the Society of Critical Care Medicine. Now you are probably thinking that you are not an intensivist and what the hell do I need this course for? The reason you need it is because it is a course to help you identify and correct problems that may keep your patient from needing an intensivist. Taken from the FCCS web site (http://www.sccm.org/fccs_and_training_courses/fccs/pages/default.aspx) :

Course Purpose

• To better prepare the non-intensivist for the first 24 hours of management of the critically ill patient until transfer or appropriate critical care consultation can be arranged.
• To assist the non-intensivist in dealing with sudden deterioration of the critically ill patient.

• To prepare house staff for ICU coverage.
  
• To prepare nurses and other critical care practitioners to deal with acute deterioration in the critically ill patient.

This course connects so many dots that it will amaze you.

Do you remember when you were in your advance practice program and you had to keep up with those "procedure logs"? Well guess what kids, a current procedure log is required to get credentials and privileges at many facilities across the country. Most facilities I have dealt with require a procedure log for the past 2 years. These logs are also a requirement for re-credentialing as well. They don't have to be fancy, and many times if you work in a hospital your friends in HIM can print one out for you. Below is an example of a portion of my monthly procedure log for one of the facilities I work at as an ER provider:

CPT	Count	CPT Description
10060	24	I&D ABSCESS;
10061	49	I&D ABSCESS;
10120	1	INCS & REMOV FB
10140	1	I&D
11740	5	EVACUATION
12001	46	SIMPL REPR
12002	20	SIMPL REPR
12004	4	SIMPL REPR
12011	17	SIMPL REPR
12013	7	SIMPL REPR
12014	2	SIMPL REPR
12031	1	LAYER CLO
12032	4	LAYER CLO
12034	2	LAYER CLO
12035	2	LAYER CLO
12041	5	LAYER CLO
12042	7	LAYER CLO
12044	1	LAYER CLO
12051	2	LAYER CLO
12052	3	LAYER CLO
13121	1	REPR COMPLX

The CPT codes are required. Make sure that you include everything, no matter how simple or unimportant it may seem at the time.

And lastly, back to the "investing in yourself" part. You will be required to provide transcripts and official documents from certifying agencies for licensure and credentialing. The fees for these items can add up very quickly. Additionally you will have a license fee for an advance practice license and prescriptive authorities in each state you work in (I currently spend about $500.00 every 2 years to renew my advance practice licenses and prescriprive authorities). If you live in a compact state (such as Tennessee) you will not have to have an additional RN license in another compact state (such as North Dakota). But if the state is not a compact state (Alaska), you will be required to purchase a RN license as well. And some states (ex. Alaska) require you to have a business license. Now don't forget that you are required to have a DEA number for each state you prescribe in as well.

*Pharmacies, hospitals/clinics, practitioners, teaching institutions, and mid-level practitioners register for a three-year period. The current three-year registration fee is $551. The new fee for the threeyear registration period would be $731.The three year difference is $180, or an annual difference of $60.

You need to allow 6-8 weeks for each new license you apply for as well as 6-8 weeks for a DEA number.

I have just adressed the highlights, if you are considering the "rental life" and have specific questions, send me an email and I will try to help you find the answer. If you have general questions, please post them in the comments section so we can share them with everyone.

Now go make it a great day!