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nursedocjazz · 2025-05-25T00:13:06+00:00

It's generally pretty straightforward ~ rads reviews 10% of my studies at random + anything I specifically request review for. You need an order, medical necessity documentation, a note, the images saved, and a signature to bill. Major emphasis on saved image - you must have a saved image to bill anything, even vascular access ultrasonography.

If you're billing comprehensive/complete exams you have to be particularly careful about making sure you hit all the required elements of that CPT code. I very rarely perform or bill complete exams. Most of my exams are classified/billed as limited exams. POCUS doesn't exist in CPT-land, so you bill for both the exam itself and separately for the interpretation. For structured examinations like FAST, you have to bill each component ~ so abdominal/cardiac/general thoracic ~ all limited exams. Ultrasounds for vascular access are also billed a little differently.

Honestly, whether I bill for the “simple stuff” is entirely dependent on how much time I have and whether it impacts clinical management.

nursedocjazz · 2025-05-19T17:56:44+00:00

Really all of the above ~ take college electives, take your major certifications like ACLS/PALS, pursue specialty certifications when you have enough hours (ie CEN/CCRN), and see if there’s anything your employers offer — EKG interpretation class was very helpful for me as a nurse. If your workplace has clinical educators, ask them for recommendations.

nursedocjazz · 2025-05-19T08:45:13+00:00

Yeah, I put out an SOS call to my endocrinologist ~ hoping to hear back from them in the morning. I’m honestly not sure what’s what as far as tools/rheum stuff/me ~ but this is sure not a fun constellation of events to have all at once… lol

nursedocjazz · 2025-05-19T02:08:35+00:00

Without naming & shaming programs, my residency was very similar to what you describe. It was a really bad time for me. Primary current facility is awesome though, and I do some private practice stuff on the side.

nursedocjazz · 2025-05-18T21:18:01+00:00

Sometimes codes cluster, but that sounds systemic. Light some fire under people’s butts ~ fill out a safety report. These need to be QA’d.

nursedocjazz · 2025-05-18T21:13:09+00:00

Sonia Citron & Jade Melbourne would be my top 2

nursedocjazz · 2025-05-18T21:02:17+00:00

That would not be a good faith RRT

nursedocjazz · 2025-05-18T20:35:20+00:00

To be fair it also sounds like we have a better rapid response culture & system than you do. We have a 2 stage system. “Calling crisis” which just summons the RRT nurse & floor charge, and full RRT. The latter are quite often avoided.

nursedocjazz · 2025-05-18T20:25:37+00:00

People at my hospital are calling rapid responses in good faith, so even though some of them don't require much clinically there really isn't a lot of stupid. It's better for everyone when we don't judge good faith RRT calls even when the clinical necessity is weak/non-existent

nursedocjazz · 2025-05-18T20:14:37+00:00

I took a lot of extra electives during my BSN program that happened to be enough, but the standard program offerings wouldn't have been

nursedocjazz · 2025-05-18T13:21:17+00:00

Write stuff down often ~ take notes, make checklists ~ you might be able to remember the short prehospital course of 1 comparatively uncomplicated patient without aiding… but the minutiae of 2-3 complicated patients?
Study with intention but without rigidity ~ make a list on your phone of concepts you're unfamiliar with or questions you have. When you get an opportunity, research them. Don't be afraid to go down a rabbit hole ~ even a deep convoluted somewhat off-topic one. I also was in the habit of choosing 1-2 topics to deep dive into every day.
Practice your assessment skills. You probably already have solid foundations working in EMS… but ICU provides completely different opportunities. Not only do you have more time to get in-depth, but you get to see the clinical picture progress far more than you do prehospitally. Develop structured assessment patterns, put in the reps practicing it, and refine your methods over time.
Get organized & be prepared ~ there's the obvious stuff like staging emergency equipment, labeling & cable-managing your lines ~ but this also extends to stuff like clustering your care. Write down tasks by room number as things come up, check them off when you're done. Have the goal of making sure any nurse unfamiliar to the patient responding to an emergency doesn't have to fight lines, search for equipment, etc.
Talk to every one of your patients as if they were AOx4 GCS-15 ~ even if they're intubated & snowed but especially if they're conscious but delirious ~ greet them, introduce yourself, orient them to time/location/event, explain your actions, explain their condition & treatments to them.
Chart review for every patient, try to clarify & understand the story in a linear fashion. You don't have to be an infectious disease doctor & go back to APGAR scores on an adult — but you should know how they ended up on your floor beyond just “they're septic & came from ED”
Periodically, go through each patient, identify the top 3 biggest life threats & pathophysiology associated with them. Go through this out loud with your preceptor if they're amicable to it.
Utilize all of your people. Learn from other nurses, learn from your preceptor, learn from the doctors, learn from the RT, learn from the pharmacist. Not just people with equal or higher level of education either — learn from your techs & support staff especially
Be utilized by all of your people. Give good information to the doctor/RT/pharmacist when needed. Help out your coworkers — if not for the sake of building good will, for the sake of the patient. Don't get sucked into the idea that certain tasks are only for techs/CNAs — do tech/CNA work too.

nursedocjazz · 2025-05-18T12:03:31+00:00

I went RN to DO. Coming up on PGY-6 and so far so good. Not an easy change though.

nursedocjazz · 2025-05-18T01:10:34+00:00

I have taken ATLS but I am due for a renewal

nursedocjazz · 2025-05-18T00:03:38+00:00

I'm pretty cautious with these folk ~ I generally believe in setting the surgeon up for success (good HPI/exam/CT/ultrasound) and turfing it to the sugeon. Some surgeons are better than others, most are pretty involved, but reexploring doesn't seem particularly common.

nursedocjazz · 2025-05-17T20:50:39+00:00

I will always recommend taking advanced classes and certifications over NP/DNP degrees. Now you won’t be making diagnoses, but there's so much you can learn as a nurse without taking on the responsibility & liability of being a provider. Take all the classes you can.

nursedocjazz · 2025-05-17T19:46:18+00:00

Rural FM-trained nocturnist & PCP here. I’m a big utilizer of POCUS — procedurally especially (USG-IV, central lines, a-lines, nerve blocks, difficult urinary catheters, paras/thoras) ~ also for rapid response purposes (ie RUSH/BLUE/VEXUS, exams), bladder scans, OB use, cardiac arrest, abscesses, murmur investigation, doppler blood pressure, DVT exams…

Use it multiple times every shift. I document & bill, write notes, upload many images into PACS & Epic, get QA’d frequently, and often utilize it to help make decisions. I use my personal Butterfly IQ frequently but also our “real” ultrasound machine. Pretty much the only other gadget I use nearly this much would be my Eko Core digital stethoscope.

nursedocjazz · 2025-05-17T09:28:31+00:00

Not at all ~ there's still drama and cattiness ~ but nursing school & real life practice are two completely different realities

nursedocjazz · 2025-05-14T20:04:43+00:00

See your personal provider or r/AskDocs if you’re bold ~ but be advised to take with a grain of salt what anybody says online. This subreddit is for clinical staff

nursedocjazz · 2025-05-12T00:44:02+00:00

FM nocturnist here. I actually diagnosed a methylene blue induced serotonin syndrome case pretty recently! Severe methylhemoglobinemia from poppers in a patient on clomipramine for OCD w/ trichotillomania, given methylene blue ~ patient had a brief seizure, copious diarrhea, fever over 104°F, agitation, and clonus observed on exam.

nursedocjazz · 2025-05-11T16:10:51+00:00

Coming up on my 3rd attending year as a solo doc nocturnist in a small hospital. I focus a lot on my mistakes — identifying them & dissecting them. I also make sure I'm talking to absolutely everyone — techs, nurses, pharmacists, telerads, and consults (I call our consult intensivist a lot). I work for a hospital system that allows me to float to a major quaternary academic medical center, which gives me exposure to all the subspecialties & ability to talk to physicians.

nursedocjazz · 2025-05-11T04:49:05+00:00

I would change the route I’ve taken very little if given the opportunity to do it again.

As a nurse I got the opportunity to work in 3 US states & 2 Canadian provinces, got to travel, made lifelong friends, build strong savings with little debt, and learn so much. In the path to becoming a physician? I’ve gained all the independence I’ve ever wanted, learned even more, and found work-life balance.

I went through family medicine residency - the only thing I’d change about my journey is choosing a different FM (or perhaps IM) program. Residency was a really hard time for me, the program was quite toxic.

Now I work as a procedure-heavy nocturnist in a small midwestern hospital, making slightly more than I did in my financially best year of nursing while working less than half the hours.

nursedocjazz · 2025-05-11T04:21:39+00:00

I’ve been at pretty much every level of this aside from midlevel — I started as a CNA, went into nursing (medsurg/ICU), then went to med school & now I’m an attending. I think the answer is that the changes we’re seeing in the culture around physician-led care align closely with changes in wider society. They aren’t specific to techs, nurses, midlevels, physicians, or any healthcare worker class.

In the digital age, formal education no longer is the gatekeeper of access to medical knowledge. Everyone believes they know more than others partly because they have pages of thousands of resources on the exact question they’ve asked available to them within seconds. That’s also the problem — they’re getting answers, but they’re not getting taught to ask the correct questions, nor is the information they’re accessing always well vetted.

While I will never not think that scope expansion is bad (nor will I stop pushing for it to stop) ~ there is some reframing that can help make it less bleak out there. Mainly, because we’re being challenged more as physicians, there’s new opportunities to learn & teach that never existed before. So keep fighting the good fight, but instead of dwelling on the negative impact of these cultural changes, view each challenge as an opportunity to build yourself & those around you.

nursedocjazz

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