Talking MSN with Jennifer Scott: FNP Practice

When looking at the commitment involved in earning an MSN, it’s nice to talk to nurses who have “been there, done that.”

Part two of my interview with family nurse practitioner Jennifer Scott looks at her practice, the impact of health care reform and her views on the DNP for advanced practice nursing.

You can find Jennifer’s blog at The Nurse Practitioner’s Place.

What is your practice like?

I work in a Federally Qualified Rural Health Clinic which is partly funded by government grants. Most of my patients either don’t have any insurance and see me on a sliding fee system based on their income, or they have Medicaid. We take almost all types of insurance.

I am a Family Nurse Practitioner, so I see infants ranging from 3 days old to my oldest patient who is 95 years old. I love this mix because there is usually something interesting happening in my day. I see an average of 15-24 patients daily.The closest hospital is 22 miles from my office so I often see acute injuries from the local farming community, tire shops, and local restaurants. The town is very small and only has one blinking traffic light!

I have an awesome working relationship with the front desk staff, nursing staff, and the other health care providers in our practice. We have a true collaborative working system and we are all listened too equally in the practice. In fact, one doctor asked if I could challenge the medical boards because he thought that I could pass them. Talk about high praise! I have never been made to feel like a question that I have asked is stupid. The only thing that I am still trying to do, is break our CEO of calling NPs and PAs “mid-levels”, which is a term that I despise! She’s getting better!

How has health care reform impacted your practice?

Health care reform has impacted my practice in a few ways. There has been an influx of grant money into the health care system which facilitated a larger office space and better equipment. It has dumped a lot of funds into the National Health Service Corps which made it possible to get my student loans dropped from $83,000 down to just $3,000 in three years. This has made it feasible for me to contemplate going back to school to finish my DNP before my credits expire.

I would like to see Florida FINALLY join the ranks of all the other states that allow NPs to have prescriptive authority. I hate to have to bother my collaborating physicians for a script for a sleeping pill. I can’t write the children’s ADHD meds or the men’s testosterone meds either. I can legally write medications that can stop your heart and kill you, but God forbid I help someone get a good night’s sleep!

Health care reform may impact NPs in the future by including the ability to Baker Act an unstable patient, declaring death and signing death certificates, writing home health orders, and maybe one day, independent practice. I look forward to seeing what happens in the next few years.

You have your MSN. Some are calling for the DNP to be the entry-level to advanced practice nursing. Do you see this affecting your practice?

The push for the Doctorate is a hot debate right now. Will it affect my practice? Not likely. Our company has not declared a need for the Doctorate and realizes that we can take care of our patients with the degree that we already have.

I see it as the same push that has been around for years regarding the BSN as the entry level. THAT still has not happened either. I think that if you want to get the terminal degree, go right ahead! Right now, it doesn’t make any difference in practice. There are no additional privileges such as prescriptive authority, better reimbursement, or independence. I doubt that there will be a huge pay grade difference either.

People are wondering if patients will prefer a NP with a Doctorate over a Master’s level Nurse Practitioner. I don’t think that they will. Patients don’t care whether there is a DO or a MD behind physician’s names because they don’t know the difference between the two. All they want is someone to listen to them and make them feel better. That’s medicine and nursing in a nutshell.

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