Transcript
Speaker: oh Uh, why don't you start off? I'll let you. I feel like I always get to go first and quiz you first, so. You do. It's just because everyone thinks you're more important, which you are. i just get to be the ugly little sister. All right. This is On Call.
Speaker: Alice would be really cool to just wear scrubs all the time, and you don't have to think about what you're going to wear to work. That is awesome. We're here to answer your questions. we can sit down and discuss all... Wait, I gotta go. I'm on call. Wait, you're on call? I thought I was on call.
Speaker: Ha ha ha.
Speaker: Hey, everybody. Welcome back to another episode of On Call with April and Alicia. I'm Alicia. I'm April. Well, that was a delay, April. Did you forget who you were? There was no delay. felt like there was delay. we had this producer, we'd be like in studio right now. We'd be like, Sarah, could you please rewind that? I thought you were going to be both of us today. Oh, I am. I'm April and April. I'm April and I'm April too.
Speaker: there How are you, Ape? Well, it's another week. It is another week. You know why what I'm super excited about? Weather, weather, weather, weather. That's all want to talk about. It's funny because I was going to go weather and the fact that your favorite season is coming and I'm super excited. oh hold on, April. You're late to the party. My favorite season started June 30th.
Speaker: That's when that's when um Super Bowl season started, but ah Just for everybody that I know, all of you guys wanted to know this. um Have you seen how many hurricanes have come out of the Pacific basin this year? i have not. Like Hawaii, but you know, we've got a site in Hawaii. I mean, I hear about them as they're happening, yes. What's interesting is when I watch the Weather Channel, because sound, you know, we our footprint's so large across the whole country, I hear stuff on the Weather Channel, and I'll go, Hill Country, oh, that's Texas. Like, because I remember our sites, and or I'll go... you know, Long Beach. Oh, we used to have a site Long Beach or you hear all these different things, but um we have a site, Kona.
Speaker: And they, well, i don't think they got the direct hit from that first hurricane. They've had two back to back. That poor Hawaii, I think they even said like people are still out of power on the, whatever the last iowa island is at Kauai. You were just recently there. You know a lot about Hawaii.
Speaker: I know. Well, we went to Oahu and Maui. So that's what I know about. i don't know about the rest Whatever the furthest one is, um is the one that took the hit anyway. It is the Super Bowl season, though.
Speaker: And they said, the Atlantic is firing up, and I'm not excited about it for Havoc. But you know, had a good storm. You do, but do you know that I love a good fall? and that's heard, and I was just already wondering if your pumpkins are out and your leave decorations in all of your fall. That's funny though that you say that because that is the plan this weekend. Last weekend, Kirsten said, Mom, we should have put the fall stuff out. And I said, we're going to wait until next weekend because the official first day is like the 21st, I think. So I said, next weekend it's on, girl, because she's like my, you know, my spirit animal with these things. Like she loves fall. She loves Christmas. She loves But the hay bale, I love Christmas. She loves all the decorations. It's just, it's surrendering that summer's over or something. I don't, I don't know. Now I will say, because i feel like it has been a scorching between 80 and a hundred degrees consistently.
Speaker: since i don't know february march i don't know how long it's been hot um i i do invite like whatever alleged cold front they say maybe coming through a little bit because i'm just like you know some like crisp bear might not be too bad it's been it's really humid where we live um i know you guys are getting like tons of rains but it uh don't know how unrelenting it's going to be Right now. Yeah. going to be a little crazy.
Speaker: I'm excited. We have some cooler temps, like especially overnight. And I'm like, ah, love it. I was thinking about, um I was watching Jersey and I know you're not there, but did you see that? um marathon that happened this past weekend and the flood. like that So the all these runners in Jersey, it's like a big standard race, I guess there. And all these runners are on this path and the river or the tributaries, whatever is within that respective park, flood during the middle of the race. And now they've got all these runners out on these paths that have like three feet of water.
Speaker: Yeah, that they're now doing rescues during a duringuring a marathon. Again, folks, don't run. i was going say no to solve. No marathon. I'm kidding. We now officially have an excuse to not run a marathon.
Speaker: Running may save your life or not running. but may save your life may Not running may be better for your health. will say it. Depends on the situation, probably. Absolutely. oh So, well, anything else going on with you? I know last time we talked, we had some car breakdown.
Speaker: was driving? They did. They did figure out the problem and um it is now fixed. But it it went on. Like after our last call, i got out at home and they they called me and everything's fine. and I got home, pulled it into the garage and it died again. And they had to like come out and jumpstart. It was like quite the ordeal. But...
Speaker: They figured out the problem and it is fixed. So and we are driving successfully driving a new car. That's right. Well, I have to tell you, i will actually tell you this and very quickly because we have a really cool topic for today, but, um, Juliana's got her temps.
Speaker: And um I had been only prior to temp life, had just been doing parking lot stuff in between practices or if Maddox was doing something, you know, we'll teach you to back in, turn your turn signal on, get comfortable in tight spaces, things like that. She communicates to her father that she's been driving with mom.
Speaker: So he picks her up from school the other day Tahoe. Says, get in and drive me home. So she doesn't tell him, I've never driven on the road.
Speaker: Oh God. So um the the message that I got was that was the scariest ride of my life. um And ah just by the way, she's like covered on all vehicles. and insurance on And I'm like, well, first of all, she should have been. And second of all, we we should have asked, has she been on the road?
Speaker: Right. Have you driven on the road? She had no idea. And she does that. We love to hug the right side thing. yeah So I'm like, well it's better to go off the right side of the road than in oncoming traffic. So we'll say yeah we're working on that one I remember that first drive, like the day she got her permit. She's like, I want to drive all of you in the neighborhood. And i was like, Oh, good Lord. And Molly's like, do I need a helmet? And I was like, maybe, but like, let's go get in the car. And I couldn't look out the way I was like, thereious Oh my God. Yeah. Like i I was like, I can't look out the window because there's cars. And if she's anywhere near close to them, I'm going to make a noise and it's going to freak her out. So I was like, eyes forward, like just
Speaker: the first day but now you know your little arm that slowly comes out where you're going to push the wheel just a little bit and gg would say um dad get pushing the wheel and i said well um some people get a little spicier about that part um i said the pushing of the wheel isn't to be aggressive to you it's so we don't wreck that's yeah but that's the last i mean i do let that part go yeah I do catch myself like pressing my invisible will break sometimes. Cause I'm like, I'm trying to not say anything. Cause I know she's goingnna get annoyed if I like slow down and I'm like trusting that she's going to do it, but my foot can't help it. know And it's golf cart. Is it not? It's like, Hey, slow down. And it's an immediate stop. It's like slam. And I'm like, okay. um Okay.
Speaker: Well, let's ease into the break. I was okay. All right. like this like I don't know if I'm built for, for this. um She's actually the only child. I have two that are driving and I never taught them.
Speaker: I just didn't have we didn't have the connection. um Our personalities were too similar so that they actually worked out well with other adults. She and I work out very well where she doesn't hear some of the other ones. So this is gets to be actually my true virgin experience here. So i'm excited about that.
Speaker: Oh, that's it. Okay, but there's something bigger that's happening. so we got driving, being we got weather. We'll talk about what is cooking up in the Atlantic Basin next week, everybody. But what's also cooking up next week is APP week.
Speaker: That's right. Next week is National Advanced Practice Provider Week. So we'll celebrate that the 21st to the 25th. So that is the, of course, you know, we recognize the hard work of our colleagues all the time, but especially during this week, um,
Speaker: We take time at Sound to really recognize the work that's completed by our you know physician assistants, nurse practitioners um at our sites across Sound and all that they do every day to support the care of their patients, you know answer questions for families, support for families, local community support, all of that.
Speaker: So we're excited. And I think in honor of APP Week, we're going to do our traditional fact or fiction. um But we're going to go a little bit beyond that. Like, I want to get into the nitty gritty. What does APP stand for? What is like, do they work in healthcare? care Where do they work? I want to get into those type of things for this episode. do you feel about that?
Speaker: I think that sounds good. and we should do it. Let's do our traditional. And all the APPs out there, whether you're sound or you're not, happy APP week. This one is for you. That's right. So we're excited to do this. All right, April, do you want me to start off? You want to start off? Who goes first?
Speaker: oh Why don't you start off? i'll let you I feel like I always get to go first and quiz you first. so You do. It's just because everyone thinks you're more important, which you are. i just get to be the ugly little sister.
Speaker: All right. Number one, APP. APP week. Let's go. NP. So this is going to be factor fiction. An NP and a PA, they may care for similar patients, right?
Speaker: But the educational roles they take to get there are fundamentally different factor fiction. That's a fact. Tell me why. I'm going to have you tell me why first. All right.
Speaker: All right. So you have to keep me honest here. um So. Wow. i would Let me tell you, I'll let you, going let you talk about PAs. How about that part? All right. You want me to tell you why? Okay. All right. So yes, that you're absolutely right. It's fact. the This is the foundation for a whole conversation. I think you and I could talk about this for forever. A patient may see an NP one day and then a PA another day, and parts of those visits may look similar, the way history is done, exam, diagnosis, et cetera. But professional education behind those roles is completely different. I think it'd be cool for you to tell me, how'd you get to be a PA? And then maybe I'll tell you what it looked like for an NP.
Speaker: Yeah, that sounds good. So the PA, um you generally will have your bachelor's in something. um Doesn't necessarily have to be healthcare care related, but mine was. I had a bachelor's in emergency health services. So um I was an AMT in college. um And so typically...
Speaker: an emergency medical technician on the ambulance. Yeah. No, I wasn't asking you. I was asking as if I were somebody who didn't know what it was. Cause I think we throw around a lot of these things. So she started as an EMT.
Speaker: So ah maybe more of a broad medical background. Yes. um And then to and then, of course, you have, you know, your set of like prerequisites for PA school, like all your science classes and all those things that you have to have. um A lot of times you have to have your bachelor's once once you're applying to PA school. um You also have to have hands on patient care hours. And that can be.
Speaker: you know As an MT, I also worked as a physical therapy technician. um you know I was the person who hooked up patients to ice and heat and all those things you know before and after the physical therapy appointments. So you have to have usually about an a thousand hours, at least a thousand hours of that hands-on patient care experience. um Also, they like to see some PA shadowing.
Speaker: And then you apply to PA school. And then PA school itself is anywhere between 24 to 27 months. Mine was 26 months. And so you spend your whole first year didactic of courses. So like in the classroom learning, you like you'll do a couple.
Speaker: you know like We did a history and physical rotation on our like I think the second half of our first year where we went out like one day a month or so and like did history and physical on patients. And then your second year is all clinical rotations. And you complete rotations in think there's like eight required fields, including like emergency medicine,
Speaker: you know, OBGYN, primary care, pediatrics, like there's, you know, surgery. um And then you do two electives at the end and each rotation is usually about a month um with a clinical receptor. There are some entry-level PA programs too, where you can go into college as a freshman and be on the PA track. um And then you'll finish that in about five years.
Speaker: So would that be like pre, so similar to like a pre-med track, there'd be like a pre-PA track? Yeah, kind of. I mean, you'd go in and you're in that track. And so you don't have to like then apply to PA school, like you'll compete at all at that school.
Speaker: So you'd say when you went into college, did you know you wanted to be a PA? No, actually, I planned to do physical therapy. So I was working as a that's why I was working as a physical therapy tech. Um,
Speaker: And actually, i needed the prot for a bit, thought that I was going to do pharmacy. So i also worked as a pharmacy technician. But then one of my patients was a PA um but at the physical therapy office. And he was he was an ortho PA. And he was like, you should really think about PA. And to be honest, I wasn't really fully familiar with it at the time. And he was like come shout at me for a day. And I was sold.
Speaker: So. There we are. and know. The rest is history. Beauty was birthed. ah yeah there you go what they say well i was So I was just trying to to think in distinction of tracks, you know, so because for NPs, nurse practitioners, we, our pathway grows solely out of nursing. And so from my experience, it actually started as patient care assistant at 19 years old and then into the nursing track, um,
Speaker: Basically, an NP would be an advanced practice registered nurse, right, who completes a graduate level of education. so but But at the basis we start, for me, actually did an associate's program first because I wanted to get into work field. And at that point in time, BSNs or Bachelor's of Science of Nursing were not um a like 100% requirement to be a bedside RN. So I did ah very, very, I mean, it was intense. It was Monday through Friday, eight to five every day. Like you could only work weekends. um
Speaker: I did that class two and a half years, I think, got the associates, got into nursing, then um immediately had applied to get my BSN. I had no idea where I wanted to go, but at that point I knew i was gonna have to stay within this respective track.
Speaker: At that point for an NP, then you can apply for different tracks of graduate school. So when you want to advance your degree, you want to begin to assess and diagnose. um I applied for my grad school.
Speaker: I chose the acute, or well, first actually got the primary care track, but then I did the primary care, then the acute care track, which are different tracks that you can go into, but got those hours. And I think you mentioned a thousand. I was actually looking back at my curriculum. And I would say we were about a thousand hours as well. So that's postgraduate hours or or graduate not postgraduate, graduate hours. That's not in addition to like the the experience that you have in in your clinical setting. And that's something you also mentioned when you were EMT, you know, your bedside interaction with patients as physical therapists and training, like all of that stuff is still engagement with patients in those settings. So I only say the thousand hours respectively
Speaker: with the nurse practitioner route. But once we completed that, i think you guys take a board, we take a board and then we pick a practice setting or sometimes you structure your your clinicals to align with what it is you may or may not know you want to go into. um But I guess largely we build on a nursing foundation where it looks like you guys may build it on a medical foundation. So you had a broad, we're very,
Speaker: strict on nursing. But we do for our graduate, just like you guys, advanced physiology, pharmacology, health assessments, diagnosis and management. I'm trying to think of what else I might be missing, like evidence-based base practice or all of those things. We we do still focus on those same things.
Speaker: areas during those programs. yeah um And largely how we select where we go, where, and help make sure I'm honest here. PAs have one route, right?
Speaker: You go into PA school and you guys all have the same training. Correct. So you mentioned, I was going to say this too. So you mentioned like different tracks, right? Like, you know, acute care versus family. management So we are the PA is a like the PA degree is a PA degree. Like it's all one, one track. And then when you get out of PA school and you get your first job, um you know, depending on what specialty that is, then you may need more additional on the job training, but it's not,
Speaker: you don't get, you know, like go through one specific, like there's not different tracks that you do for a specific patient population. Right. Okay. So NP clinicals and tracks are they are tied to a population. So right and you could pick psychiatric mental health. um You could be an NP in that. um And, and maybe you're you know your agenda is to find ah appropriate psychiatric care. like That's really where you want to make your mark in medicine. That's a very specific track. You can be pediatric NP, meet the needs of pediatric patients. You can be adult, gerottology gerontology, acute care, or primary care. There's two different tracks, though. Primary care is usually what we refer to, your primary care physicians. They're out in the community. That's where you go if you have a cold. That's where you go for your just wellness assessments or your well-trained
Speaker: well-being, you know, yearly annuals, those type of things, um or manage minor acute issues. And then you have your acute track, which manages more hospital-based issues. i mean, it's everywhere. And i think every time I look up, there's a new certification. They've got them in emergency medicine. They've got them in critical care with certain certifying bodies. So In the NP world, we have to pick a specific track and then we'll get into certification later in the episode. But yeah, so that was a more long-winded answer on on my end for NP. But I do think it's really important to spend a little bit of time here to understand the background. i think the end goal is the same, but the way that we're trained is a bit different.
Speaker: No, I think, yeah, I think so too. It's a good point. And one thing I will say is, you know, even though the education, like it's one track, there are, um ah they're called CAQ, which is Certificate of Added Qualifications for PAs, um that you can take additional board exams in your specialty, like once you've been practicing. So after you have certain amount of hours and you've done a certain amount of continuing education, then you can pass this specialty exam. And then it just shows kind of, I think it shows employers that, you know, you have experience in that specialty, um you know, if they were looking at comparing you to another candidate.
Speaker: So. And I think that's good for, you know, we've got a lot of different type of people that listen to this podcast. So it in, with respects to patients that may listen and go like, oh, you know, i had a PA and an NP, like which one's better? And I think we have a tendency to do that in our culture anyway. Which better?
Speaker: Which, you know, what's the better one? What's the best one? um This isn't about better or best. This is just maybe level setting the fact that The way we train may be different and in the populations that we train for may look different, but ultimately the goal and and like the framework of medicine is the same within both sets.
Speaker: Yeah. I will happily give you a point for that one. Awesome. All right. Well, i have a question for you. See how kind I am these days. I know. Well, you know, I think I deserve it. Because I did after I'll answer it correctly. Yes, you did.
Speaker: um okay Okay. question for you is, you know, so I live currently in Maryland, right? As a PA and I practice here as a PA. But my family decides that we want to move to a different state. So let's just pick a state. We'll move to Florida, right? So. Why? Because you want to go to Disney, cheater. Yeah. Okay. You know.
Speaker: But, you know, so anyway, so true or false? um Moving or relocating your practice from one state to another often requires no additional certifications or no additional education. You can just jump from one state to the next and practice true or false.
Speaker: Do you know how bad I wish that was true? it is absolutely false. The world does think it's true. Have you ever met people and they're just immediately like, can you write me a prescription? And you're like, I'm in California. I just met you. We're at Starbucks. And you told me you had a cold and you asked me what I do for a living. Like, that's how fast can you? I'm like, I'm in Cali.
Speaker: It's a joke. That's never happened to me. But yeah, I wish it was true, but it's not. That's true. That is not true. So every um every state, you know, has different, is as you know, has different requirements in terms of like, so if you want to transfer from one state to another, you may be required to take additional education in a specific area.
Speaker: area, right? Like someone state may so heavily want to educate on say substance abuse, right? So you may have to complete that course in order to apply for that license. But you do have to look at that state, see what their requirements are complete anything that you haven't already completed and then apply for your license in that state.
Speaker: Can I add on to the, I'll make this. Yeah, absolutely. No, I'm going to make it my next question because I think it'll build. Can we rapid fire into the next question? Sure. Okay. So once,
Speaker: The NP or PA, and that works the same, by the way, for NPs, I should say that part. NPs are the same way you apply for a state license. For us, we have to apply for the RN and then the APRN, the advanced license. So two steps on ours. You can apply for compact, which is just a way for us to say, oh I've got a clean file, a clean license. And there are some states that participate, I don't know exactly how many in the RNs, but maybe 35-ish somewhere, that participate that just allow us to expedite the way we get a license, whether those are for emergencies, um to you know disasters, or if we are clinicians that are traveling type of clinicians. But I do want to push it a little bit further because licensing is one piece, but there's another there's more. So here's my factor fiction for you, April. Once an NP or a PA has a state license, so you've moved to Florida so you can be a Disney World.
Speaker: Every hospital or healthcare organization in Orlando is automatically going to allow you to perform everything permitted within your professional legal scope of practice.
Speaker: That's false. You have to. That's absolutely fiction. You have to apply. So one thing before we go into the the um explanation here too, I do want to mention too that there is now ah a PA compact license. I think we've talked about this in a previous episode. Oh, yeah, yeah. mentioned that. Yeah. There is. um It is. And more and more states are participating in it. So just want to make sure that we put that out there as well. that that And that's one last step, correct? so you Because you don't have a two-step. You don't need to get, like for us, like I mentioned, we get the RN.
Speaker: That's why our licensing process takes a little bit longer. You just have one. Okay. That's all. Yeah. I think you remember, remember you telling me that and it's going to be going up. I think it started last year or something like that.
Speaker: So yeah, it started like the idea kind of came around a couple of years ago, but more and more States are participating. So that will make it easier, you know, over time we's gonna allow here as well. And look, the more places we can practice, the more experience we get. i think that's really awesome.
Speaker: Yeah, but back to your question. Yeah. um But back to the question. No. So each you, you know, we move and then you, you find a place that you want to work and you get hired, you then have to apply to get credentialed in that facility, in that hospital. And each hospital also has the requirements that you have to meet for them. so You know, what ah part of my role at sound is that I review a lot of hospital regulation documents to understand like what is required for our clinicians to work in those sites. And you will see variation in terms of, you know, how many patient contact hours you have to have had in a certain period of time, or, you know, unless you've like just completed your training, um you know, sometimes they'll require, especially for APPs, they may require that,
Speaker: You have a training period for a period of time based on your level experience and things like that. So ah you have to make sure that you meet those requirements and then apply for those credentials at that particular facility.
Speaker: agree there. And I think it's important to point out when we were talking, we were talking yesterday about this and and I was giving you some feedback that sometimes when I see patients, they don't you don't really understand or maybe they feel like they're getting like you know, but I mentioned a steak and a hamburger um comparison, but they they feel like they're getting kind of cheap shotted because they get an advanced practice provider and not their original provider. And as if it's a subpar and and they don't go through the same rigorous processes. So i I think the two important words that we have to add to this APP vocabulary
Speaker: is credentialing and privileging. So not only do you have to complete school, not only do you then have to pass boards, and then not only do you have to then get state licensed, you then have to get presented to a hospital. a clinic A clinician may have completed their education,
Speaker: like I mentioned, earn their certification, obtain their license, they still have to get through this process. And credentialing is the verification process. This is where the organization, the hospital, the system, whatever, confirms, did you do the education? Did you do the training? But did you do it the way it was supposed to? Not like where people think, oh, you can chat GPT your way through this. You really can't.
Speaker: do that yeah in this setting. um Do you have the certification, real certification? Is it real? is there Do you have the licensure, the professional history or any of the other qualifications for them? Privileging is a little bit more specific. What clinical services or procedures can this particular clinician be authorized to perform within the setting, which then goes back to our education. What does our education allow us to do? When I say procedures, um I mean, can this person put you know intubate you, put a tube down your throat when you are in a cardiac arrest, or can this person suture you in the emergency department? Every activity that's performed on you as a patient in the hospital requires verification that the provider doing it can do it.
Speaker: um And so I think what's important is it matters because it's professional scope. It's individual competence. ah competence It's not, you know, ah a swath of competence. All NPs are under-trained. All PAs are dependent on, you know what I mean? like All of the things that you can hear. Yeah.
Speaker: Institutional privileges are not like identical concepts. Two APPs with similar credentials may have different specialty experience or procedural competencies. Therefore, they may hold different types of privileges. But for patients, I think this is important because it's reassuring. There's layers of verification always happening behind the scenes that most people never see before a clinician is even un allowed to perform certain responsibilities within an organization. And that's not just the hospital.
Speaker: That's a school. That's an outpatient setting. You know, that's cardiology. That's and your GI. That's every practice has to credential. So.
Speaker: Yeah. Well, and I think this is a good segue to um to another question is that. Let's wrap it up. Do you. Yeah, I got one more. we All right. Let's do it. Yeah.
Speaker: So, um you know, I'm a PA and I'm, I graduated and I'm taking care of patients. I'm credentialed, all the things. um And I, you know, now that I'm a PA practicing, i don't have to continue my education, right? Like I already did my, my duty and I'm good and I have my license and I'm good to ride for the rest of my career. True or false?
Speaker: Absolutely false. And would be scared of you if that's how you felt. I would also be scared, but I do think it's important because yeah you know we're talking about the initial process of you know going through your education and getting your license and stuff. But I think it is important to to mention too that that doesn't stop there, right? like There is ongoing education. um it does in terms of the requirements and the cadence of what we have to complete is a little bit different between PAs and NPs. But- For both of them, there is a process. ah So for PAs, you know, we recertify every two years. And in that time period, we have to fulfill a certain amount of continuing education credits, um both. And we have two different kind of categories of them. One is like official classes. And another one is, you know, reviewing journal articles and things like that.
Speaker: And then we actually retake our boards every 10 years. So we have to go like physically sit down and do Yeah. I mean, there is a home option now, you know, but you can do it, but it used to be six years when I graduated. So when I first recertified, it was at six years and now it's every 10. Um, so I'm already counting down as to many, how many times I have to retake my boards left in my career, but, um, but yeah, so we do have to do that. So there is a, a method of, you know, confirming over time that, you know, that provider that's taking care of you is still educated and still, you know, up to speed on the latest, uh,
Speaker: information as they're caring for their patients. So do you want to tell us about and NPs and what your requirements are? i And I would say for NPs, again, this national certifications, they they respond they correspond to the the and NPs rule type or their population, right? So there's not one universal exam that turns every graduate into the same kind of nurse practitioner certification reflects a specific educational preparation that Like all clinicians and all different national certifying organizations may certify different MP populations or roles, but here's like for me, five years. So I took my boards.
Speaker: I got certified in primary care, five years. I have to recertify. But that's not, I don't have to sit down take the boards like you do. I have to demonstrate competency by continuing medical education. I have to show them every year I've engaged with X amount of um topics. And those are all through accredited um institutions, whether it be society, hospital medicine, or AANP, or a like anywhere, even AAPA, bootcamp on demand, all of these things that we can build into. You have to do that, and then you have to do a certain amount of pharmacological credit.
Speaker: I have two, though, um certifying ah board certifications. So one is primary and one's acute. So I have to do that for both. That's yeah challenging. is April, sometimes I wish I could just take a test again because it would just, like to me, it's like, okay, um it feels, organization is not my strong suit. So um that's the harder part to keep up. But in addition to that, we then also have to maintain a separate set of CEUs or CMEs for the RN portion. So there's a lot of math to make sure that like, Hey, even if I don't work as an advanced practice RN, I would work as an RN. So I have to be able to prove that if I take this one away, I could still go bedside and put an IV in you. So yeah I don't even want to get into the amount of CMEs because it it does vary per track that you're on. But Um, ultimately it's the same thing and people are constantly engaging. If you lapse for some reason, um and you forget to renew things happen. Um, you do have to sit for your boards again, once that piece happens, because they want to demonstrate that you can accurately yeah work in the setting. So, yeah.
Speaker: Yeah. Well, 10 years I'm for it. Let's go. Well, we have to do the CME every two, but um but yeah, and then I'll say too that, you know, your state the state that you're in sometimes will add additional education requirements to renew your state license, right? Like you renew your state license as well as periodically and and your DEA, like there was recently education mandated to renew your DEA. So those things come into play as well as, you know, they see trends and things and and say, okay, we need to reeducate about, you know, a certain particular topic. Right.
Speaker: And so like, I think the bigger picture, and you said this in the beginning of this question, is you're you're just not getting somebody that graduated in 1995 who never touched a book again. um right They have to. They have to prove competency. And you know we even have core competencies in hospital settings. And i again, I'm acute-based, which means I work mostly out of a hospital. So I'm sure many of you have experiences that come from maybe more of a um you know outpatient type of a setting, but there are always things that we have to demonstrate even to our hospital partners as we're credentialed with them, the stroke care, for example, um those are competencies we have to update almost yearly, if not a couple times a year, because the data is constantly changing and our our pathways change. ACLS, I know there are certifications in different areas, but
Speaker: that we have to keep learning because medicine continues to keep changing. We're on it yeah yes We would never survive in the system if we didn't. Yeah, absolutely. Um, well, this was a fun topic. Yeah. It was like near and dear to our hearts. Right. So, um, well no i like it like time a little bit more too, because it's it's less about how great we are, but a little bit more about not just that we're great, but why. And, yeah um, and how we are a great comp like we compliment,
Speaker: a team and we make great collaborators, you know, for our, our physician counterparts who we love to work with. Um, and just love delivering good patient care. It's just, as you see these providers, if you're seeing and engaging with them in the settings, it's not because you're, you're not worth the seeing anyone else. Um, it's actually giving you more time, i believe with providers to be heard more.
Speaker: um and and you know supporting our systems the best way we can. Again, with our approach is always collaborative here. Yeah, yep, for sure. And I do want to mention too, I mean, I mentioned earlier at the call that at Sound we celebrate our P's and NPs, but that definition of APPs does also include clinical nurse specialists, certified nurse midwives, nurse anesthetists. So this week, or I guess it's next week actually. We could do a whole episode on nurse anesthetists. Yes, yes. So next week, you know, will celebrate all of you for all of the great work that you do. And thank you for all that you do every day. And, you know, to our listeners, thank you again for listening to another episode. And as always, if you have any feedback for us or suggestions, you can reach out to us at that email that is still hanging out there. That's on call. Somebody's not claiming their free sweatshirt. So sorry. Sorry. I know. I mean, I guess Alicia is going to keep wearing that sweatshirt. Yeah. I love it. It's very comfortable. smells like pure grace from philosophy if you like it. But April, we got some CMEs to do. So until the next time, you guys stay well. We'll stay on call. We got computer work to do.
Speaker: That's right. Thanks, everyone. Have a good week.
