Help save my career

Trauma Columnist · May 2, 2018

I'm so sorry for this. Okay now for some thoughts:

1. Apply to specialty practices that provide a solid orientation period. I was in nephrology for 11.5 years and our practice offered 4-5 months of orientation.

I'm now at a big teaching hospital in cardiology and had 30 days orientation (because I was an experienced provider). New providers got 4-6 months.

2. Join your state's APRN organization, go to networking sessions, CME, etc. In IL, iSAPN offers a "boot camp" for new providers, pharm updates, conferences.. They also offering a mentoring program where they pair an experienced APRN with a new grad.

3. Does your school offer any alumni services? Have you kept in touch with any classmates that might be able to help out with job tips?

I hope this helps.

Jules A, MSN · May 2, 2018

Although I am not surprised I am sorry to hear of your experience. I'd also suggest contacting anyone in the field you might know such as your health care providers or former preceptors who could possibly guide you into an appropriate position. Please also consider adding your personal experience to the CCNE's call for comments on NP education, link below, in an effort to spare someone else, and most importantly our vulnerable patients, from a similar experience. Best wishes.

https://allnurses.com/nurse-practitioners-np/ccne-accreditation-comments-1158522.html

Oldmahubbard · May 2, 2018

I am also sorry about this. However psych is not the way to go. The diagnostic differentials are even tougher, and half of what patients tell you isn't remotely true.

Before becoming a Psych NP, I did an ANP program, although I never practiced. For the ANP clinicals, I familiarized myself rather intensely with the top 10 common clinical situations that presented to that office setting. Diabetes, low back pain, etc. Treatment protocols. I found this very helpful.

One question comes to mind. You mentioned some of your classmates were happy with their choice. How is their situation different from yours?

Jules A, MSN · May 2, 2018

One question comes to mind. You mentioned some of your classmates were happy with their choice. How is their situation different from yours?

I wonder how they are measuring it when people assert their classmates are successful. How do they really know? Especially because the grandiosity factor is mighty high with some of these programs in my experience. The only way I can tell who among my peers knows what they are doing and who is awful is because I admit their patients on my inpatient unit and take a gander at the ridiculous, or not, diagnostics and prescribing.

ccw123 · May 2, 2018

Thank you for the kind words! And they are definitely helpful-- I'd eliminated specialty care jobs from what I was considering, but I'll start looking for ones open to new grads.

ccw123 · May 2, 2018

Since the reply shows up at the bottom anyway, I'll answer all the rest here. Thank you to everyone has responded. It's definitely appreciated.

-- Jules A, I will definitely do so. I would love to share my experiences and hope it makes some changes. I will also be contacting my school to give them feedback once I figure out who is appropriate to speak to.

-- Oldmahubbard, yeah psych would be a whole different ball game and it's very challenging. The happiest graduates I know from my program are psych, but then they have years of non-nursing clinical psychology experience too, so I'd likely need that first. And, haha I've been asking myself that question a lot to figure out if I'm just a failure at this job. I think it's the same combination of the three: clinicals, personality, and job. The clinical experiences of an individual in the program vary widely and with 600ish hours only and no past experience to draw on -- what you get by luck of the draw matters hugely. I don't think I drew well and the gap between my training and the jobs I look at is huge-- 2/3rds of my training was better suited for the retail health level and the 1/3rd that was supposed to be higher acuity had more routine care than I've been able to find anywhere else (as an example, diabetes care, NPs started metformin and did lifestyle education and med-compliance checks -- but any other medications were managed by the doctors on site. So despite seeing a bunch of diabetes that clinical, Ive seen almost no diabetes management that I'd actually need to do) . Personality-- I also think my successful classmates are better at faking it until they make it so they survive in their jobs and learn like crazy and become good providers ...a few of them are also horrifying to me and are going to kill patients probably. And then job--- a rare few get very supportive jobs and I think my first job was on the hard end for outpatient acuity levels and complex issues. But I think being thrown into the deep end (hopefully with lovely colleagues who will answer questions) is the norm. Everyone I know from the program in the FNP is miserable at work, and joke about crying every day, but they're surviving.

djmatte, ADN, MSN, RN, NP · May 2, 2018

The networking mentioned above is important. I think it would be a good idea to look into volunteer clinics where you might be able to improve your clinical skills at a more moderate pace. Another option is homeless shelters. One of my clinic rotations was at a homeless shelter clinic run by an NP. He set a list out of patients to see and worked through them at his pace. Some of these were complex patients, but others were more mundane and was a good setting to get used to the management side of things and work on a population that needed the care. The only down-side here is long-term outcomes as many were not compliant with medications, transient in their care, or would lose medications regularly. Also the minimal access to insurance made prescriptions harder to do.

With the networking, finding an NP that is willing to take you on for shadowing would be huge. There would likely be corporate concerns if the clinic is big enough, but if it is a smaller clinic they may be willing to let you get experience if you are considered "shadowing" and not an active provider.

djmatte, ADN, MSN, RN, NP · May 2, 2018

It does make me curious what school you went to for future reference.

FullGlass, BSN, MSN, NP · May 3, 2018

Hello, any advice would be greatly appreciated because I'm very lost right now.
Long story short: I did a career change with a big brand name accelerated family nurse practitioner program (aka get the FNP with no nursing experience). I excelled in school, was very worried about my limited clinical experience (before and during) and the quality of my clinicals, but was reassured I'd be fine. Graduate and got a job as an FNP at a FQHC and things were not fine. It was sadly a disaster from all three fronts -- it was a hard clinic with sick patients, I am not the beat at learning on the fly under pressure and other things about me that could improve, and I honestly believe my training was absurdly and dangerously insufficient for the scope of practice I am now licensed to do-- I'd seen nearly none of it before (I could have cried when I got a patient with the flu or an asthma exacerbation because it was finally something i knew what I was doing and I was capable of handling those cases fine). One month in, I quit before I was fired. I will have great character references from my employers, but a bad review of my clinical skills.
I would still love to be an FNP, and I'm so willing to work hard, but I don't know where to go from here. Its been 8 months since I graduated now (took time off for family matters I'd neglected in school and then waiting for licensing because I also moved) and my first job ended in a disaster after a month. My confidence is shot and I am afraid employers will not be willing to take a chance on me (I am applying, but it's only been a couple weeks). I feel trapped because I've already done my training--- but I don't feel trained for my role.
1. What FNP jobs could I apply for that have a more limited scope or more extensive training? I've applied to all the retail health jobs I can find, but no luck yet. Is there a market that is desperate to hire people in retail health? I'm willing to move! (Fellowship/residency programs are sadly not an immediate answer -- they mostly have deadlines that are a year away now and they are very competitive--I was rejected from two before I ever applied to any jobs)
2. What else should I apply for? Should I apply to RN jobs? Which ones? Should I try to get a post-masters in psych to try to find a more limited scope? How do I avoid torching my health care career?
3. Any advice at all is appreciated!
P.S. Please don't turn the focus of the discussion to whether nursing programs without RN experience should exist or not. If I had the opportunity, I would not attend my program again, but dwelling on that doesn't help me move forward (and for the record, I also have classmates who are happy with their choice and I'm sure they will be great NPs)

I'm very sorry you went through this. Please don't lose hope. I am also a primacy care NP w/o RN experience. I recently started my first NP job and am very happy and it appears the clinic is happy with me, too. This is a rural FQHC and the patient load is quite reasonable - 18 to 20 patients per day once an NP is fully up to speed, depending on complexity. This clinic has a long track record of training new grads and has a 6 month ramp up period, starting at 6 - 8 patients per day. Many of the patient visits are routine for annual physicals and med refills and there is usually one no-show per day. The other providers, both MDs and NPs, are extremely supportive and more than happy to answer questions and even come examine my patient if necessary. They encourage me every day to ask questions and consult with them. I've been reassured over and over again that they don't expect any new grad NP to know much and it takes a year to ramp up fully. Since this is a rural area, it is extremely hard for this clinic to recruit permanent providers, so they are really committed to ensuring the success of new NPs.

A very low stress field you might consider is sleep medicine. It is considered the easiest specialty and it quite routine. Medications are seldom prescribed. The emphasis is on a history and physical exam focusing on selected areas, then prescribing a sleep study, and afterwards, analyzing the results to determine the best treatment for the patient - CBT or sleep appliance like CPap, oral appliance, etc. Sleep medicine is really taking off, so this might be a good way to ease into being an NP. It is also very rewarding as patients are incredibly grateful to get a good night's sleep and you don't have to deal with drug seekers, disruptive patients, etc.

I also met an NP who worked at a diet clinic and she loved it. She did quick physical exams and then provided a prescription for the weight loss program. she told me it paid well, was low stress, and she had a great work-life balance.

Another specialty that can be low stress is occupational health. One of my NP preceptors worked at an employee health clinic inside of an extremely large organization that only treated employees who became sick or had minor injuries while at work. She had a lot of autonomy and got to develop preventive health programs for the employees. Her patient varied by day, but most days she had plenty of down time, other days it could be pretty busy. However, she always left at 5:30 pm and truly loved her job.

A couple of other jobs that can be lower stress - college health clinic NP, NP at a nursing home. One of clinical rotations was in a very high end huge nursing home. My NP preceptor had a great job. Every day, she would schedule routine visits on a certain number of patients and also had time to see any acute (new colds, flu, etc). She had a lot of autonomy and was out the door every day at 5 pm. The patient load was quite reasonable.

I was offered a job at a community college clinic where you only had to work 4.5 days a week during Fall and Spring, 4 days a week during the summer, and had 3 weeks off when the school was closed for winter break. As a state employee, there would be great benefits including 6 weeks paid vacation and a great retirement plan. That would have been a sweet job, too.

My point is to look for these types of things when interviewing for a new position. Best wishes and good luck in finding a job that is the right fit.

caliotter3 · May 3, 2018

The only advice I have to offer is to not be afraid to seek an RN job to get some confidence-building, and perhaps some networking opportunities, under your belt. However, I would still actively pursue the other avenues and I would try to set a definite time limit on that portion of your 'confidence-building'. You don't want to get too comfortable in that role if that is not where you want to spend your career (although there is nothing wrong with that either). Good luck.

Oldmahubbard · May 3, 2018

I agree, a LTC facility might be good. Look for one with an EMR, they are not all "high tech". The EMR with remote access is a life saver.

The work is normally at your own pace, and you can look things up. Plus there are other providers to consult with.