Nightmare New Grad NP Position

  1. Hello Everyone,

    I started my new job as a Psych NP at an outpatient clinic and do not think it is a good place to work. This is my first Psych NP job and a locus tenems position. During the interview, they made it sound great and told me the psychiatrists were very supportive. That should have been my first clue when the doctor did not talk to me during the interview. I accepted this position because I could not find any full-time positions in my area due to a saturation of new grads and too few positions available.

    I am the first NP they have had at this clinic and it serves a large population of low income and chronic mentally ill patients. I love the patients but not the administration. For example, I gave the directors copies of my scope of practice, ect. and educated them about the role of a Psych NP. On my first of orientation, they had me orient with the RN who takes vital signs and takes off the doctor's orders, ect. The RN is a new graduate and this is her first psychiatric nurse position. I could tell she was getting easily overwhelmed with her duties and was still learning herself. It turned out that I was training her entire day instead I showed her how to give injections and was teaching her about medications. I talked to the directors and suggested that I orient with the doctors since I will be doing medication checks and evals. This is a very busy and fast-paced clinic. They give you 10 minutes to do a med check and an hour for an eval. The place is run by psychologists and I feel they do not appreciate the nursing profession's contributions to patient care.

    Later that day, the clinical director ( a social worker) approached me and said that it would be a good idea if I "helped" the nurse and worked as the Psych NP during my work days. I told her that it was not a good idea since I am a new Psych NP and still learning myself. Also, I told her that they were asking me to do two roles and this is not what they hired me for or told me in the interview. Throughout the day of my orientation, the new nurse kept asking me to do things like give injections and take off the doctor's orders. At one point, she called and complained to the director that since I have an RN license, she felt that I should be helping her. when I'm not busy. I told the director that this is an unreasonable request since I will be busy doing 10 minute med checks and i hour evals throughout the day. I put my foot down and refused.

    On my second day of orientation, I was supposed to shadow the psychiatrist. I went to her office and she was rather rude. She stated that no one told her I was supposed to shadow her and she was concerned about the patient's confidentiality and did not think it was a good idea. This is the psychiatrist who I have a collaborative agreement with and I am supposed to be seeing her patients. There are two other psychiatrists there and they want me to see their patients but I do not have a collaborative agreement with them. I insisted to the director that this is necessary for legal reasons. So far, I have not seen anything in writing.

    I went to computer training to learn their charting system and the IT person kept training me on the nursing portion. I asked him to show me where I am supposed to chart the psych evals and medication reviews. He said that I did not need to learn this because I was a nurse and not a doctor. Grrr.....

    I do not have a good feeling about this position and want to quit. I've already found another position where I think I will have more support and collaboration with the psychiatrist. Every time I ask questions, they say they are busy and have patients to see. I understand this but I need to learn the charting and the routine at the clinic. The new place where I got hired has two nurse practitioners and the doctor understands our role and scope of practice. The doctors and other staff at the clinic where I am working now seem resistant to teaching and having a psych NP for some reason. They keep trying to put me in the RN position or want me to do both RN/NP roles. It is crazy....

    The problem is the agency expects me to be there for a set amount of weeks since they paid for my DEA number. It was a verbal agreement and I do not have anything in writing. The contract states they want a 30 day notice but I do not think I will be able to tolerate this work environment until I start my other job. I need some advice and was wondering if you ever had these type of experiences. How did you handle it? Thanks!
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    About TigerBlood01

    Joined: Oct '09; Posts: 32; Likes: 27


  3. by   Psychcns
    I agree you should not be orienting the RN. The psychiatrist can tell each patient that you are orienting and ask each patient if you can sit in. I would think any of the psychiatrists could do this. You want to learn how they do 10 min check ins and 60 min evals. And get to know prescribing practices at this facility. You want to spend all your orientation time with this and you do not have the time or need to orient the new RN. Your company should be helping you with this and talking to the facility on your behalf including educating the facility about your role. I would try to not burn bridges with the company if at all possible. Good luck!!
  4. by   TigerBlood01
    I suggested this to the doctor. She did not want me to sit in. I had a long discussion with my agency about several issues like professional boundaries with staff. They are calling the company to sort things out. I am just let down because this is my first job as an NP. It is not what I expected. I was told it was a supportive environment and they work well as a team. I have not witnessed this and did not feel warm and fuzzies from some of the staff. An example is getting the door slammed in your face after you politely introduce yourself as the psych NP to the nurse who screams that she does not have time to talk to you is a HUGE red flag for me. It seems like a place where I do not want to work, lol. Maybe it is a blessing in disguise so I can be released from the contract if they really don't want me there
  5. by   bsnanat2
    This place sounds like a nightmare. They are obviously using an agency for a reason. I understand your concerns about the contract and honoring your agreement, but remember that a contract is an agreement between two parties and they seem to not be holding up their end. You were told certain things about the position that are simply not true. You may be able to offer to simply reimburse the agency for the DEA fee and move on. While not the ideal thing, if you have another job offer and this is how this agency and facility operates, would it really be such a big deal if this bridge gets burned? Sounds like if you stay you may get burned. BTW, sometimes when we are "new" at something we are way more apt to allow others to abuse us. You are an NP and should be treated as such, not treated like you are "new". I hope it goes well.
  6. by   linearthinker
    I agree. Reimburse them for the DEA license and get out of there.
  7. by   TigerBlood01
    Update: I stayed there for 2 days. The agency tried to convince me to be patient and give them time to learn what the role of an NP is. I showed them in writing what our scope of practice is and set professional boundaries with staff. They are not interested and want to put me in a bad position with my license which could affect patient care in an adverse way. Of course, they tried to say I was breaking the contract which is not true. The company had a hidden agenda which was not revealed in the interview. I never received a written job description which was promised to me. I have learned and decided these third party agencies or recruiters have no interests in helping nurses or nurse practitioners with finding a good fit in employment opportunities. We are just warm bodies to fit a slot for their financial gain. I do not care about burning a bridge with this agency. They started the fire and burned themselves. I am not working for agencies anymore. I view them as parasites and nurses/nurse practitioners are their hosts. I plan to cut off my own food supply to them in the future.
  8. by   TigerBlood01
    Sorry. Forgot to add. I found an NP position without a third party involved. WINNING!!!!
  9. by   bsnanat2
  10. by   LPN2RN2BSN2MSN
    Well Tigerblood01, this is a good lesson to remember, I was just accepted to a psych NP program. Just curious, what state are you practicing in? Do you think that this would have been less likely to have occurred in a state where NPs were completely autonomous?