[yellow finch]

Well, it looks like I did the right thing by working while in grad school. I've done my best work, have been the best nurse I could be, and networked with the NPs/PAs/MDs who round through our unit. It seems like potential jobs are starting to pop up.

The NP of a growing Neurology group wants to meet with me outside the job about one of the NP positions opening up this year. They're hiring one NP by July 1st and the other by December (my graduation date). We've got a nice rapport and I've expressed my interest to remain in the Neuro setting.

The NP for the two Neurosurgical MDs who are the most loved in our unit has offered to precept me this Fall when I'm allowed to specialize. Then, last week, one of the MDs asked me if I would want to come work for them. I asked if he was serious and he said, "yes, current NP is overworked and we're expanding." When I told him I didn't graduate for another 8 months he said it wasn't all that far away. (This is the job I want the most)

Then the MD of the other Neurosurgery group said today they would be looking to hire another mid-level mostly for clinic hours and not so much OR or rounding time. This would occur in the next 9-12 months.

I feel lucky and honored that these folks are showing interest in me. However, I would hate to get my hopes up only to have them smashed to find out none are open in December.

Am I just being too eager putting out my feelers or talking about possible jobs? At first I thought I would stay in my current job as a RN until passing the boards, but don't want to pass up any great opportunities.

How soon is too soon to start seriously looking? Is there some way I can secure a job this far in advance? How do I go about setting up meeting times to discuss these jobs and what is my goal in doing so this soon in the game?

Any advice is appreciated! I want so much to work with the one group that I'm almost willing to offer myself as their office/rounding RN just to start learning the job early on. Would this be a good option?

Gosh, I'm confused and overwhelmed.

[traumaRUs]

Wow - congratulations. I think its not too early to put out feelers and even accept a job if they are willing to wait. Be very thankful you are in a place that has many job openings. This gives you a distinct advantage. I wouldn't shoot any job down just yet because you might change your mind before graduation and you don't want to close any doors. However, perhaps you could do some clinical time with a prospective employer and that would give you some more inside info.

Let us know what you do...

[core0]

Originally Posted by traumaRUs

Wow - congratulations. I think its not too early to put out feelers and even accept a job if they are willing to wait. Be very thankful you are in a place that has many job openings. This gives you a distinct advantage. I wouldn't shoot any job down just yet because you might change your mind before graduation and you don't want to close any doors. However, perhaps you could do some clinical time with a prospective employer and that would give you some more inside info.

Let us know what you do...

I would agree with the clinical time with a potential employer. The one caution is to not underestimate the time it takes to pass certification, get a license get credentialled ect.

David Carpenter, PA-C

[traumaRUs]

I live in an area that has few mid-level positions. I was unable to get a job right out of school because of this and kept my staff nurse position in the ER for another 3 months. When I took the test, I had my results in one week. However, credentialling took literally forever. I am credentialled at five hospitals in three systems. One of the hospitals took 8 months to get the paperwork done. The credentialling board only meets four times per year! I was able to work once I got my license but couldn't go to that particular hospital. The other hospitals took anywhere from 2-6 months to do the paperwork. Part of this was because I was an LPN, then RN and had practiced in multiple states and they had to get info from any state I had ever been licensed in!

David brings up a valid point: depending your duties, you might not be able to be hired until you get licensed. As to credentially, that takes place after you are hired.

[VivaRN]

I'm in a similar boat -

The HIV clinic I have clinicals at offered me a position as in "we want to bring you on board". I set up a meeting a few months ago discussing employment because I knew I wanted to work there. Hey, you've got nothing to lose by being proactive or asking what you can do while still in school to be a good candidate. I graduate in August.

My preceptor suggested I use my remaining clinical time to begin the orientation process. Can you do clinical with the people you want to work with? If anything it will help you get to know each other before committing, and if you choose to commit it'll ease the transition.

Credentialling is still an issue and I'm not sure how that will play out. So, got my prn stuff lined up in case there's a gap between school and work. The more they have invested in you, though... I doubt they would leave you hanging for too long, or leave you for someone else (I hope).

It does kinda stink that we can't work as NP externs the way you can be an extern while waiting to take NCLEX.

Good luck and congratulations! I'm also in Atlanta - must be a fertile field for us NP's here

[core0]

Originally Posted by VivaRN

I'm in a similar boat -

The HIV clinic I have clinicals at offered me a position as in "we want to bring you on board". I set up a meeting a few months ago discussing employment because I knew I wanted to work there. Hey, you've got nothing to lose by being proactive or asking what you can do while still in school to be a good candidate. I graduate in August.

My preceptor suggested I use my remaining clinical time to begin the orientation process. Can you do clinical with the people you want to work with? If anything it will help you get to know each other before committing, and if you choose to commit it'll ease the transition.

Credentialling is still an issue and I'm not sure how that will play out. So, got my prn stuff lined up in case there's a gap between school and work. The more they have invested in you, though... I doubt they would leave you hanging for too long, or leave you for someone else (I hope).

It does kinda stink that we can't work as NP externs the way you can be an extern while waiting to take NCLEX.

Good luck and congratulations! I'm also in Atlanta - must be a fertile field for us NP's here

Its perfectly acceptable to do a clinical where you hope to get a job (at least in PA land). I recommend that practices that are looking at hiring PAs trial some students (kind of like a try out).

For a clinic, credentialing usually isn't an issue since the clinic usually does there own credentialing. They may be able to use you in an RN role until you get certification.

David Carpenter, PA-C

[emtneel]

What is credentialling exactly?
Is this always necessary?
Is it just for hospital?
I am not really familiar with what this means?
Thanks
Neelia

[core0]

Originally Posted by emtneel

What is credentialling exactly?
Is this always necessary?
Is it just for hospital?
I am not really familiar with what this means?
Thanks
Neelia

Take a needle. Jab it repeatedly into your eye. Thank the hospital for the privilege. Sorry thats just what it feels like.

Generally only hospitals privilege. However, some large health care organizations or universities also privilege all providers. From you have the privilege of being able to order stuff in the hospital. There are different types of privileges. The most common are consulting and admitting. Consulting allows you to see patients but not admit them as well as write orders. Admitting allows you to do all of the above.

In addition you have to be privileged to do certain things. For example prescription drugs are one privilege. Schedule drugs are usually another. You also have to work within the state guidelines. For example if the hospital says you can prescribe schedule drugs but the state does not allow it, you still cannot prescribe schedule drugs. There are other privileges that one would think are part and parcel of being an NPP such as diagnosis and physical exam. However, you have to remember that these are generic privileges and outside RNs for example come under the same guidelines. Also the hospital can restrict privleges if a provider is "bad". For example a physician with a history of misdiagnosing lung cancer might have their privilege to read x-rays revoked.

Finally if you want to do certain procedures you have to demonstrate proficiency. For example I'm privileged to first assist which in my case was a sign off from the surgeon and my case log. To be privileged for paracentesis, I had to show my case log and have five procedures observed. Other procedures such as suturing, intubation and central lines are commonly privileged.

The hard issue is that now hospitals insist on original source verification. This means that they have to get verification from the source for every hospital that you have worked at, every state you have a license in (or had), your graduation from school, your certification etc. If any of these are delayed then your whole application gets held up. After all of this is ready then it is reviewed and voted on by the credentialing committee (usually members of the medical staff).

Only after you have been given priveleges can you do anything in the hospital at all. As you can see the longer you have doing this the longer it takes to verify it all.

David Carpenter, PA-C

[VivaRN]

Originally Posted by core0

Generally only hospitals privilege. However, some large health care organizations or universities also privilege all providers. From you have the privilege of being able to order stuff in the hospital. There are different types of privileges. The most common are consulting and admitting. Consulting allows you to see patients but not admit them as well as write orders. Admitting allows you to do all of the above.

Darn, I think this applies to me because this clinic is affiliated with a hospital. I can admit patients directly although I don't manage them inpatient. Other providers have told me horror stories about this process. What a mess. Is there any way to get started before graduating?

Thanks David for taking the time. I have learned so much from you!

[core0]

Originally Posted by VivaRN

Darn, I think this applies to me because this clinic is affiliated with a hospital. I can admit patients directly although I don't manage them inpatient. Other providers have told me horror stories about this process. What a mess. Is there any way to get started before graduating?

Thanks David for taking the time. I have learned so much from you!

You can get your application and start it now. Check and see if they have temporary privileges. These seem to be vanishing but some hospitals have them. Also depending on your state there may be some method to work between graduation and certification, but again this seems to be vanishing.

Ultimately they will want your license which in most states waits for your certification.

I cannot emphasize enough the need to keep copies of everything that you send them. If it gets "lost" then its easy enough to give them another copy.

David Carpenter, PA-C