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Trilldayz,RN BSN 12,036 Views

Joined Jul 25, '08. Posts: 529 (35% Liked) Likes: 453

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  • Nov 10

    And...if you do decide to relocate to an "outside the metro area," please don't look at as undesirable.

    People live in more rural areas too. I live in a rural area near a fairly large city of 300,000. I practice at several small clinics in rural areas. I get loads of experience because my pts are too sick, don't have cars, can't drive, no mass transit to get to the "big city" (which isn't very big but I digress).

  • Nov 10

    I am an ACNP of 10 years, preparing to recertify and I have won multiple regional prestigious awards as well. I can tell you that big cities are saturated with NPs and it is hard for anyone to get a good position with experience less than at least 3 to 4 years in these cities. I have had difficulty obtaining a job that I really want in my home city, even with my experience, and am now working in another city 5 hours away where I'm trying to build a reputation for myself, using locums. I recommend getting out of the very large cities to extended suburbs to see if you can find anything that could help you. Even better, try calling the offices of the other MDs to see if they could use your help. Even if it is for a day a week, I'd take it, and work somewhere else for the rest of the week. What you're going to have to do is network and start low. Keep your expectations low. I did that the first two years of my career and I can tell you that I earned less than a patient care tech, but the experience and networking was invaluable. I have never worked outpatient, obviously, because I am Acute care, but it's a suggestion.
    Best of luck with your search for a good job.

  • Jul 12

    Well, I would say first DON'T GIVE UP. Second, it looks like you're in Houston. I'm north of you and I DO NOT see the same job situation in other Texas metros. In fact, I see the opposite. A "normal" salary offer for a newby is this canned "$95K" to start which I heard everywhere and must have come from
    some idiotic HR factoid resource. At any rate I would scoff at anything below $90K as an NP. I do agree that racking up more credentials is key plus years of experience and EXPERIENCE IN THOSE YEARS! They gotta be able to make money off of you or it just won't work. If you're being passed over then it may be worth while to get some head hunter feedback from the agency you're working with just to see if it's an interview thing you could
    change. If not, then you only need one "yes" for now so don't get discouraged. I'm puzzled at an employer asking you to get your DEA registration, did you not prescribe in your last NP gig? That's a big deal if you didn't b/c I got asked that all the time. It's good that you have it so you can get up and running quick for a new employer otherwise it's sit and wait and they can't use you for much. At any rate, you probably know all that.

    Contrary to what I am reading here I've had a D.O. internist tell me there is NO shortage of physicians really in major cities, just where nobody wants to live in the first place. Probably holds true for midlevels so looking outside the metro may be better. I'm sick of school but I am going to go back and get the RNFA done after having an ortho surgeon tell me that's the ticket b/c you write your own paycheck from billing and basically are a free employee to the ortho. That benefit should be transferable to any location, any state.

    In a nutshell, don't give up just yet. I can see Houston being a little crowded but all Texas metros are getting that way. There are better paying gigs for sure but might take some networking. Get on FB and check some local PA/NP groups. I did and got a few knocks from just dabbling. I'm staying put for now but will use those sources later on. Good luck.

  • Jul 12

    Quote from zedillo85
    They should fight for autonomy in all 50 states then... It's either they can replace PCP MD/DO completely or they can't.

    In states that they are fully autonomous, they should not be looking for jobs. MD/DO PCP should since there is no difference in the care provided by NP vs. DO/MD in primary care and yet NP is way cheaper...

    Why would an employer hire a MD/DO PCP over a NP in states where NP have full practice right?
    Until APRN nursing gets it's collective stuff together in terms of training people I'd be absolutely terrified to have an army of NP's replacing primary care provider MD/DOs. There is just way too much variability in programs and the quality of NP's being pumped out of the market due to a failure to standardize and the zealousness of Universities to cash in on the advanced practice craze.

    Why would an employer hire an MD/DO? Honestly all the 'employers' that have interviewed me since graduation were MD/DO's and a lot of them are catching onto the fact that NP programs come with insane variability. Not all MD/DO's are going to be amazing, but you can bet that they have very similar training across the board. Same with PA' for that matter.

    Ever single day on this site you see, "What is the fastest route to NP where I can go online, have easy coursework and never have to work as a nurse!!!!". It's not... "Oh wow, I want to enter a career where literally I can make a mistake that alters someone's life forever, where I have a ton of liability, can get sued, or spend thousands on a degree and lose my ability to practice if I'm don't know what I'm doing... so please tell me which program, route, path offers me the absolute best and most thorough education!".

    Yet there are totally school's out there that with "Just graduated with your BSN? Have No nursing experience! Able to set up your own unstructured clinical rotations where you basically just watch your doctor friend do H&P's for 500 hrs!? Well you're in luck! Boy do we have a deal for you! For just the small price of a black market kidney, you too can become an NP!".

    The flood of providers and the lack of standardization hurts the NP profession - not the fact that MD/DO's do primary care.

  • Jun 16

    Quote from Trilldayz,RN BSN
    I feel like I fell for the "FNPs can do anything" myth. It is NOT TRUE in my neck of the woods.

    Maybe I'm just impatient, or asking for alot, i don't know.
    Its true most places and I don't think you are being inpatient or asking a lot. Unfortunately, you are in the same boat as many other NPs who drank the university KoolAid served up to undergrads who believe the Land of Milk and Honey NP fairy tale. You aren't the first and sadly I suspect your experience will increase exponentially in the near future.

    At this point the best I could offer is to really work your professional contacts for an inside tract to a NP job. Good luck.

  • Feb 18 '16

    Quote from ghillbert
    Negotiate HARD when you take your first job - often that is your opportunity to start higher on the ladder and raises from there are often a % of your base salary - so start as high as you can! Once you take the job, you have little bargaining power.
    I would encourage all new grad NPs to make it a short term goal to change jobs anyway after their first year. Much more realistic than to plan to stay in the same job forever and hope that incremental annual pay increases will bring one up to where one should be. It has gotten a lot harder for many new grads to negotiate higher pay for their first job because the markets are so saturated with other new grads in some areas and the employers know this. One should always ask for more, but if they say no and what they're offering seems reasonable (and is significantly more than what one makes in one's current RN job) then it would make sense to take it and start building NP experience rather than to let the opportunity slip away---especially if one is in a location where jobs are very hard to get. A year goes by quickly, and after a year of experience one will be in a much better position to negotiate for more money.

    If the current employer really wants you to stay after that then they need to step up with the money or you, as the ambitious NP that you are, should be ready to step out and move on to better options. The key is to be willing to make the move. You will find that once you have NP experience that your situation is very different from that of the new grads who are having trouble with finding their first job.

  • Feb 10 '16

    It sounds like a pretty good deal, congrats.

    I would check on a few things if you could:

    1. Who handles referrals and PAs?
    2. How much do other providers have to chart at home?

  • Feb 10 '16

    Not a bad offer. Texas has a lower COLI than the northeast (where I am from) so that helps a lot. Remember this is a starting point, not an ending one!

  • Feb 3 '16
  • Feb 3 '16

    If you've signed I would think it's a done deal. I would look for little cracks/openings over the next year as you establish yourself as a great provider in that practice. Little opportunities may present themselves in the form of colleagues that would be up for some sort of 5/4 swap where one week they work the full five days and you work four days and then you switch the next week OR gently putting out feelers that you would love a 10 hr work day so you would have one day off per week.

    TRUST me...you are going to be hating life when you have kids and you are in the office 9-5 five days per week. Or at least I would. I'm sure some do it and they love it but it would not be my ideal. If you have no kids right now then use this time to rock that first job, be flexible and put in your time. Then when you do start having children you will have a workplace that values you and your contribution and may be willing to re-negotiate to 3-4 days per week (with appropriate salary reductions of course.)

  • Feb 1 '16

    Wow the pros sound pretty good to me. I guess the question would be if the no pedi patients and drive are a deal breaker for you. If not and you think you would enjoy this place and it would be a good learning environment then I think its a solid offer. Congrats on the offer!

  • Feb 1 '16

    Sounds good! It sounds like it's not your ideal population though?

  • Jan 7 '16
  • Jan 7 '16

    For the same reasons that some MD residency programs selectively market to foreign medical grads, who then can be used for whatever from overcharging Medicaid to tampering with prescriptions to involving females to activities usually called "having some fun while on call in hospital". They think they are dealing with people who are either desperate, stupid or afraid, or all that put together.
    I know it is more difficult to say than to do, but if every single NP, or an RN or every one else, for that matter, will just report to authorities every single suspicious activity, the things will start to move in the right direction sooner or a bit later. We will not hesitate to report a child covered with bruises in ER, even if eventually it will came out that the child is very well cared for but in serious figure skating training and so bruises caused by falling on ice. Why, then, should a person not employed in a "pain clinic" opened a month ago in the nearby strip mall hesitate to call authorities and ask to investigate?

  • Dec 13 '15

    Quote from Trilldayz,RN BSN
    Thank you for your empathy! (((hugs)))
    Hey, ya know what... the fact that you saw something that disturbed you (and it wasn't even anything that directly effected you,) and you took action on it... just shows you have a lot of heart! Honestly, it really doesn't matter how other ppl interpret or respond to the ad. I do think it's great you wrote to get feedback on the scenario and your actions... another person might not have been that open and/or might have felt so righteous in their actions not to do so. So, it seems to me, REGARDLESS of if it really was or was not an overreaction...you seem like you have a big heart, you stand up for what you believe in, and you are open & willing enough to seek out others' opinions & feedback when you are giving it a second thought. Sounds to me like you have a great set of values & moral principles... and we NEED more people with those qualities around today... sadly, even in some of our fellow nurses! So Bravo!


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