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Palliative Care, DNP 15,641 Views

Joined: Jun 28, '11; Posts: 778 (56% Liked) ; Likes: 1,933
DNP, FNP from US Family Nurse Practitioner

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  • Mar 16

    "It wasn't a good fit, and our priorities were not aligned."

  • Mar 16

    If you have been credentialed at a position they will know you had the job so I wouldn't attempt to leave it off your CV. I'm sure others will offer suggestions on how to spin it in a palatable light. Only you and the organization know what happened but I pray it wasn't the case of another new grad who was woefully unprepared by their university to function in the provider role.

  • Feb 24

    I currently work for the VA as a NP, some of the info on this post is only marginally correct, VA NP's are NOT GS employees, we are nurses first and NP second, we nurses are ALL classified on the same system and there is NO, I repeat NO logic on at what pay level an NP is paid started at, it is 100% on how you write up your experience and how the wording is formatted to fit within the VA frame work. The system is very, very rigid and inflexible from my experience, you write up your packet and it is sent to a group of nurses, and NP's and they read it and decide what level you start as. I've seen RN's with 25 years experience start as a Nurse 1 and some RN's that were much better at word smithing and start as Nurse 3, step 12 (highest pay grade).

    In a nutshell:

    As a new NP, they can start you at any pay grade depending on what the board says you start at, and the Pay grades are basically Nurse 1, 2 or 3. Once you get to Nurse 4, that's not a clinical nurse, normally a part of the executive leadership team.

    Each Nurse level (1,2,3) will have between 12-15 steps, and you make your money at the initial placement level, because once you are in the system it is VERY difficult to advance, you can, but it's very difficult, politics can become involved and I'm just not jumping through the hoops and kissing that much behind in order to advance that way.

    My example, I've been with the VA for 7.5 years, I started as a CNA, then LPN, then RN and now FNP and I'm only a Nurse 2 step 4, and I will be the first to admit that I am no good at their write up system! There are RN's that are nurse 3's and make more than I do, I would make more if I worked the floor as a staff nurse with nights and weekend differential!

    I may or may not make nurse 3 at some point, I don't know.

    As a new grad, I KNEW that I should NOT start with the VA as a NP until I quit the VA, got at least one year away from the VA and with at least 1 year or more of NP experience and then come back and write a strong board write up and then I could start as a nurse 3, however, I was in the Southeast and they are cranking out NP's a dime a dozen and it's very hard to find a job and if you find one, it's often for low pay ($60,000 - $70,000 yr)

    I am currently in a specialty service, I work under Medicine and not nursing, however, to advance I still must go through Nursing for advancement and training, my orientation week was with the NA's, LPN's and RN's doing floor nursing stuff, I actually work with all MD's, I'm the only NP, I work under the medical model pretty much by default.

    My advice do not start with the VA until you have at least 1-3 years of experience, find someone in the system to help you write your experience and translate it into VA speak and DO NOT, I repeat DO NOT take a Primary Care job with the VA, unless you like up to 1000 patient panels, it can be rewarding but there is severe burnout with the NP's in Primary Care due to "alert" fatigue, imagine having a 1000 patients, each of whom has secure messaging and can send you a message at anytime and you must respond to it (alert) and you order 10 labs and an X-ray and the results come in as (alerts) and you must also see the patients that are scheduled, whom often come in late and if the patient is unreasonable, you can't discharge them from your practice as you can in private practice. So the PCP's are getting overwhelmed but do a great job! My personal VA PCP called me at 6pm with lab results (alert) and I asked her what in the heck she was still doing there at 6pm, she started at 730am. I thanked her for her hard work, but man o man.

    And lastly, the benefits, I don't know, maybe they are OK, but FERS retirement is NOT great, the old retirement system was GREAT, my friend will receive 80% of her base pay at retirement under the old system and she currently makes $103,000 as a RN. Under FERS (me) I make just under $96,000 as an FNP and my retirement is 1.1% of my base pay x the number of years worked, so if $100,000 x 0.01 is $1100 x 20 years = $22,000/yr in retirement, not exactly something to be able to live on. But they expect Social Security and what you make in your TSP (401k) to make up the difference, which is better than nothing, but not a make or break factor either.

    Good luck with your career decision, I'm a 20 year military Veteran and I generally like working at the VA, and the annual leave is nice and I like the stability of guaranteed 40 hours per week, but if you can make $30,000 more per year in a non VA setting and work for 20 years, that's an extra $600,000 over your career. Just something to ponder

  • Feb 24

    I am working as an NP at the VA. The pay for NPs is way less than the PA pay, its very upsetting. The PAs make 10,000-18,000 more than us. We have lost 4 Nps this year already.

  • Feb 24

    I'm wondering if their NP pay rates ever caught up with the invention of indoor plumbing?

  • Feb 24

    Quote from Studentworker
    Hi everyone. I joined this page to ask this specific question. I used to be a PCA, and am currently a college student. During my winter break, I was home and there was a snow storm that made visibility terrible, and the roads were not even plowed. I was scheduled to come in that night for an overnight, and had told my employer I probably wouldn't be able to get there due to the snow over 24 hours in advance. I messaged every single other person that worked as well, and everyone either did not want to or were even further away than I was. I had to end up just saying that I could not come in. I drive a very old sports car that has BALD tires. When I even hit a patch a slush doing 5 mph, I will still slide. Living in a town with all hills that was unplowed and had ice all over, I couldn't even get out of my driveway, and knew there was no way my car would make it there. My family did not allow me to take their four wheel drive vehicles, or even my brothers car which is at least a little safer. I do not live at school, so I didn't have anywhere I could stay beforehand to make it to work. I ended up being fired, and was obviously upset. I got yelled at for being "unprepared" and "irresponsible", as if I could have just snow shoed there or had any other option. This is NOT my full time job, it was simply for patient care hours. I did NOT take on this job thinking I would have to do this, nor was it ever mentioned to me. There were people on campus that just did not want to go in and cover me. Is this really my fault? I hate losing a job and a reference, but I can't control what car my family gives me, or that I have no viable option. I'm an undergrad, not a nurse knowing fully well what I have to do. Also, on overnights you get paid $20 for the whole entire night. You don't get paid hourly. I don't think totaling my car or getting hurt or killed is worth any amount, much less $20.
    This is why you got fired.

  • Feb 24

    When I worked in hospice we strongly advocated against suctioning, in fact it could trigger the gag reflex and cause more distress. We advocated for/ and encouraged drying meds such as levsin and atropine but secretions at eol are usually much more distressing to the family than the patient themselves, so we'd educate family but no we never suctioned hospice patients.

  • Feb 23

    Sometimes facility policy will deviate from what you learned in school. As long as it's not unsafe or blatant bad nursing, follow the FACILITY policy. To put an even finer point on it, sometimes policies differ from ED/floor/stepdown/ICU.

  • Feb 23

    I think most of us understand what you were trying to say. Perhaps the heading got some fired up. Seasoned Nurses VS Newbie Nurses makes it sound like a heavyweight title boxing match

  • Feb 23

    Well sonny, when you've been a nurse as long as those "other" old people, you realize ACLS guidelines change and even though the flavor of this revision says to use or not use a certain drug these old dogs have been through 10-12 revisions with those same drugs either on or off the list, and have seen them work in real codes, not in class. Don't get me wrong, I agree nursing is changing so fast, and so often, it is hard to keep current, but maybe next time ask why ....


  • Feb 23

    I don't see people hating on the OP. We get probably a hundred threads on this same topic every year, and some of us get a little cranky when we see another seasoned vs. new nurse debate. Especially when the posters are still in school and have NO idea what working the floor as an actual nurse is like. A wise instructor once told me, when I complained to her about the RNs cutting corners in my clinical setting, "There's school, there are tests, and then there's real life". She was a practicing nurse, so she wasn't speaking from a high perch in academia. She was also right, and as I became a seasoned nurse myself I learned where I could (and could not) save time. I also took the time to explain to the students and new nurses I precepted that what they saw me do might not always be the way it was done in school, and that I expected them to do things exactly the way they were being taught.

    We realize that new members may not know that this issue has been raised ad nauseam, but don't hate on *us* for being a little less than patient with these threads. They never end well, and we know it.

  • Feb 23

    School teaches what it should be like in a perfect world. What you are meant to take from your education is how to be a safe beginner nurse. When you get to the real world, a lot of either shortcuts or quicker ways to do things are learned because demand on nurses time is high. The bridge between seasoned nurses actions and current practice is in that a seasoned nurse knows the basic safety requirements and what absolutely must be done in any given situation and can keep good practice while taking out unnucessary steps or extra interventions to reach the same goal. Soak up what you can from your preceptor and apply your current knowledge to do the same thing.

  • Feb 23

    You aren't in school anymore. Good luck to you.

  • Feb 23

    You won't be very well liked with that mindset. So what if seasoned nurses don't do things like you learned in school? School isn't real life sweetie. Instead of trying to point out how "out of date" they are, learn something from them! Good luck

  • Feb 23

    (Shakes head) Move along. Nothing to see here.