Advice Please: Interview tomorrow for ER NP position

Editorial Team / Admin · Sep 14, 2005

Hi all,
I was hoping to get some input about an interview I have scheduled tomorrow. It is in a Level III emergency department. There is a physician there 24/7 with double coverage by a NP during peak times. I am a new grad ACNP. I have never worked in an ER type environment. I have 10 years experience as a RN with the last 6 in critical care.
For those of you with experience in the ED, what do you think are important questions for me to ask/or things to consider with this opportunity? I know I will have a big learning curve and they seem willing to accept that as well as I am ready to continue to broaden my knowledge on areas I am less comfortable (trauma, ortho stuff etc.) My area of expertise is cardiology and I have been a little disappointed for lack of opportunities in that area in my hometown. I feel comfortable with acute patients with CP, dyspnea, syncope, CVA/TIA, Abd pain. I think they would prefer to have someone who can see kids too, but the medical director said he was willing to consider an ACNP because of the training etc.
I also have an interview next week at the hospital I work at now as a RN. For a NP position that would create an outpatient heart failure management clinic and also work with one of the CT surgeons (My facility currently does not do hearts, but will begin after 1/1/06)
I guess I anticipated getting out of school and having a perfect job waiting for me.....too bad someone woke me up from my dream land. I have been so busy with my education over the last year that now having to wait is making me crazy...wait to get authorization to take boards...wait for interviews....wait for job.....wait to get licensed until you get job.....aaarrgh...thanks for listenind to the vent.
Any words of wisdom?
Thanks, Kristie

Hello, Kristie,

The position that is coming up in Jan. of '06......do you think you will possibly get that one? Just wondering. Is that the type of work you really want to do? If so, can you take this one in the ED until the other one opens?

Now, if you do take the one in the ED, you will need ACLS, preferably ACLS EP, PALS, NRP, ATLS. This really is just about mandatory what with the responsibility you will have.

It sounds as if they are willing to let you work just out of school in such a highly specialized area and that is a great compliment to you. And, you will have 24/7 physician to help guide you until you get the feel of things.

If I could place myself in your shoes, I would take the ED position. I think in the long run it would be most satisfying for me, but, I am not you.

Hard decision........hmmmmmmm.

What do you REALLY want to do????

cgfnp · Sep 14, 2005

Hi all,
I was hoping to get some input about an interview I have scheduled tomorrow. It is in a Level III emergency department. There is a physician there 24/7 with double coverage by a NP during peak times. I am a new grad ACNP. I have never worked in an ER type environment. I have 10 years experience as a RN with the last 6 in critical care.
For those of you with experience in the ED, what do you think are important questions for me to ask/or things to consider with this opportunity? I know I will have a big learning curve and they seem willing to accept that as well as I am ready to continue to broaden my knowledge on areas I am less comfortable (trauma, ortho stuff etc.) My area of expertise is cardiology and I have been a little disappointed for lack of opportunities in that area in my hometown. I feel comfortable with acute patients with CP, dyspnea, syncope, CVA/TIA, Abd pain. I think they would prefer to have someone who can see kids too, but the medical director said he was willing to consider an ACNP because of the training etc.
I also have an interview next week at the hospital I work at now as a RN. For a NP position that would create an outpatient heart failure management clinic and also work with one of the CT surgeons (My facility currently does not do hearts, but will begin after 1/1/06)
I guess I anticipated getting out of school and having a perfect job waiting for me.....too bad someone woke me up from my dream land. I have been so busy with my education over the last year that now having to wait is making me crazy...wait to get authorization to take boards...wait for interviews....wait for job.....wait to get licensed until you get job.....aaarrgh...thanks for listenind to the vent.
Any words of wisdom?
Thanks, Kristie

I understand your frustrations, as I have experienced the same BS. The process is mind-bogglingly redundant and obviously created by someone who wasn't able to lay their hands on a patient in the first place.

As far as questions for the ED... I would ask how many patients they see annually to get an idea of how many you'll be expected to see. I'd also ask the ever-so-infamous 'what's in it for me?'. Will there be productivity bonuses? Will there be hourly, salary, overtime, etc etc. I'd ask who's in charge and how long have they been there. I would talk to any current NP/PAs there and see how they like it, what they like and dislike about it, what to expect as far as $$$ goes and whatever else you want to know.

Get as many interviews and offers as you can so you can weigh the good/bad things about each. And, you have some negotiating power if you are offered 60K at one place and 90K at another.

Good luck, and congrats on graduation.

Kristiern1 · Sep 14, 2005

I understand your frustrations, as I have experienced the same BS. The process is mind-bogglingly redundant and obviously created by someone who wasn't able to lay their hands on a patient in the first place.
As far as questions for the ED... I would ask how many patients they see annually to get an idea of how many you'll be expected to see. I'd also ask the ever-so-infamous 'what's in it for me?'. Will there be productivity bonuses? Will there be hourly, salary, overtime, etc etc. I'd ask who's in charge and how long have they been there. I would talk to any current NP/PAs there and see how they like it, what they like and dislike about it, what to expect as far as $$$ goes and whatever else you want to know.
Get as many interviews and offers as you can so you can weigh the good/bad things about each. And, you have some negotiating power if you are offered 60K at one place and 90K at another.
Good luck, and congrats on graduation.

Yes, redundancy seems to be the order of the day.....I got a letter today from ANCC saying my application for exam was not complete??? Seeing as how I spent about 3 hours filling it out and double checking it about 8 times I can't believe it. Apparently they can't find record of my being a ANA member. Although I have my state card right here. They said I needed to submit an additional 140.00 because I was not eligible for the discount...Of course please keep in mind it took them a month to send this to me saying it was incomplete. So I spent 1 hour on hold awaiting a human at the ANCC and apparently was blessed with the employee of the month who must have missed the day of training...."The customer is always right". Anyway after about 3 hours of phone tag I am hoping to have this resolved in the morning.

Im hoping to have some more pros and cons to consider after my interview... From what I can tell from the info they sent it is a 115 bed hospital with ED volume of 17,000/yr.

I am already an ACLS provider and instructor, I have taken PALS before and was certified for 2 years till it lapsed. I have my CCRN certification with a subspecialty in cardiac medicine. I was looking at some websites about when a TNCC course or ATLS class would be offered to gain those skills.....Thanks for the input I will let you guys know what happens.

Kristie

MaleAPRN · Sep 15, 2005

Hi,

Here's my 0.02 cents:

I would take the ED position over the cardiac clinic position.

I was a ED NP for over 2 years till I decided to go to CRNA school last year. I was a FNP though, not ACNP. As a ED NP, you'll get to see a wide spectrum of patients that you'll never see in a cardiac clinic (pretty obvious). You'll apply your critical thinking skills in the ED moreso than in the controlled clinic setting. I know I did. Eventhough I was an FNP in training (I worked in the ED as a nurse for years, so I knew the routine), I did most of my internship in the ED and the DOCs molded me and I performed many procedures that I wouldn't dream of doing as an FNP...such as lumbar punctures, art lines....etc. True, as an ACNP in the ED, you won't see OB or Peds patients...but, it depends on the ED group that hires you....if you work for them and they train you on something....well, guess what? You're doing it under their supervision....so you're covered.

Not a lot of ED's hire NPs. But, if you get the chance to hire on to an ED position....GRAB it! You'll be MORE marketable later on....if you later decide to work in a clinic based setting. This has been my experience.

Goodluck.

V.

Trauma Columnist · Sep 15, 2005

I would KILL (figuratively) to get an ER job. That is my background though and where I feel comfortable. I would ask:

1. Number of patients/year.

2. Nursing/patient ratio.

3. Do they favor family presence during codes/resucitation?

4. Will you receive extra credentialling for RSI/intubation, central line placement, chest tube placement?

5. Hours on duty plus what amount of call?

6. How are xray discrepancies handled? Only by an MD or do you do your own?

7. If you get the position, I would definitely look into the following:

PALS, ENPC (emergency nurse pediatric course), TNCC, CEN (certified emergency nurse), PHTLS (pre-hospital trauma life support).

These are important because you must be able to handle whatever comes through the door. It is also nice to know what your pre-hospital providers are able to do...are they BLS first responders only or are they critical care paramedics? Big differences.

Can you tell what job I would take??!! tee hee hee

Good luck...judi

cgfnp · Sep 15, 2005

Yes, redundancy seems to be the order of the day.....I got a letter today from ANCC saying my application for exam was not complete??? Seeing as how I spent about 3 hours filling it out and double checking it about 8 times I can't believe it. Apparently they can't find record of my being a ANA member. Although I have my state card right here. They said I needed to submit an additional 140.00 because I was not eligible for the discount...Of course please keep in mind it took them a month to send this to me saying it was incomplete. So I spent 1 hour on hold awaiting a human at the ANCC and apparently was blessed with the employee of the month who must have missed the day of training...."The customer is always right". Anyway after about 3 hours of phone tag I am hoping to have this resolved in the morning.
Im hoping to have some more pros and cons to consider after my interview... From what I can tell from the info they sent it is a 115 bed hospital with ED volume of 17,000/yr.
I am already an ACLS provider and instructor, I have taken PALS before and was certified for 2 years till it lapsed. I have my CCRN certification with a subspecialty in cardiac medicine. I was looking at some websites about when a TNCC course or ATLS class would be offered to gain those skills.....Thanks for the input I will let you guys know what happens.
Kristie

That sounds about right with the ANCC, and the AANP isn't any better. That is exactly why I won't join either one. They do NOTHING for me in my state (which is a state that won't let me write for CS). And, they have this untouchable attitude that they think makes them powerful. What they don't know is that it is killing them, because those of us who can see through the bullstuff won't put up with it, and therefore won't send them our money. I'll take my chances speaking with my political rep personally, and if I want a law changed, I'll write it myself.

You seem pretty sharp to me Kristie, so when you start talking to docs about jobs (or hospitals) they will pick up on your intelligence quickly and that will make them want you. Put your resume on some websites that allow free resume postings. I did that a few months ago and the first 4 weeks I got about 5 or 6 calls per day and I'm still getting emails and calls for jobs. Get as many offers as you can. Don't even waste your time with those that offer you less than 70K. And make them know that you won't entertain anything less.

Good luck, and have fun!!! ED jobs are nice and usually pay more if you can stand the rotting system displayed in your face every day (drug seekers, medicaid waste, etc etc etc etc etc etc...)

Kristiern1 · Sep 19, 2005

Thanks for all the great advice. I had my interview and was offered the job. Everyone seemed really great (all six people who were in my interview). Here are a couple of questions again I hope you guys can help me with.

1. I graduated from an ACNP program. I did not have any pediatric content. In this job I the MD would sign all my charts that I see as well. They said they would send me to do clinic with a local pediatrician for some orientation to children. They also said that the doc's typically see the "sicker" kids anyway. I cannot find any specifications in my nurse practice act for my state that clearly says I can or can not see children in my practice. Any ideas? I would never be there alone as md is there 24/7.

2. Just out of curiosity anyone work as an NP at an hourly rate? If anyone feels comfortable telling me what they think a fair rate is for a new grad I would appreciate it!

I told them I would let them know by Friday if I accept. I am very interested, but I have another interview on Thursday (The heart failure clinic job). The ER does sound more appealing but the one thing I failed to mention to you guys earlier is that it involves a 50 mile one way trip. The heart failure clinic job is 5 miles away.

I am so confused, and to add a little more stress I am taking my boards next Tuesday, so please send me some good testing vibes!!

Thanks

Kristie

cgfnp · Sep 19, 2005

Thanks for all the great advice. I had my interview and was offered the job. Everyone seemed really great (all six people who were in my interview). Here are a couple of questions again I hope you guys can help me with.
1. I graduated from an ACNP program. I did not have any pediatric content. In this job I the MD would sign all my charts that I see as well. They said they would send me to do clinic with a local pediatrician for some orientation to children. They also said that the doc's typically see the "sicker" kids anyway. I cannot find any specifications in my nurse practice act for my state that clearly says I can or can not see children in my practice. Any ideas? I would never be there alone as md is there 24/7.
2. Just out of curiosity anyone work as an NP at an hourly rate? If anyone feels comfortable telling me what they think a fair rate is for a new grad I would appreciate it!
I told them I would let them know by Friday if I accept. I am very interested, but I have another interview on Thursday (The heart failure clinic job). The ER does sound more appealing but the one thing I failed to mention to you guys earlier is that it involves a 50 mile one way trip. The heart failure clinic job is 5 miles away.
I am so confused, and to add a little more stress I am taking my boards next Tuesday, so please send me some good testing vibes!!
Thanks
Kristie

You should get at least $35/hr and I'd put a stipulation in there to increase to $45/hr after 1 yr, as you should be rolling pretty smooth by then. (or some equivalent incremental increase).

That's a long drive, and you will get sick of that. You may try to work out staying overnight or 24 hr shifts or something like that if you take the ER job.

As for the kids, don't worry. If your state practice act doesn't mention it, then you can do it as long as your collaborating doc can for the most part. It's nice that they're sending you to a peds office. You'll get the hang of that quickly either way, so don't worry about it.

Good luck. You'll do fine on the test.

MT-FNP · Oct 19, 2005

$35 per hour? Are you kidding? Don't ask for $35 per hour, demand $80 per hour - especially in the ER. Bottom line is, you are doing essentially the same job, with the same liabilities and responsibilities, as the MDs who are making ~$150 per hour. Do you deserve 1/2 of what they make or 1/5?

JACKMAC · Oct 19, 2005

I would be very careful about seeing children if you had no content in school and were not tested on children on your certification exam. That means that an ACNP is not certified to see children as I understand it. That would be practicing out of your scope of practice, a major deal. Before you see any children I would check with your state BON. I think you could get into some serious trouble with your license. ANPs run into the same problem.

Kristiern1 · Oct 19, 2005

Jack Mac,

Thanks for your reply to this post...Initially I did accept this job, but after one day I realized that I had been misled. I was informed that the ER doc cosigned all the charts which was not the case. I resigned for the reasons you mentioned. I worked to hard in school for my degreee to put it in jeopardy for this. Now on to hopefully a better fit!

Kristie