Calling all new NPs!

[amalay]

Hi friends,

So I'm a freshly graduated PNP from a direct entry master's program - got my RN and PNP in the same program. I've never had any employed inpatient RN experience, but I have worked as an RN in outpatient pediatric psychiatric centers and private clinics for about 1.5 years as I finished up the NP portion of the program. I'm just about a month onto the job -- my first employed NP position.

I just wanted to hear some feedback from other new NPs with little to no prior RN/NP experience (outside of school/clinicals) - I have to ask, is feeling a little incompetent a "normal" part of the process switching from student to working professional? I recognize that I haven't seen a WHOLE lot, much of my primary care rotation was spent doing well child visits and not so much urgent care visits. How have others adjusted? What are good resources that you tend to lean on?

Any advice or just sharing of your experience would be so helpful! I'm not the most confident person in the world, so I always tend to talk myself into these ruts where suddenly I think I'm not cut out for this. =/

Thanks!

[amalay, MSN, RN]

You make a very good point Jules. I think definitely think I have to take a step back, especially since I'm new. Thanks for clarifying the whole psychologist therapist role, I had always been confused about whether they are qualified to make a medical diagnostic of depression.

While I did start that child on a stimulant for adhd, pending their establishment with psychiatry. ..I didn't do the same for the depression case. I stead I've placed several calls to psychiatrists in the area in hopes of being able to figure something out.

I do feel like adhd is commonly managed in primary care (with psych or mental health involvement) but mood disorders are a whole different ball game.

[Jules A, MSN]

Some therapists, LCSCW maybe? and psychologists can diagnose however they can not prescribe and as someone who has seen pretty bad diagnosing especially in kids. Unless I know their work I would be hesitant to take their assessment at face value without confirming myself that the patient met the DSM-5 criteria. In any event it is just disrespectful and out of their realm to make specific medication recommendations.

While I do like some of the nursing aspect being a NP has on my patient care I continually ask myself if a physician would do the same. If they wouldn't I don't. I don't routinely take vitals or do clerical tasks. If I need a specialist recommendation I have the office staff arrange it. There is also the option of giving the patient a list of providers and encouraging them to advocate for their own care and schedule their own appointments. I'm not going to get sucked into spending time that I'm not billing for or practicing outside my scope because I either feel sorry for the patient's situation or am narcissistic enough to think I am solely responsible for their well being. I think some of this is what keeps NPs in a nursing role which enables the low wages we see posted here as well as the constant taking on additional tasks that no one would ever expect a MD to do.

[amalay, MSN, RN]

Yeah, I am always miffed when therapists or psychologists push for meds without thinking about consequences of their recommendations. It's really not that easy to decide to manage and prescribe antidepressants and the like.

And I would have to say I partially agree wi th what you said, I definitely have noticed that the physician's in my practice. ..advocate better for themselves? One is relatively new herself, out about 2 years after residency. And she us very very adamant about what she should and should not be doing, not really that ambiguity that I feel.

[CallieNicole]

I love your perspective on the difference between practicing as a member of the medical team vs nursing team and your way of asking yourself constantly if a physician would do the same. I will remember this during my practice.

This is a constant disagreement between myself and one of my friends. She believes that her practice means incorporating the nursing role of being the "savior" and hence, she constantly changes employers because she has difficulty meeting the quota and the reason is she takes on other responsibilities that she should not be taking for her patients. Her employers always try to give her a second chance but she resigns when she is pushed to meet her numbers because her justification is she is a nurse first and foremost. At present, she is working at a community clinic and making a salary of the lower end of the spectrum.

[Jules A, MSN]

I love your perspective on the difference between practicing as a member of the medical team vs nursing team and your way of asking yourself constantly if a physician would do the same. I will remember this during my practice.

This is a constant disagreement between myself and one of my friends. She believes that her practice means incorporating the nursing role of being the "savior" and hence, she constantly changes employers because she has difficulty meeting the quota and the reason is she takes on other responsibilities that she should not be taking for her patients. Her employers always try to give her a second chance but she resigns when she is pushed to meet her numbers because her justification is she is a nurse first and foremost. At present, she is working at a community clinic and making a salary of the lower end of the spectrum.

Sadly your friend's misguided mission as a Florence Nightingale ambassador isn't uncommon and shoots us all in the foot, imo. She isn't doing what she is being paid for and then hides behind the "holistic care" mantra to excuse her lack of efficiency.

If I was Amalay and had the opportunity to work with a new physician I would make it my duty to be her BFF. If you can hook up with a sharp, new doc right out of school although lacking in experience they can be a wealth of knowledge especially in the area of professional practice. They don't get pushed around and that is where I want to be.

Focusing on being a member of the medical staff has been very helpful for me in many realms such as salary negotiations, my duties and the respect I receive from staff. I know what they pay psychiatrists and therefore know what my worth is to the organization. Physicians like working with me because I operate like one of them. I respect their knowledge, and the clear cut, practical nature in which they approach things. I have learned so much from their insight and by aligning myself with them. Bottom line is I'm not paid to be a nurse I am paid to be a provider and make over $175,000 before OT.