First NP Job and unhappy...What to do?

[TCUgirl15]

I just started my first NP job out of school in January...so I have been there 3 months now. I am really unhappy and not enjoying what I am doing. I also don't want to be a baby about things and make a decision I will regret later. Let me explain my position, and hopefully get some feedback as to whether this is a good situation and I am just experiencing the "first year" stress or if I could be in a better place right now and should do something about it?

I am in an underserved area, family practice. I shadowed a physician for 1 day and then started seeing patients on my own. For the first month this was 6 patients a day or so. 2nd month i jumped to 8 patients a day, then 12 patients a day (which is where I'm at now). Next month 2 out of my 4 days will be walkin only and I have 24 open slots.

I guess my main frustration and feeling of isolation comes from feeling like I never had training, and as a brand New NP straight out of school I felt like this was a disservice to me. There are 3-4 physicians at the practice that are helpful when I can grab them, but they are super busy too and none of them are directly responsible for me. My "supervising physician" is not at the same site as me and I get virtually no feedback from him. I feel like I'm a hinderance to the other physicians when I'm asking questions (because as mentioned, they are busy too!) I get patients put into my template that are extremely complicated, and was told to just treat the pertinent issues and then pass them on to one of the physicians. I feel like an idiot most of the time and feel pretty isolated.

Just this week, finally my clinical director said that we would start sitting down to go over my patients at the end of each day, but she kind of makes me feel like an idiot as well.

Is this typical for how training as a new NP goes? At times I feel like my feelings of unhappiness and frustration are justified, and then other times, I feel like maybe I'm being too needy and should suck it up.

If anyone could shed some light on this for me I would be extremely grateful!! How is your first NP job supposed to be structured? Is it wrong to leave a job prior to staying a full year to give it a fair chance?

I think it does not help that I LOVED my RN job in L&D that I left to be a Family NP. Maybe I just have a passion for Women's and I made the wrong choice. Feeling very confused and lost in my career at this point, just looking for some feedback on other's experiences in starting out as an NP.

I appreciate the feedback!! Thanks!

[Melody007_FNP-C, APRN]

My FNP proram requires 180 hrs of women's health.

You are a FNP which should give you access to a women's health position now because I know most FNP programs expect you to do a lot of hours in woman's health. I'm an Adult NP and I had to do at least 40 hrs of woman's health, so I know you had to do a lot more than than that. So you should be able to parlay a job in that area, especially given your RN background. What have you got to lose, you are already unhappy in your current situation. Plus if you get a job in that area then you can decide if you want to go back for a post masters cert in it. I know a few WHNP who actually went back to school for FNP to be more marketable. Good luck!

[traumaRUs, MSN, APRN]

Sorry for your frustrations. You have received some very sound advice. I agree that giving it another 3 months would be a good idea. When I got out of school, I went right into a specialty in which I had NO experience. I rec'd approx 4 months orientation with either an MD or NP. This was necessary due to thats how long it took to get credentialing done at all the hospitals/clinics.

Best wishes - let us know how its going.

[Jules A, MSN]

My FNP proram requires 180 hrs of women's health.

But it would still be worth running past your BON. Imo whenever there is a specialty certification available such as in the case of Psych, which many FNPs feel they are qualified to do, I think there is a great liability if something goes wrong and the practitioner doesn't have the appropriate certification.

[sauce]

Sounds like you may need to spend some time reading at home in regards to things you are unsure of in your practice. Self study is a powerful tool. But if you don't like it you may want to do womens health

[blondenurse12, MSN, NP]

As much as I complain about my job, I will actually recommend it to you (for a short term fix). I work in retail health. I've been doing it nine months now and I need out but I think in terms of a job as a new/ish grad, it's pretty good. You get to see a fair amount of minor illnesses i.e.- skin rash, sore throat, sinusitis, UTI, bronchitis, otitis externa and media, ruptured TMs. It's not all benign, we do get some off the wall stuff at times that need to be referred out sometimes emergently (peritonsillar abcesses, acute asthma exacerbations, petechial rash that turned out to be ITP). We also do teaching for smoking cessation, weight loss and do in office labs like Hga1c and lipids with teaching. The pace is less intense and typically the managers and physician support staff are really good.

Since you have most of your experience as L and D, I think this would be a good way for you to hone some skills as a general practitioner and then you can go forth from there.

[Alicia777, MSN, NP]

Tough situation! Yes, I agree with the others, look for a WH job. But THIS time, talk about what your expectations are in terms of the orientation before you're on your own.

When I interview for my job I asked what my orientation and mentoring process would be like. I think it's important for them to know you expect it. It's not the MDs fault-they have no idea (other than reading your resume) how comfortable you are flying on your own. Remember, they had 2 years of internship and 2 of residency to be providers..

Good luck

[carachel2]

I think part of your problem is a.) you had expectations that you would have an orientation like you did as an RN...and you did not. Most of us do not unless working in specialty i.e. derm, etc. My very first day on the job was = start seeing patients. Slowly at first and then building up.

b.) you are expecting to be an expert in a field in which you are a total newbie. Drop that expectation, vow to learn something new every day and keep reading and learning.

You are VERY fortunate to be in a job where you were allowed to see patients so slowly at first. That is a huge gift...but could also be holding you back because you have learned to do your job for so long at that slower pace.

Hang in there and don't expect so much of yourself !

[CASTLEGATES]

I echo what was just said.Take your clinicals, what you learned and apply to the best of your ability. Easy to say that (knowing you can't go back in time), but perhaps that may help those in clinicals now (see yourself handling all this on your own). Part may be confidence, and going to the other providers, busy or not, and asking them anyway. You've got to be a little aggressive, if it means sink or swim. Those are only my naive thoughts :-)

[Riburn3, BSN, MSN, APRN, NP]

You're absolutely not alone. I was fortunate that my first job out of school (my current job), was in a clinic that I did a huge chunk of my school rotations in, so I already was familiar with the charting, staff, patients, and expected patient load. That said, my first day I was also given my pad and was told to start seeing patients and didn't get an orientation.

My saving grace is I have absolutely no shame about asking the physician I am with or the other NP with a decade of experience for help, and thankfully, they are very good to me and know I didn't get a residency. That right there to me is the difference between a bad experience and a good experience. Most of us don't get a long orientation (if any), and if you feel like asking questions of other providers is a burden when all you're trying to do is learn and be safe, you're likely in the wrong type of environment.

I also want to say that I cling to my phone and reference my uptodate and epocrates apps all the time. Even when I know what's wrong or have the treatment plan lined up, I always double check myself. This alone as helped me memorize tons of treatment standards and dosing protocols for a variety of diseases, and it makes you feel like you have some legit backup if someone questions your treatment plan.

[Jules A, MSN]

I also want to say that I cling to my phone and reference my uptodate and epocrates apps all the time. Even when I know what's wrong or have the treatment plan lined up, I always double check myself. This alone as helped me memorize tons of treatment standards and dosing protocols for a variety of diseases, and it makes you feel like you have some legit backup if someone questions your treatment plan.

This is good practice and worth much more than just making you feel legit. :)

[BeautynBrains_RN]

I feel the same way and am in the same boat (became and NP in Jan. And my sup physician is not at my site). I work in corrections as a NP and I told them, I will not see patients until I have had adequate training and fortunately they listened...I still have not seen any patients, but am paid for the shadowing and trainings that I go to. Remember you have the license and responsibilities to look out for you as well as your patients.

The confidence will come for the both of us with practice, I remember feeling this way when I first became an RN.

[Jules A, MSN]

I feel the same way and am in the same boat (became and NP in Jan. And my sup physician is not at my site). I work in corrections as a NP and I told them, I will not see patients until I have had adequate training and fortunately they listened...I still have not seen any patients, but am paid for the shadowing and trainings that I go to. .

Its excellent that this worked out for you but in most cases, at least in my experience, unless agreed upon ahead of time most employers expect us to hit the ground running and assume that we received our "adequate training" in school. Although I applaud you for advocating for yourself and your patients I'd advise new grads to discuss their orientation expectations well ahead of actually starting the job.