First NP Job and unhappy...What to do? - page 2

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... Read More

  1. by   traumaRUs
    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.
  2. by   Jules A
    Quote from Melody48_MSNEd
    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.
  3. by   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
  4. by   blondenurse12
    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.
  5. by   Alicia777
    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
  6. by   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 !
  7. by   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 :-)
  8. by   Riburn3
    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.
  9. by   Jules A
    Quote from Riburn3
    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.
  10. by   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.
  11. by   Jules A
    Quote from 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. .
    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.
  12. by   Panadama
    You are NOT being too needy!!!! and I wish you didn't have to suck it up, but I think on some level - you will need to. I find as an NP we are neither nurses nor doctors and so, are in a sort of "no-man's land" when it comes to any sort of formal orientation. (The world of healthcare has not caught up with what a nurse practitioner does and so feels that we are "mini-doctors" and can do everything a doctor can and oh look- for less money!!) I have to also state that, unfortunately, this is the way most NPs are "taught" in medicine, the "sink-or-swim" mentality (talk about eating our young!). My biggest frustration in coming from critical care, (as you have experienced in L&D) to primary care - is the barn door is wide open in primary care - anything can walk in that door! For me, it isn't just airway, breathing circulation any longer - it is derm, OB/GYN, endocrine, GI/GU and the list, as we all knows goes on and on and it scares me at times! I was a highly competent critical care nurse and thought I could do anything - until I became a primary care NP. It has humbled me. I had never looked in an ear, or looked at tonsils, had seen strep throat or diagnosed seborrhea keratosis before - (cobblestones? in a mouth? I mean, what the heck!). But, with all that said, two things - you need to first pat yourself on the back in attaining your FNP degree!! That was a lot of hard work and you need to recognize that! The second thing you need to do is hang in there for at least a year, if not two. In my experiences in life, when I start something new, I have noticed that at the six month mark I feel myself "psychologically exhale" and see a glimmer of hope - "I think I just might be able to do this". At the one year mark, I feel even stronger and at the two year mark, "I know what I know and I know what I don't know" and then for me, the real learning begins. I myself am struggling with primary care having been practicing as an adult NP for 9 months now. I realize my next sentence may start a lot of dialogue, and I don't mean this to be inflammatory in any way, but - I don't feel that our NP programs set us up to practice as new grads in our current healthcare system. It appears that the APRNs and PAs are going to be the ones that save our primary care healthcare system" but I feel strongly that the expectations are too high and I don't feel that we are supplied with enough education to be a PCP without some sort of either; residency programs, a more structure masters programs, or a "certified" orientation program for new grads (whose certification would come up every 2 years?). I love what I do, but I don't like the hours, the salary, the responsibility (same as a physician, yet much less salary) and the lack of support we are offered as NPs in many primary care environments.
    I understand your desire to go back to what you feel comfortable in, but, consider this your 2 year med/surg orientation before you choose a specialty?!?
  13. by   Jules A
    Quote from Panadama
    I realize my next sentence may start a lot of dialogue, and I don't mean this to be inflammatory in any way, but - I don't feel that our NP programs set us up to practice as new grads in our current healthcare system. It appears that the APRNs and PAs are going to be the ones that save our primary care healthcare system" but I feel strongly that the expectations are too high and I don't feel that we are supplied with enough education to be a PCP without some sort of either; residency programs, a more structure masters programs, or a "certified" orientation program for new grads (whose certification would come up every 2 years?). I love what I do, but I don't like the hours, the salary, the responsibility (same as a physician, yet much less salary) and the lack of support we are offered as NPs in many primary care environments.
    I understand your desire to go back to what you feel comfortable in, but, consider this your 2 year med/surg orientation before you choose a specialty?!?
    I like what you have written and agree with this part especially that for NPs who are changing specialties like you have done our education is insufficient and that we would greatly benefit from a residency or fellowship program. It is my concern that as the number of new NPs, especially those with no RN experience, the data on our outcomes will fall sharply. Just a gut feeling folks so no requests for journal articles.

    That said Pandama with regard to your complaints about wages please consider getting involved with your states NP organization, start networking and being vocal about salary expectations. There are plenty of us out there who are compensated fairly based on our productivity but you will find more who are willing to work for whatever crumb is tossed in their general direction. In my opinion this job is way to challenging not to make an excellent income and that takes nothing away from my dedication to my patients.

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