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

Panadama · May 18, 2015

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?!?

Jules A, MSN · May 18, 2015

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.

Basilejc · Dec 24, 2015

I know this is an older post BUT I feel frustrated about my new FNP job as well. I was also very happy in my past job, working in a Pediatric office as an LPN, when I decided to go back to school, attending an accelerated NP program because I was not an RN. I felt pressured to go the FNP route instead of the PNP track, I love pedi. My new job is in as community health center, working with many very sick patients who have not had any care for many years, along with my"supervising" physician being off site. I'm told that the physician is always reachable but.......it is not the same as talking face to face about a patient case. I was offered a position in a commercial urgent care setting but turned it down, thinking it would be too limiting in scope. There have been a few occasions that have me questioning the setting I am working in and I am very unhappy, along with feeling totally abandoned. I'm just not sure if I could get another job in the current market without 1-2 years experience.

I'm hoping that it was just a bad experience this week that is causing an over exaggerated, microscopic examination of myself and my skills. I have made it this far and did not give up on my education, I'm not about to quit now, but I sure feel like it today.

As a side note: I wish there were residency programs to help NPs transition into practice better. I did look into this in my area but the only one I could find was more than an hour and a half away, which would not work with my home life.

I would be grateful to get to get some feedback from others, good, bad or otherwise.

TammyG · Jan 2, 2016

Basilejc, your new job sounds similar to my first job out of NP school. I did not receive any orientation, just a prescription pad and a full schedule from day one. I saw patients mainly in Medicaid nursing facilities who had bounced around the system for years and have never had consistent care. I was way way way over my head. My supervising physician was available by phone and rarely answered any questions with more than two words. Plus I was working 60â€“80 hours per week to complete my documentation.

I was going to stick it out a year, but I was encouraged to start looking after six months. I was pleased to find that employers were interested in talking to me and the six-month issue did not prove to be a barrier. I just explained that it was not for me, and why. Leaving the job was the smartest thing I ever did. Jobs that don't offer orientation also are cheap with respect to other elements of the practice.

Kt52 · Jan 21, 2016

Perhaps looking for an FNP position in Public Health ( many states have women's health care inbedded in public health departments) would be an option, or maybe Planned Parenthood. I don't know what the atmosphere is like for fnp's in your state I.e. very few jobs available, but you are a valuable asset and have both the right and responsibility to feel like you are giving safe patient care. Sometimes as a new grad we are reluctant to make waves, but it isn't unreasonable to ask your employer to set aside time to go over complicated cases or discuss concerns.

If that doesn't work out try to find another np in your area who can be a mentor for you. In Oregon we also have the benefit of a teaching hospital with a consult line. Whenever I am stuck or just want another opinion I call there. Lastly, looking at the conditions you most frequently treat and spend some time establishing a practice plan. Practice guidelines are a big help in this. If you have a practice plan for at least 30% of those you see your day will be less stressful.

juani · Aug 24, 2016

I realize this is an older post but I've been practicing for 9 months now and I feel just as you did when you initially posted. I initially worked part time for a workers comp clinic, easy and boring, for 3 months. I them took a 2 year contract with a non profit under-served clinic. Great experience and opportunity...and that it has been. The problem is I don't think i ike primary care! IM tired of patients returning with their non-compliant excuses and all the annoying measures we have to capture for the patient and company. I hate working 5 days a week and would rather go back to teaching nursing students and work part time as a FNP but with patients who aren't addicted to narcotics or have multiple comorbidities. Am I dreaming? I was a nurse for 20 years in various areas; Postpartum, NICI, Pedi, Adult home health, urgent care. Does it get better?

Rant over! Thanks for listening!

Juanita

Goldenfox · Aug 26, 2016

I realize this is an older post but I've been practicing for 9 months now and I feel just as you did when you initially posted. I initially worked part time for a workers comp clinic, easy and boring, for 3 months. I them took a 2 year contract with a non profit under-served clinic. Great experience and opportunity...and that it has been. The problem is I don't think i ike primary care! IM tired of patients returning with their non-compliant excuses and all the annoying measures we have to capture for the patient and company. I hate working 5 days a week and would rather go back to teaching nursing students and work part time as a FNP but with patients who aren't addicted to narcotics or have multiple comorbidities. Am I dreaming? I was a nurse for 20 years in various areas; Postpartum, NICI, Pedi, Adult home health, urgent care. Does it get better?
Rant over! Thanks for listening!
Juanita

It can get better, but it depends on what we're looking for and where we look for it. A new grad NP might get lucky and fall into a very good paying position with awesome benefits and receive a really good orientation. But that's not the reality for most new NPs nowadays. When I was brand new as an FNP I burned out quickly on it too. Day after day after day it was the same thing over and over again. I was seeing a LOT of the same people coming back again and again and not getting any better because of their non-compliance and addiction issues. Some of them were actually getting worse. The physician who was training me loved it because he could keep billing and collecting. There were serious ethics issues going on there that I just didn't want to deal with anymore so I quit and went to another primary care practice that was pretty much the same thing. Then once I got to networking with other NPs I found that that's the way many of these places are. So I left, primary care and went over to acute care---which is still a lot of the same thing over and over again, but its not as bad. It is standard fare now that you are now expected to see a new patient approximately every 10 to 15 minutes and this is so that the physicians/corporations can continue to rake in the cash---of which they pay us only a small percentage. But it is what it is. If you have good support and you can work quickly you can get often through it ok. If not, you're likely going to find yourself working a lot of extra hours and not getting paid for them.

In another thread I once posted that I don't miss anything about bedside nursing and, in retrospect, that was not entirely true. I do miss propofol and ventilators.

Goatie · Mar 28, 2017

Sorry to hear you had a bad experience with your first job.

For my first job, I had ample help from other NP's and a doctor at an office - I stayed for 5 years, but because

doctor had the "last word" on everything, I felt like a glorified RN.

Because I have been an NP for 20 years now, I've been to many different settings- and if I'm unhappy, I leave. I definitely left a couple of jobs that were causing me to have physical illness like chest pain, headaches, and insomnia from stress and anxiety. Sometimes I left jobs after 6-12 months: This has not stopped me from getting other NP jobs, there will always be others. My advice to you is this: Stay for a few months (6 to 12), but if you are very unhappy, move on. For new grads, definitely ask about standardized procedures, training/shadowing length, malpractice insurance, accessibility of supervising physician, and length of probationary period (its usually 3 months, where they give you feedback/whether to keep you or let you go/areas for your improvement)...

PM10421n · May 1, 2017

TCU girl, I am in the SAME EXACT situation. I was an RN, graduated with my MS and became an FNP, moved from a big city where all my friends and family are to an isolated rural underserved area so I can get a broader experience, and here I am 2 months in and I find myself googling "new nurse practitioner experiences" so that I can find people that I can relate too.

Unlike you, I start my FNP job 1.5 years after graduation, so it's been difficult just trying to remember everything that I have learned. However, like you, I am unhappy. Everything that you wrote in your post is EVERYTHING that I am going through right now. The feeling of isolation, the feeling of being an idiot, the feeling of frustration of not knowing a lot of things, the feeling of hinderance to other physicians when I ask for help, ..etc.etc.. Its bad enough that I beat myself up. When I started a couple of months ago, I started seeing 8pts/day, now I am doing 12pt/day, eventually they would like me to see 20-25 pts/day. I don't even know if that's possible.

I know this original post was back in 2015 but I'm wondering how did you eventually handle the working environment? What did you eventually end up doing?

danielle2000, MSN, RN · May 2, 2017

Unfortunately, it is so true. You get dropped and you are expected to keep running. My first job was like this. I get in the clinic, no back up no resource other than my books I have lugged through my clinical rotation. It almost feels as if I am being punished for wanting to advance my career. Right now I am looking for employment elsewhere because where I am currently working is disorganized, too many people in the pot. I can't stand inconsistency and expecting you to rise above like you have 30 years experience. Just done. So, I breathe, meditate, and thank my lucky stars for a new day and realize I have options.