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

  1. 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!
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  2. 33 Comments

  3. by   Dranger
    Why did you leave the bedside? My gf is a L&D nurse and she cold never imagine leaving the bedside to be an NP. Did you really want to be an NP or did it just seem like the next step?

    Have you looked at a residency program? How much learning outside of work do you do? Realistically you can't drop into a practice as a new NP expecting to be at the same level as board cert/residency prepared physicians.
  4. by   Jules A
    It sounds like you are in a tough situation but not one that is unique in my experience. Although I'm sure there are some who got a reasonable orientation as a new NP I personally wasn't one of them and neither were any of the NPs I was in school with and have remained in touch with. I started two jobs right out of school at the same time and was basically showed my office, handed a prescription pad and given a patient load equivalent to the physicians and experienced NPs I worked with.

    This is one of the reasons I continue to post, and take flack over, how important it is to have experience as a nurse and a background in your specialty. I would bet if you were a woman's health NP you would feel way more comfortable and competent. The other problem is that now you are no longer considered a new NP so I'm not sure anywhere else is going to want to give you an orientation either. I'm not really sure what to advise but did want you to know you aren't alone.
  5. by   Jules A
    Quote from Dranger
    Realistically you can't drop into a practice as a new NP expecting to be at the same level as board cert/residency prepared physicians.
    But this is the expectation. I have a friend in NP school now and at least her school has the decency to inform the students not to expect an orientation as a new grad.
  6. by   TCUgirl15
    Quite the opposite, I don't feel at all that I am at the level of a residency prepared physician, and I did not expect that. On the contrary, I kind of feel that the practice I joined expected that, which is part of my frustration.

    To answer your first question, I left the bedside to have a better schedule with comparable salary for my family. My husband is a Firefighter/Paramedic, so he has an odd schedule, and as an inpatient RN, I worked a lot of weekends/holidays. We just wanted one of us to have a more consistent schedule, and I've always enjoyed education (this was my 4th degree). So I guess, in a way, it seemed like the next step for me, but more so to reach my full potential, I suppose.
  7. by   TCUgirl15
    Quote from Jules A
    It sounds like you are in a tough situation but not one that is unique in my experience. Although I'm sure there are some who got a reasonable orientation as a new NP I personally wasn't one of them and neither were any of the NPs I was in school with and have remained in touch with. I started two jobs right out of school at the same time and was basically showed my office, handed a prescription pad and given a patient load equivalent to the physicians and experienced NPs I worked with.

    This is one of the reasons I continue to post, and take flack over, how important it is to have experience as a nurse and a background in your specialty. I would bet if you were a woman's health NP you would feel way more comfortable and competent. The other problem is that now you are no longer considered a new NP so I'm not sure anywhere else is going to want to give you an orientation either. I'm not really sure what to advise but did want you to know you aren't alone.
    I'm starting to feel like you are probably right. I was encouraged by so many to do Family, because it was a broader scope and I'd be more marketable. But, I'm finding that I think Women's Health is my passion and all of my RN experience was geared towards Women's as well. Starting to feel like I made a mistake
  8. by   Jules A
    If primary care truly isn't for you then maybe consider a post master's certificate in Women's Health? I'm not sure if the Nurse midwife track has many similarities to our FNP but that might also be something to consider especially if you don't mind school.
  9. by   Sha-Sha RN
    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!
  10. by   anh06005
    Quote from Sha-Sha RN
    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!
    Yes! I can still hear Hollier in my review CD's telling us as FNP's we are trained to provide care to women and pregnant women up until they give birth. We CANNOT attend a birth but can provide routine prenatal care.

    You might grow to enjoy family practice but if you truly enjoy Women's Health I wouldn't blame you for browsing around while you still have a job to pay the bills. I never thought I'd want to do family practice (I love cardiology) but I'm actually finding that I enjoy it quite a bit.

    I will say I at least got some orientation unlike you. The first week or so I just kind of shadowed and maybe went in to see patients and was followed by the doctor and they signed off on my work (since my billing numbers hadn't been approved yet I couldn't bill). Anyway it wasn't until 4 weeks or so I actually started getting patients on my schedule. I have a cap right now on 20 a day but I can increase it anytime I want. I am still trying to figure out the best way for me to chart (our system has several options for personalization) so I don't want to overload myself until I have a good system.

    Anyway I hate your first job was something with such little orientation and I'd be leery and questioning my decision too. Orientation was my biggest worry being a new grad and I made sure my new manager was aware. Thankfully they had just hired a new grad PA about a year before so they knew what kind of worked.

    Good luck in whatever you choose. May you grow to love your job or find one you do enjoy!
  11. by   honeykrown
    Quote from 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

    I appreciate the feedback!! Thanks!

    TCUgirl,your experience is very similar to mine. I am 6 months into my new position and I just started getting 13pts a day. Not to any fault of mine but pt never show up for appts due to the remote location. Also I get 40 mins for new pt evaluation/PE which is the bulk of my day. I did get only 1day orientation with 2 providers. I think I was more comfortable because I worked there as an RN while I went back to school. We are divided into teams and I have 2 providers on my team whom I can approach. One is approachable and one makes me feel stupid but that does not deter me from discussing cases as its for the pt and my personal development. If they are both not available, I discuss the case with another provider. I have learnt to use the resources around me. I have also been scheduled to see same day patient (although for 4hrs instead of the whole day) and I love it because they are not always complicated.

    I think we have it good because browsing this board (and based on discussion from past student) most people are thrown in to sink or swim with seeing up to 20 in first month and increasing significantly thereafter. I do believe in a 8 hr day 13 is fair. approach a free provider
  12. by   TCUgirl15
    Quote from anh06005
    Yes! I can still hear Hollier in my review CD's telling us as FNP's we are trained to provide care to women and pregnant women up until they give birth. We CANNOT attend a birth but can provide routine prenatal care.

    You might grow to enjoy family practice but if you truly enjoy Women's Health I wouldn't blame you for browsing around while you still have a job to pay the bills. I never thought I'd want to do family practice (I love cardiology) but I'm actually finding that I enjoy it quite a bit.

    I will say I at least got some orientation unlike you. The first week or so I just kind of shadowed and maybe went in to see patients and was followed by the doctor and they signed off on my work (since my billing numbers hadn't been approved yet I couldn't bill). Anyway it wasn't until 4 weeks or so I actually started getting patients on my schedule. I have a cap right now on 20 a day but I can increase it anytime I want. I am still trying to figure out the best way for me to chart (our system has several options for personalization) so I don't want to overload myself until I have a good system.

    Anyway I hate your first job was something with such little orientation and I'd be leery and questioning my decision too. Orientation was my biggest worry being a new grad and I made sure my new manager was aware. Thankfully they had just hired a new grad PA about a year before so they knew what kind of worked.

    Good luck in whatever you choose. May you grow to love your job or find one you do enjoy!
    yes! Definitely I can practice in Women's Health as an FNP! I wouldn't have done family if I could not have! Actually one of my job offers was for an OB/Gyn, and I turned it down to give Family Med a try. Now I'm questioning that decision at times. We will see. I think I'll give it at the least 3 more months and see how I feel at that point. just feeling down right now about my decision but it seems my situation is not unlike what is normal for most new NPs.
  13. by   Melody48_MSNEd
    Why don't you do women's health? FNP covers that!
  14. by   Melody48_MSNEd
    My FNP proram requires 180 hrs of women's health.


    Quote from Sha-Sha RN
    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!

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