Hospital vs. Private Practice. Input please

[caitiecait]

I have some questions regarding private practice vs. hospital NPs. When I think about what I want to do the idea of working in a hospital, ICU, ER, or being a Hospitalist NP is something I am not quite sure I want to do, but working in a private practice is something I think I would love to do maybe even Urgent care. As of right now I work in the ICU, and it's ok but I can't wait to get into something else. I guess the main reason I do not want to work in the hospital is I hear NPs in the hospitals have loong hours, work weekends, holidays, and work maybe 4 to 5 12 hour shifts. But if I found an area I enjoyed it might be different, which leads me to this if I were to to work for the hospital I would want to work for a teaching hospital my dream would be John Hopkins, Cleveland Clinic, Duke Medical Center, UVA, or anywhere else where they are using new ground breaking technologies and NPs have more autonomy and are being more utilized ex: at Cleveland Clinic Pulomonary NPs get to help place stents and assist in surgical procedures! That would be an area I would love. So I guess what I am getting to is this: what is a typical day like for NPs in the hospital setting and private practice setting? What areas do you specialize? What is your stress level like? What are your hours, on call, weekends, and holidays like? And how much do you make? Also it be interesting to hear back from those who work in a teaching hospital. Just so you know I am applying to NP school right now and am hoping to start in the fall, so I know once I start clinicals I will get a better picture, but I would love to hear everyone's input.

[labcat01, BSN, RN]

I'm not an NP so my opinion means nothing :)

but I was talking to a PA about this the other day. She was telling me some interesting things...

She works with a surgeon in private practice and they mostly serve the hospitals outside of a large medical center. She said the pros of this are that she has more responsibility and gets to use more of her skills. The downside is that she has to work slightly longer hours then her co-workers at the big teaching hospital AND she said she sometimes feels isolated because there aren't a lot of other mid-levels around to interact with. However, at the big teaching hospital, there are a lot of residents and they always get chosen over the PAs to do surgical procedures/skills/etc.

Anyway, just thought I'd throw that in there since we were JUST talking about it. I know I'm still more partial to working in the hospital when I (eventually) become a NP or PA. Good luck!

[Jo Dirt]

I am going to start a FNP program and may even be able to take a class this summer.

I would like to live in a rural area and run a small clinic where I can treat UTIs and stitch minor lacerations and do yearly physicals for truckers and such, though I probably will have to get out in the workforce for awhile before I take on something like that.

I am working at a nursing home and have been put in the office part of the time=MIND NUMBINGLY BORING. You are lucky to work in a critical care environment. I wish I could work in an ICU where I could ogle the cute male nurses from time to time...no, I didn't just say that (that dirty old woman was the one talking.) What I meant is that I wish I could work in an ICU where I could really utilize my nursing skills and advance my knowledge base. Seriously, I need more of a challenge, working at the nursing home is so boring it's eating my brain.

[Corey Narry, MSN, RN, NP]

[color=#3366ff]"i hear nps in the hospitals have loong hours, work weekends, holidays, and work maybe 4 to 5 12 hour shifts".

this is true speaking from my own personal experience as a nurse practitioner employed by a health system/hospital. however, np's at our system receive overtime pay for anything over our scheduled amount of hours worked, holiday pay, and weekend differential.

working for a hospital has its perks for me. our hospital system which includes 6 hospitals and a network of out-patient clinics employ over 300 non-physician providers including np's, pa's, cnm's, and crna's. this provides a great opportunity to network with other providers of the same level as myself. we are represented by a mid-level council and our mid-level director gets to sit on meetings involving hospital affairs. there are opportunities to moonlight in other departments and be paid at the moonlighting rate. we have hospital-sponsored benefits at the management-level. aside from cme allowance, we get to attend hospital-sponsored cme offerings for free. mid-levels get onsite preferred parking regardless of seniority.

[color=#3366ff]"but if i found an area i enjoyed it might be different, which leads me to this if i were to work for the hospital i would want to work for a teaching hospital my dream would be john hopkins, cleveland clinic, duke medical center, uva, or anywhere else where they are using new ground breaking technologies and nps have more autonomy and are being more utilized ex: at cleveland clinic pulmonary nps get to help place stents and assist in surgical procedures! that would be an area i would love".

i don't work for any of the institutions you mentioned. however, i do work in a quaternary teaching facility that is not part or attached to an academic institution or medical school although the hospital has a long list of residencies and fellowships as well as medical student rotations similar to the academic institutions you mentioned.

in my area of practice (cticu), np's do get to perform procedures such as lines, bronch's, and chest tubes and are quite autonomous when it comes to patient management. i find that this is the case because our hospital does not offer a fellowship program in cardiothoracic surgery. in addition, we only have one general surgery resident rotating with us at a time.

in contrast, i know of np colleagues who work in an academic medical center in the same category as the institutions you mentioned. they are actually limited in what they are allowed to do because there are many residents and fellows rotating in their service at one time.

[Gator FNP]

I have been a FNP for 3 1/2 years, all in physician offices. I recently changed to a teaching hospital setting. My reasons for changing were: better hours (shorter), no w/e, no call, medical/403/long term disability benefits.

When I worked in an office, my hours were 8:30-5:30 at my last position, if I was lucky, I had 45" for lunch, did not finish seeing pts until 5:45-6:15 pm. Did not leave office until 7-8 pm, I usually left charting for the next day.

Unfortunately, at this office if a pt arrived late, we still would see them, which would throw off the rest of the schedule. I am enjoying my shorter hours, I work in an out-pt department.