How to get experience outside primary care

  1. I'm facing a bit of a dilemma. I'm a new FNP grad (May of this year) and ended up with a job at the site I did my clinical rotation. For reasons that make sense to almost nobody, I refuse to quit my RN job (it pays very well, I get a pension, I have a flexible schedule) and want to instead work as an NP 1 day a week. My RN employer offered me a promotion to NP but because the NPs essentially do nothing but H&Ps and have to work 4 10 hour days for only slightly more money, I declined because I want more real experience.

    The problem I'm facing is that I don't think I actually want to work in the family practice office where I currently work. As I'm only there 1 day a week it is difficult to establish relationships with patients, and even the new patients end up following up with the MD (he and I are the only 2 providers at this office). When I see the doctor's patient's it's usually for more trivial manners as his patients are not generally receptive to me significantly altering their plan of care for chronic issues (which I can understand).

    I think my actual goal would be to work in an urgent care as they seem most likely to hire someone for 1 day a week and nobody really cares who they see at an urgent care. Unfortunately, I have very little knowledge of how to function outside a family practice office. My entire RN career has been at a forensic psychiatric hospital with very little "real nursing" and my NP school didn't force us to do rotations in specialties so 90% of my clinical experience was in an internal medicine office. As a result, I can't do many procedures well (if at all) and I can't read Xrays. I also have no experience treating people younger than teenagers as we don't accept them as patients at my office and my NP program counted anyone under 18 as pediatric.

    Is there any way I can go about getting experience somewhere else? While it sounds crazy, I don't even really care about getting paid but I think if I walked into a specialty office or urgent care offering to "volunteer" they'd think I'm crazy. Any thoughts?
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  2. 14 Comments

  3. by   BCgradnurse
    IMHO-you're really limiting yourself and future opportunities by only working one day a week as a NP, especially as a new grad. How are you going to gain any experience or increase your competence that way, or get sufficient training in a specialty you're unfamiliar with if you're only willing to give 1 day per week? I also would be reluctant to let you see more complex patients at this point, as essentially you've only worked around 30 days or so as a NP. You're still very much a newbie.

    FNP programs train us to work in Primary Care. Some will give you experience in certain procedures; others will not. Pretty much every procedure I do I learned on the job, and I did take a workshop in suturing on my own. There are a lot of workshops/CE courses out there that can teach you skills not covered in your program or practice.

    I understand you have your reasons for keeping your RN job, but I think you're going to have to devote more time to gaining NP experience if you want to develop the skills and competency needed to move into another NP position. Just my opinion; YMMV.

    Edited to add-I have been working per diem in Urgent Care for 4 years. I had 4 solid years of full time internal medicine experience prior to taking this job. We always have several providers on at the same time, but in many UC centers you would be solo. I would not have been hired without my IM experience. I had some training on the EMR, shadowed for a shift, and then was expected to see a full complement of patients. No hand holding or slow ramp up. You get some pretty complex patients walking into UC because they don't want to go to the ER, and solid IM experience is key to managing them.
    Last edit by BCgradnurse on Dec 3 : Reason: added info
  4. by   FullGlass
    Urgent Care NP jobs almost always require 1 to 2 years of previous NP experience. I also don't understand how you can become a competent NP by only practicing one day a week. You really need to make up your mind if you want to be an RN or an NP. Both are great careers. If you really want to become an Urgent Care NP, then be a full time NP in this family practice for 1 to 2 years, then apply for Urgent Care jobs. Good luck.
  5. by   traumaRUs
    I agree with above posters and it seems like this is something you recognize too: without some solid NP experience, you aren't going to be on the top of the list for any UC. Why did you become an FNP if you didn't want to work as one? Did you not consider that your RN benefits trump your NP?
  6. by   Psychcns
    I would take the H and P job. You would be working as an NP and keeping your pension and other benefits. It sounds like you could also keep the one day per week job for more experience.
  7. by   catbox9
    Quote from Psychcns
    I would take the H and P job. You would be working as an NP and keeping your pension and other benefits. It sounds like you could also keep the one day per week job for more experience.
    Unfortunately, that won't work because I currently don't work on Fridays at my RN job but if I promote I would work on Fridays which is the day the family practice office wants me to work because the Dr. likes to leave early on Fridays and is hoping to eventually not work at all on Fridays.
  8. by   BCgradnurse
    Quote from catbox9
    Unfortunately, that won't work because I currently don't work on Fridays at my RN job but if I promote I would work on Fridays which is the day the family practice office wants me to work because the Dr. likes to leave early on Fridays and is hoping to eventually not work at all on Fridays.
    As a previous poster stated, I think you need to decide if you want to be a NP or a RN. You're never going to advance as a NP with your current situation. I'm also curious as to why you went through the expense and work of NP school if you don't want to put the time into the job.
  9. by   FullGlass
    Quote from catbox9
    Unfortunately, that won't work because I currently don't work on Fridays at my RN job but if I promote I would work on Fridays which is the day the family practice office wants me to work because the Dr. likes to leave early on Fridays and is hoping to eventually not work at all on Fridays.
    If I read your original post correctly, your RN employer has offered to hire you as an NP. That means you would keep your benefits. My advice is take that job. What is wrong with doing H&Ps? That is the foundation for NP practice and for MD practice, as well. You can't do anything unless you have a good H&P. Do that for awhile, become a solid NP, and then keep your eyes open for other opportunities. You really need to decide if you want to be an RN or an NP. By only working one day a week as an NP, you are not gaining the experience and skills required to be a competent NP. As a result, it is unlikely you are going to be assigned complex, interesting cases. Most MSN clinical rotations require 2 or 3 days a week! You have to crawl, then walk, then run. If you don't want to be an NP, there is no shame in that. My sense is that you may be afraid to give up something you are comfortable with and make the leap to being an NP full-time. I, too, am curious as to why you went to NP school?
  10. by   catbox9
    Quote from BCgradnurse
    As a previous poster stated, I think you need to decide if you want to be a NP or a RN. You're never going to advance as a NP with your current situation. I'm also curious as to why you went through the expense and work of NP school if you don't want to put the time into the job.
    While you're essentially correct, I wouldn't say I'll never advance at all. Even though I don't work full-time, I still see some pretty complex internal medicine patients and do get to do a lot of decision making with the MDs guidance. I feel like I've learned a fair amount since I started. Of course, if I was doing it full-time, I would be learning a lot more.

    As for why I decided to become an NP...I really don't have a good reason. I've always thought my RN job was meaningless (I work at a psych forensic state hospital) so I wanted to do something meaningful. I like my RN job because of the lifestyle it gives me, but I want to do something that matters. No hospital would hire me per diem as I have zero experience so I went the NP route because there is a huge lack of primary care providers in this area and even though I'm still not very marketable, I knew that I would at least be able to do something.

    Quote from FullGlass
    If I read your original post correctly, your RN employer has offered to hire you as an NP. That means you would keep your benefits. My advice is take that job. What is wrong with doing H&Ps? .. My sense is that you may be afraid to give up something you are comfortable with and make the leap to being an NP full-time. I, too, am curious as to why you went to NP school?
    I probably didn't describe that job very well. Technically you're doing H&Ps all day, but you don't really take a history or do much of a physical. You essentially look at the patient's record from their prior facility (prison) and re-order what they're already on whether or not it makes sense or is good medicine (if they're on atenolol and nothing else for HTN, just leave it). That job will teach me absolutely nothing and I will forever be non-marketable to any other employer if I do that and nothing else. Other than the fact that a medical assistant isn't legally allowed to write orders, you could quickly teach an MA to do the exact same job because it's so easy. The only reason the job exists is because somebody needs to write the initial orders for the patients and the NPs are far cheaper than the physicians...plus there's a huge lack of physicians at my facility. The job is basically a career-ender once you take it as you're forever non-marketable once you work there and everyone around here knows it.
  11. by   BCgradnurse
    So I'm hearing that you don't like your RN job except for the benefits/schedule, don't like your 1 day a week NP job, want to move to a different 1 day a week NP job, but don't want to put any more time and effort than 1 day a week into being a NP, which leaves you with few to no options. You call the NP job at your current facility a "career-ender", but think only working 1 day a week as a NP isn't? I'm not sure I understand what you want to do. Somethings gotta give. Sorry, but I still think your expectations are unrealistic, and it sounds like you're in a rut. Why not make a change and give a full time NP position a chance at a facility that you like and can be engaged with. Do you actually want to stay at the psych hospital until you can retire and get that pension? Do you want the chance to grow as a NP and be able to handle complex patients on your own, without physician guidance?

    Obviously, you need to do what's best for you, but I'm not really sure what it is that you want out of your career, be it as a RN or NP, and I'm not sure why you posted here as it doesn't seem like you want to make real changes.

    I wish you the best of luck in whatever you do.
  12. by   catbox9
    Quote from BCgradnurse
    So I'm hearing that you don't like your RN job except for the benefits/schedule, don't like your 1 day a week NP job, want to move to a different 1 day a week NP job, but don't want to put any more time and effort than 1 day a week into being a NP, which leaves you with few to no options.
    That's all essentially true.

    Quote from BCgradnurse
    You call the NP job at your current facility a "career-ender", but think only working 1 day a week as a NP isn't?
    While you might be right, I still feel that doing 1 day a week, while certainly not traditional or ideal is still better than doing nothing or working at my current facility. If I worked that job full-time I would certainly gain traditional experience so isn't working 1/5 time allowing me to get the same experience...just at 1/5 the rate?

    Quote from BCgradnurse
    Do you actually want to stay at the psych hospital until you can retire and get that pension?
    Absolutely, yes. I've been there 10 years and can retire at age 55 so whether or not I like this job, there is no way I can leave this facility.

    Quote from BCgradnurse
    Do you want the chance to grow as a NP and be able to handle complex patients on your own, without physician guidance?
    Yes, but not if it means sacrificing my other job.

    Quote from BCgradnurse
    Obviously, you need to do what's best for you, but I'm not really sure what it is that you want out of your career, be it as a RN or NP, and I'm not sure why you posted here as it doesn't seem like you want to make real changes.
    In a perfect world I would someday be working as an NP at my current facility 4 days a week (10 hours/day) and then working at an urgent care as an NP somewhere 1 day a week. I am trying to find a way to do that without leaving my current job full-time job. If that is, in fact, impossible then I will eventually take the full-time NP position with my current employer. I am willing to make some changes, but not leave my current job. I am willing to work for free if need be at an urgent care or wherever in order to learn how to function in an urgent care. I'm also not particularly in a hurry....if it takes me 10 years to get to where I want to be then fine. I know that urgent cares will hire people on a part-time basis (i.e. 1 day a week) so I'm just hoping that someday I can find a way to be in that position.
  13. by   catbox9
    Perhaps this is a better question. Pretend for a moment I was working full-time as an NP in a primary care office but wanted to someday work in a different setting (whether it be urgent care, dermatology, orthopedics, or wherever) but was told I lacked the experience in that specialty. How would I go about getting that experience?
  14. by   traumaRUs
    Hmmm...now you've changed the premise of the thread. For this current scenario:

    1. Try to get hired into a practice that offers extended orientation. Our nephrology practice offers 3-5 months customized orientation.
    2. Apply to a teaching institution that would be willing to train you.
    3. Obtain a post-MSN certificate with a concentration in that specialty and focus your clinical hours on that aspect of your education.
    4. Volunteer with an organization that provides the specialty care - perhaps a missions trip, volunteer at a free clinic

    I guess for me I'm still stuck on why you became an NP if you really enjoy your RN position? I really really loved my last RN position (level one trauma center ED). I only became an NP to give me more options as I got a little older. I do sometimes regret my educational choice but I'm kinda stuck with it too at this point.

    Perhaps just use your NP education for volunteer activities in order to keep it current and stay with your RN job?

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