The raw truth about what NPs really do

Specialties NP

Published

I am a new RN working L&D at the bedside. Honestly nursing is no where near what I expected it to be. I come home every day crying. I feel stressed, overwhelmed, and exhausted all of the time. I am VERY interested in continuing my education and becoming an ARNP. This time I want to be sure I know what I'm getting myself into before getting neck deep in school debt. So I want to know what are the pro's and con's of the job? If you could do it all over again what would you do? What area is the lowest stress? The lowest risk? Which area has the lowest rate of lawsuits? I want to know all of the complaints and all of the perks of being an NP. I just want to be prepared for reality because being a bedside RN slapped me in the face... HARD.

Specializes in FNP, ONP.

Agree with above. Professionals do not punch time clocks, lol.

I LOL'd about working for a different pimp. Very true. As a NP you will have to worry about money/billing, I don't have any NP colleagues who don't except those in free clinics, and they have a different set of money problems. Grant writing is a pain in the patoot, and there is never enough money to go around! It is different being a provider than being a nurse. You don't get to mitch and boan about not having supplies while "the man" gets his bonus, because you will be the one, while still needing supplies, wanting your own bonus, lol. It is a different view of providing care: conserving/allocating resources, earning money- issues that probably don't affect the day to day practice of most RNs very much, but that direct the practice of most APNs, and it can be frustrating. There is no getting away from it. A very little bit in the University systems, but even there money is going to be at issue as departments fight over budgets. One department will argue that their Charlson, Higashi, or Total Illness Burden Index score is higher than another's, and the other department will argue that that metric shouldn't be used because blah blah blah. They will fight tooth and nail for peanuts, becuase ther isn't enough to go around. The department that publishes the best research will get the most in the end, because most of the money comes from grants and donors. So just being out of for profit health care won't save you. And that is my least favorite reality of my job, and it is never going to go away.

I have never given much thought to being sued, probably because I never have been. Once it happens (not if, when) I'll worry about it more. I try to document well and hope for the best. I have a colleague who was told by a patient recently, "Gee doc, I really like you, and I hate to do this to you, but I need a new roof, and my son is going to college soon, so, sorry man."

I get crazy sometimes. I go off on tangents when I just flat out refuse to indulge people for weeks at a time because I get so irritated at the lack of accountability and intrinsic motivation. During that time I don't always like my job or all of my patients. I lose faith in human nature. It happens if I just see too many people taking advantage of the system, too many people refusing to make any effort at all, too many abused children, too many neglected elders, too many narcotic seekers, too many liars, too many demanding jerks, too many whiners, too many entitled losers, too many know-it-alls, too many prior authorizations, too many charts back from medical records for review, too many forms to complete, coupled with too few pleasant patients for respite in between, all within a short span of time. I'm human, it happens.

I have these mini freakouts about 1-2x a year, and they last about a week or two. It means I need a vacation, or some validation, small reminder that what I am doing does matter. I get one or the other and I usually all right again.

What I love about my job- I do what I want to, for whom I want, when I want, how I want, if I want to. I make my own schedule, can come and go when I please. If I decide to have breakfast with my son, I call and say, cancel the 9:00, I won't be in until 10, or I can not call and just saunter in at 10:00 if I want to, lol. I wouldn't do that because I think it rude, but if I did that, no one would say boo to me about it. I have office mates who do, our practice manager makes petty remarks to the other providers about them behind their backs, but she doesn't say anything directly to them, she is not big on confrontation, lol. My point is, if something important comes up and I need to change my schedule, I have the freedom to do it on a moment's notice and I answer to no one but my own conscience. Now, do it too often and the money issue will come up again, lol. ;)

I love that I get to choose how I practice. No one tells me how to provide care, what kind of patients to see/not see. I was free to determine how to shape my business and if I decide to change it, that too is up to me. If I decide tomorrow I don't want to see females, or anyone under age 14, or over 65, etc, fine. If I decide I want to do some cosmetic derm, I could do that. I decided last year to stop doing IUDs, for instance. Takes too long, I need a chaperone, and they are expensive devices I have to order and have lying around. Not worth it, I'd rather refer that out. I like that I get to decide that on my own. No one tells me "you have to do this," "you can't do that." To me, that is an extremely valuable aspect of independent practice.

I control my day. I control my career. It is up to me. All of it. I never enjoyed that kind of autonomy as a Nurse and I relish it now. Of course, it is tremendous responsibility as well, and not everyone would find it worth it. Some people just want a job they can go to, "clock in" and go home. I wanted a real profession I could steer myself, so this is an ideal fit for me. I wouldn't change a thing.

Up Vote Up Vote ×
Specializes in Anesthesia, Pain, Emergency Medicine.

Very well said. That is, by far the best aspect of being an APRN.

Up Vote Up Vote ×
Specializes in APRN, ACNP-BC, CNOR, RNFA.
Agree with above. Professionals do not punch time clocks, lol.

I LOL'd about working for a different pimp. Very true. As a NP you will have to worry about money/billing, I don't have any NP colleagues who don't except those in free clinics, and they have a different set of money problems. Grant writing is a pain in the patoot, and there is never enough money to go around! It is different being a provider than being a nurse. You don't get to mitch and boan about not having supplies while "the man" gets his bonus, because you will be the one, while still needing supplies, wanting your own bonus, lol. It is a different view of providing care: conserving/allocating resources, earning money- issues that probably don't affect the day to day practice of most RNs very much, but that direct the practice of most APNs, and it can be frustrating. There is no getting away from it. A very little bit in the University systems, but even there money is going to be at issue as departments fight over budgets. One department will argue that their Charlson, Higashi, or Total Illness Burden Index score is higher than another's, and the other department will argue that that metric shouldn't be used because blah blah blah. They will fight tooth and nail for peanuts, becuase ther isn't enough to go around. The department that publishes the best research will get the most in the end, because most of the money comes from grants and donors. So just being out of for profit health care won't save you. And that is my least favorite reality of my job, and it is never going to go away.

I have never given much thought to being sued, probably because I never have been. Once it happens (not if, when) I'll worry about it more. I try to document well and hope for the best. I have a colleague who was told by a patient recently, "Gee doc, I really like you, and I hate to do this to you, but I need a new roof, and my son is going to college soon, so, sorry man."

I get crazy sometimes. I go off on tangents when I just flat out refuse to indulge people for weeks at a time because I get so irritated at the lack of accountability and intrinsic motivation. During that time I don't always like my job or all of my patients. I lose faith in human nature. It happens if I just see too many people taking advantage of the system, too many people refusing to make any effort at all, too many abused children, too many neglected elders, too many narcotic seekers, too many liars, too many demanding jerks, too many whiners, too many entitled losers, too many know-it-alls, too many prior authorizations, too many charts back from medical records for review, too many forms to complete, coupled with too few pleasant patients for respite in between, all within a short span of time. I'm human, it happens.

I have these mini freakouts about 1-2x a year, and they last about a week or two. It means I need a vacation, or some validation, small reminder that what I am doing does matter. I get one or the other and I usually all right again.

What I love about my job- I do what I want to, for whom I want, when I want, how I want, if I want to. I make my own schedule, can come and go when I please. If I decide to have breakfast with my son, I call and say, cancel the 9:00, I won't be in until 10, or I can not call and just saunter in at 10:00 if I want to, lol. I wouldn't do that because I think it rude, but if I did that, no one would say boo to me about it. I have office mates who do, our practice manager makes petty remarks to the other providers about them behind their backs, but she doesn't say anything directly to them, she is not big on confrontation, lol. My point is, if something important comes up and I need to change my schedule, I have the freedom to do it on a moment's notice and I answer to no one but my own conscience. Now, do it too often and the money issue will come up again, lol. ;)

I love that I get to choose how I practice. No one tells me how to provide care, what kind of patients to see/not see. I was free to determine how to shape my business and if I decide to change it, that too is up to me. If I decide tomorrow I don't want to see females, or anyone under age 14, or over 65, etc, fine. If I decide I want to do some cosmetic derm, I could do that. I decided last year to stop doing IUDs, for instance. Takes too long, I need a chaperone, and they are expensive devices I have to order and have lying around. Not worth it, I'd rather refer that out. I like that I get to decide that on my own. No one tells me "you have to do this," "you can't do that." To me, that is an extremely valuable aspect of independent practice.

I control my day. I control my career. It is up to me. All of it. I never enjoyed that kind of autonomy as a Nurse and I relish it now. Of course, it is tremendous responsibility as well, and not everyone would find it worth it. Some people just want a job they can go to, "clock in" and go home. I wanted a real profession I could steer myself, so this is an ideal fit for me. I wouldn't change a thing.

You're my hero, lol. You wrote that like a "boss". I can't wait to own it like that.

Up Vote Up Vote ×
Well said!!! I sure don't wanna clock in either! I come in and see my patients and when I'm done I go home. I don't need a time clock to show my worth. That's staff nurse mentality and ARNPs are well beyond that phase of our careers.

Last year I had to clock in once sometime during the day to show I was there. Now, I have no clock to punch but I'm paid by the hour as are most of the physicians, psychologists, social workers here are. Professionalism is not dependent on a time clock and I'll take those 2 extra overtime hours this week. All of us get paid by the hour when we are on call also.

Up Vote Up Vote ×

I punch a clock and get paid hourly. I don't consider myself less professional. Actually the rumor has been that some NP would claim she was at work but would be gone from the office for hours. I make my own hours and work at my own pace. I'm a contractor and have no immediate supervisor to report to. When I did outpt I just claimed 40hrs on my time sheet because there were days I would leave early and worked through pretty much every lunch. Every place is a little different but in general I dont have anyone cracking a whip over me as NP.

Up Vote Up Vote ×

I don't actually "punch a clock" but I keep track of my hours. I work for a small family practice and it just makes no sense to be on salary. If we are having a slow afternoon I go home and do not bill or submit hours for that time. When we are crazy busy and I am staying 2 hours late to finish referrals, labs, refills, etc....I get paid for that time specifically and I submit the hours.

Keeping track of your hours does not necessarily mean you have a floor nurse mentality. My husband is an entirely different profession and he has always been salaried. I honestly don't see anything "professional" about being salaried. I don't even want to think about the countless hours he was at work until 10 pm or he went in 3 hours early to work to get a head start. These were *completely* uncompensated. How is that professsional for anyone ?

Up Vote Up Vote ×

Look, I see this is totally taken out of context here. I made that post in defense of my APN family. To me the person that I was responding to, I assumed they were not yet an ARNP. I was just saying that clock or no clock, that does not make us any more nor less professional. That's all I'm saying. I get so much slack from people who I thought were my RN counterparts about making the mistake of becoming an ARNP and about how much more they are making at the bedside or what not. I see this mentality everywhere now and it's such a shame that we jump down each others throat for simple misunderstandings. Nursing is so divided and to me that's why we will never thrive as a great profession because of this "dog eat dog" mentality. If it was a misunderstanding in my part, then I apologize.

Up Vote Up Vote ×
Specializes in PICU.

Whether or not a job classification should be paid hourly with overtime or salaried is a legal definition outlined in the DOL's wage and hour laws. It isn't a choice. If you look at what constitutes an exempt vs. non-exempt employee, an NP is definitely exempt. Therefore making it illegal to pay NPs hourly and there is no required overtime. If a company wants to structure their compensation package to allow for overtime as a way to encourage or reward their employees they can. However, they need to be careful of not crossing certain lines or they run the risk of incurring liability for illegal compensation practices. I know there has been discussion before about the classifications of NP with respect to the wage and hour laws and nothing is black and white, but I think having people aware of the fact that there are laws governing this is important.

As for individual's attitudes not being professional, I see that much more frequently than I care to. I've seen too many people who wanted to be NPs so they could work less, not more, and not realizing that it is much more work to be an NP than an RN.

Up Vote Up Vote ×

Hear about the doctor at a party complaining about patients who call him? He asked a lawyer standing nearby and the lawyer said he billed anyone for any minute of his time. A few days later the doctor found a bill in his mailbox from the lawyer.

1
Up Vote Up Vote ×
Specializes in Nursing Education, CVICU, Float Pool.

Last year I had to clock in once sometime during the day to show I was there. Now, I have no clock to punch but I'm paid by the hour as are most of the physicians, psychologists, social workers here are. Professionalism is not dependent on a time clock and I'll take those 2 extra overtime hours this week. All of us get paid by the hour when we are on call also.

I agree.

Up Vote Up Vote ×
Specializes in Psychiatric Nursing.

Agree with being paid. Lawyers are a good example in this case. They are professional and exempt from overtime but they charge enough

I had an NP friend in outpatient who would be called in the morning to cover a sick call at the inpatient facility. She was expected to also see her outpatients in addition to covering the unit. Or she thought she was. And was not paid extra. One night she was at the clinic till 9pm. And she resigned that eve.

I worked as a staff nurse one time where the charge nurse took it as her professional responsibility to stay 4 hours late every day looking for things not done so she could report them.. She was a favorite with administration..

Lots of opportunities to work for free.. I find employers open to discussing work load. "I can do this or this but not both.", etc

Up Vote Up Vote ×
+ Add a Comment