Thinking of leaving being an NP: job market vs. quality of life questions

Specialties NP

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I'm a new NP, graduated 1.5yrs ago and have been working in hospice for 6 months. I was applying for positions a few months before graduating and ever since, including across the country when I worked at the VA. I live in South Florida which anecdotally I hear is one of the worst markets for NPs in the country. The NPs I know and folks I graduated with mostly work for private MDs inpatient 60-80hrs/wk for minimal pay (80-100k) and become slaves to their work. The only leads on jobs I've had have been similar ones in internal medicine from private MDs with minimal benefits and back breaking work. My current position seemed ok at first, but it became clear that they wanted me to do primarily nursing and administrative work with only minimal NP duties and no management of patients (on top of unpaid overtime due to salary). Down here bureaucratic non-patient care jobs are very common for NPs. There's next to no hiring in primary care, major hospital systems, and with sane hours. Doing the math everyone I know makes significantly less than a comparable RN with pay for overtime and the quality of life is much less with essentially unending responsibilities to the job, inflexible schedule, minimal travel opportunities, etc.

I'm contemplating going back to working as an RN and per diem NP until the situation improves or permanently, and I wanted to get some perspectives on that. I imagine things get easier with experience, but I'm not seeing very many people willing to train without 60hrs of work/wk, oncall, and rotating weekends which is too much to ask for me personally (respect to those who are willing). Right now my plan would be to try and keep per diem assignments for hospice evaluations or h&p type stuff that's easy to acquire per diem, and work agency or travel to pay down loans. The only lingering worry I have is about my resume and if things improve in the future what the outcome would be. Thanks for any insights others may have....

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Have you thought about relocating to an area with better conditions and prospects for NPs?

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I have, but I own a home and would lose money on renting/can't sell. I have family in the Bay Area which obviously is one of the best markets, but as I've been looking I would still take a substantial pay cut with a higher burden of hours. In the bay area the NP jobs I'm looking at pay the same as I make now essentially with a higher cost of living, whereas RNs make ~30k$ more annually with the overtime or per diem/travel. I'm definitely soliciting knowledge and advice in that domain though...

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There's a problem when people talk about RNs making $30K more than an NP by working OT. The goal is to not work OT. Another goal is not to take orders but to give them. Another goal is to see how your treatment decisions improve another persons life. Lot's more….

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I mean I agree, but I haven't met any NP who works less than 60hr/wk anyway. Even primary care NPs are given excessive caseloads with call backs, charting, and follow up. I love the work of an NP, but everything is a balance. The industry uses the fulfilling aspect of the job as a ransom against the rest of your life it seems like.

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I have never worked 60 hours unless I was working 2 jobs. The key is to find a collaborative physician and negotiate expectations and pay in advance and have it written into the contract. Even if you are salary discuss how you will be compensated for extra time or call. (I love me some comp time and rvu bonus)

if that doctor cant meet what you want kindly thank him for his time and move on to the next.

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I am curious if you would have reconsidered had you had access to knowledge about this reality prior to your career move? Or would such forewarning have made a difference? Did you talk to many NPs prior to starting school? I guess what I am really asking is if these working conditions were a total surprise.

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Specializes in CTICU.

I am in Pittsburgh, work 40hrs (salaried, so not exactly, but close enough) and earn more than "minimal wage". I agree it sounds like your area is the problem.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

OP, I would leave that position if I were in your shoes. First, you are working in a specialized field (Hospice) with no real provider role. That alone will make you less attractive as a candidate for future positions that involve actual clinical decision-making in managing patients. I would feel better working long hours in a setting where I actually make treatment decisions in disease management since I know I could use this as a steppingstone to future opportunities that may lead to better hours and benefits. It goes without saying that going back to the RN role will push you back in the "competitiveness scale" in terms of future NP job prospects.

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What happened locally is between entering school and completing my degree the bottom fell out. I was aware, but when I began major hospital systems were still hiring and there was demand. Ever since then it keeps getting worse with 4+ area universities pumping out graduates in a saturated market and very little demand. Additionally I had originally estimated I could get a HRSA PCP type job which when I first started looking were more plentiful, then the government shut down happened with cuts to those funds at the same time the jobs were drying up. Knowing what I do now, I likely would have tried to minimize debt and waited honestly.

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Specializes in ICU.

I'm thinking of becoming a DNP, but my understanding is with your title, you can work as a MD, but just can't prescribe narcotics. So why don't you start your own business. I'm not sure what type of NP you are, but if you are a FNP, open your own office and work for yourself. That is the sole reason I will be becoming a DNP, so I can contract with the Labs myself without a MD's approval for blood tests. Do home calls. You already are in the field of the elderly and know your clientele. You have so much to work with if you decide to take the leap of faith and work for yourself--YOU ARE A NP--rather than try to work for someone who determines your worth.

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Distinguished Nurse, there's a number of reasons why that's tough. Most states don't allow independent practice so you'd have to have a collaborative agreement. I've met Nps in Florida that have done that and hire an MD to collaborate, but it's not the same as what you describe since everything flows from the physician's license. Mostly that's how medicare guidelines are structured even when states do allow independent practice anyway since NPs get less reimbursement than MDs most practices will run things through the MD in this semi-complicated manner. The other thing is I have no interest in business. One of the great things about nursing is you can have a life outside of work if you want one. Adding managerial and financial concerns of a practice to me would be a big decrease in quality of life and increase in the amount of work and no amount of money is worth that to me :)

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