Advice on changing jobs

[Katya000]

Hello all,

This is my first post here. I am a FNP, graduated May 2014, and I have been working in a rural area in an independent state since August 2014.

I see patients independently, with a physician available at the clinic for questions, as well as a couple other NPs who have more experience than I do. I love working as an NP and love the patient care I am able to deliver. It pains me to leave, but I feel there isn't much other choice if I want to keep my license.

I am actively looking for a new position, and have a phone interview coming up this week for a job that is out of state. The clinic I am currently working in has many, many issues. In 6 months, they will see a loss of 3 providers—a total of 4 if I manage to find a new position as well.

People leave because the clinic operates so poorly that it puts our licenses at risk. I am consistently pressured to see people well out of my scope of practice, despite discussing with the state Board of Nursing who agreed with my stance. When discussed with the chief medical officer (CMO) he stated that woman should be fired from the Board”, and that they don't understand what it is like to work in a rural area”.

I want to be clear—I see very complicated primary care people as well, BUT they want me to see people outside of primary care, specifically complex psychiatric patients, that I have not been trained to treat. From the conversation I had with the BON, it is okay to see these patients and bridge them to a psychiatric provider if they are stable, -OR- to collaborate with a mental health colleague if they are unstable—but to never take upon their care solely.

The CMO does not feel it is an issue for me to see them independently. He feels I will get the hang of it” after some time and that I just need to see them with him to gain experience, and then I will be okay to take upon their care 100%.

Despite multiple conversations, he does not understand that legally, if I make a mistake (from lack of training/experience) I will be hung out to dry in a courtroom for working outside of my scope. And to add to that, in a meeting with him, the CEO and the nurse manager, I explained all of this and my concern about making a mistake and being held legally responsible, the CEO replied to me, Well I hope you won't make any mistakes”.

Nobody else said a word in response (despite a pep talk the day before from the CMO about how it's called practicing medicine for a reason”, we all make mistakes, yada yada).

There are many other reasons I would like to leave, but this is the most compelling.

My concern is this: how do I discuss the concerns I have with my current job without turning off anyone during the interview for my prospective job? And how do I frame questions to ensure I won't end up in the same spot I am in now?

I am really excited about rural & underserved primary care and I love my patients. I also love the majority of my coworkers, but things are so bad most of the great staff is escaping from the clinic in droves, including two other NPs that work there, who've been immensely helpful to me in my first year in practice.

I'm so stressed out and unhappy in my current position I am really concerned I will just go off” so to speak, especially since I talk too much when I'm nervous.

[caliotter3]

Come up with a politically correct reason for wanting to change jobs and practice delivering that excuse. I would be tempted to say that I want a change of scenery, but I know that is too trite to say at a job interview.

[Katya000]

Well, I did say that I loved the area and that my fiance is having trouble finding employment in our area (he's an NP too, graduated with me--we met in school!). This stuff is true. The hours are also much better since it's two weeks on, one week off and I will be able to spend time checking on my grandma, whose heath is recently failing. Would you recommend avoiding why I want to leave my present job completely?

[caliotter3]

I sure wouldn't say any of the reasons you have given. Figure out a way to put a spin on any inquisitive prods and focus on your reasons for seeking greener pastures, outside of getting away from a bad, less than desirable employer.

[Jules A, MSN]

And kudos to you for not allowing yourself to be pressured into working out of your scope. Too many NPs both based on pressure from their financially driven employers and also their co-dependent "save the world" ideals compromise and practice out of their scope especially in psychiatry. In addition to putting their license in jeopardy it can be detrimental to a vulnerable population. Good luck with your job hunt.

[automotiveRN67]

Avoid the negatives with your current job. Research the job you want, and focus on why it is a great fit for you. Bring that up in the interview.

Something like

"I'm not unhappy where I am at. But, after talking with the recruiter/HR/representative in your company, I believe the job you offer may be a better fit for me in the future. I am excited about the prospect of ......, offered by your position."

[aprnKate]

Katya000,

I am in the same boat as you. I work in rural health as well and love the patient population. I love what I am learning. I am looking for another job in aims for a better work and life balance and scored an interview and it went well. They said that they working on a contract to offer me. I have less than a year experience. during the interview with your job prospect; be yourself and be truthful why you are leaving your job if it comes up. Just say "its not safe because...i felt .... "but also focus on your strong points...focus on how that situation made you a strong provider and how you dealt with the situation professionally. Explain what you learned from experience. Turn the negative experience into a positive reflection of your character as a nurse practitioner and then tie that into your patient care focus on that and be curious and ask questions on the patient population of your future job prospect and how the practice runs differently from you have experienced.

Don't forget to tell them what is important to you in terms of work environment and patient care. As a new grad, I am very picky with the jobs I chose. If my interviewer did not ask how I deliver my care to patients or we did not discuss patient care delivery or we don't have the same mission/goals then I cross them off my list as a future employer. I let them know that I am not someone who is just going to sit in a clinic and make revenue for them, I make sure that they know that I truly care for all my patients and I aim to provide quality and safe care.