Am I Crazy? A New NP Story

Updated | Posted
by CardiacRNLA CardiacRNLA, BSN Member Nurse

Specializes in Tele/Interventional/Non-Invasive Cardiology. Has 5 years experience.

this-normal-feel-right.jpg.3f344ad228cddaf3e4f01ca85ee22a15.jpg

I am a new grad NP who took a job as a cardiology NP for a smaller, private practice. My background has been both inpatient and outpatient cardiology for the past 6 years. But obviously this is a new role to which I need to acclimate. I have been here for 5 weeks so far and I really have my misgivings LOL. Not sure if I am crazy, if my experience is the norm or whatever. But this just doesn't seem right. 

My first day, right as I walked in, I see mounds of papers on my desk. Patient studies, surgical clearances, device interrogation reports etc. The senior MA placed them there and said that the Dr. said to look them over. I have NEVER given surgical clearances. While I have given test results, the verbiage on these reports are vague and different. And I never really dealt with interrogation reports. And this is where it starts. 

From the second day, I have been seeing patients in clinic by myself, with little to no guidance or oversight. Yes, my supervising MD is there, but he is also the owner, so he does business related stuff during clinic. He also comes late and schedules patients before he gets there and I am expected to see them. Even when he is there, I am told how to what to do, but I have no training or instructional time to develop my clinical judgment. At some point, I will expected to make these decisions autonomously, so I need to know the "why?" 

Then I find out my credentialing for a local LTACH is complete and I am told I will start going there with another doctor in the practice. I get ONE afternoon and then I am told to go alone. These patients. are medically complex. The supervising MD is available by. phone, but not always right away. And when I do speak with him, his responses to me sound really condescending. Needless to say, of course, I've made a couple of mistakes like contradicting myself in a note and I missed an abnormal result on a study. 

I take ownership and I felt awful. Conversely, it is my opinion that like medical errors, there are user (individual) issues and systems issues. Basically I have not been given the adequate training, oversight, and guidance that I believe would lead to success. 

I am terrified to think that my hospital credentialing will be complete next month. My greatest fear is that I will be left to my own devices in the inpatient setting. which will lead to more serious errors.

Another big problem of mine is that I am not a good advocate for myself. I either am too timid or come off too aggressively. Any experienced NPs that can help to provide some insight? Is this experience typical for a new grad NP situation? Should I be able to handle this? If this isn't, how do I express my concerns. 

Any help is greatly appreciated! Thanks all! 

Signed, 

- Terrified New Grad NP 🙂

juan de la cruz, MSN, RN, NP

Specializes in APRN, Adult Critical Care, General Cardiology. Has 30 years experience. 9 Articles; 4,336 Posts

I felt compelled to respond (after a long absence from this website) since I am working in Cardiology  for over a year now after transitioning from a Critical Care NP role which I did for over 15 years! Cardiology is a broad field with various subspecialties under it's larger umbrella so depending on the focus of the clinic or practice you joined, the learning curve could be steep.

Despite you working in Cardiology as a nurse prior, the transition to provider role and all the decision making involved won't be easy. It is obvious from your post that there is a disconnect between the expectations you are held to by the practice and the reality of you're unpreparedness to take on the responsibilities being given to you.

Typically, the interview process is where you establish those expectations and sometimes we must act confident to get the job offer. However, you now have to face the reality that given what you said on the post, you have a real risk of making mistakes that can cost your license. This is a no-brainer and if I were you, I would immediately seek a meeting with your Cardiologist to understand what your learning needs are and what responsibilities you can take on.

Good luck. For what it's worth, my transition from Critical Care to In-Patient Cardiology wasn't so bad because I had great support from the physicians I work with.

CardiacRNLA

CardiacRNLA, BSN

Specializes in Tele/Interventional/Non-Invasive Cardiology. Has 5 years experience. 158 Posts

40 minutes ago, juan de la cruz said:

I felt compelled to respond (after a long absence from this website) since I am working in Cardiology  for over a year now after transitioning from a Critical Care NP role which I did for over 15 years! Cardiology is a broad field with various subspecialties under it's larger umbrella so depending on the focus of the clinic or practice you joined, the learning curve could be steep.

Despite you working in Cardiology as a nurse prior, the transition to provider role and all the decision making involved won't be easy. It is obvious from your post that there is a disconnect between the expectations you are held to by the practice and the reality of you're unpreparedness to take on the responsibilities being given to you.

Typically, the interview process is where you establish those expectations and sometimes we must act confident to get the job offer. However, you now have to face the reality that given what you said on the post, you have a real risk of making mistakes that can cost your license. This is a no-brainer and if I were you, I would immediately seek a meeting with your Cardiologist to understand what your learning needs are and what responsibilities you can take on.

Good luck. For what it's worth, my transition from Critical Care to In-Patient Cardiology wasn't so bad because I had great support from the physicians I work with.

Thanks for your response! I could not agree more. Being an RN and an APRN is so different! During the interview process, I did relay those concerns. I was assured I wouldn’t be expected to be at the level of an seasoned NP. And because my credentialing would take a while that I would be brought along gradually. I’m not saying this was an intentional bait-and-switch. I believe the ideal situation and the reality of being short handed overshadowed everything. 

I really would like to make it work. But this is where I need to have a strong (and safe) foundation. I know I need to have this conversation. I need to write out what I’m going to say and have a plan to present. 

juan de la cruz, MSN, RN, NP

Specializes in APRN, Adult Critical Care, General Cardiology. Has 30 years experience. 9 Articles; 4,336 Posts

I also want to add that sometimes physicians mis-use NP's and don't understand our role. The fact that someone piled a bunch of results on your desk to figure out is not a role for a provider. This is like being asked to answer messages from patients and triaging them without knowing the background of those patients. Even if you understand what those mean, it will take digging into the EMR to even figure out what the context was on those tests. I would have said hell no to that.

CardiacRNLA

CardiacRNLA, BSN

Specializes in Tele/Interventional/Non-Invasive Cardiology. Has 5 years experience. 158 Posts

It’s kinda funny you say that about answering questions and triaging…because they have me doing that too LOL. Sigh 😞 

traumaRUs

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 30 years experience. 164 Articles; 21,143 Posts

Listen to Juan - knows what he is talking about. 

Numenor

Has 10 years experience. 403 Posts

You need to do a fellowship ASAP. This is reality. Sure they did you dirty the first week but those 500 clinical hours are going to be put to the test and even a couple week of orientation isn't going to help much.

These places don't hire NPs to train them, they want production right away.

Compared to NP school my fellowship was 100x more productive for learning. I am nearly independent in my role but NP school did not prepare me for it. Structured residency education did.

 

Edited by Numenor
changed

CardiacRNLA

CardiacRNLA, BSN

Specializes in Tele/Interventional/Non-Invasive Cardiology. Has 5 years experience. 158 Posts

If only, I wish I could do a fellowship. But there aren't really any here in Florida, oddly enough. And when I brought up an out-of-state fellowship to my husband right after I graduated, let's just say he wasn't on board LOL. 

AlwaysTiredNP

AlwaysTiredNP, MSN, APRN, NP

Specializes in Emergency Medicine. Has 10 years experience. 39 Posts

This doesn’t sound like the best environment, and I agree that some physicians don’t understand what we do, or anything about our scope. 
 

If you don’t think someone there is willing to provide you adequate training and orientation, you may have to decide it’s not the best fit. Don’t stay somewhere that compromises your license.

CardiacRNLA

CardiacRNLA, BSN

Specializes in Tele/Interventional/Non-Invasive Cardiology. Has 5 years experience. 158 Posts

13 hours ago, AlwaysTiredNP said:

This doesn’t sound like the best environment, and I agree that some physicians don’t understand what we do, or anything about our scope. 
 

If you don’t think someone there is willing to provide you adequate training and orientation, you may have to decide it’s not the best fit. Don’t stay somewhere that compromises your license.

Well, I really wish I could find something else.  But my market here is saturated it appears. And I’ve only been doing this for 6 weeks. At times, I really DO feel as if my license is being compromised. 

Prime example: this past Friday I went to the LTACH were we see patients. I tried to reach out to the “supervising physician” by phone and by text and he never answered back. Supervision of a new NP by phone, sigh. 
 

I’m balancing my comfortability, patient care ethics vs the reality of my finances. I’m not sure what to do. I’m going to speak the owner (the head MD) and see if anything changes. 

AlwaysTiredNP

AlwaysTiredNP, MSN, APRN, NP

Specializes in Emergency Medicine. Has 10 years experience. 39 Posts

I get that you feel that way, but nothing is worth compromising your license. Nothing.
 

You might feel like there are no jobs available out there based on online listings, but the more you get out there and start networking the more you will realize that there are a lot of jobs available that are unlisted and open via “back door” entry. 
 

I really understand needing the job and desiring experience, but please know this is not your only option. Join your local NP association, attend meetings. Usually they announce positions there at meetings. Since you are newly out of school, you may still be in contact with old preceptors; contact them! 
 

usually, I would say give it time- because transition sucks. I know I’m in the middle of it myself but you should not be left to make these decisions on your own without being able to reach someone for consult, even another more seasoned NP. It’s dangerous, for patients and you.

Think about it. Hang in there *hugs*

Numenor

Has 10 years experience. 403 Posts

On 5/22/2022 at 3:22 PM, AlwaysTiredNP said:

This doesn’t sound like the best environment, and I agree that some physicians don’t understand what we do, or anything about our scope. 
 

If you don’t think someone there is willing to provide you adequate training and orientation, you may have to decide it’s not the best fit. Don’t stay somewhere that compromises your license.

What do you consider adequate training? 2 weeks? 6 months??? The job expects her to come in and work as a provider. Did her school not provide that? NPs want to have their cake and eat it too (especially with independence). We need an education revamp so stuff like this doesn't happen.