Any advice for a new grad FNP's first job position?

Hi there! Got an interview as a Field NP that is hybrid (remote/home visits). They accept new grads and from what I got from the recruiter, remote and field visits could vary each day. But I would be conducting preventative visits, post discharge visits, post partum visits, colorectal cancer screening, and diabetes care. Compensation 135k-145k annually (I live in California). Hours are either 4x10s (ONE Saturday per month) or 5x8 M-F. 18 days PTO with good benefits. I did ask if there was room for growth in which they said yes there would be some advancements. The only hesitance I have is that this won't be a primary care position in which I utilize the skills from nursing school and there won't be any prescribing or lab ordering/interpretation. I'm worried that this position wouldn't be beneficial for me in the future if I decide to search for an inpatient or a clinical position... Indeed job reviews also show that this job is pretty easy but can be mundane and management can be poor (taking this with a grain of salt).

Honestly, I do lack experience as well. I am a direct entry RN to NP with 1.5 years of RN experience. But I don't have inpatient experience because I did not want to do bedside nursing. I was able to land a remote RN position due to covid. Now I am a FNP new grad.. part of me wants to find a primary care position or speciality to utilize and practice my skills but with the lack of experience, it's been difficult landing a job. And it doesn't help that I have imposter syndrome as well.. Anyway would accepting this position put me more behind for the future or will it still allow me to have open doors to other positions? This hybrid position sounds appealing to me because it sounds low stress, decent pay, and do-able for a new grad. Just want it benefitting my resume for the future, since I feel like my RN remote covid position wasn't much "experience" to begin with. 

Hopefully I was able to clear on my concerns. Thank you SO much in advance!

[Newbie101]

Hey! I am also a new FNP with minimal RN experience in inpatient setting. I only did 6 months of Med Surg and did home health for 2 years. SO practically have 3 yrs of RN experience while I was in FNP school. I started my new job in primary care this week! AND I have been struggling with imposter syndrom and I feel so nervous and like I know nothing, so making me regret going for this FNP position. BUT I have great support and orientation so I'm looking forward to learning. I honestly feel like FNP is a totally different scope of practice and you learn everything all over again. 

[dt0327]

Thank you so much for your input! It makes me feel less alone in this boat. I ended up choosing the Home Health NP job. It's been about a month so far and I love how I can make my own schedule and have some days working from home. It's a different type of stress (traffic, technology issues) than what I'd deal with in primary care, but I like low stress so far. But I feel like eventually I might want to dabble into primary care or even a specialty.. 

That so good you have a great orientation and supportive team! That's what makes a difference in a new role. You'll learn SO much! Good luck!

[Mergirlc, RN]

Newbie101 said:

Hey! I am also a new FNP with minimal RN experience in inpatient setting. I only did 6 months of Med Surg and did home health for 2 years. SO practically have 3 yrs of RN experience while I was in FNP school. I started my new job in primary care this week! AND I have been struggling with imposter syndrom and I feel so nervous and like I know nothing, so making me regret going for this FNP position. BUT I have great support and orientation so I'm looking forward to learning. I honestly feel like FNP is a totally different scope of practice and you learn everything all over again. 

Just curious, when you started your position, were you already able to see patients within 15 minutes and go on to the next and next w/o issues?  Time management is so difficult; especially w/ patients w/ multiple comorbidities.  I'm in clinicals right now and it's a challenge to keep it around 20-30 minutes, let alone 15! 😅

As someone who will be where you are at right now within 6 months or so, I kinda want to know what awaits me in terms of how tolerant (or not) some places are when you're a new grad.  

[FullGlass, BSN, MSN, NP]

Mergirlc said:

Just curious, when you started your position, were you already able to see patients within 15 minutes and go on to the next and next w/o issues?  Time management is so difficult; especially w/ patients w/ multiple comorbidities.  I'm in clinicals right now and it's a challenge to keep it around 20-30 minutes, let alone 15! 😅

As someone who will be where you are at right now within 6 months or so, I kinda want to know what awaits me in terms of how tolerant (or not) some places are when you're a new grad.  

It is normal for a new grad NP to require longer appointments initially.  That is why most practices provide a ramp-up period.  In addition to learning to see patients - history, physical, etc. - one must also learn the EHR and other administrative systems.  For example, when I started my very first primary care NP job, I only saw 4-6 patients per day to start.  Over the course of 4 to 6 weeks, that ramped up to a full schedule.

It is also normal to be nervous when starting out.  I felt like I had forgotten everything I learned in school!  🙂  However, what came back to me instantly was performing the PE and taking the history - all the repetition in labs and clinicals paid off.  But I had to look stuff up for each patient - right meds, labs, etc.  I was a nervous wreck for the first 6 months, then things slowly got better.  At the end of one year, I was pretty confident, did not have to look much up, did not run to my supervising MD very often, etc.

So be kind and patient to yourself.

DO NOT take a job with a facility that does not have a reasonable ramp up period!

[Mergirlc, RN]

FullGlass said:

It is normal for a new grad NP to require longer appointments initially.  That is why most practices provide a ramp-up period.  In addition to learning to see patients - history, physical, etc. - one must also learn the EHR and other administrative systems.  For example, when I started my very first primary care NP job, I only saw 4-6 patients per day to start.  Over the course of 4 to 6 weeks, that ramped up to a full schedule.

It is also normal to be nervous when starting out.  I felt like I had forgotten everything I learned in school!  🙂  However, what came back to me instantly was performing the PE and taking the history - all the repetition in labs and clinicals paid off.  But I had to look stuff up for each patient - right meds, labs, etc.  I was a nervous wreck for the first 6 months, then things slowly got better.  At the end of one year, I was pretty confident, did not have to look much up, did not run to my supervising MD very often, etc.

So be kind and patient to yourself.

DO NOT take a job with a facility that does not have a reasonable ramp up period!

@FullGlass   

Thank you so much for writing this and the encouragement.  I really needed this right now.  I often read your posts and respect and appreciate your opinions, thoughts, etc..

After reading what you wrote, I don't feel as bad anymore.  Right now during my clinical rotation, I and the others in my group are able to take around 3-4 patients each.  Not too shabby, but all of us certainly still need time to hone our time management skills.  Of course, I'm not going to mention how much time it takes for us to complete charts because that adds another 12 hours of writing 😂 😂

 At least gauging what you wrote, it seems our preceptors and the school have actually done everything they could to help us and be somewhat successful after graduation.

[FullGlass, BSN, MSN, NP]

Mergirlc said:

@FullGlass   

Thank you so much for writing this and the encouragement.  I really needed this right now.  I often read your posts and respect and appreciate your opinions, thoughts, etc..

After reading what you wrote, I don't feel as bad anymore.  Right now during my clinical rotation, I and the others in my group are able to take around 3-4 patients each.  Not too shabby, but all of us certainly still need time to hone our time management skills.  Of course, I'm not going to mention how much time it takes for us to complete charts because that adds another 12 hours of writing 😂 😂

 At least gauging what you wrote, it seems our preceptors and the school have actually done everything they could to help us and be somewhat successful after graduation.

I'm glad to help!  🙂  This made me remember that when I first started out, I put a lot of pressure on myself.  As a classic overachiever, I believed I should have known everything.  As a result, I was sometimes afraid to ask for help.  Fortunately, there were 2 excellent physician mentors at the clinic.  One, in particular, urged me to ask for help whenever I needed it.   I also learned my NP colleagues were happy to help, as well.  Once I realized no one would look down on me for asking for help, my life got a lot easier.  I must have been running to Dr. X 10 times a day or more the first few months.  But after several months, I ran to him less and less until at about one year, days would go by without me running to him.  My advice is to identify who is willing to help you and don't hesitate to take them up!  Even experienced NPs usually have a few people that they will ping when they need advice.  🙂

 

[AlpacaTraveLlamaDNP]

The best advice I got, was not to aim for Money my first year, to aim for experience and confidence.  You would laugh at my first year's income, but the experience I received at my State's University Medical Center was priceless for my Career.  Now, I will admit the resources there spoiled me very much, as now I am in a Rural Family Practice that folks would have to drive two hours to receive these resources, and that's just not financially feasible for my client base.

But, instead of money, focus on life balance and a comfortable place to grow and find your stride as a developing HCP.  A place where the culture matches your personality.  What's one year?  You've worked so hard, sooo sooo hard, now take some time make that Lab Coat fit better and more comfortable.

A weird kind of off topic advice, if your place of employment doesn't do this, introduce it ASAP.  A photo of the patient (with consent), to place in the chart.  Seeing your client by face is so important to seeing a person when you view the chart.  Each visit, renew the photo.  It can tell a story of so many things, but the biggest gain I get is realizing who I am treating, it jogs my memory, puts a face to a name, not a Diagnosis to a name, and increases the efficiency HCP - Patient Relationships.  I've seen Pulmonary clients age before my eyes too soon, and caught underlying conditions just on a photo timeline as well.

Next, trust your gut.  I find myself regretting about 95% of the time I don't follow-up on a gut feeling.  That sixth sense can save your patient's life, quality of life, and livelihood.  If you feel a test is needed but not clinically indicated, FIGHT AGAINST THE MACHINE!!  
Advocate Advocate and then Advocate some more.  Learn all your resources.  Learn from your failures, victories come from lines of failures.  Failures are part of growth, not a failure of growth or character.  We are human, and mistakes of all nature are hiding all around us.

Lastly, have fun, recharge, and take care of yourself too.  If you don't attend your spiritual needs, if you neglect your self, you will eventually neglect all else.  Make it a goal to recharge weekly.  Make it a priority just as important as making meetings on time.  If that's 15 minute undisturbed for coffee and a chat with a friend every morning, then practice it like religion.  Keep a journal so you can map your growth, and it's wonderful therapy.  The weight of the World will be felt on your shoulders soon.  Know your outlets, ask for help, and listen to that wonderful informative gut.  Luck and Blessings!!

[barcode120x, RN, NP]

Currently, I have 8 months of work experience as an FNP. I'm working as a sub contractor that does wellness visits and a medical examiner for the VA, but lately, the patient load has been very inconsistent (no patients = no pay) and have been on the lookout for part time and full time positions in the primary care setting.

Like you, my biggest concern was that annual wellness visits can be considered primary care, but it's not something you can really call actual experience. I'm currently looking for both PT and FT positions because I need consistency is work/pay and I decided to specifically look for primary care position. There are some hidden gem positions in the non-clinic setting, you just have to look. I'm currently in the process with an employer that does primary care visits in a senior living community. I have seen other listings like this from other companies, so may be something to consider. The pay is significantly low, as the recruiter told me it's based on my experience (which I basically only have 8 months as an FNP LOL), but I figured I'd just go through with it to get the experience and get in the field. The patient load is 2 patients per hour which was an appealing thing for me. Not only that, but I'm also comfortable doing home visits as I already do that with my current contract for the wellness visits.

Seeing a patient every 15 minutes in the clinic setting was scary. When I was precepting, one of my clinic would double up on patients and I was seeing 6-8 patients  every hour. It can be done and I definitely can do it, but it is not my cup of tea.