Ask for a Raise and get another degree?

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I have been an FNP for 2 years part time. I LOVE my job. Its super flexible, and I have 3 small children, 4,3, and 5 months. I work outpatient internal medicine. I see about 11-14 pts who are scheduled between 830-1130.

I "hi-jack" apppointments as I like to describe it. Pts think they are seeing my doc, then I walk in. She only mainly does Physicals, and I do mainly sick visits and followups. I am paid hourly-50$. I clock in and out. I want to ask for a raise but I don't know if it will ruin the relationship I have with my doc. I do about 1-2hrs of work off the clock. Charting, etc. I like to go home/gym- leave the office and work. I have no PTO but I can go on vacay whenever.

My doc also actually reviews most of the labwork, and sends to me a few a week. Even though I see a ton if her pts. (She sees maybe 5-8 physicals per morning) that is alot, I know. My husband gets mad that i work at home sometimes for free, so he has been bugging me about this.

Has anyone asked for a raise for a job they loved and wanted to keep? How has it affected their relationships? I really love it, but in about 5-7 years, I want to move to a large hospital for larger benefits, and pay, but not right now.

My next problem is that I don't think I am smart enough. I ask TONS of questions and I "bother" my doc alot. She has never said that- but I FEEL it. Not to mention, our pts full wait time in the office is sometimes an hour even more. They hate it and so does my doc. I think alot because sometimes I don't know all the answers. I worry ALOT.

Example- saw a cat bite, severe pain, put her on Keflex over the phone then switched to Augmentin bc that is the recommended- i saw her about 2 days after she called bc she had no transportation. I also ordered an X ray bc I was SUPER worried about more sever cellulitis I couldn't see. I spent a long time pondering and went with the X ray- SUPER GLAD THIS IS ANONYMOUS. I couldnt bother my doc for something so "simple". I was worried for my patient and that I might miss an osteo!

Thus is mainly an adult gerontological practice- there are no kids. I don't know if I should pursue an AGNP or an AGACNP now or wait till I plan to move jobs. I don't know if I just keep doing CEs and CEs if that is enough. What do you do? Sometimes I over worry because she is a BIT of a micromanager and questions my diagnoses. She also sometimes sees the pts I "cant" handle- which I hate and she does come up with different diagnoses. She has 28yrs exp as an internal med doc and was also once a medical director. I REALLY respect her, but I don't know how to become better and which path to follow.... go to school, CEs only?? What to do...

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I don't quite follow your post.... your patient's set up an appointment with their pcp and then you come in. why don't you have your own schedule? I don't think I could handle a job like that( I would not be happy if I was the pt either) . I only see 11-15 patients on my full days (it sounds like you are seeing that in 3 hours) ..... and I make your hourly wage...so I think your underpaid. I think that also explains why your patient's have a 1 hour wait. That is a schedule that is set up for failure.

As far as the questions.... I wouldn't feel bad. I have been practicing about 1 1/2 years. about 4 months ago I noticed that I have reached my 'comfort zone' where I can handle most stuff without stressing about it later. ... I am not researching stuff when I get home or asking a lot of questions to other providers. when I first started up to date was my saving grace. I still look stuff on there on occasion. Up to date would have led you right to augmentin for the dog bite .......I know because I have looked :) As you start to see more and more repeat stuff it just gets easier and easier.

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At first I thought it was weird that I was "hi-jacking" those appointments. But then, I realized that the other NPs in my area, they were doing the same. I am not really sure exactly now this idea came about. But I also know that some NPs have their own schedule too.

Thanks for letting me know. Even if I was underpaid,I don't really FEEL it, but Im more worried that asking for a raise will ruin the good relationship I have.

Though I will definitely keep the overbooking in mind as a reason for wait times.

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Specializes in allergy and asthma, urgent care.

If you haven't had a raise in 2 years it's time to ask for one. Keep in mind that your employer is not your friend, and this is a business relationship, not personal. You are doing work for which you should be appropriately compensated. I would also discuss your schedule and present any ideas you may have to improve patient flow, patient care, etc. Lose the mindset that your boss is doing you a favor by employing you.

I love my job, and I sit down with my boss annually and review what I've done, what I can do better, and any ideas I might have for the practice. Then I ask for a reasonable raise. I've never been turned down. My boss respects me and our relationship is very good. I am an asset to his practice and he has taught me a lot. Asking for a raise is the norm fora good employee and it shouldn't affect your relationship at work.

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Specializes in DHSc, PA-C.

Although your pay is low for seeing 11-15 patients from only 8:30-11:30 I don't see why you deserve a raise. Time management is bad because wait time is an hour and your medical decision making is poor. Per your statements of not knowing how to properly treat a cat bite, needing to constantly ask a lot of questions, and being questioned on your diagnosis/SP coming up with different diagnosis. How many times have you made a decision on a treatment or diagnosis that wasn't caught? Should you be practicing in this situation? After being in a position for two years you should know your stuff and be more comfortable by now. By your own statements it doesn't sound like you are safe to be practicing without more oversight.

Patient's should not get a bait-and-switch. This is unprofessional to have a patient come in thinking they are seeing the doc and then you "hi-jack" the patient. All sorts of wrong. You should consider another position with more oversight or do a residency.

Sorry for my blunt statements, but this is a patient safety concern and should be addressed right away.

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Specializes in Family Nurse Practitioner.
If you haven't had a raise in 2 years it's time to ask for one. Keep in mind that your employer is not your friend, and this is a business relationship, not personal. You are doing work for which you should be appropriately compensated. I would also discuss your schedule and present any ideas you may have to improve patient flow, patient care, etc. Lose the mindset that your boss is doing you a favor by employing you.

I love my job, and I sit down with my boss annually and review what I've done, what I can do better, and any ideas I might have for the practice. Then I ask for a reasonable raise. I've never been turned down. My boss respects me and our relationship is very good. I am an asset to his practice and he has taught me a lot. Asking for a raise is the norm fora good employee and it shouldn't affect your relationship at work.

I agree 100% and would have offered the same advice although it sounds as if the OP is struggling both to complete work and also requires quite a bit of hand holding? I am always prepared to walk if I request an increase and they won't agree but I have to wonder if that wouldn't be the best strategy in this case if I'm reading correctly and the OP really loves the flexibility of the job, probably just had a significant maternity leave time off that they accommodated and their Doc tolerates a fair amount if indecisiveness? I would definitely ask and if they offered a reasonable explanation as to why they won't in this case would possibly stay. My guess is there might be uncomfortable, but hopefully useful, feedback garnered from making a pay increase request?

The deal breaker for me would be not completing the work during the shift. I almost never do anything on my own time and have no intention of working for free so the OP either needs to figure out if they are the productivity problem or the work load is unreasonable.

Interesting thread and unfortunately probably not uncommon so I bet others can learn from the content. Good luck, OP.

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Thanks for your honesty! Yeah- thats why I am trying to figure out a way to get better. Whether from more CEs or just shadowing another provider or going back to school. Most of the time the handholding usually occurs with her patients who don't want to see me (obviously get tons of those) or who are very deconditioned. My doc holds my hand for these patients because she has the experience to work them up without sending them to the ER. Anyways, thanks. I really have to keep in mind how much I am doing, but I guess I am very uncomfortable with the question. Do you really finish all your work at the office? Including the charting? Do you get in early or stay later to do it? Im trying to figure out a way to do this... esp the calls involved with returning lab results. Do you call in ptsafter one week if they have no lab work for their follow up? Its driving me crazy that the pts do this and Im stuck with making phone calls....

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Specializes in DHSc, PA-C.
Thanks for your honesty! Yeah- thats why I am trying to figure out a way to get better. Whether from more CEs or just shadowing another provider or going back to school. Most of the time the handholding usually occurs with her patients who don't want to see me (obviously get tons of those) or who are very deconditioned. My doc holds my hand for these patients because she has the experience to work them up without sending them to the ER. Anyways, thanks. I really have to keep in mind how much I am doing, but I guess I am very uncomfortable with the question. Do you really finish all your work at the office? Including the charting? Do you get in early or stay later to do it? Im trying to figure out a way to do this... esp the calls involved with returning lab results. Do you call in ptsafter one week if they have no lab work for their follow up? Its driving me crazy that the pts do this and Im stuck with making phone calls....

I have always finished all work while at work and while being paid. It is all about time management and outpatient charts should be easy to breeze through. 99% of the time I complete/close/sign a patients chart before even moving onto the next patient and before they have even walked out the front door. Maybe spend some time with more experienced providers on how they chart. The key is to be thorough, but not excessive or charting unimportant information. My back ground is ER. So, I had to move, move, move and this helped me fine tune my charting skills. When I went private practice I kept my ER mentality, but never rush the patient or make them feel like I am not giving them enough time.

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Specializes in allergy and asthma, urgent care.

I do all my charting as I see each patient. I work in a specialty practice, so the number of conditions I treat is limited. I've also templated most of my routine follow up visits so I can chart in a snap. I rarely take work home. If I do, it's because I got lazy during the day and spent too much time chatting with staff. I utilize our staff to make phone calls to patients as much as possible. I will call with abnormal or critical results that need immediate action, but the MAs can certainly call with normal results or simple abnormals with instructions.

I thought a bit more about your post after I replied, and I think it's pretty awful for your boss to make you see her patients, without telling them first. I would be angry about that as a patient and as a provider. Perhaps you could talk to her about having your own schedule, and having the follow ups and sick visits scheduled directly with you.

Do some continuing ed and try to focus on the most common conditions you see. Get to know the most prescribed meds and diagnostics for common conditions.

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My advice is never work for free. If you have not had a raise in over a year you are due for one. Negotiating tips would be to estimate your worth (how much $$$ do you generate), and compare your salary to other NPs in the area. $50/hr seems low. Physicians generally see NPs as cash cows because we generate so much money for half what they earn. Do not sell yourself short, that physician does not want to lose you as an employee, or revenue earner.

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Specializes in Tele, ICU, Staff Development.

$50.00 an hour and zero benefits is lower than RN wages in some areas.

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Specializes in Neurology, Psychology, Family medicine.
$50.00 an hour and zero benefits is lower than RN wages in some areas.

Weird comment. Pay has so many variables across the nation the input of "you make less than someone else" without much more information is useless to the conversation.

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