California NPs - trouble with finding "the" job?

[amalay, MSN, RN]

I may be going through a mid-life crisis but I'm feeling very lost as an NP these days. I'm going into my 5th year as a PNP in Northern California, and currently already at my 3rd job, and already feeling like I want to do something else. I don't know if I'm just flighty, or if I just haven't found "the" job for me? Just as a brief history:

1) My first job is probably the most ideal, now that I'm looking back at it all. I was 100% clinical, saw patients 8-5pm M-F, and had little admin work (ie: covering MDs inboxes and tasks, aka scut work). I got to see a good variety of patients and had MD's available to consult. I left the position because I was moving cities.

2) My second job was at a school-based health center. I left this position because it lacked variety (basically only well child checks and birth control/Depo) and also was very slow-- only about 6 patients per day, maybe 8-10 if you included some walk in immunization requests.

3) Currently at my third job as a part of a large organization that really feels like it doesn't know what it's doing with NPs (or maybe they do?). 50% of our time is spent doing admin work (covering MD tasks, etc) and 50% of it is in clinic seeing patients. On average, in a 40-hr work week, I think right now I have about 10-12hrs/week if clinic (just sick visits) and then option to flex 4-8 more hrs of depression/anxiety visits. So maybe total 14-20hrs/week of face to face patient contact. The rest is sitting around and admin. Not sure if this is sustainable...sounds like a SUPER sweet retirement job though, since there are days I'm being paid NP salary to basically answer emails.

I really appreciate and love the people I work with currently. But when I look at it in terms of what I'm really doing as an NP...I feel like it's a waste to spend THAT much time doing admin and EHR/inbasket work. And I really hate how sedentary it is, at least when I'm seeing patients I'm moving from room to room. There are some days that the medical assistants look busier than I am and it makes me feel useless/stupid.

I'm not sure if there's ever a possibility in my current organization to move away from this model, but I also don't feel like a move into a 4th job anytime soon would be a very good look for me.

What are your thoughts and any advice for me? For those of you PNPs or FNPs, what does your work-day look like and how do you feel about 50% admin work vs face-to-face patient contact?

[ArmaniX, MSN, APRN]

My one question is, did you not interview for the position and ask about your work schedule, shadowed?

It sounds like you’re not a fan of the “scut” work yet moved into a job with a much greater amount of it. Unless you did not realize this dislike until well into the job...

I think your best venture is to sit down and figure out what it is you want out of your job... how much clinic time, how many patients you’d like to see in a day. Make that silly list of “wants & donts” and then utilize it in your next job search.

Eventually you may want to settle with one for a while, as you mentioned a new job roughly every year is exhausting and probably not promising to hiring managers.

[amalay, MSN, RN]

When I interviewed it was clear that the MDs were not yet 100% sure what my tasks would be, so I described to them my current work day. They sort of alluded to the fact that I would be doing some group visits (ie: for international travel, obesity, asthma, etc).

I figured at the time my job would be a mix of group visits and regular clinic, along with 1-2 hours of admin time each day. Since I've only been here for roughly a year and a half, I spent a majority of last year pretty hopeful about maximizing face-to-face patient time. I made clear that I like to see patients.

I mean in all honesty, this is a pretty sweet job and I know I sound ungrateful for not wanting to be paid NP salary to answer emails. Since it is my 3rd job, I most likely won't be jumping ship so soon but I still think about it often.

[FullGlass, BSN, MSN, NP]

Where on earth are you working that you have that much admin time? If you want to focus on patient care, then apply to FQHCs. They are desperate for people. Also look at primary care for the large hospitals chains that have outpatient clinics like Dignity, Sutter, etc. They are focused on pumping patients through in high volume. You can also look at specializing and specialty clinics will certainly keep you busy, as will urgent care.

The biggest shortage of primary care providers is in the San Joaquin Valley and in the North State (north of Sacramento).

[amalay, MSN, RN]

I actually do work for a large chain company (a la Dignity, Sutter, Kaiser although I don't want to specifically say which!), and ALL of their NPs and PAs are 50% admin and 50% clinic within my region.

[ToFNPandBeyond]

On 1/14/2020 at 12:34 PM, ArmaniX said:

My one question is, did you not interview for the position and ask about your work schedule, shadowed?

I agree with ArmaniX, you've got to interview back!

My rule of them is I never start a position where an MD has no idea what an NP does, or you're the first NP to ever work that position, etc. You're essentially their "Guinea pig "until they learn about your role.