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the cold hard reality for FNPs in primary care...?

Posted

Specializes in School Nursing. Has 7 years experience.

I'm just starting my MSN/FNP, the idea being to finish in about three years while working most of the way through.

I work in the ED, and I like the variety. I'm seeing a lot of stuff that would (and often should) be seen in primary care. I like the patients and my coworkers. The ridiculous behavior of certain folks doesn't usually get under my skin. But the hospital is a brutal grind - at least for me. The noise, the unpleasant physical environment, the lack of control over basic decisions like when I'm allowed to eat, the risks of being hurt intentionally or accidentally....I don't think I could keep this up for 20 years.

What I really want is a comfortable middle-class existence, doing something reasonably useful in the world, using my brain, with a chance to actually interact with patients, but also with the energy to enjoy my family and personal life.

So like many people I thought: FNP. But now I wonder....what will my options be, realistically? Grinding through 30 patients/day in the outpatient world might be physically easier (presumably I would get to sit sometimes, and I wouldn't be lifting people), but it's also more responsibility and maybe not much more pay. And, it doesn't really give me any more time to interact with patients than I have now.

If you're an FNP in an outpatient setting...have you found a work niche that is a little more (for lack of a better word) humane? Where, and how?

Edited by laflaca

My Cold Hard Reality of Primary Care

Arrive at work around 8:15. See a wonderful variety of patients (HTN follow up, well adult physical, low back pain, two URIs, DM2 follow up and an acute knee injury (band and football practice are back on!). My average per morning is 6-8 patients; do a stack of refills, decide on a plan for the two scans I ordered and review a stack of labs. Eat lunch for 15-30 minutes and then see afternoon patients...abdominal pain, a well woman physical, a UTI, a dog bite, etc. etc. Finish up charts, review final labs and leave the office around 5:30-6:30 depending on how many referrals need to be completed, labs reviewed, etc. Along the way I got to hear about one patients trip to Australia, congratulate one on the birth of a new grandbaby, empathize with one who is the primary caregiver for her mom and do my best to educate people along the way of the dangers of antibiotic overuse and the importance of lifestyle changes in some chronic diseases.

If I worked full time, I would make around $97K. In my region, RNs do not make that without significant overtime or shift diff or both. I don't lift people, put myself at risk or deal with a loud, noisy and disrespectful environment. *I* decide when I need a bathroom break and when I leave. I don't work weekends or holidays. I work in an office that respects the provider patient relationship and we are not required to see the 30 patients a day that you speak of. I *choose* to only work part-time so I can be with my child after school most days of the week AND we travel extensively.

Your reality doesn't have to be the one you are describing. Look around, be willing to relocate and take your time in the job search.

BCgradnurse, MSN, RN, NP

Specializes in allergy and asthma, urgent care. Has 12 years experience.

I worked for 3 years doing primary care in an urban community health center. I burned out in that setting and in that short time frame. I had to see 30-35 patients a day and was given 15 minutes per visit, be it for a sore throat or a complete physical with gyn. I would spend several hours every night at home charting. I decided to leave primary care altogether and go into a specialty area. I work in an asthma, allergy, and immunology private practice. The pace is much better. i actually have time to spend with patients and I do a lot of teaching with them, which I love. I rarely stay late, I never work weekends or holidays, and I get all my charting done before I leave for the day. My office closes for an hour at lunch everyday, so I have time to eat, run an errand, or even take a walk. My focus is narrow so I've been able to really gain expertise in what I do. It's also somewhat repetitive and a little boring at times, but I'll take that any day over the craziness I used to deal with. I do work 1-2 shifts a month at an Urgent Care clinic just to keep my skills up. I am paid well, I have little to no stress, and I work with wonderful people.

Not all primary care practices are like the one I worked in, but it was enough to dissuade me from doing primary care for the foreseeable future. I don't like having to be all things to everyone. You may find a primary care setting that works for you.

midwestFNP

Specializes in Family Practice/Urgent Care. Has 7 years experience.

I work in a primary care setting dealing mostly with underserved/vulnerable/impoverished patients. The majority are on state assistance but I have a fair amount of commercially insured also. I see everything from coughs and colds to patients with multiple chronic health issues. I work M-Th and I set the amount and type of patients I see. I usually end up seeing somewhere in the range of 18-20 per day. We are given an hour for lunch but I usually end up taking that time in my office to review charts, labs, do refills etc because I like to leave at 5:00 on the dot or earlier. I work with 2 other NPs so time off is never an issue. I will make close to 100k this year with bonus. I don't work holidays or weekends and I'm getting all my loans paid off through the NHSC. There are lots of good jobs out there for primary care NPs!

BostonFNP, APRN

Specializes in Adult Internal Medicine. Has 10 years experience.

I work a mix of outpatient and inpatient. I have a wonderful job where I can set my own schedule.

I start at 730 and see 1-3 hospital patients on rounds then 6 patients in the clinic in the morning. I have an hour lunch which often use to run errands or catch up on charts of needed. I see another 6-8 in the afternoon and I leave at 430-5. I alternate between 4 days and 5 days per week depending on patient load. If I have heavy patients I may only see 8 in a day. I schedule 15 min add ons, 30 min follow ups, 46-60 min physicals.

I go the psych center to do admission h and ps on patients first, 8 days a month 3-4 hrs per day, then i work 7 on 7 off night shift in the hospital doing 8-18 admissions per night and take pager on 50-80 patients. sounds bad but you get used to it. and it pays 150k a year so yeah ill take that. esp for first year out of school. probably 50 hours per week for the 150k. 180k if i work extra weekends often. but i won't make that this year since we got the raise in the middle of year. probably be more like 120 this year. next year 160k though.

If you don't mind working hard you'll make good money. Of course the acuity is higher also. get a lot of sick icu patients but we have sub specialty back up as needed. usually not until morning though.

MedievalNurse

Specializes in Family Nurse Practitioner.

I have only been working as an FNP in a primary care setting for about a month and a half now, but I love it and even on my most stressful days, I wouldn't want to do anything else. I have a big variety, seeing anything from new work injuries to managing primary care for people with complex medical issues. We do everything from preventive health to DOT physicals (I haven't started those, but working on a class so I can take that exam). I don't make as much money as I could as an RN, I make 75K per year, but that will go up to 90K once all of my credentialing comes through (Medicaid, Medicare, etc), BUT I also don't lift heavy patients, I don't clean up body fluids, I take a few minutes break whenever I want, etc. The autonomy present, even working with a physician (I am in Texas) is so refreshing. My knowledge matters, I am respected, and I get paid to use my brain.

I have friends who still work as bedside RNs and they enjoy that work. I think this is fabulous for them, and I am glad they are happy. I do miss the 3 twelve hour shifts and night shift since I am essentially a night person, but I do not miss the work. 13 years was enough, and I am thrilled to have this new challenge. I think what it ultimately comes down to is an individual choice. As I have seen it discussed in other threads on these boards, being a nurse practitioner doesn't always mean you are going to make more money than an RN, but it is a completely different profession, and it is like comparing apples and oranges. I am a new NP, I don't expect to be at the same point in that career as I was when I was a highly-skilled critical care nurse with many years of experience and two major certifications to my credit. Just as you will find those who don't make as much money (me) you will find those who make a lot of money. I don't think anyone should decide (or decide against) to become a nurse practitioner just for the potential bump in income. Evaluate what NPs do and be sure that is something you will enjoy. I get to spend a lot of time educating patients and encouraging them to make healthy choices, all in the hopes of keeping them out of the hospital.

Good luck in your choice.

laflaca, BSN, RN

Specializes in School Nursing. Has 7 years experience.

Thanks so much to everyone for the insightful replies!

gerry79

Specializes in ED, Cardiac Medicine, Retail Health.

I am a relative new NP (10 months), and my transition from being a floor nurse to an NP has been wonderful. I see 18-20 patients a day, my environment is low stress, and my pay has significantly increased ($35/hr to $53/hr with up to 10% yearly bonus). I work 3 ten hours days and have 2 four day weekends a month. I do have weekend and holiday commitment, but I am not working a day night rotation and no overnights. I get a mandatory 1 hour lunch break, and do not run around like a chicken with my head cut off. Also, I work alone and do enjoy the autonomy. Yes, I do have more responsibility, but my stress and anxiety level has significantly decreased since my floor nursing days. I use to dread every shift as an RN, and had anxiety attacks while headed to work when I was an ED nurse. I feel I am being payed for my knowledge, respected by the patients, and valued by my employer (since I bill and bring in income). I remember the nights of battling incontinent dementia patients (and the bed facilitator who wanted to load us up with them with no regard to staffing), cursed out by drunks, tortured by pain seekers who were on the call bell every hour on the hour, and not valued by the hospital. For ME, it was a no brainer to continue my education and become an NP as I realized hospital/floor/ED/unit nursing was not my cup of tea.

Edited by gerry79
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bibibi

Has 3 years experience.

What kind of setting do you work in?

gerry79

Specializes in ED, Cardiac Medicine, Retail Health.

I work in retail health (CVS minute clinic).

I am a relative new NP (10 months), and my transition from being a floor nurse to an NP has been wonderful. I see 18-20 patients a day, my environment is low stress, and my pay has significantly increased ($35/hr to $53/hr with up to 10% yearly bonus). I work 3 ten hours days and have 2 four day weekends a month. I do have weekend and holiday commitment, but I am not working a day night rotation and no overnights. I get a mandatory 1 hour lunch break, and do not run around like a chicken with my head cut off. Also, I work alone and do enjoy the autonomy. Yes, I do have more responsibility, but my stress and anxiety level has significantly decreased since my floor nursing days. I use to dread every shift as an RN, and had anxiety attacks while headed to work when I was an ED nurse. I feel I am being payed for my knowledge, respected by the patients, and valued by my employer (since I bill and bring in income). I remember the nights of battling incontinent dementia patients (and the bed facilitator who wanted to load us up with them with no regard to staffing), cursed out by drunks, tortured by pain seekers who were on the call bell every hour on the hour, and not valued by the hospital. For ME, it was a no brainer to continue my education and become an NP as I realized hospital/floor/ED/unit nursing was not my cup of tea.

gerry79...wow! you have well stated every reason I went from ER RN to NP...cheers to us becoming NPs!

Did you do the program online or was it a traditional classrom