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Did you feel prepared after graduation?

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Kahalaukane is a MSN, RN, NP and specializes in Family.

281 Profile Views; 18 Posts

I am a recent grad of a FNP program in CA, and I have been talking with a variety of experienced and new grad FNPs about their experience coming out of school and starting practice.  Most of them have expressed feeling inadequate in understanding their professional role, liability, employment contracts and malpractice insurance.  These were topics I never discussed in my program and have been studying on my own time to try to understand. 

Another common concern was the inability to recall information effectively, and the need for additional reviews after studying for boards.  I personally found the Fitzgerald, Hollier and Leik reviews helpful, however, I cant say that I retained much useful information.  Does anyone have any thoughts or suggestions on how the reviews could be better utilized for students and new graduates?  Looking for ways to improve the overall process of transitioning from a RN to a Nurse Practitioner.

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AnnieNP has 20 years experience as a MSN, NP and specializes in Adult Primary Care.

1 Follower; 482 Posts; 3,577 Profile Views

The first year I practiced I constantly listened to Margaret Fitzgerald.  Not just the review course, but I ordered many of the different CDs on different topics and listened to them during my drive to and from work (40 minutes each way).  I have been practicing now for 12 years and every few years I go to a Fitzgerald review course to catch up on topics that  I don't routinely see in my practice.

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FullGlass has 1 years experience as a BSN, MSN.

5 Followers; 2 Articles; 759 Posts; 7,509 Profile Views

Pretty much every new NP feels this way.  There are an increasing number of NP residencies available, so I suggest you try to get into one of these.  

As for remember information, your employer should provide you with a subscription to UpToDate.  I use it all the time to look up stuff.

I also kept my board exam review book on my desk and used that a lot at first - I took the Barkley review course and used their workbook, with lots of my own notes in it.  I also used their CDs and listened to them while driving to refresh my memory.

Hang in there!  The first 6 months are the hardest and then it will gradually get better.  By the end of my first year, I was pretty comfortable and confident.

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527 Posts; 10,428 Profile Views

I definitely didn't feel prepared. If you end up working in primary care, I highly recommend The Curbsiders, an internal medicine podcast that I've been listening to for almost two years now. It's three internists who bring expert medical specialists to talk about different things like geriatric depression, HTN, menopause, CKD, osteoporosis and vitamin D, medical cannbis--you name it, they run the gamut. The older episodes are very informative; the more recent ones are hit or miss for me now but I am still a very dedicated listener. The amount of information I've learned through this podcast goes above and beyond what I learned in NP school. 

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verene specializes in mental health / psychiatic nursing.

1,509 Posts; 9,690 Profile Views

Another new grad, not yet working as an NP. I feel nervous and definitely wish I knew more, but at the same time I do feel my program gave me a solid base foundation.

I'm sure that the role transition will be stressful and at times overwhelming, but if I give it some time. I'll start to feel more competent. For myself I have and am continuing to educate myself - reading up on topics I want to know more about, practicing case studies, and utilizing my RN work to think through rationals/decisions for patients I work with.  I'm also making my own cheat sheets because 1) quick reference and 2) the process of making them is helping to cement knowledge in my head.

I do think it is important to remember that we are not expected to have absolutely everything memorized, we are novice NPs, and even those with many years of experience still need to look things up on occasion. Being able to quickly identify an appropriate resource to answer a question is just as, if not more important, than having the answer in your head already.

Finally, I am being selective in my search for a first job and prioritizing finding an organization that is going to be a supportive practice environment and good place to learn. Speaking with current mentors in the field has led me to organizations that are more likely to offer this environment, as well as learning about professional networks for supervision and ongoing non-coworker mentorship.

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traumaRUs has 27 years experience as a MSN, APRN, CNS and specializes in Nephrology, Cardiology, ER, ICU.

15 Followers; 160 Articles; 20,955 Posts; 189,440 Profile Views

Here's some advice:

1. Ensure you have an adequate orientation. This should be a combo of didactic as well as shadowing and ease you into the role. It takes a while to get credentialed by insurance companies and hospitals so orientation is really a must. 

2. Find a mentor - someone you trust and can talk too. Preferably this would be someone in your practice. However, you might need to look to your state's APRN organization to see if they have a mentor program. 

3. Join your professional organizations. For instance, AANP or if in a specialty, ENA, ANNA, etc.. They offer publications as well as chat forums.

4. Don't forget to start your CME, the 5 years goes by fast and you don't want to be caught short. I personally use AudioDigest for a lot of my CME because I spend so much time in my car. 

5. Ask questions - don't be intimidated - remember your patients are depending on you. 

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54 Posts; 2,229 Profile Views

Hello I’m a new grad as well. FNP to be exact.  I hear you as I’m in a similar situation.  I received two offers, first was med mgmt in SNFs, which offered $85000/yr plus quarterly bonus (I actually make more as a nurse)😳.  The second is in psych, in SNFs as well.  The second one is ‘pay for service’ which I’m not too familiar with... and they have also agreed to pay 50% if I decide to get health insurance....please explain this to me and which do you think will be best position for a new grad?  TIA

Edited by Reyval04

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verene specializes in mental health / psychiatic nursing.

1,509 Posts; 9,690 Profile Views

3 hours ago, Reyval04 said:

Hello I’m a new grad as well. FNP to be exact.  I hear you as I’m in a similar situation.  I received two offers, first was med mgmt in SNFs, which offered $85000/yr plus quarterly bonus (I actually make more as a nurse)😳.  The second is in psych, in SNFs as well.  The second one is ‘pay for service’ which I’m not too familiar with... and they have also agreed to pay 50% if I decide to get health insurance....please explain this to me and which do you think will be best position for a new grad?  TIA

Neither sounds great honestly. The SNF pay is too low, and I wouldn't recommend psych in a SNF for an FNP as my understanding is this track has little training in managing geropysch patients, which would be a lot of what you'd be working with.  Furthermore, depending on state regs it could be out of scope to practice primarily in psych as an FNP.

My recommendation would be to keep looking for something that is going to be closer to your clinical preparation and/or interest areas, has good support/mentorship, and a reasonable salary.

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54 Posts; 2,229 Profile Views

Verene thanks for the response.  So the second offer came back and is giving me a quarterly bonus and $50 for orientation....I’ve been applying since February and graduated in December 2018.  I’m just eager to start somewhere decent and decent pay .

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verene specializes in mental health / psychiatic nursing.

1,509 Posts; 9,690 Profile Views

19 hours ago, Reyval04 said:

Verene thanks for the response.  So the second offer came back and is giving me a quarterly bonus and $50 for orientation....I’ve been applying since February and graduated in December 2018.  I’m just eager to start somewhere decent and decent pay .

50$!!!! for orientation!?? That is insulting. I understand the desire to work, but I don't think either of these jobs are 1) going to set you up for safe, competent new grad practice or 2) are going to pay you what you could make elsewhere.  There have to be other jobs out there, and I would suggest casting a wider net either in terms of facility type or geographically and utilize your professional and personal networks to find work!

For reference, I am also a new grad (PMHNP) and was just offered $136K/year + differentials for education/additional skills + pay increase after 6 month probation + CME money + PTO and extremely generous benefits in a facility that is experienced in hiring new grads, and offers structured orientation along with on-going mentorship & training. Additionally, I can renegotiate after 1 year of practice. 

I got this offer through networking! This is a position I did *not* apply for - I chatted with a professional contact who who passed my CV along to her boss (CMO), who then contacted HR and had them invite me in for an interview despite the fact I hadn't formally applied.

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3 Followers; 1,406 Posts; 6,829 Profile Views

Keep in mind, my quarterly bonus exceeds my actual salary.

It is possible they start you at 85k to see if you can actually do the work.

No FNP should take a psych med management position in LTC. You are way out of your league.

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Pixi NP specializes in Maternal/Child Health, Correctional Health.

2 Posts; 14 Profile Views

I agree with pretty much all the comments above. I’m about 8 months into my first job. My annual is in the ballpark of 140k plus a pretty generous benefits package. My organization doesn’t have a formal new grad residency program but the senior NPs were eager to have me and very willing to train me and let me learn at my own pace. We anticipated about 6 months with my training wheels but by month 3 I was  ready for a little bit of independence. There were tears but that’s totally normal. I still feel lost at times but I always have resources and supportive knowledgeable coworkers to turn to. Support is the most important thing in my opinion. 

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