Do most NPs start working after licensure?

sandnnw, BSN, MSN, EMT-B, APRN · Aug 18, 2009

You situation depends. Here's my story:

ANP, graduated in DEC. In JAN, went to Iraq (reservist) for six months, so I couldn't take either test (AANP, ANCC). Upon getting back to US, continued studying and waited for both bodies to allow me to test. ANCC got me first, two weeks later AANP allowed. AANP questioned my "women's health" sites, interesting, considering my accredited graduate program, but I played along, delaying testing for two weeks. Passed both, now...here's where the story get's better.

AANP, within five weeks, cert arrived and the state received confirmation, recognizing my ANP the next day. ANCC has sent me nothing yet. The state received confirmation from them three days later and posted on the state site, showing that I have both credentials. I have called ANCC three times now, and have been assured that my cert and pen have been "resent to the vendor." So, you can imagine my frustration. I paid for that cert and pen, I want it. I have been recognized by the state for over five months now, even with ANCC, and they continually fail to follow through!

So, back to your question. I am also contracted by the government - three years, for paying most of my lovely southern ivy tuition. Wonderful education, but I'm paying for it now. The government (VA) does not seem to want new NPs. I have applied for everything even smelling like a NP job, no luck. They continue to hire experienced NPs (I don' t blame them). In the meantime, I have to look for part-time NP jobs.

Thus far, I have sent about 30 resumes. I have found two per diem jobs and finally this week, started in a busy walk-in clinic. Although I cannot see children, they still think I'll fit in fine. The admin even asked me what it would take to go back and get my FNP (Yikes!) My two per diem jobs are not fruitful, but they are resume fillers.

One step that helped me, Monster.com and career builder.com, uploading my resume. I get calls, sometimes several per day, wanting me to come for an interview, out west. I cannot relocate, so this has hampered me as well. Also, my VA contract has killed chances for full-time work anywhere else. When I approached the VA HR rep, she suggested that I get part-time work to get experience, gee thanks, duh!

So, moral of the story, watch taking funding from contract sources, esp the VA. I'm sure the military and HHS is not like this. Looking back, I should have probably just swallowed the loans myself and would have been working FT as an NP already. It has taken me five months to find anything near clinical NP work. Of course, in this economy, that may not be too bad. But, listening to the fussing about healthcare and PCPs, it leaves me with a bitter taste...and a contract I cannot afford to get out of ($38K).

That's my sad story. I'm sure there are others, and mine is sorta unique. Also, the market I'm in is flooded with mid-levels. Four NP schools and one PA school. Starting salaries are deflated (65-70K). Your area may be different, hopefully. I wish you luck! (and patience)

jimbo

Advanced Practice Columnist / Guide · Aug 18, 2009

I graduated in Dec 2003 and got a job offer in Jan 2004. However, I opted to take the boards first and asked to start after being certified. At the time, the hospitals in the area were hiring NP's who have just graduated and have not been credentialed. At the current time, the hospitals in the area are hiring ACNP's but will not give a start date until credentialing goes through. They claim it's a JCAHO requirement. Obviosuly, credentialing will only go through if the ACNP's have received both the national and state certification in addition to a slew of other requirements. Taking the current economy in consideration, there seems to be less openings for NP's in the area and we've had an increase in applicants for lesser positions available. Some NP's who have applied actually lost their previous NP positions when their hospital downsized. Kinda scary.

msmith · Aug 19, 2009

Hey Jimbo,

Thank you for your response. Sorry to hear about all of the hassles the VA has given you about finding work. I am not involved in the VA in any way at the present time. I actually did my primary care clinical at the VA this past summer and it went pretty well. I did look into some job openings there, but they were bent on me having my certification first before applying, but they did tell me that they were open to hiring new grads with experience. That is out here in Chicago (Hines and Jesse Brown VAs). Anyways, I hope that you are able to find the full time work that you desire. Let us know how it goes! :)

And NP Gilly, thanks for sharing your story too. I think it's great that you were offered a job before certification. However, I think things have changed quite a bit since 2004 in terms of NPs finding work without licensure. I have gone on a few interviews (about three for full time NP positions). None of which have come through at this point in time. I am still very hopeful that I will be able to find something. In the mean time, I have accepted a position working in an endocrinology office as an RN whereby I don't have to work weekends or nights like I am doing so right now at the hospital I am employed for. I think that will good experience too, having that background working with diabetes patients.

Tomorrow my ANCC application goes out in the mail and we'll see how long it takes to get confirmation of receipt and notification to test. It will be very interesting. :confused:

allnurses Guide · Aug 19, 2009

I graduated May 2009 and started working on June 30, 2009, before I took my boards. Passed my boards (ANCC)July 13th, got my cert. number July 21 (Cause I requested it online immediately after I passed), and had my state license and controlled substance license 2 weeks after that. I'm still waiting for my DEA number, but I heard that can take 3-4 weeks. I can honestly say I had no problems with ANCC, but I know others have. It took about 4 weeks to get my authorization to test after I submitted my application, and I could have tested the next day if I wanted to (which I didn't!). I worked under my manager's license until I was certified and licensed.

I'm fortunate that there is a real need for FNPs in my area, and most of my class had jobs before certification. There were still many places that wouldn't hire until you were fully credentialed, and I didn't want to wait that long before I went back to work.

Good luck on your boards and with finding a job!

msmith · Aug 19, 2009

Hey BCgradnurse,

That's very interesting. So you did an FNP program while I did an ANP program. I am wondering if that's part of my problem. Where do you live? Out here in Chicago, there aren't too many openings for ANPs, but for FNP's the job market seems a little better especially with these minute clinics having openings for FNPs. But I have to say that that's not the job I would want after freshly graduating even if I was an FNP. Too, I think the job market for midlevel providers is quite saturated out here in Chicago and there really aren't too many openings. And I don't want to do OB/GYN or ONC. My specialty is cardiac. I am so discouraged right now especially after hearing stories where NPs started working before testing. I just don't think that's going to be me. I'm starting to wonder if I'll ever be an NP. :cry:

Trauma Columnist · Aug 19, 2009

I live in downstate IL near Peoria and the job market stinks for all mid-levels. I am an adult health CNS who graduated in May 06, took certification and ended up getting a job in July 06.

Fast forward to our horrid economy (unemployment >10% in IL) and I'm working prn in an ER. Because I will have more abilities if I can see kids, I'm back in school to get the peds CNS.

blusueNP, MSN, APRN · Aug 19, 2009

I feel like I am trapped in my current RN staff position - I graduated in Dec with my MSN in women's health and because I have to work full time - I have precious time to study but have decided to sit for the WHNP certification in October - I have written to a few clinics that specialize in women's health and have asked them if they hire new WHNP's, but have not received anything back from any of them. Can anyone out there give me any helpful advice or better yet, contacts? I live in the Tampa bay area of Florida.

allnurses Guide · Aug 20, 2009

The ANPs, PNPs, and WHNPs do seem to be having more challenges finding jobs (I live in the Boston area). None of the FNPs I graduated with are working at Minute Clinics-I agree that's not the optimal first job for an NP. Most of my friends are in private or hospital associated practices- I don't think any are working as hospitalists. I work in a community health center. As I have said before on this site, my state has mandated health insurance, which created a great need for providers. It's very difficult to find family practice docs, so there have been a lot of opportunities for FNPs in Massachusetts. I'm not sure if the market is getting saturated here or not, but I get emails from my state NP association several times a week with job opportunities. If you have a state association I would strongly encourage you to join. Several people I know also had pretty good luck finding job openings on indeed.com.

Keep sending out those resumes and try not to get discouraged. Focus on passing your boards and talk to everyone you know who might know someone who knows about a position.

Sending out good job hunting vibes to all who are searching.................

msmith · Aug 21, 2009

Thanks BCgradnurse for your response and your post. Makes me want to move to Massachusetts in a way. But not ready to leave my home city of Chicago just yet. I agree that more of the specialty areas are harding places for NPs to find work. I guess at this point it's just a waiting game. I'm going to focus on studying for the ANCC exam and I'm starting a new RN position with an endocrinology practice in a couple of weeks. I think that should be good experience. Hopefully so, anyway. In the meantime, I will just keep looking.

Sheri FNP-C · Aug 22, 2009

I graduated in May. I had a total of 4 job offers, 2 came before graduation and 2 immediately after. I got the AANP authorization to test at the end of June and took the exam early in July. I got my official certificate last week. I got licensed mid July (my state does not require certification for licensure). I then had to apply for an NPI number and DEA number. NPI was issued the same day, DEA took about 3 weeks. Once that was all in place, along with NP malpractice ins., the practice needed to work on getting me credentialed with insurance companies and the hospitals I will be rounding at. So far I am credentialed with less than 1/2 of the ins. companies and only 1 of the 2 hospitals I need privileges at.

I started working around 8/1 only part-time as an orientee. The doctor working with me comes in after I see the patient, does a quick exam, and signs the scripts. I think this is necessary or they couldn't bill under their name.

I will officially start in September seeing 20 patients a day. I am a bit nervous...20 seems like a lot to start, but we will see how it goes.

It is so much more of a process than I ever imagined. Had I known, I don't know if I would have started looking for a job so early. However, I am lucky to have worked in hospital management so I had a lot of connections in the community. Otherwise, I am quite sure I would not have had such good luck finding a job. Also, I am lucky that the practice was willing to wait for me to finally be able to work.

All I can say is hang in there! Something will come along.

celclt · Aug 22, 2009

You situation depends. Here's my story:
ANP, graduated in DEC. In JAN, went to Iraq (reservist) for six months, so I couldn't take either test....southern ivy league ....
ok, I know you are a Vandy grad-what options do you have for talkng on your debt from the gov't just to get a FT NP position? You are in a position now to be very marketable, but as time passes w/o FT NP work, how does that play out? Kind of sad that you busted your ass @ Vandy and cannot reap any of the rewards of that.
Are Gov't contracts only worth it if you are willing to relocate ( Indian Res,ect)? Are they not contractually bound to have you to repay the loan (if not otherwise deferrred) and furnish a position-what is their end of the bargain? Do you have to repay them if you are not contracted with them w/in X amt of time?