Doctor Hiring NP's

FullGlass, BSN, MSN, NP · May 19, 2018

Hello there. Thank you for asking NPs directly for input. Here are my thoughts:

1. Salary varies greatly by location. You'll need to do research on local salaries for NPs in your area. Also, when you start interviewing NPs, you'll get a good idea of what they are currently making and their compensation expectations and you'll get a good feel for the local labor market.

2. A new grad NP will cost less, but any new grad NP is going to need ramp up time, training, and close supervision - that is true whether or not they have RN work experience. NPs don't have residencies like MDs and DOs do. The advantage is you can mold the new grad NP to suit your practice. If you don't want to be bothered and want an NP who can hit the ground running, then hire an experienced NP.

You have to come up with a good interview process to weed out the crap NPs. Ask some clinical questions. Present a clinical scenario and ask questions based on that. Ask the candidate to describe some difficult cases, cases similar to what they would encounter in your practice, etc., and how they handled those. Have the candidate shadow you for half a day or so and see if they pitch in and help with H&P, their comments after seeing a patient, maybe even have them do a PE while you watch, etc. Culture fit is also important, too - with you and with your patients. A great clinician that you hate and that your patients hate isn't going to do you any good. There is a lot of information on the internet on how to do a good interview.

Learn what are the good NP schools and which are subpar. Ask for a copy of the NP's transcript if they are a new grad. A lot of people on this forum put down for-profit schools, but I am open to an NP candidate who didn't go to a great NP program if they had RN experience and had to work their way through their NP program. People get out of school what they put into it.

I don't remember everything I learned in school and I doubt MDs and DOs do, too. My office mate is a great MD and he is always researching stuff on the internet. I had NP clinical rotations with MD residents who were surprisingly ignorant, in my opinion and the supervising MD thought so, too.

3. Continued education - being a healthcare provider requires continuous lifelong learning. Providers make mistakes, and that goes for MDs and DOs, too. You can set some practice guidelines like providers must check prescriptions against uptodate, etc.

4. It's great that you are striving to provide good benefits. However, the only one you mentioned is maternity leave. That isn't going to be of interest to everyone. Consider: bonus, insurance, CME, sick and vacation time. You get what you measure, so set up a bonus structure that rewards your desired behavior.

Good luck!

Jules A, MSN · May 19, 2018

Hi and welcome,

Prepare yourself for this thread to get derailed by sniping but hopefully you will get some sound insight regardless. It is no secret that my opinion is I believe RN experience is crucial based on our lite education. That is not to say all with RN experience make good NPs or that those with no RN experience can't be competent just that I believe RN experience is valuable and necessary. I would seek NPs with either ED, physician's office or med-surge experience as they should have years of triaging and assessment encounters that can be invaluable in honing the intuition of knowing when something is just not right. I would ask about the school and particularly their clinical experiences. My preference is NPs who were trained by physicians as I think they are more likely to produce a succinct experience without unnecessary and time consuming hand holding that so many NPs rest on their laurels with.

Salaries vary geographically, between specialities and also based on the person's abilities to perform and negotiate. You will need to find out what local NPs make. The best way for you to set up what you are interested in doing is to collaborate with a sharp NP you know and trust from residency or even one of your family members who is a NP. I have offered guidance to my mentor Docs on salaries, what to expect ability-wise and who to hire. If you are opening a primary care office and will be utilizing FNPs the salary will more than likely be the lower end of the range although I would highly advise being willing to pay for quality.

Benefits to me are translatable into dollars so I do the math. The whole "mommy thing" turns me off so don't pat yourself on the back too hard for your consideration of maternity leave unless you want to attract that crowd and I don't need to point out the pros and cons there.

Regarding ongoing education one of the docs I work with likes to teach and will host informal lectures on common presentations which I love attending. Its often information I already know but reinforces what I'm doing is correct and the pearls can be priceless. I would make it open to everyone and not force it on anyone. Here again your hiring will be key unless you want to be saddled with a kindly but incompetent practitioner essentially working under your license regardless of full practice authority or not. Personally unless you find a rock star or are in a specialty where your NP was board certified such as psychiatry I would probably lean toward PAs as I feel their education is superior.

Good luck with whatever you decide.

cayenne06, MSN, CNM · May 20, 2018

Agree with Fullglass about the importance of a thorough process for assessing potential new hires, especially new grads.

I tend to disgree about the importance of RN background. I had almost 10 years experience as both an RN in L&D as well as a lay midwife prior to becoming a CNM 3 years ago. While i value the experience and do think it helps me be a better provider, it is in NO WAY a substitute for intensive clinical training as an APRN/PA. Not even a little bit. The roles are too different and the breadth of knowledge needed is night and day. Even though i specifically chose a highly respected and clinically intense hospital-based CNM program, I never had any illusions that i was competent to practice independently as a new grad.

No freshly minted MD would declare themselves competent to be a solo provider, and their education/experience is astronomically more comprehensive than an NP. Its too easy to become an NP, sorry but its true. Which means careful hiring and close support for new grads is essential.

Thankfully i work in an incredibly supportive environment with an amazing doc who has my back and who is always just a text away. Not to mention a plethora of experienced APRNs and opportunities for education etc. Plus i have a wonderful staff, plenty of PTO, opportunities to advance in the organization and expand my scope of practice- all the stuff that makes a job satisfying. It sounds like that is the environment you are striving to create! You'll be able to attract and retain quality providers in a practice like you are describing, IMO.

FullGlass, BSN, MSN, NP · May 20, 2018

Hi and welcome,
Here again your hiring will be key unless you want to be saddled with a kindly but incompetent practitioner essentially working under your license regardless of full practice authority or not. Personally unless you find a rock star or are in a specialty where your NP was board certified such as psychiatry I would probably lean toward PAs as I feel their education is superior.
Good luck with whatever you decide.

This is a very dismaying statement from an experienced NP. As in any field, there are great NPs and bad NPs, just as there are great PAs, MDs, DOs, and bad PAs, MDs, DOs. There are plenty of excellent NPs practicing. There are also plenty of excellent new grad NPs. Statements such as the one quoted here just reinforce the stereotype of nurses eating their own young.

djmatte, ADN, MSN, RN, NP · May 20, 2018

This is a very dismaying statement from an experienced NP. As in any field, there are great NPs and bad NPs, just as there are great PAs, MDs, DOs, and bad PAs, MDs, DOs. There are plenty of excellent NPs practicing. There are also plenty of excellent new grad NPs. Statements such as the one quoted here just reinforce the stereotype of nurses eating their own young.

Nobody ate anyone there. It's an important observation about the current limitations of np education and something anyone starting a business should consider.

And please stop using that phrase. You were never a nurse and can't speak to that statement. You never worked as a nurse, never worked with other nurses outside of school rotations, and certainly are in no place to judge other nurses actions. You said it yourself.. You're a provider. That's all you wanted out of your career path.

Susie2310 · May 20, 2018

This is a very dismaying statement from an experienced NP. As in any field, there are great NPs and bad NPs, just as there are great PAs, MDs, DOs, and bad PAs, MDs, DOs. There are plenty of excellent NPs practicing. There are also plenty of excellent new grad NPs. Statements such as the one quoted here just reinforce the stereotype of nurses eating their own young.

If it's dismaying it's because it's the sad truth. Ultimately the patient is the person who suffers. The patient doesn't know how little training the NP has had.

guest769224 · May 20, 2018

Statements such as the one quoted here just reinforce the stereotype of nurses eating their own young.

How could you possibly know that if you have never worked as an RN?

guest769224 · May 20, 2018

And please stop using that phrase. You were never a nurse and can't speak to that statement. You never worked as a nurse, never worked with other nurses outside of school rotations, and certainly are in no place to judge other nurses actions. You said it yourself.. You're a provider. That's all you wanted out of your career path.

Grand round of applause with this comment. Couldn't have said it better.

cayenne06, MSN, CNM · May 20, 2018

If it's dismaying it's because it's the sad truth. Ultimately the patient is the person who suffers. The patient doesn't know how little training the NP has had.

It is *not* eating your young to advocate for a more standardized and rigorous process for entry into practice. *WE* should be policing our own profession, and I would argue we are setting our aspiring APRNs up for failure by allowing such watered down education. I want my colleagues to be competent, and I want my profession to be respected.

Of COURSE there are competent APRNs. I am one of them, and so are the vast majority of my colleagues. Heck, a motivated student could come out of the worst school and still become a stellar NP. And of COURSE there are incompetent people in every field, from MD to dog walker. That is completely beside the point though.

The point is that APRNs as a whole need to figure out how to raise the bar for our newbies, so they can feel confident they are getting a solid, comprehensive education. We have a responsibility here.

I know I am a CNM and in some respects we are different from NPs. There is not anything close to the explosion of diploma mills for CNMs like there is for NPs, but it could happen for sure. I left non-nurse midwifery (I was a CPM) specifically because of the substandard education and shockingly low bar to entry. I do *not* want to see CNMs lower their standards. think this is an issue that all APRNs should take seriously , or even non-clinical MSN or DNP prepared nurses. I have an MSN in nursing education, and it certainly did not prepare me to teach in a didactic setting. I dont even recall much in the way of education-specific content. It was all the normal nursing theory fluff with some research stuff thrown in. I think we need to hold ALL of our graduate education to a higher standard. I want to get a terminal degree someday, but I would never consider a DNP, no way.

aok7, NP · May 20, 2018

I am a new grad NP with pretty diverse RN experience.

I am on the other side here, as I have a great job as a RN, and I am looking for a good fit as a new NP. I have been applying for jobs for a few weeks, and have been very happy to have had many interviews, either by phone, Skype, or in-person. Interviewing has taught me how to discern between someone who is just looking for a NP and someone who cares to have an invested NP join a team. I would recommend that you interview as many people as time allows, as this alone will give you insight.

I happen to think character traits of the individual, and then shared professional values, are most important. Experience working in health care of any type helps us to develop ourselves, and I automatically wonder about a potential employer if my nursing care and interactions over the years are overlooked as not important. I tend to think this type of MD would do best with an experienced NP, anyway.

I do come across a good deal of people who do not want to hire a new grad. My preceptor in my final clinical wanted to hire me, as in every way I had proven myself during the semester. She, as well as the providers in the clinic, pretty much made me feel I'd have a job when I graduated. The doctor who owned the clinic, a doctor I'd never met, told my preceptor he does not hire new grads. He apparently told her to have me apply after I get a year of experience as a NP. That kind of treatment makes me determined to stay loyal to whoever WILL invest in me and take a chance to hire me.

Good luck!

Trauma Columnist · May 21, 2018

1. As others have stated, salary varies according to location and experience. Also, look to saturation - many big cities have oversaturation while in rural areas you will have more choices as to who to hire because APNs are hungrier.

2. Experienced/new grad - I vote for experienced. As a new DO yourself, getting an experienced APN will make your job easier. Of course, with experience, comes a higher salary so thats a trade-off.

3. Continuing education - there should be an allowance of between $2000-3000 per year so that your APNs can attend CME.

4. Benefits - PTO - expect to give 4-6 weeks first year for new grads, 6-8 weeks for experienced. Maternity benefits - should figure into PTO. I'm a crotchety old lady with grandchildren so I would never apply where maternity benefits are advertised as I don't want to continually take up the slack for pregnant APNs (I told you I'm crotchety - lol). Thats what FMLA is for IMHO. Retirement plan - needs to be solid. 401k with profit sharing is one way to do it.

Best wishes for a successful transition to owning your own practice. As to the nurses eating their young comment - please ignore it. As APNs we need to never utter those words.