Does your first job define you?

MallysMama · Oct 23, 2015

It probably isn't possible to do much negotiating with the teaching hospital. What is your draw to that facility? Is there nothing else around? The difference in pay can be significant.
No experience changing specialties but would guess that starting in a new specialty would be at least a little easier for an experienced NP to sell themselves as opposed to a new grad. ?? Good luck!

Thanks!

There are plenty of other hospitals around....but a large majority of my clinical rotations are in the school's hospital. So I figure I'm more likely to find a job there- since I will know quite a few of the providers by the time I graduate. (I also currently work there as an RN.) I plan on applying to multiple different hospitals...but I've already had one of my hospital's specialties show an interest in hiring me. If they turn out to be the only ones.... I don't know! I want to be picky! But I also recognize that I will be a new grad and can't be TOO picky....right?!

allnurses Guide · Oct 23, 2015

I'm wondering y'all's opinion on how much a first NP job defines you and your future options. Say you have a set area you're hoping to work, but another -very different- offer comes along first. Will taking it hurt your future chances of getting into the area you want? Or is any experience helpful?

I feel that your first job will absolutely play a role in your career, though I am not sure it will "define you". Your first job is the environment where you will learn the most clinically; what you learn and how you learn it will form the foundation of how you practice.

My advice to my students is to look for a first job that offers: professional mentors, collaborative support, a structured orientation period, and has experience training novice NPs.

twozer0, NP · Oct 23, 2015

Where and what you make depends on your long term career goals. Pay is not everything. Academic centers pay less because of the demand for people to work for them. Lets face it, you dont go to Hopkins, Mayo, or Cleveland Clinic for the pay. You go for the experience and as a stepping stone to build your brand for the future of making yourself more marketable. If your first job pays less than what you would expect, perhaps do an opportunity cost on the pros of working for an institution and what could come out of it after a few years. Sure you might work for less now, but having that on your resume can work wonders for you later (pending your goals on what you want).

I would personally probably not take a job at an academic center (now) because I like the country and rural setting. Farm life is for me and so is family and community. The funny thing is I never even wanted to live in the country but the peace it allows me to have and allowing my children to enjoy wildlife is invaluable.

Later in my career I would consider it, and even the pay it entails (though I would try and negotiate the best possible salary). Should I want to do research or teach, these are the things that positively reflect on your chances to get those positions.

Jules A, MSN · Oct 24, 2015

Academic centers pay less because of the demand for people to work for them. Lets face it, you dont go to Hopkins, Mayo, or Cleveland Clinic for the pay. You go for the experience and as a stepping stone to build your brand for the future of making yourself more marketable.

Unless someone wants to go into academia which generally pays lousy also I don't think it is usually worth it if there are other better paying opportunities available unless as in the case of the OP where they are able to easily get a job in the specialty they want because of their connections there. I would however use it as a very quick stepping stone because every year that you lose tens of thousands of dollars can really add up.

I would still recommend shopping around because the money difference can be staggering. I make 45% more than a NP I know who works at a well known teaching hospital. In my area the two biggies are truly only legends in their own minds but people continue to drink the KoolAid which baffles me.

Annaiya, NP · Oct 24, 2015

I think it depends on your specialty and what you might want to do later. Getting comfortable diagnosing and writing notes and time management all translate across specialties. My thing with first job is it will form the basis of the rest of your practice. First learned habits are the hardest to break, so I wanted to start somewhere where I would get trained in the best way to do things. Every place varies, but at least nothing I learn in my job is the wrong way to do things. This can't be said for everywhere. I also wanted a place where I would be trained in by NPs and they were used to the on-boarding process. If you start with a good foundation, the basics will translate to any other specialty you might want to go into later.

Jules A, MSN · Oct 24, 2015

I also wanted a place where I would be trained in by NPs and they were used to the on-boarding process.

I initially chose hospitals where I would be trained by and working solely with psychiatrists because I wanted to operate and be treated like a physician. I was the first psychNP to have admitting privileges at two hospitals. It was easy to assimilate because I aligned myself with physicians and was therefore treated like one.

It has been interesting as other NPs have joined or attempted to join the team. There have been 2 who have flourished and 4 who didn't fit in or last very long leaving the physicians with mixed feelings about us. The ones who didn't last were fair providers, no rocks stars but ok, they tended toward conservative dosing which isn't a good fit for acute inpatient psych and was interpreted as they were unsure of what they were doing which in a way was true. They had issues with the work load and call responsibilities. In most cases the work load concerns were them not being able to keep up which was largely due to them operating more as a nurse than a provider.

Excellent thread OP!

sauce · Oct 24, 2015

One of my old bosses said that most nurse practitioners are lazy. He was probably right. They still have that do as little as possible nurse mentality. Then the ones that actually worked hard were so slow bc they tried to be holistic. There are good ones though also, just according to many docs, not that many.

Gotta work hard baby and relinquish that nursing schema

Jules A, MSN · Oct 24, 2015

One of my old bosses said that most nurse practitioners are lazy. He was probably right. They still have that do as little as possible nurse mentality. Then the ones that actually worked hard were so slow bc they tried to be holistic. There are good ones though also, just according to many docs, not that many.
Gotta work hard baby and relinquish that nursing schema

Thats sad and as quick as I am to criticize NPs thankfully I can't say most are lazy, they do want the cushy "I'm a Mommy" or "I paid my dues working weekends" jobs but I don't think that is because they are lazy just not professionally motivated.

I have known a couple of total Rock Stars, but literally only two. Most I have known were slow as hell and again like you said because they were insinuating themselves in areas that was not their job, the whole holistic thing again.

sauce · Oct 24, 2015

We haven't paid all our dues till we die.

right?

:)

MallysMama · Oct 25, 2015

I have known a couple of total Rock Stars, but literally only two. Most I have known were slow as hell and again like you said because they were insinuating themselves in areas that was not their job, the whole holistic thing again.

In your opinion- what makes a "rock star" NP? Is it something that can be learned, or do you feel it's more natural talent?

Jules A, MSN · Oct 25, 2015

In your opinion- what makes a "rock star" NP? Is it something that can be learned, or do you feel it's more natural talent?

I think there needs to be a bit of a natural talent but that the fine tuning is learned. Without the natural talent, good gut instincts I'm not sure you can identify the subtleties that you might be missing.

Its fairly subjective but the ones I personally think are Rock Stars are bad the asses. They are in with physicians, look professional and demand a high wage. They aren't a bleeding heart with a disheveled wardrobe of prairie skirts with knee socks and Birkenstocks doing the stuff the doctors don't feel like doing. They are well known and respected in their specialty, don't order unnecessary tests, prescribe medications because a patient demands them or worship patient satisfaction scores as a true indication of their ability.

MallysMama · Oct 25, 2015

They aren't a bleeding heart with a disheveled wardrobe of prairie skirts with knee socks and Birkenstocks doing the stuff the doctors don't feel like doing. They are well known and respected in their specialty....

Thanks for sharing what you feel makes a rockstar NP! That's quite the image you paint. I just wanted to clarify....do you feel someone with a "bleeding heart" isn't capable of being well know and respected (a "rockstar")?

While I haven't become an NP yet- so I can't say for sure if I will sink or swim- I have always been an empathetic, kind person (one you would consider a "bleeding heart"- though better dressed). However, I'd like to think I can still be an excellent NP- one who earns what I'm worth, and is respected and well known. I feel like maybe you equate soft with being incompetent. But can't it be possible to be that way and still be a "rockstar"?

On a side note- I think The Bleeding Hearts would be an excellent 80's rock band name!