F.R.U.S.T.R.A.T.E.D. with "NUMBERS" and Bubbas! (VENT)

[DaisyRN, ACNP]

well, hello long lost allnurses.com friends. at my last post, i was very frustrated with my current job situation. i was working with a doctor that refused to do her documentation and was a huge liability for all of us. well, since that time, if you remember, i was moved to the larger office to work under the physician that is basically our medical director. also, there have been two other mid-levels come and go. in their "going," i was pulled from the hospital doing rounds and running the stress lab to being office only. blah. i have been in the office setting for about a year and a half now. i am trained as an acnp, but received training in my program in the outpt setting, so scope is not an issue.

the issue is that while i was in the hospital setting for the cardios, per their request, because they did not like supervising stresses as it kept them from ringing in the big bucks on catheterizations they could be doing at that time, i was accumulating overhead expense. i am employed by a private practice/corporation and our docs have privileges at the hospital. well, in stress tests, there are two main billable charges... one that is pennies and one that is substantial. care to guess who receives the "substantial" return? yes. the hospital. so, i was losing out on good billable charges because i was in the hospital where they wanted me to be (and quite frankly where i preferred to be to). well, lo and behold... all the "production bonuses" that i was suppose to be earning were never coming in. i looked at my monthly numbers and see that i am in the negative. every month. my overhead expense alone is somewhere in the $20-30k range.

well, when they "asked" me to move back to the clinic full time, i examined my numbers and realized that i had a $50k debt to the corporation. it is not something that i have to pay out of my pocket. i still get paid, but i have zero opportunity at production because i am so far in the hole. i asked the ceo (who micromanages all money issues) about some how washing this out because it was not technically "my fault" i was crapped out on reimbursement. i was doing what the doctors wanted me to do and they continually held me to a higher level of overhead. he said, "sure... i'm sure that it will all get washed out." i asked for a raise. i got it, not exactly what i wanted, but still, a raise... more "guaranteed" money every month since i know production is out.

i have never received a production bonus in 3 years. the other np that works with our partner office does exceedingly well financially. each month, i am able to look at mine and her charges/reimbursement and it is nearly the same. she just doesnt have a $50k deficit she is solely responsible for.

so, this came up with my supervising doc and another doc in the office. they were mad for me, said it wasnt my fault and were going to talk about it in the meeting. meeting came, and nada. the cards i work for are very old fashioned, don't think they need an np kinda mindset, although 1-2 of them do. and the others, still have me do their stresses and take patient calls when they are out of the office. so... whatever. it just gives me some idea of their lack of respect for me as a "colleague."

i am important enough to do the jobs they don't want to do, but i'm not worthy of their help in my financial situation.

so, here i am... this is my first np job... and i have been through it. first with the unreliable, crazy woman cardiologist and now with a bunch of bubbas that don't want to help me out. i am frustrated! i get tired of managing bps all the time and adjusting chf meds all the time. this is not what i went to school for.

so, my thoughts... there are only two hospitals here. one is in the midst of a "feud" with my group of cardiologists and tend to group me in that "troublemaker" category because of the docs im with. and then the other hospital is small and not hiring. i really do not want to have to drive... it would be 40-50 minutes for the next town (and i have driven that for the last 10 years!) we have just recently moved closer to town now and it is nice to drive 15-20 minutes instead. :)

i have thought about exploring rn specialties that i never got to try, i.e. sicu. i have thought about going back to school for my fnp so i could work in the er (my background). i have thought about giving up all together and being a personal trainer/cake decorator. ha. i don't even know what i want to do anymore! a part of me doesn't even want to be an np anymore. i don't want to deal with all the hooplah of the "numbers game." this job has just put a horrible taste in my mouth. i don't even enjoy going to work anymore. i love the people, for the most part. and even my supervising doc is great... but there's only so much he can do. it's all up to that blasted ceo.

i applied today, for a hospital based np position at the smaller of the two facilities, but i'm worried about that because i would be the first one. i was the first np to my current job and it's been the pits! i'm also somewhat worried because i have gotten away from a lot of "generalist" subjects and been focused solely on cardiology for the last 3-4 years.

advice? tips? suggestions? comments?

sorry for the vent... i just don't have many to talk to. and i am tired tired tired of talking about this at work. it is not getting me anywhere!

oh... and btw. my hope was to supervise a chest pain unit with these guys and i talked to them about it 2 years ago. thought it was a good idea. nothing. now, they have talked about it again, but could it just be a carrot dangling in my face? quite frankly, i am tired of dealing with these people and their empty promises and just don't know where to go from here...

[traumaRUs, MSN, APRN]

I'm so sorry that it hasn't got any better. Don't have any advice for you except to say that if you aren't happy, you should try to move on.

Do the ERs in your area hire NPs? If so and you think you stand a good chance, I would go the FNP route or the PNP route - to get the peds cert and then go for it.

[DaisyRN, ACNP]

well, the er hires pas, currently. i've known the er guys for a long time... i worked with them for 6 years and still have regular dealings with them. i talked to the director a while back and he said he'd consider hiring me, but he is fully staffed at the moment. they just got through hiring a bunch of newbies not long before i talked to him. honestly, i think it would be a turn off if i were unable to see the whole scope of patients. it is a very busy er, so i think there is enough work even if i didn't have prego women or kids in my allotted patient population, but i wouldn't want that to be an issue. the post master's fnp would only take 2-3 semesters. that may be what i end up doing.

in all honesty, i do miss the er... i miss the shift work. my hubs is a police officer that is moving to night shift, so shift work has its advantages. plus, i miss the "treat em and street em" philosophy... chronic bs is not my bag. lol. i even thought about just going back to being a regular ole er nurse, but that would be incredibly humbling. i'm very good friends with the clinical director and she offered me a admin role with her, but i don't think i would enjoy that so much either.

[traumaRUs, MSN, APRN]

I too miss the ER terribly. I did a peds CNS recently just so that if the opportunity arises, I can do prn in the ER. However, our practice is short a full time NP so that's not gonna happen anytime soon - lol!

Sounds like the FNP is the way to go.

Good luck Daisy.