Family Practice or SNF

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Hello,

I am a new grad FNP having trouble deciding between a family practice or an SNF.

Context:

I currently live in a state that is practically an anti-new grad state. After searching within my home state for some time, I decided to apply out of state and got a bite with a family practice. No guarantee offer with the family practice yet; they want me to get their state's NP license first.

While waiting for the other state's NP license to be approved, I received an email in regards to an NP position at an SNF within my home state.

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Now, I am leading towards the family practice clinic. I want to work with adults and children and be in a marketable position after 1-2 years for walk-in clinics.

However, there is not much information on the family practice clinic. No glassdoor reviews. No indeed reviews. (Though I am aware that anyone can claim to have work for someone and then write a good or bad review online, they tend to help me weed out bad employers.)

Their yelp reviews are average patient clinics (i.e along the lines of "They did not answer my phone calls~" or "They did not give me antibiotics when I had a cold.") The practice currently has a couple of clinics with plans to expand.

Honestly, I think it would be a great opportunity to see how clinics are built from the ground up and be one of the first ones but it would be a huge financial risk. The other state is one of the top three most expensive states to live in. (Sorry for the vagueness; this dilemma is currently happening and I do not know who may stumble upon this thread.)

Below is a list of the pros and cons specific to each position.

Family Practice - PROs

-Adults and children patients (or, at least the chance to see children)

-The chance for office procedures (if this is also the case for SNFs, please let me know).

Family Practice - CONs

-The front desk decides who you see; they may add walk-ins without consulting you

-Patients are expected to return. If they are not returning, then you must be doing something wrong, and the fact that they prefer to be seen by the doctor has nothing to do with it~

-Expected patient load. This practice expects providers to eventually see 4 patients per hour.

SNF - PROs

-The patients are set. It is a matter of meeting a quota per week and hours are flexible; likely 15 pts. per day

-See the same patients with occasional new ones

SNFs - CONs

-If it is like bedside nursing. Assessing, diagnosing, prescribing OK, but, being the RN as well? No. Just no. I hate bedside nursing, not so much the patients but their relatives who think that the nurse is also their nurse ?

I don't know how well-staffed the SNF is but it will be a deal-breaker if they want me to work as an RN as well.

-Unlikely to perform office procedures (maybe wound care?)

Now, as a new grad, I realize I am in a "beggar cannot be chooser" position, but, if given the choice, I want to choose the position where I am likely to succeed, stay at least 1-2 years, and then be in a position to move on up.

So, if I am in the position of having to choose:

Should I risk going with the family practice with not much information on it?

Or, should I go with the SNF which may prevent me from being considered for positions where providers need to see children? I have some ideas to remedy this (i.e. doing volunteer work), but, what is your take?

Extra info:

Family practice's orientation 2 months

SNF practice's orientation 3 months

Doing both will not be possible at this time.

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Specializes in Home Health, Primary Care.

I say follow your heart. Go with what you want to do, not with what you're forced to do. You don't want to do SNF because you want to be able to ensure your marketability in the future. Hell, since you're getting licensed in the next state, look around for other FNP positions in the state if this one doesn't come through.

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If you aren't locked in to the SNF position (on the hook for bonuses or student loan repayments), it probably won't hurt to go there in the interim. Out of state licenses can take time and there's no guarantee that job will still be there when you actually get that license approval. Just ensure the SNF contract (if there is one) is clear about expectations for the job and ensure there isn't anything binding you to the facility for any specified period.

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Specializes in OB.

Wait why do you think the SNF would ask you to also work in the RN role doing bedside care? I've never heard of such a thing but maybe I'm missing what you're saying. I've met several NPs who worked in nursing homes/SNFs and really liked it for the flexibility.

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On 2/1/2020 at 1:00 PM, LibraSunCNM said:

Wait why do you think the SNF would ask you to also work in the RN role doing bedside care? I've never heard of such a thing but maybe I'm missing what you're saying. I've met several NPs who worked in nursing homes/SNFs and really liked it for the flexibility.

Not too long ago, another facility attempted to get me to work as an APRN (as needed) and as an RN as needed, but more so as an RN "because the other NP did it," but they would have paid RN salary when I did RN work ?

It was not an SNF, but, still...if one facility had the idea to do something like that, could another try the same?

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Specializes in OB.
2 hours ago, DTWriter said:

Not too long ago, another facility attempted to get me to work as an APRN (as needed) and as an RN as needed, but more so as an RN "because the other NP did it," but they would have paid RN salary when I did RN work ?

It was not an SNF, but, still...if one facility had the idea to do something like that, could another try the same?

Wow, that's crazy. I guess anything's possible, I've just never heard of that scenario before. Hard pass!

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I did Family Practice for a year and Minute Clinic for a year and have been doing SNF for over 8 years now. I love working in a SNF and would not ever go back to clinic work. The major factor for me is flexibility, I'm a mom with 2 little kids and the flexibility is invaluable. Plus I like being able to see pt's on my own timeline and not being tied to a clinic schedule. I've never been asked to act in an RN role in the SNF.

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Specializes in NP, ICU, ED, Pre-op.

I work at a SNF and love it as well. The patients really appreciate the care and attention you give them. Lots of flexibility, and in no way am I working like a bedside nurse.

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Specializes in ICU, LTACH, Internal Medicine.

One SNF I was once tried to be pushed into claimed that they have "policy" that every provider note must have VSs and blood glucose documented and taken right at that time. That was all right but they did not have staff to do that, so I must do it myself and document under my name and also in "nursing" section so that they looked like done. If I wanted to access ambulation/feeding, these were done by CNAs and they "couldn't" report to provider by another "policy" so I must ambulate or feed the patient. Also, I "might want" to come in, access the drug cart (with narcs in there), give the patient, for example, HTN AM pills and then come back in 2 to 3 h and get vitals if I wanted to monitor their action. I also was made responsible for all labs I ordered incl blood draws, urine collection, etc. All that was, of course, under thick gravy of "there are still RN letters after your name", "we just expect you to help a little", "this is not about you, it is about patients" and so forth.

The DON and admins were unpleasantly surprised first by the directions I magnanimously advised them to go to with the true God's speed and then by a swarm of State surveyors coming there without as much as phone call beforehead every week for a couple of months.

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I'm not clear if the SNF has stated their expectations that you will work as an RN as well or of you are concerned about this. As the other posters have stated, make sure the expectations are clear. You can also advise that it will be impossible for you to bill for 15 patients a day if you are working two jobs (and their bottom line will be negatively impacted). If they expect you to work as an RN, they are not a great employer and do not understand the NP role and I would run from that job as fast as possible (and be thankful that they were open and honest in the interviews as so many employers are not).

Also, SNFs can be a good way to get both acute and primary care experience. Depending on the capability of your SNF you can be managing sepsis, acute respiratory failure, etc in house in a way that may not happen in private practice.

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Both of those job sound bunk. I currently have the potential to see up to 4 patients an hour but that changes based on patient issue (i get more time for chest pain, abdominal pain, new anxiety etc.......). It's busy when scheduled appropriately.....and when it's not scheduled fairly???? it's not manageable. I would ask to shadow.

I have never heard of a NP in a SNF doing patient care....and honestly they usually see 6-8 pts a day in my area.

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