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First Job for New Grads

mistaFNP mistaFNP (New) New


I am a new grad FNP looking for my first job. Fellow NPs please tell me about your first NP job.

1. What type of clinic?

2. 3 Pros

3. 3 cons

4. Would you have done anything differently?

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

1. What type of clinic? Very large (18+ MD, 5 mid-level providers) nephrology practice

2. 3 Pros

a. flexibility

b. autonomy

c. pay

3. 3 cons

a. With very large practice, there can be a disconnect between providers

b. Long hours

c. I work totally on my own and miss the collegial environment working with other NPs/PAs

4. Would you have done anything differently?

My nursing background is ER and ICU and would have held out for a hospital position. However, after 8 years, I do sincerely enjoy my job.

Penguins10, MSN, RN, NP

Specializes in Primary care.

Private practice nephrology group that also does a fair amount of internal medicine.


1. The physicians and PAs that I work with are bright and love to teach.

2. Lots of exposure to complex patients.

3. Mix of inpatient and outpatient provides excellent learning opportunities and good mix of autonomy and feedback for a first job.


1. I don't bill, thus practice administration sees me as an expense item not an asset.

2. Can be challenging to see patients in a group practice e.g. have to catch up if haven't been at a particular site in a month, different ideas about appropriate controlled substance prescribing etc.

3. I don't really have a third.

Do differently?

Not really, this has been a great fit. Talk to other NP/PA folks that work there, people are usually pretty honest. I think a collegial environment where people like to teach and you can learn about whatever clinical niche you're interested in is key in your first job (e.g. if you want to do peds don't take an internal medicine job).


Specializes in Adult Internal Medicine. Has 10 years experience.

Clinic: Small independent practice in adult internal medicine (2 MD's, 2 NP's, 1 PA).


1. Challenging and interesting medically complex patient panel.

2. True collaborative practice environment where all the providers love the work we do, support one another, and engage one another multiple times a day regarding patients and advances in practice. We are not required to change our practice to meet administrative goals.

3. I am treated as a partner in the practice not an employee.

4. We cover our own patients in the hospital.


1. Challenging patient panel.

2. Administrative red tape.

3. Lack of large healthcare system type support (properly developed and integrated EMR, tech support, case managers, triage nurses, etc)

Differently: I think the only thing I would have done differently and advise others to do is make sure everything is in writing when you take the job (it avoid awkward conversations) and make sure you start slow and ramp up slowly.

JeanettePNP, MSN, RN, NP

Specializes in Pediatric Pulmonology and Allergy. Has 8 years experience.

My first job is in pediatric pulmonology.


1. an area where there's a lot of need (where I live has one of the highest rates of asthma in the country) and you can really see your work making a difference in kids' lives

2. Lots of autonomy, I work in my own office 2 days a week and it's basically up to me how I want to grow my practice.

3. Great doctor to work for, congenial work environment.


1. Limited skill set, I know a lot about asthma and sleep medicine but would like to expand.

2. First NP hired by the practice so a lot was trial and error, figuring out my role, salary, benefits etc.

3. Long hours, we work evenings to accommodate kids after school and it's hard as a working mother not to be home for supper/bedtime 3 nights a week.

What I would have done differently: Nope. It was my first job offer and I grabbed it. I have no regrets.

1. What type of clinic? Certified rural health clinic

2. 3 Pros

- Autonomy

-Pay = higher than in the city I live in

- I like getting to know my patients very well especially if its a small community.

3. 3 cons

- No place to live nearby that is affordable or decent: towns I will work are in oil boom areas they charge $425 dollars a week for a mobile trailer and more outrageous for apartments and homes that I would not consider living in at all. To actually have a home there you would have to buy a plot of land and build your own house- not an option right now.

- Commute: I will work in 3 different towns. different travel times are 45 minutes, 54 mins, and 1.25 hours one way if I move to the very southwest part of town. Currently I live in the NW side of my town and so travelling is much further right now

- Scarce resources = means that somethings are overpriced so if you go out to lunch food is usually more expensive than the city that I live in...exceptions of maybe fast food restaurants. Also, not a lot of specialist you can refer your patients to. Most patients are indigent and don't have means of transportation.

4. Would you have done anything differently? No. this is my first job as a FNP. I haven't even started yet but I don't think I would have done anything differently because at this point in my life I am looking for a job position that will give a strong foundation as a FNP and personal fulfillment. I think that working in the city will not give me those two things.

1. What type of clinic? Hospital - inpatient diabetes management

2. 3 Pros

1) limited scope of practice made my new job less terrifying

2) I did not have previous hospital experience, so I really benefitted from working in that environment

3) great schedule and work hours

3. 3 cons

1) low pay

2) this particular hospital does not hold NPs in high esteem

3) OJT was intense...computer systems, hospital culture, how to find info I needed, etc.

4. Would you have done anything differently? No, I think this was a good first job for me (still here 3 yrs later) but looking for other opportunities now. I don't like the thought of changing jobs, so perhaps have already stayed longer than I should!