First Job, Unsure of Role

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My first NP job ever, and they are opening a new clinic, which is where I'll work, though I'm training at one of their current clinics. When I was interviewing, I was told that they would have 1 new doc, in addition to 2 current docs, plus me. First NP in an organization of about 60 docs, spread across multiple clinics (Physician owned group). They did also ask if I was interested in patient education, which I said I love educating my patients, esp new dx, like DM.

Fast forward to my first week, and I've trained all week on the EHR, which is a good thing. However, an MA showed me the plan for the clinic (new building), and now apparently they have hired 2 (not 1) new docs. There are 4 doc offices, each doc with their patient rooms nearby. I have no office, no patient rooms...there's one triage room, far away from all the doc offices, where I'll see patients. It's next to the storage area. Additionally, they were not going to give me a lab jacket until I asked. The HR lady was surprised that I might wear one. The docs each get $1000 q3 yrs to decorate their areas. I don't know how I would ever meet my RVU goal for bonuses having one patient roomed at a time.

What I have going for me, is that they did not give me a contract. I feel like I am being lumped in with the front office/supportive staff. My onboarding packet looks like what every one of them is given. I only need to give 2 weeks notice, and My EHR trainer told me that she knows they will utilize heavily, but she knows the docs are unsure of exactly how to use me. I honestly feel like it will be humiliating to show up, feeling like I'm a provider, yet only have 1 room in the corner, in the opposite area from the other providers, doing God knows what. I don't know what to do...wait and see what's in store when we move to the new clinic 2nd week of August, or talk to them now? don't have a job-description, but I don't want to be treated as an RN. What to do?

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Specializes in Nephrology, Cardiology, ER, ICU.

It doesn't sound like an ideal situation. Is this a primary care group? I would be asking lots of questions

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Specializes in Family Nurse Practitioner.

I would get on this immediately. It is possible the MA is incorrect but regardless if you have these questions clarification of your role is necessary. I try not to talk with anyone but the physician who is my medical director when it comes to salary and duties. I would find out who is the physician in charge of either the group or your particular location. Ask which of the offices and rooms will be yours and if they tell you its the broom closet that opens the dialogue. I'm not about whining for an office with a view but would insist on enough rooms to see patients.

Something to watch out for and really, all NPs need consider this is how we answer the "patient education" question. When NPs gush about how much we love to educate patients that tends to materialize as patient teaching of everyone's patients with minimal if any billing involved. I like that you framed it as you love educating your patients but in the event they are a little slow on the uptake I'd be sure to phrase it as the patients on my service or whatever term your specialty uses so they don't picture you pulling out the orange and showing patients how to inject insulin because that is not the job of an APRN.

I'm assuming they are paying you a healthy wage and it is in their best financial interest to utilize you to your fullest scope, which will vary based on your state's regulations. Lay out your expectations of the role, how many patients you are capable of seeing in a day and the number of rooms that will require. I would ask if all providers have a dedicated MA and also mention the nice perk of $1,000 to furnish your office. I always approach it as if I'm an equal to the physicians with regard to privileges and that has worked well. This will be a learning experience for all and can be a wonderful experience for you but will require firm boundaries to avoid being used like a nurse either inadvertently or purposely.

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Thanks for the responses. I will definitely talk to them, though I'm somewhat worried about them realizing that their potential plans for me to work as a glorified RN, does not match my plans. I don't have a job lined up in case they pull the... "We'll, I'm sorry this didn't work out," speech (if anyone is to give this speech, I want it to be me). I'm wondering whether I should just start looking for something else. Talking to them won't generate an extra provider office, or patient rooms. Seems like at some point they decided to hire another doc, who is now taking the rooms I was to use.

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Specializes in Family Nurse Practitioner.

I'm always looking for something else but definitely don't bail on this without finding out what their plans are. This is a decent size organization so if they need to shift gears with regard to location it is possible and definitely not a bridge you want to burn. Remember speculating based on rumors isn't reliable. You don't know if they want you to work as a glorified RN and if that is their intent you can educate them on the value in using you to your abilities or if they aren't receptive you can part ways.

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It doesn't sound like an ideal situation. Is this a primary care group? I would be asking lots of questions

Yes, it is primary care

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This would make me nervous, because it could go either way. You could be the NP pioneer in the organization that opens their eyes, or it could go splat.

Not having an office really concerns me. Where you you supposed to do your work, make your calls, etc?

You didn't mention what the RVU expectation is. Surely they know that RVU units are not given out for RN level work.

All of this would be difficult, even if you were experienced.

I am curious as to why, in a large organization, suddenly they are hiring an NP?

All that being said, each one of us had to start somewhere. If I had to guess, the job market is tight in your area.

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How tight the market is depends on whom you talk to. I got 2 job offers pretty early into my search, and I settled on this one.

Update:

I went in today, and they show me an office from a doc that's retiring (it has 3 patient rooms), and tell me to use it till the move. Lo and behold they want me to room my own patients "for now," because they can't hire me an MA without knowing how many patients I'll be seeing. Plus when they move to the new location, it will be PCMH model, so providers won't have their own personal MA's, and they may not need the EXTRA MA..

I made it clear that I had a problem with the set-up, and they need to figure out a solution that does not involve me rooming anything (plus giving my own shots). Both the office and nurse manager, don't think this is appropriate either... definitely blurrs the lines. So we are scheduled to talk to the COO tomorrow. I did also mention to them that I don't want to be stuck in a broom closet at the new location, and I need to know what the set up will be. They said they are working to figure it all out "because one physician unexpectedly accepted our offer, after not hearing from her for a long time, which is what messed up our plans with the rooms, and everything." I'm not sure what this has to do with me, as they could have easily told her "sorry, but the position is no longer available."

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I considered a position with a physician who had never worked with a NP, but I ended up choosing an established group with MDs and NPs in part to avoid a situation as you describe. I'm sorry to hear you're going through such a hard time, and know that the way you're getting (or not getting) treated would make any NP feel uncomfortable.

The only advice I have is to remember that if you do keep this job, you need to find a way to earn respect as the NP you prepared so hard to become. Get your space, your coat, fair access to necessary information, and anything else you need to be a success. You need to do this for you, and importantly, for our profession. Those MDs, MAs, and everyone in that clinic will be watching you, and their view of the NP role will be shaped by how you handle this. All the best to you.

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Personally, I wouldn't work for an organization that has never worked with an NP. Too much of a risk not being able to practice to the fullest extent of our scope, and such a headache trying to educate others that the buck doesn't stop at being able to do RN duties.

However, if one is considering interviewing for an organization that has never hired on an NP, I advise interviewing back and asking questions regarding their understanding of the NP in the given specialty you're working in. In what ways do they see the NP contributing to providing patient care? How will the NP be supported (ancillary staff)? Asking these types of questions may help weed out those companies that aren't right for us.

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How tight the market is depends on whom you talk to. I got 2 job offers pretty early into my search, and I settled on this one.

Update:

I went in today, and they show me an office from a doc that's retiring (it has 3 patient rooms), and tell me to use it till the move. Lo and behold they want me to room my own patients "for now," because they can't hire me an MA without knowing how many patients I'll be seeing. Plus when they move to the new location, it will be PCMH model, so providers won't have their own personal MA's, and they may not need the EXTRA MA..

I made it clear that I had a problem with the set-up, and they need to figure out a solution that does not involve me rooming anything (plus giving my own shots). Both the office and nurse manager, don't think this is appropriate either... definitely blurrs the lines. So we are scheduled to talk to the COO tomorrow. I did also mention to them that I don't want to be stuck in a broom closet at the new location, and I need to know what the set up will be. They said they are working to figure it all out "because one physician unexpectedly accepted our offer, after not hearing from her for a long time, which is what messed up our plans with the rooms, and everything." I'm not sure what this has to do with me, as they could have easily told her "sorry, but the position is no longer available."

I think you did some right steps here in exploring further and setting expectations. Stick to it. But also be constructive. If a dedicated MA isn't available, share one with another md (the new hire for instance) until they decide how many they need. Not all offices operate on a 1:1 ma provider ratio. Ours tries to, but often we get one pulled to our sister clinics. Work still gets done by the ma's, but just a reality of staffing.

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I think you did some right steps here in exploring further and setting expectations. Stick to it. But also be constructive. If a dedicated MA isn't available, share one with another md (the new hire for instance) until they decide how many they need. Not all offices operate on a 1:1 ma provider ratio. Ours tries to, but often we get one pulled to our sister clinics. Work still gets done by the ma's, but just a reality of staffing.

I agree. I suggested to them yesterday, that since the plan is for me to start off with 30 minute appointments, and the doc whose pod is close to mine doesn't see too, too many patients, and he has an LVN as well as an MA, that maybe they could room my patients. Each doc has 2 people to help, so I figure between all of the MAs and nurses, they should be able to work something out for my slow schedule. I also have the option to state how many patients I want to see in the morning, as well as in the afternoon.

I don't think that the clinic is bad, they are just naive to the use of an NP, I think. Many docs have been there for 20, to over 40 yrs...nurses who've been there as long as since the 70's. My collaborating doc...one of her MAs has been with her there for 19 years. The CEO started there in the 80's as front office staff, so did the COO. People probably wouldn't stay there that long if there wasn't something good about the organization, which is why I picked this job. I just need to figure out how to get them to understand how to utilize me to my maximum potential. Otherwise, I don't see this working for me.

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