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Discussion

First NP Job

Hoping for some advice from experienced NPs....

I graduated in the spring of this year, passed my boards a month later. Interviewed at two different places, one rural family practice clinic and another semi-rural oncology clinic which would require us to move across the country. My background is nursing was 8 years as an oncology RN.

I accepted the job in oncology because this is the field I love and know best.

I started about a month and a half ago. This is a brand new clinic that just opened- a satellite branch off of a main clinic in a large urban city that is about 90 miles away.

I trained up at the large clinic for about 4 weeks strictly shadowing their MDs... this was my "orientation"

Now I'm "training" at the clinic where I will be working. The MD just finished her fellowship in June. I am not credentialed yet with all of the insurance companies so they are not allowing me to see my own patients. We are seeing around 1-3 patients per day. I just shadow the MD in the rooms. She does not let me do anything more. I have asked and she has only let me see one patient before she went in to double check my work.

The only thing she continually asks me is when I will be able to take call so she can get a break.

She is very difficult to communicate with and I feel that she is treating me like a resident and she is the attending. She bosses me around and just has me make phone calls that she doesn't feel like making. When I ask her questions she gets frustrated and her usual response is "didn't you learn this in school" I was in a FNP program....we did not learn the ins and outs of oncology practice. I know a lot from my experience as a nurse, but there is still a lot for me to learn.... For example, she wanted me to call a pathologist and add on markers for a new diagnosis lung cancer. I asked her what markers and her response was "look it up" So--- the mentorship is severely lacking.

It is very frustrating to not have a good mentor. I don't feel like I am learning anything and there are no other providers in this practice. It is me, the MD and an LPN. That's it. Since this is a brand new clinic, I don't anticipate that we will be getting busy for quite some time. Credentialing office says it may be up the 6 months before I can see patients on my own.

So, my question is, what do I do? A large part of me wants to quit and find a new job that is more appropriate for a new grad. I think this place jumped the gun on hiring a oncologist and an APP. There will not be enough patients for two providers for, at the very least, a year. I am getting no mentoring. I am learning only from reading NCCN and UptoDate incessantly because her response is always telling me to "look up the guidelines" It will be quite sometime before I can even see patients on my own and even then, I will be seeing 1-2 a day if that. Do I stick it out? A side note is that my spouse is not loving this area at all--- we moved across country for this job. He is not very happy here, and I can't say that I am either. We thought the move would be worth it if I had a great job. But, it's not panning out that way.

I should add in that I got a sign on bonus and the company paid for all my licenses (DEA and two states for RN and NP ) so I feel added guilt. They have invested a lot in me...

Please help. I would love some feedback. Am I just being a baby?

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    Not an NP, but I'd quit in a heart beat. Know your worth. I did the same for "dream" jobs in the past, only to find out the people/culture were horrible, despite the big brand name.

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    As a brand new NP you need experience, guidance and supporting mentors. From your post this doesn't seem to be the case right? Also you mention that your spouse is unhappy with this move and you are not happy either because of the work situation. Is this job more important than both your happiness?

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    I find it odd that you are not qualified in her eyes to see pts, but you are fine to take call.

    It is going to be a long time before there is enough volume for 2 providers. Possibly a very long time.

    I wouldn't quit without having another job lined up though.

    It's really too bad you moved across the country for this.

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    Couple thoughts from the physician perspective.

    Im sure your attending physician did not realize that she would be starting at a practice and responsible for teaching a new grad NP how to be an oncology practitioner. She doesn’t know what to you know and what you don’t know. Reading what you wrote - I see a big conflict. You admit that you don’t know how to do this job yet, but seem frustrated you won’t quickly be given more responsibility. Her responses to you to look things up - well I heard that about a million times in med school and residency. We don’t take it as an insult, but as part of the learning process. It’s termed “active learning” as opposed to passive learning wherein you are spoon fed info.

    This sounds like a really challenging and frustrating situation for you. It would be helpful if there was more structure to your training process, and more discussion regarding medical decision making etc.

    So, what can you do about it? Maybe proposing a makeshift training program would help show your initiative and commitment to learning. I would buy an oncology textbook and ask your attending to help you break it up into sections that you can read and make outlines from. Then put those outlines into a binder with dividers so you can reference it when needed.

    Remember it took your attending many years to learn to do this job. Show your commitment to learning and explain to her that you need her to mentor you — she may not realize this was your expectation. If that doesn’t go over well, perhaps start looking for something that you feel more ready for.

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    • Author

    Thank you, @TuxnadoDOI appreciate the perspective of a physician. I have a few comments on this. She did know that I would be a new grad working with her. We both signed on for this job in April-May. She and I spoke on the phone around this time and I told her I was be a new grad. I think the appealing part for her was this is a rural clinic and I have 8 years of rural oncology experience (rural onc is a different beast compared with a big teaching hospital).

    I’m not claiming I know everything about oncology, but I have a very good background in oncology as a nurse. But, I don’t think seeing a patient on my own is asking for a lot of responsibility. I’ve got oodles of notebooks and oncology and hematology textbooks. I’m not afraid to look things up. But I’m also not afraid to ask questions.

    I will try and make the work and research I do more apparent. Perhaps that will make things a little better.

    Thank you for the feedback

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    I think her attitude, the way you’ve described it, is disappointing considering she knew you would be a new grad. We really just don’t know what you guys learn in your NP programs, but she should have been more prepared for mentoring. For us, seeing patients on your own is something you only do after years of supervised training, so that’s why we consider it a heavy responsibility. To us it is the ultimate level of responsibility. I wish you the best of luck and hope things improve!

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    • Experts

    Since neither you nor the physician is super busy, maybe meeting with her and simply explaining your concerns:

    1. You are a new NP and though you have lots of nursing oncology experience, being the provider is certainly a different and more responsible role.

    2. Propose an orientation for yourself. I like TuxnadoDO's idea of obtaining a textbook on oncology (even if its one you already own) and dividing it up into manageable topics and then the two of you go over it after you've read it.

    3. Further explain that you want to provide the best care for all your patients and to do this, its needs to be a team approach.

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    It sucks when you're not supported by those above you. It makes for unnecessary fatigue and disgust. You may have to look for another job, or be miserable. Hope you find some way to work it out.

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    On 9/19/2019 at 11:55 PM, dnpfnp said:

    Thank you, @TuxnadoDOI appreciate the perspective of a physician. I have a few comments on this. She did know that I would be a new grad working with her. We both signed on for this job in April-May. She and I spoke on the phone around this time and I told her I was be a new grad. I think the appealing part for her was this is a rural clinic and I have 8 years of rural oncology experience (rural onc is a different beast compared with a big teaching hospital).

    I’m not claiming I know everything about oncology, but I have a very good background in oncology as a nurse. But, I don’t think seeing a patient on my own is asking for a lot of responsibility. I’ve got oodles of notebooks and oncology and hematology textbooks. I’m not afraid to look things up. But I’m also not afraid to ask questions.

    I will try and make the work and research I do more apparent. Perhaps that will make things a little better.

    Thank you for the feedback

    I think you should hang in there and learn as much as possible before throwing in the towel. It’s a new practice and therefore slower that’s an opportunity to take your time and learn. Also I did all my clinicals with MD’s and one thing I learned was to look everything up before I asked a question. One MD stated that’s how they actively learn during residency etc so I should look at my clinicals as a mini residency. Moving from a oncology nurse to a oncology NP is a different role and the MD is probably unaware of the transition period. Maybe she is relying on some of your past experience. My advise is to have an honest and open conversation with her about your expectations and goals. As others have suggested develop a training system and see if she is open to it.
    Good luck

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    To me a new NP to a new small clinic is as a new nurse grad in a school nurse setting- you're pretty much on your own. A new NP and a new RN need to be where they can get experience. Experience comes from a larger, busier setting with many departments to learn from.

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    Regardless of your newness or any other circumstantial factors, it is unacceptable to ever be demeaned or treated unprofessionally.

    i d quit but I d surely not leave without having VERY strong words with the MD.

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