First NP job-toxic work environment vs. newbie blues

Specialties NP

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Hi. I have been combing the net trying to find advice about this topic. I am in my forties and have worked alot of years in many roles. I just started my first NP job at a federally qualified health center a few months ago. I knew the population would be difficult and that the workload would be heavy because a friend worked there. I was told that after a three months I should have the client load to support working four days per week instead of five. I was told that my collaborating physician would be available to me. I was led to believe that the management was supportive of new grads, especially in light of the fact that they lost four providers in 6 months.

So what has really happened is I was given a period of three weeks in which to build my caseload from one patient per hour to three. I currently see from 15-20 patients per day on average, but have had 24 scheduled often, in month four. I have been given no administrative time. I was told that my numbers were good, but not good enough to warrant a four day work week, and that the issue would be evaluated again in 6 weeks. And even if the numbers support it, they further stated that if provider shortage is an issue, then it may not happen. They would not give me my numbers, nor would tell me what they were looking for. I was given a contract three months after I started, which I had to ask for repeatedly, which I have not signed. They wanted me to sign a copy back dated to my start date and there were things in the contract that we never discussed when I accepted the position. Finally, they are switching the MA that I have been working with to place me with an MA they feel needs improvement. There was no email, no meeting, nothing. They want me to report to them the MA's weaknesses. And my collaborator is not a primary care physician, and has not co-signed for medical equipment she does not want to be responsible for, such as at home suction for a trach patient.

I wrestle with myself about this. I do work hard. I love to help people. I am overwhelmed by the complexity of the patients, combined with the lack of support from the management/collaborator. I feel I have no work life balance. I spend at least 10 hours per week outside of the "40 hours" charting. I work through my lunch periods every day trying to catch up on labs, med requests, emails...etc. Is this just me adjusting to this new role, or is this a toxic place...or maybe both? Advice anyone? I would greatly appreciate it.

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newbie blues....I have struggled with those....the good thing with those federally funded places is that they can schedule 30 and usually a good chunk of those are no shows which thins out the day a bit.

You have a friend who works there so that seems like your best option to talk things out with and vent.

I did a good chunk of clinicals in a federally funded clinic and was reminded not to cure all their problems, but to focus on why they are there for the visit. You do not have time to solve everything in a 15 minute visit. We would reschedule and cover something else. If you did not you fall behind.....

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Specializes in Family Medicine, Tele/Cardiac, Camp.

Your job sounds uncannily like the place I just left. Right down to the insanely high turnover.

After working in a similar practice for about 9 months, my biggest takeaway was that I went into it without asking the right questions and meeting the right people. Of course, that being said, there were also a lot of surprises that I couldn't have anticipated. A lot of the challenges I faced were similar to yours - overbooking, no admin time, unavailable physician collaborators despite being told they would always be available, not knowing my numbers or what was expected of me, problematic MA's, and always overtime. While I was contracted for 40 hours a week, it wasn't unusual for me to do 50 or even 60 hours a week with the time that I ended up putting in after work and on the weekends.

Working at FQHC's has it's pros and cons as I'm sure you're aware. I LOVED my patients. I loved them so hardcore and still think about them. I loved the difference I was making in their lives and even though the hours were grueling, I found my job to be very rewarding. Up to a point. I learned a ton and, in some respect, enjoyed the complexity. But you DO have to focus on only 1 or 2 issues per visit and that can be very difficult as people are often lost to follow up for months or years at a time.

As time passed I did become faster and more efficient when it came to seeing patients, labs, returning phone calls, paperwork, meds etc. But as that happened, I also became more and more miserable in my personal life as my work-life balance really suffered.

Of course your situation is your own, so I can't advise you one way or the other. It could be newbie blues, or it could be a toxic environment. Only you can decide if your environment is something you need to warm to or something that is just increasingly making you miserable. Have you tried speaking with your collaborating MD? What does your friend have to say about your experiences?

Whatever you decide, I wish you the best.

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Specializes in allergy and asthma, urgent care.

I worked in a FQHC for 3 years, and experienced many of the same things you mentioned. I had to stay for the 3 years because I had loan repayment from the National Health Service Corps. Providers only stayed for the term of their loan repayment, and then moved on. Unfortunately, I think this is the rule, rather than the exception with these health centers.

I was completely burned out by the time I left. My health suffered. I was completely turned off from Primary Care. I also learned more than I would have in another environment, and saw diseases and conditions that you would not see in a typical suburban population. Financially, it was invaluable to me, but I'm not sure I would have stayed as long as I did had i not had the loan repayment obligation.

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TikToc411-Thank you for your reply. I will say that I have learned to keep the problems limited. My primary concerns were the other issues. My friend left that practice. She had dropped off the face of the earth the entire time she worked here, and became burnt to a crisp. But, she did encourage me to work there to gain the experience the place offers, and be "experienced" in order to move on. I am just trying to discern whether or not to wait it out for a year, or run like hell.

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SnowShoeRN, MSN, NP I have learned so much since beginning practice in this environment. And I love my patients. But, I know that my health has suffered since beginning this job. My personal/academic life have suffered as well. I have charting that I should be doing as I write this, so 50-60 hours per week is on par here as well. This adds to the stress level. I can talk with my collaborating MD, but am not very hopeful about the response since she is not a primary care physician and in the past has not co-signed for DME like suction machines, because she did not want the responsibility. (SMH) Thank you for your support and advice!
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BCgradnurse, MSN, RN, NP My intention was to apply for loan reimbursement. The work is immense and the stress is great for the additional funds, which would be surely be beneficial. But the question is, is my health and personal life worth the cost? I have been reluctant to apply because I do not want to be tied to this place. My friend stayed for three years, but she was completely turned off for primary care. She recommended I work there for the experience, but did not recommend that I stay for longer than one year. I can totally see why now. My health has begun to suffer. My personal life is non-exisent and I put my academic career on hold temporarily. I am going to write the pros and cons, make daily check marks, and evaluate. Thank you for your input!
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Specializes in Family Medicine, Tele/Cardiac, Camp.

Loan repayment is a good reason to stay a FQHC, but keep in mind that just because you apply doesn't mean you'll get it. I was told when I interviewed that everyone who applies, has gotten it. Well, after doing a little more research I found out that wasn't true and I became one of the many who didn't end up getting it, even though my debt to income ratio was quite high. Best of luck in what you decide.

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