Sooo, I'm having a dilemma. I started my first NP job about a month ago and for multiple reasons it is just NOT turning out to be what I envisioned, both in a work-life balance and even more importantly, a professional way. I was initially so excited about this job. I'm working at a world class institution (if nothing else comes of this career phase, at least the name will look good on a resume) and thought it would be awesome/advantageous to further my RN specialty by taking a first NP job working with a similar patient population. I also suspected that being in an academic environment with multiple resources and the support of a fellow midlevel/a few experienced attendings would be a solid way to start as an NP. I'd heard from a few former RN coworkers turned NPs that some settings who'd never used NPs before or just expected COMPLETE autonomy instantly were pretty terrible work environments that they had quickly left.
However, fast forward a month and there are some serious issues. First, and perhaps least important (LOL) is the fact that the other midlevel and I work 10-12 hour days 5 days a week. Truthfully, I would say 85-90% of the time it is 11-12 hours. Apparently for months before I came there was talk of constructively addressing this with increased staffing but it seems that nothing has changed. Our division used to have an experienced nurse working with us but stupidly enough she has been transferred elsewhere within this larger outpatient setting, leaving us again with a crazy amount of work. Because really, as I'll discuss more later, the reason for staying so late is NOT because we are doing mostly advanced practice level work, it is because the two us are doing EVERYTHING for this patient population between the two of use-refills, prior auths, disability paperwork, returning allllll patient phone calls, doing charting and notes that are apparently "supposed" to be done even though they mimic that of the MDs, seeing patients in clinic, tracking certain testing requirements/procedures for the patients, etc., etc., etc.
When I interviewed for this job, it was reiterated constantly throughout the entire process that although this specialty/division had previously utilized RNs/LPNs alongside the MDs, they had realized for multiple reasons that it would be advantageous to transition to having APNs/PAs in the mix. Even during one of my interviews with one of the attendings, we discussed midlevel autonomy quite frankly and I was again led to believe that at some point I would achieve a reasonable level of it.
Truthfully, now, my biggest gripe, even more so than my schedule (and my relatively pathetic salary given my area's insane cost of living/taxes...one of the highest in the country), is that the other midlevel and I are treated like glorified RNs. And really, this DOES NOT appear to be changing at alll. After every patient's appointment, one the the MDs has to see them before they leave, we discuss the patients with the MDs every day prior to our phone calls to them with updates/lab results and without fail the conversation pretty much becomes them telling us what to do, and although they have all been cordial to me, any "teaching" I get is pretty much from asking questions and pushing for a reason as to WHY they are choosing something. I'm not a whiner and certainly don't expect full freedom at this point, but it's abundantly apparent that we WILL be treated like non-provider staff indefinitely. I just feel like this is very sad because I have enough experience in the specialty that I'm far from clueless, despite of course still needing to learn a lot.
I guess my question is whether I should stick this out for a least a year just so my resume continues to look solid. Of course even if a "better" job presented itself in the meantime I would not quit this job until I had secured another offer. I suppose I'm just worried that I will lose provider skills, thinking ability, and just that whole mindset/persona if I continue in this job. It is just very silly to get shot down about putting a patient with insomnia on 25mg of trazodone qHS and instead being told to put them on Ambien - no rationale, just, "No, give her some Ambien" (stupid example, but just what came to mind). Of course I try to research things, continue to learn, etc., but at the risk of sounding whiny I'm so bogged down but all of the above clerical junk that I mentioned...as well as "confirming" everything.I.do with an MD that this is tough to do. So, basically, hope that all of the above magically changes and try to hang on, or look for something more advanced-practice oriented to give myself a good foundation?
I'm soooo sorry this is so long...apparently this is the result of holding your frustrations in at work.
Thanks Jules A. I'm a pretty intuitive person and I feel that you are probably right. Even though I'm kind of freaking out that I've basically uprooted my life only to realize that this position is not right AT ALL I appreciate the truth. On a only-half-joking note, if anyone is looking for a NP and willing to treat me like one- primary care, geriatrics, transplant, adult - I am SO interested
Thank you for not being offended by my lack of candy coating. :) I would imagine there are plenty of places who would love you although on the other side of the spectrum most might expect you to truly function independently. In my experience orientation was being handed a prescription pad and shown a desk but it sounds like you are ready!
I agree with those who say this is not a good job for you. As a new provider you need to be in a place where you can be mentored to develop your skills. These folks do not have a clue. You should not be doing refills, prior auths etc. unless the culture is that everyone (including the MD's)are helping out . It is not your problem if refills aren't done- it is a problem in how the place is run. (There are agency RN's) They need education in the NP role. It is probably easier to look around and find a job where you can develop your NP skills..In the meantime try to educate them. How did they become so clueless?
You might also review your job description to see what you are doing compares to what you were hired to do. Also this place may not want a APRN as a provider.
I saw a job listing once where they wanted an NP as office manager where the NP could do everything and provide patient education.
Jules A, MSN
8,864 Posts
Thank you for not being offended by my lack of candy coating. :) I would imagine there are plenty of places who would love you although on the other side of the spectrum most might expect you to truly function independently. In my experience orientation was being handed a prescription pad and shown a desk but it sounds like you are ready!
Best to you.