FNP the good, bad and ugly (if any)??

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I posted a similar topic, but did not get any responses so I'm hoping for something different this time around.

I looking to get some insight into being an FNP from other FNPs with experience. What are the best parts of your job? What are the not so good parts? If you could go back, would you have done something else in the nursing field? If so, what?

Sometimes you have a picture in our head that isn't always the reality and I'm hoping by asking others, the picture will become clearer to me.

Thanks!

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Specializes in Adult Internal Medicine.
I posted a similar topic, but did not get any responses so I'm hoping for something different this time around.

I looking to get some insight into being an FNP from other FNPs with experience. What are the best parts of your job? What are the not so good parts? If you could go back, would you have done something else in the nursing field? If so, what?

Sometimes you have a picture in our head that isn't always the reality and I'm hoping by asking others, the picture will become clearer to me.

Thanks!

The best thing you can do is shadow some FNPs in areas you are interested in working; see what it is like for you compared to what your goals are.

I love my job and I would do it over again without question. I am day-to-day independent in a wonderful collaborative practice where I manage my own schedule without RVUs dictating my practice, I cover the hospital in the mornings and clinic in the afternoon, and I work with older complex medical patents. There are frustrating parts of the job (insurance, administrative red tape, IPAs, etc) that I could live without.

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Specializes in Community Health.

I'm only 10 months into my career and my response may be different as I work in a HRSA site.

Would I choose another profession? No. The good thing about being a FNP is you are always a nurse first so I can still moonlight and do RN work for extra cash. Also there are many different specialities so if you don't like primary care, you can do specialty, administration (director of nursing), retail, school nursing ect.

The good- In a HRSA clinic in a underserved community, I learn something new everyday. Alot of these patients don't have insurance so I can't defer treatment to a specialist for things like weird rashes, DVTs, seizures, or CKD, I have to learn about it and manage myself (within my scope of practice).

The ugly

-my pay is not that great

- as above, I can do without administration, red tape, ect. I have some administrators demand that I see a friend of theirs for a non-emergent problem. Blah!

-The uninsured pt's in my practice, are hard to treat and non-compliant as most can't afford medications and office visits.

-I sometimes have to call specialist and ask if they can see a patient (pro bono without money or insurance if I get something like a GFR of 11. Sometimes they say yes, and other times no. If no, then I'm stuck until I can wait for Medicaid to approve the pt for dialysis. So I'm kind of a social worker????

-I am expected to see a certain amount of

patients per day. Here's my issue. If I worked in an area where everybody was compliant and insured, I could see 20+ patients per day. I sometimes pray for a drivers physical or a sinus infection every once in a while. My patients are sick. I can't see a patient on 20 different medications in 20 minutes. Especially when they completely ignore there diabetes and want to focus on their narcotics. On average, I see at least 2 patients per day with blood sugars >500 No insurance, no money for insulin and they're not going back to the ED.

So, to sum it up...I am mentally fried, tired, but a lot smarter and a better nurse then I've ever been in my entire career. Gotta weigh the good and bad and figure out what's important to you.

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Specializes in Clinic NP.

Money. Security. Options.

Annoying patients, more annoying management, more so annoying having to manage my staff.

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I work inpatient specialty and am all over the hospital since I see pts who have surgery of all different types.

Likes: Varying locations (I'm not stuck in one spot all day long)

Focusing on one area of a patient's care

Being able to help educate the RNs about my area is specialty and answer questions they have

Having the time to answer patients' questions, point them in the right direction for their own care after discharge, etc.

The pay is not awful

I'm not stuck with the same patients or family members for 12 hours straight! I see 'me and move on.

Dislikes: Sometimes focusing one one area of care can get monotonous

Some days I feel like I'm educating the same RNs over & over about the exact same issues

Some patients really don't give a rip and I'm wasting my breath trying to teach them how to care for their own health

The pay is not great, and economic times being what they are - and thanks to healthcare reform - no one in our hospital system is getting a raise through 2014.

Reporting on every single patient I see to some of the supervising docs I work with

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Specializes in ER.

The good:

Moved up the food chain. No more midnight shifts, mandation, lazy coworkers, backstabbing.

Really enjoy the pace of urgent care, the days fly by!

No more breaking my back helping 300 pound patients onto the commode!

Really use my brain on a daily basis--learn something new every day...

Love my coworkers in the clinic. They have a much better attitude than CNA's, ward clerks and fellow nurses on the floor or in the ER.

The bad:

Get sick of drug seeking patients in the urgent care.

Get sick of practicing dentistry---I see the same patients with bad rotted teeth every week--they cannot afford to go to the dentist and they need pain meds and antibiotics. Write for both, call the pharmacy, find out they filled the pain meds but not the antibiotic!

Paperwork----rural health, critical access, PCMO, every day, another form to fill out

Prior auths---trying to find meds that patients can afford. Every day, insurance companies change their minds about which ACE, ARB or diabetic med they will pay for.....end up doing a bunch of hoop jumping!

Patients who think you can wave a magic wand and solve all their problems. Trying to get patients to understand most of their problems are induced by bad lifestyle choices and cannot be solved with another pill.

Referrals----filling out forms, dictating letters, getting auths to send patients to a specialist, who ends up being mean to the patient, does not come up with any good plan for the patient---oh, then the patient is mad at you for making them drive 2 and 1/2 hours to be glanced over for 5 minutes by the specialist!

Pay does not match up with responsibility.

However, in spite of the shortcomings, I am glad I went back to school, and would never go back to bedside nursing!

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I'm only 10 months into my career and my response may be different as I work in a HRSA site.

Would I choose another profession? No. The good thing about being a FNP is you are always a nurse first so I can still moonlight and do RN work for extra cash. Also there are many different specialities so if you don't like primary care, you can do specialty, administration (director of nursing), retail, school nursing ect.

The good- In a HRSA clinic in a underserved community, I learn something new everyday. Alot of these patients don't have insurance so I can't defer treatment to a specialist for things like weird rashes, DVTs, seizures, or CKD, I have to learn about it and manage myself (within my scope of practice).

The ugly

-my pay is not that great

- as above, I can do without administration, red tape, ect. I have some administrators demand that I see a friend of theirs for a non-emergent problem. Blah!

-The uninsured pt's in my practice, are hard to treat and non-compliant as most can't afford medications and office visits.

-I sometimes have to call specialist and ask if they can see a patient (pro bono without money or insurance if I get something like a GFR of 11. Sometimes they say yes, and other times no. If no, then I'm stuck until I can wait for Medicaid to approve the pt for dialysis. So I'm kind of a social worker????

-I am expected to see a certain amount of

patients per day. Here's my issue. If I worked in an area where everybody was compliant and insured, I could see 20+ patients per day. I sometimes pray for a drivers physical or a sinus infection every once in a while. My patients are sick. I can't see a patient on 20 different medications in 20 minutes. Especially when they completely ignore there diabetes and want to focus on their narcotics. On average, I see at least 2 patients per day with blood sugars >500 No insurance, no money for insulin and they're not going back to the ED.

So, to sum it up...I am mentally fried, tired, but a lot smarter and a better nurse then I've ever been in my entire career. Gotta weigh the good and bad and figure out what's important to you.

You can only do your best. If they are not helping themselves, forget about doing any more than minimal care. Maybe when tragedy strikes, they'll come around. Everyone's readiness trigger is different. Just document for your protection.

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