Graduating NP: jobs, salaries etc

BlueDevil,DNP, DNP, RN · Jan 9, 2012

i graduate after this semester and have been offered my first job after graduation. i have a few options, all of which are different. money is not my greatest focus but rather finding a placement that will teach me and support me as a new grad np. having said that:

1. what do i need to ask about the job conditions? they are offering an hourly rate and "usual" benefits. it is the same organization i already work for. expected days, hours, how many patients/day, do you have to take call? do you have expenses associated with the practice? (a colleague found out after the fact that she had to pay for her own laptop-$1800 out of her own pocket just to start the job) profit sharing potential? since you already work there, does your previous experience count as "time in service?" another colleague worked icu as a staff nurse for 19 years, went to np school and then went to work in the same unit as a np. when they calculated her pay, she got credit for having been there for 19 years and started out at over 100k a year, much more than the experienced nps in the unit. maybe not "fair," but her loyalty to the system was rewarded (they also paid off all of her tuition loans, which is a very nice $65k bonus, lol).

2. what do i need to ask about the training process/educational development? is there anything you wish you knew before you started your first job? conference or ce money etc? it varies from $1500/y on the low end to $3,000 on the high end. everyone seems to get about one week off paid to do cme activities. find out if it rolls over or disappears at the end of the year. i get $2200, reimbursement, not upfront. i only went to one conference and it didn't cost that much so i was able to negotiate to donate the unused cme dollars to the charity of my choice.

3. how much more money per hour should i expect over rn rate? i know the position has a salary range and their offer is right in the middle (and right where i indicated would be my minimum acceptable pay rate). i currently am salaried but the offer works out to be about $5/hr more than i make as an rn... just doesn't seem much. cant answer that, it depends on your area, just know your market. advance for np/pas just released survey results a day or two ago that said the avg starting np salary dropped from 80k to 70k in 2011 and more decrease was expected in 2012. this may or may not apply to your area. it is actually pretty on target for mine. the last data i had from the aanp (2009-10) for my area said the avg salary here was about 84k, and that is exactly what i was initially offered actually, but we are hiring in at 76,400k now, and it is nonnegotiable for new grads. our practice does not recognize rn experience at all in salary negotiation. 2 weeks or 20 years, it's all the same. we do have a pay scale ladder for experienced nps, but i don't think they really negotiate much, just nickle and dime a little. i was able to wrangle an extra 3 days of paid vacation, lol, but no additional salary. i did strike a deal for patient satisfaction bonuses. i have made a killing in patient satisfaction in the past, lol. they love me. i don't treat chronic pain at all and so don't get a lot of the problem pts that often lower scores in the first place. the other np in my office made $24k in productivity bonuses last year. we have very different patient panels. she sees about 24-25 pts a day, mostly chronically ill adults. she does some outstanding documentation to code everyone up to a 14 or 15! i'm not as fast as she is, seeing about 18-20 a day, mostly young families, infants and kids and i end of with a lot more 13s and wouldn't bring home that kind of bacon based on productivity. the point is, figure out what kind of practice you think you are going to develop and what it's potential is, and negotiate toward your strength. mine is pt satisfaction, hers is productivity. mostly, know your market!!!

the good thing is that they really want me, and i know they need several nps and are finding it hard to find suitable candidates. i think they are willing to negotiate at least somewhat.

thanks for any guidance. i am really torn about staying in my current dept or leaving for this new opportunity. i love where i work but the role there would not be as challenging as the new job offer, and i love a challenge!

good luck

MelanieAPN · Jan 9, 2012

I agree with much of previous post by BlueDevil, DNP.

1.) Expected number of patients to be seen per day and acuity of patients seen is important. As for job conditions, know the importance of the relationship you may have with your collaborating physician. Not sure what state you are in, but this makes a a huge difference for some new APN's. Some enojy mentoring their APNs, others don't.

2.) I get 3,500 yearly CME, but employed in specialty inpatient environment on East Coast.

3.) Previous Poster seemed very accurate according to paysacle. Again, salary is dependant on practice environment and patient acuity. I am assuming the productivity bonuses are related to outpatient numbers and data. In the inpatient world, our bonuses are linked to RVU points and procedures performed. Patient and family satisfaction is important to me and I see only adult patients in the hospital.

Good Luck with your career as an APN :)

Advanced Practice Columnist / Guide · Jan 9, 2012

Great tips from both the above posters

1. If it's the same organization you're already working for, then you should be pretty familiar with the institutional set-up. Will you be under the same department under the same hierarchical structure? Is is it under a medical service or a nursing service and is there a difference in the benefit plan between both (i.e., managament level benefit options offered to physicians and non-physician providers as opposed to regular benefits to nursing staff). In the same vein, are there additional perks as an NP? (i.e., premium parking slots in the hospital, an office)

2. CME money varies as already pointed out. There is also wide variability in how the money is distributed. I've worked for an institution where providers receive a debit card with a Mastercard logo each year loaded with a set amount of cash to be used for CME's and other educational activities (can be used for buying textbooks). The medical affairs office does monitor the charges and will question purchases not tied to an educational activity. The other downside is a fellow NP had the card stolen and had such a hassle with verifying that the charges were fraudulent. I currently work for an institution that sponsors 100+ CME activities a year and as a member of the staff, we get discounted fees and are eligible for reimbursement for CME activities.

3. True about paycsale as other poster stated. West Coast and Northeast paycsales are higher (even for nurses) in the setting of a higher cost of living. Hospitals have variable pay structures as well. Where I used to work, a new grad NP is considered inexperienced and starts on the lowest pay scale. Where I work now, an NP's salary is calculated based on total number of nursing experience so a new grad NP with 20+ years of bedside experience will start higher than someone who is a direct entry NP grad with 3 years of NP experience.

4. True about RVU's and how hospital settings put a lot of value in that. Which means productivity is based on how many notes, H&P's, consults, and procedures you do. But it's not a good thing for a clinical role that is not procedure and note-heavy. There are NP's in hospital settings who are very productive and busy but a lot of their dailiy activities can not be measured by RVU's (i.e., calling Radiology to expedite a test, following up culture and sensitivity results from the lab, speaking to consultants on the phone or in person, etc.). Make sure you know what your role involves and you don't fall prey to your productivity being evaluated by RVU's when it is not an RVU heavy role.

canchaser, BSN, RN · Jan 10, 2012

Juan, what's a RVU?

Trauma Columnist · Jan 10, 2012

RVU - relative value unit

RVU-relative value unit - Physicians Practice

It has to do with how providers are reimbursed.

allnurses Guide · Jan 11, 2012

Great information, thank you so much NPs!! I will have to find out about the RVU thing - it's a critical care unit and once off orientation, credentialled etc, I'll be working as the overnight 'fellow' with a supervising intensivist. The NP bills if they do admission notes or procedures etc. If you work days with a physician then you bill under them. The NPs/PAs come under a midlevel office which is part of the physician division rather than nursing. NPs do wear the same color scrubs as RNs though which I think is misleading!! Heh. I have been able to complete several weeks' clinical rotations in this unit and the collaborating physician and lead NP are both eager to teach and super supportive so I am really looking forward to working with them (although of course terrified!).

Trauma Columnist · Jan 11, 2012

Sounds like a very cool opportunity.

Congrats and good luck.

Advanced Practice Columnist / Guide · Jan 11, 2012

Critical care is typically an RVU-heavy service. Depending on the patient population, turn around could be quick so you're doing H&P's, placing lines, intubating, bronch'ing, tapping lungs or bellies all of which are billable. Since you said you will work nights, I'm not sure if you'll be doing ICU progress notes which is also billable. I used to work in an ICU where the day NP's do 1/2 of the caseload to do progress notes and the night NP's do the other half. Another billable note is the Critical Care Event Note which is separate from the progress notes and is done when you are called to the bedside to address events such as sudden hemodynamic instabilities or ventilatory issues you were asked to address. It's great that you have an intensivist to work with at night. That would be a good way to learn 1:1 from a mentor. Procedures are not that hard to learn with a supportive teacher. Many of the ICU procedures we do now are so much easier learned due to newer technology and have lesser risk of complications (i.e., smaller bedside sonogram equipment for line placements and taps).

jamela1989 · Sep 23, 2016

What position do you work?