Help! My 1st NP job sucks!

[stal2s]

Hi all,

Thanks in advance for listening to my rambles. I recently started a FNP position in a ENT private practice (6 weeks to be correct) and honestly thought it wouldve been the best thing. The interview process was smooth, where the doctor and the office manager painted such a beautiful portrait of how wonderful it would be to join the practice. They even took me out to dinner and threw a welcoming party for me. I guess, I shouldve known by the initial treatment that working there would be a hellhole.

6weeks into it, I want to quit. I want to leave and never come back. I signed a contract and thought I read it thoroughly but I guess I was wrong, I have to give them a 90 day notice for resignation. I cant imagine staying there x 3months more but I suppose it would be better than 1 year.

This doctor is mean, obnoxious and rude. He is nice to his cosmetic patients (obv because thats where the money comes in) but has no patiences for the ENT group. When I ask him for help with a patient, he didnt' want to go in and told me to take care of it. I dont understand how this can be a learning environment. I also am not ACLS certified ( i plan to be) and he has me pushing versed and fentanyl and watching monitors. I know that if God forbid something were to happen to a patient, I would be the first one to be thrown under a bus and blamed for not being certified. Another instance is when we had a new pediatric patient. I understand that I am FAMILY NP so I am able to see all ages but he basically said that (I) " would take care of it" How can I take care of it when Im still new? Maybe I just expect for him to be more understanding that I am new and to walk me through it instead of letting me fumble in front of the families. Another example of what happened was last week I had a patient that his partner saw and the patient needed a hearing test and to be scoped. After doing all that, the patient wanted to see a doctor. I proceeded to tell him and he said to me "I am not seeing that patient, they came here for a test and it was completed, tell them to make an appointment to see my partner". WTH! He's a diva and also slams doors when he's upset.

There is another doctor there that is amazing, he is down to earth, patient and willing to teach me. Unfortunately, he is not enough to have me stay. There has been 6 girls that have left the practice too ( they are ancillary staff but still). I know that the girls that work in that office hate it so they are on their way out too.

The two doctors approach the patients differently and has allowed me to care for patients differently. However, whenever the jerk sees me doing something, he always tells me to do it the right way. The problem is, that's the way the other doctor showed me and I'm comfortable with it. (the nice doctor tells me to do things the comfortable way)

I never thought this job would be a bed of roses but I also didnt think it would make me cringe when I have to go in and work with him. I guess I just want to know if I am nuts or if this has happened before to someone else. I dont want to screw their practice by breaking the contract but at the same time, it is the beginning of my career and I dont want this is leave a bad taste in my mouth, more than what it is.

[tryingtohaveitall]

Ugh, that sounds terrible. I don't really have any advice to give, but have you tried to talk to the nice dr? He can't be blind and must see how his partner is. It's in his best interest for things to improve for you so that they don't have to start all over.

GL!

[traumaRUs, MSN, APRN]

Since this is a new specialty for you (I'm guessing?) I would ask for more official training. My first job out of APN school was with a nephrology practice. I knew nada about kidneys except that we should have two of them - lol.

I had five months of training which included 1:1 time with several of the doctors (there are now 17 in the practice) as well as time with several of the mid-levels (we now have 5). This gave me lots of time to develop my renal assessment skills as well as just the nuts/bolts of the practice.

Without that much training, I would have been so lost. As it is, I've been with this practice over 5 years now and feel much more comfortable but still occasionally bounce things off an MD or another mid-level.

This is not a supportive environment at all.

[79Tango]

Do you have your own DEA license? If not, you may want to look into it (along with your ACLS). DEA is a very tough thing to obtain if you are not already working and many facilities will want that in-hand upon applying.

[guest416560]

The first time a patient goes apnic after you push too much fentanyl you're toast. I wouldn't think twice about leaving. You don't want to be on the witness stand testifying about how "you were new" to a prosecuting attorney. Leave and don't think twice. You are putting your license in jeopardy.

[CCRNDiva, BSN, RN]

May I ask what type of nursing you did prior to becoming a FNP? I'm surprised they would hire a graduate NP without experience with sedation and procedures if they expected you to do that.

I would suggest you request additional training and get your ACLS immediately. Attend some NP conferences. You may be correct in the belief that this may be too much for a new grad with your level of nursing experience. On the other hand, there will be difficult doctors in every practice. It's not uncommon at all, so you will have to learn how to deal with them.

[Corey Narry, MSN, RN, NP]

OK, the serious risks to your license (not being trained in conscious sedation) is not something you want to ignore until you're ready to leave the practice in 90 days. If there's a practice manager in this clinic, you need to sit down with that person and discuss these concerns. First, what does you state practice act say about NP's providing conscious sedation and what does the scope of practice say about the role physicians have as far as working with an NP (i.e., supervising, collaborating, independent practice)? Second, it could be possible that the physician thinks that by asking you to push those meds, you are merely acting as an RN assisting in the procedure. Medicare allows non-anesthesiologists to provide conscious sedation to patients in the clinic setting as long as providers are trained to manage complications and have emergency equipment available. Sometimes nurses who assist are not even ACLS certified and I'm sure this physician is adequately trained to secure an airway should a severe airway compromise occur and reversal could not be achieved (he's an OHNS specialist after all).

But it does go beyond just knowing ACLS and since your role is now that of a provider, you are actually held to the same knowledge expectation as that physician if a litigation occurs and your participation in the case is questioned. Maybe the physician does not know that and it is a serious threat to your license if you continue in this arrangement without the practice addressing this issue. I'm sure this is something they will want to remediate especially if you're covered by the practice's malpractice policy. Regarding his attitude, that's something you can't change no matter how many times you sit down with him and talk it out. He actually didn't really do anything inappropriate by not speaking to the other partner's patient who just came in for a test. The other physician should call that patient and discuss the test with him.

[ivanh3]

Rule number one: don't quit a job till you have another one. Or least a good shot at another one. Not in this economy. Meanwhile, protect your self by offering best practice and good documentation.

I would at least finish the 90 days. Of course that may make your environment strange/awkward to have to work for 3 months after giving notice. They may let you go once you are replaced. Learn what you can in the meantime and hit the books about the meds you are giving. Take an ACLS class as well. I would not just bolt out. Future potential employer may be understanding about these things, but then again they may not. There is rarely only one applicant for a job.

Ivan

[rich2008]

You have one life to live and its horrible to waste it being miserable. Get out!

I am now on my second NP job. The first one wa with a narcisistic whack job who was always at the fry cleaners or the hairdresser getting her hair straightened. She was so self centered and had an irrational fear of driving on the highway. So she would never go see nursing home patients. She taught me nothing other than to look out for yourself.

Its all great to want to be in medicine to help people but you really have to put yourself first. The people you work for obviously dont give a crap about you, find something else.

[VivaRN]

I'm all for having a sit-down with the nice doctor and/or the practice manager. They invested in you enough to bring you in and it is in their interest to keep you. I would be very upfront about your learning needs and need for precepting, your desire to attend conferences and access further training in ENT, and that you will not be doing conscious sedation until you are certified to do so. Sometimes practices without experience working with NP's don't know what your needs are - speak up and try to improve the situation before you quit.

If you make your needs known and nothing changes, start job searching. Make sure the good doc at least will give you a good reference.