How to know where to land after NP graduation

Trauma Columnist · Feb 27, 2008

Wow - I'm impressed with your organization! I graduated in May 06 with an adult health CNS which I did as a post-MSN certificate. I wasn't nearly as organized as you. My experience was 10 years in the ER and 1 year in ICU and 1 year in med-surg. I really wanted to work in the hsopital. However, in my area, jobs are tight so you kinda take what you get. So...as long as you live in an area where you can pick and choose, you go!

I am in a 15 MD, 7 mid-level nephrology group. Of course, I get along better with some doctors than others. There are two MDs that I have never even met and I've been here 18 months! This is a very autonomous position so I don't see doctors on a daily basis. For me, that works.

Good luck...sometimes it just works out great with the first job. Other times, you might have to change jobs.

yellow finch, BSN, RN · Feb 27, 2008

I'm currently 10 months away from FNP graduation. I don't plan to apply to any NP jobs until passing the boards because I have a terrific job with little pressure to move on until I'm ready.

The only way I know where I may want to end up is by interacting with the physicians that round through our unit. You really get a feel for the type of people you'd be dealing with simply by interacting with them at the bedside.

It will be in my final semester this Fall when I can branch out and work out some clinicals in specialty groups to really know what they do and if I'm drawn to a certain area. I've already approached Pulmonary, Psych, Infectious Disease, Urology, and a few others.

As for the fear of boredom (which comes very easily to me), I am already planning on being very direct in my interviews. My interests do not lie in being tied down to the clinic only. I want to round through the ICUs, I want to perform invasive procedures, assess and place orders for critically ill patients, and will do whatever it takes to achieve this. It won't behoove me to hold this back during the interview and may offer jobs that would otherwise be less than stimulating.

In the end, you have to be proactive in your goals and desires. Seek out new opportunities for education and clinicals. Be straightforward in your interviews and don't let anybody tell you to limit yourself. This is the rest of your life... your future career... you will eventually gain that which you seek. At least that's how I see it and won't accept anything less.

GOOD LUCK!

lifelong · Feb 27, 2008

Thank you for your comments, I know it's a process I will be living for the next 9 months. I graduate right before Thanksgiving....hopefully. So, if you come across anything that might be helpful, please let me know. I am eager to figure things out.

Another question I have is can I work as an RN after I graduate while I am in limbo (waiting to take certification exam, getting transcripts, etc.)? I thought (probably wrongly so) that since I have more education, I would be held to a higher standard (I am thinking legally). Or am I safe since I haven't taken the certification exam? I am a pretty cautious gal, but things happen. I know I will want to take a little R&R after graduation, not sure if 6-8 weeks is realistic on the homefront. Any additional thoughts?

Advanced Practice Columnist / Guide · Feb 29, 2008

Hey there, I have been lurking a while and thought I would post.
I am currently in an ACNP program at Wright State University and will enter clinicals in April. I have 14 years of adult ICU experience (SICU/CICU). I am anxiously waiting to get into clinicals...but am cautious because I have so much to learn. My questions are these:
1) How do you know where to land after graduation? Most of the students have an inkling of where they want to go or have had conversations with physician practices/hospitals. I am totally open (thinking Divine Intervention will assist). Initially, I thought about neuro since in the SICU, there is a ton of neuro and I kind of like it, although hospitalist, trauma or surgery in general intrigue me as well. The cardiac NPs I see don't model the way I want to as they seem reliant on the physicians to make any changes in care. The ones I see are knowledgeable and friendly but do small tasks...pull IABP lines, assist in CT placement and at times seem to be pushing paper or more in a liaison position. I have not seen any of them assess a patient, write a note or direct care. I am more hands on, so even though I am in CICU, I probably won't be a cardiac NP. My visibility on the cardiac NPs is limited to only my hospital.
2) My clinicals are set in such a way that I will spend time with a hospitalist group (hospital setting), internist group (office setting) and a neuro team (both internal and external hosp settings). How do you know if inpatient/outpatient is for you? Is it a feel? My very limited knowledge thinks the outpatient world would be boring after a while, but the routine might be a wonderful change. And the inpatient world might be more draining. But inpatients are all I know and maybe that's a better fit. I don't want to take the easy way, I want o figure out what's right for me...and that's where I am struggling.
3) How will I know if surgeons or medical teams are right for me? Initially, I am thinking surgical and would go for a RNFA after graduation down the line...and would like to work on those cases I have seen in the office. Will I burn out over time? I don't want that either.
I know I have time to figure things out. But, I also am a "chewer" and need to chew on things a while. If there are certain things you all have thought through during your clinical time or questions to ask etc...that would be extremely helpful. Or just your experience in how you landed where you did might give me things to think about.
Thanks!

1. I did have a lot of classmates who already knew what they wanted to do or had a job lined up before we even finished our program. I wasn't one of those students. The best thing to do is to interview in as many places as you can and see if you will land the job you liked the best. That was basically what I did. Also ask around and see what other NP's are doing in places other than the hospital you work for. I hear you when you said that it can get really boring if all you do day in and day out is to do paperwork and not make any clinical decisions on your own. I was offered a position in a similar specialty (Cardiothoracic Surgery) at a hospital 5 minutes away from where I live. The pay was about the same but the job involved nothing but discharging floor patients, pulling IABP's, pacer wires, and chest tubes so I did not make the move and stayed put where I am now where travel time can take me as much as 40 minutes on a bad day.

Also being able to do what you want to do can sometimes take time especially if you are joining a group who knows nothing about how you work and what skills you bring. I joined a group of NP's that have already paved the way for me and others in order to be able to do actual patient management and invasive procedures. However, that level of respect did not come overnight. The NP's that preceded me were strong-willed and had many experience to bring to the table. They had strong personalities and were convincing enough to persuade the medical staff to allow us to do more.

2. As an ACNP, you should already have a strong desire to manage hospitalized patients. Although some ACNP's are also involved with patients in the clinic, a large bulk of their work involves in-patient rounds. I had some out-patient cardiology service and pulmonary service rotation in my program. That was actually a good break for me but I figured it would probably get boring if that's all I will be doing. That's just me.

3. Just my observation in terms of the difference between Surgery and Medicine is that if you are in a surgical specialty you should be prepared to be physically present at the hospital even at the most "ungodliest" hour. You will never have a cushy job and you will "work". That's just the nature of most surgical specialties.

Dixiecup · Mar 4, 2008

My dream is to be a psych NP. But since I'll have close to 100K in student loans to pay back, I will be forced to work in the rural clinic setting at least for a while so the government will pay back part on my loan!

yellow finch, BSN, RN · Mar 4, 2008

Thank you for your comments, I know it's a process I will be living for the next 9 months. I graduate right before Thanksgiving....hopefully. So, if you come across anything that might be helpful, please let me know. I am eager to figure things out.
Another question I have is can I work as an RN after I graduate while I am in limbo (waiting to take certification exam, getting transcripts, etc.)? I thought (probably wrongly so) that since I have more education, I would be held to a higher standard (I am thinking legally). Or am I safe since I haven't taken the certification exam? I am a pretty cautious gal, but things happen. I know I will want to take a little R&R after graduation, not sure if 6-8 weeks is realistic on the homefront. Any additional thoughts?

I don't believe you could be held accountable as a mid-level provider until you've actually passed the NP boards. As I see it, you'd just be an RN with a master's level education in the interim. Like I said before, I plan on staying at my current job until I pass the boards since I don't want the added pressure of orienting on a new job while studying for the boards. Plus, I can use PTO for studying or taking a prep class. Get paid to study!!

Good luck to you! Even though I graduate a month after you, I'm envious that you get done sooner.