How much orientation is needed for a new NP?

Specialties NP

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I have accepted a per diem job at a weight loss clinic (the pay is really good). Since I am a new grad, I'd like to ask the experienced NPs in specific specialties regarding orientation.

1.) How many days of orientation should I request? I am planning to ask for 3 days. Would this be enough? The manager gave me 8 pages of weight loss medications that they routinely prescribe at the clinic. I believe i can study these in a period of 1 week.

2.) Would orientation provided by another NP suffice my orientation? Or should I ask if I could shadow the supervising doctor for at least a day?

3.) Are orientation days at the clinic usually paid? Even if it's just shadowing the NP?

Thanks a lot!

I get a fair amount of dialysis pts in psych also and have gotten to know the local nephrologists up close and personal. I have one's cell number in my phone. ;) With that physician I usually know what I can add without upsetting the apple cart but I always give his office a heads up to med changes or additions and for anything unusual I speak to him personally-and document it of course.

To me it is both prudent and a matter of professional courtesy to touch base when adding something to the regimen of patients with complicated comorbidities.

Hey you gave me a great idea, Jules! It would make me feel a lot better (sleep better every night) if I notified the PCP or specialist, if I were to pescribe something that may interact with currents meds or diseases. I will ask the manager if this is ok and not in any way violating the clinic's protocols or whatever. I am hoping this is fine! But I will do it anyway. Thanks!

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Nope - you would be surprized what physicians, providers, etc., will give dialysis pts!

There is one chiropractor in my area that told one of my pts that they didn't need to continue to come to dialysis because they urinated and they could just take some holistic meds to keep their urine output up so they didn't need to come back.

I called the chiropractor's office to find out what holistic meds they were giving them but they threatened to call the police for harassment! I only called once!

Just FYI too - the FDA does NOT regulate herbal supplements so you really have no clue what you are getting and many supplements are contraindicated with certain disease processes.

Wow! That chiropractor is weird lol. I don't think that was harrassment. If anything, I would want to talk to you if I was the chiropractor. I'd like to know if these holistic meds could affect the patient's overall health then document (to cover my behind).

So yes, I really have to read/study these herbal meds! Hitting the books now......... ;-)

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Specializes in Family Nurse Practitioner.
Hey you gave me a great idea, Jules! It would make me feel a lot better (sleep better every night) if I notified the PCP or specialist, if I were to pescribe something that may interact with currents meds or diseases. I will ask the manager if this is ok and not in any way violating the clinic's protocols or whatever. I am hoping this is fine! But I will do it anyway. Thanks!

The way I would approach it is "I normally notify my patient's other providers of new medications for safety and continuity of care" and see what they say. I have found that many PCPs really know their patients, have cared for them long term and can give valuable information that I might not have known otherwise. Doc to Doc without consent is not a HIPAA violation and imo good practice for continuity of care.

I'm wondering if you will get some patients who are basically looking for stimulant type medications? Poke around online and see if there are provider organizations for this specialty to help you with the nuances of this area. I'd suggest for anyone knowing the websites, if available in your state, for checking on prescribed narcotics, benzodiazepines and stimulants. These often are "overlooked" when a patient is telling your their med list, especially when prescribed by EDs or multiple providers. If things ever go bad because they were taking something that interacted with what I prescribed I want to make sure there was no possible way I could have known about it. Again document!!

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The way I would approach it is "I normally notify my patient's other providers of new medications for safety and continuity of care" and see what they say. I have found that many PCPs really know their patients, have cared for them long term and can give valuable information that I might not have known otherwise. Doc to Doc without consent is not a HIPAA violation and imo good practice for continuity of care.

I'm wondering if you will get some patients who are basically looking for stimulant type medications? Poke around online and see if there are provider organizations for this specialty to help you with the nuances of this area. I'd suggest for anyone knowing the websites, if available in your state, for checking on prescribed narcotics, benzodiazepines and stimulants. These often are "overlooked" when a patient is telling your their med list, especially when prescribed by EDs or multiple providers. If things ever go bad because they were taking something that interacted with what I prescribed I want to make sure there was no possible way I could have known about it. Again document!!

Yes, agreed! Thank you. I will approach it the same way you do. Your statement sounds tactful, patient-centered, and professional.

Ok, i'm also now surfing the net for answers. Thanks again, Jules!

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Specializes in Psychiatric Nursing.

One of the stimulants, I think Adderrall has recently been approved for binge eating disorder. Very controversial. I would be especially careful especially with people with cardiac issues.

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Specializes in Family Nurse Practitioner.
One of the stimulants, I think Adderrall has recently been approved for binge eating disorder. Very controversial. I would be especially careful especially with people with cardiac issues.

I have mixed feelings about this new indication and unfortunately my limited experience with it on the inpatient unit has largely been in patients with borderline personality disorder and coexisting substance abuse being prescribed it by you guessed it- their PCP. :(

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Specializes in Hospital medicine; NP precepting; staff education.

Excellent advice. Take it from me, for what it's worth : I now take metoprolol BID because Adderall put me into SVT.

That being said, congratulations Cocoa! I'm interested in what else I can learn from this thread.

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Nope - you would be surprized what physicians, providers, etc., will give dialysis pts!

There is one chiropractor in my area that told one of my pts that they didn't need to continue to come to dialysis because they urinated and they could just take some holistic meds to keep their urine output up so they didn't need to come back.

I called the chiropractor's office to find out what holistic meds they were giving them but they threatened to call the police for harassment! I only called once!

Just FYI too - the FDA does NOT regulate herbal supplements so you really have no clue what you are getting and many supplements are contraindicated with certain disease processes.

That would be medical malpractice on the part of the chiropractor. Maybe you should turn that in to the medical board in your state for review.

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Specializes in Internal Medicine.
That would be medical malpractice on the part of the chiropractor. Maybe you should turn that in to the medical board in your state for review.

My thoughts exactly! How dumb is that chiropractor? I would have told the patient to run and hide far far away from that person. That's downright dangerous advice that could kill the patient. If fixing kidney failure were really that easy, that chiropractor would be a billionaire at this point.

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Specializes in Tele, Hospice, Family practice.
Congrats on your new job! I thought Ca has a high cost of living? I read nurses make abt $60-$95/hr in Ca. Why are NPs offered less/same pay as RNs?

Cost of living in CA is high, especially LA and SF. As a new grad in LA County as an RN, I was making $35-$40/hr. I worked in a hospital on a tele/onc unit. As a new grad NP, my first offer was at $45/hr. Are you kidding me?? But, it has gone up in the past 3 years. It all depends on location, specialty, etc. If you have experience and work in a specialty, I can see making over $50/hr, but not up to $95! I'm making just over $50/hr as an NP!

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Specializes in Internal Medicine.
Cost of living in CA is high, especially LA and SF. As a new grad in LA County as an RN, I was making $35-$40/hr. I worked in a hospital on a tele/onc unit. As a new grad NP, my first offer was at $45/hr. Are you kidding me?? But, it has gone up in the past 3 years. It all depends on location, specialty, etc. If you have experience and work in a specialty, I can see making over $50/hr, but not up to $95! I'm making just over $50/hr as an NP!

I would imagine a lot of this is supply and demand. California is such a weird animal for nursing. The pay is great, but if you are a new RN it is very competitive. I have a ton of friends and former coworkers that I know simply because they left California since it was so difficult to land a hospital job without any experience. Meanwhile, because it is so unionized, hospitals pay a mint for people with experience that can hit the ground running. I did an ICU travel contract in California that paid me almost $70/hr, and when it ended they offered me $55/hr to stay on fulltime. It's silly over there.

I would imagine in the more desirable areas of California it's very competitive for NP's, but that same travel agency offer's me contracts at $100 an hour to work in some of the more undesirable parts of the state. Like everything in business, it's location location location.

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Specializes in Outpatient Psychiatry.

When I started I got a key to the office, some preprinted prescription pads, and a tutorial of the charting system. Then I saw over a dozen patients. Of course, there wasn't an orientation to be had. We have tons of psychotherapists, but I'm the only guy here that can prescribe. I have office staff that "makes my treatment fit insurance,"and they're superbly helpful. Beyond that I'm a lone ranger without an imaginary tonto.

In a medical clinic, I could see the need for broader orientation. In psychiatry, my training is mostly limited to psychiatry so I've seen psych practices. If you're a FNP then you could've trained at anything so weight loss and similar niche area probably require a couple days of orientation.

Talking about weight loss, I have a lot of inherited patients on topiramate. Many of them go to their PCPor someone, learn of its use for weight loss, and return taking that and phenermine. Then they start to complain that they're feeling more anxious and restless. "But my Abilify makes me hungry!" Me: "So eat grapes instead of Doritos."

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