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!

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?

Allcanbe,

RNs may get paid that much in SF or Bay Area. I know Kaiser and UC nurses may also get paid higher than the smaller hospitals in the same area. In the Southern side, I get paid $51/hr as PRN without benefits. New RNs start at $28 per hour as full time employees. Yes, cost of living here is high.

Not sure how to answer your question about NPs getting offered less than an RN's pay rate. New grad NPs start at $44/hr ($16 higher than a new RN). Maybe because positions I have been applying for are in clinics that are small with

Also, as a new grad, it would be hard to justify a high starting pay. The culture around here in my area is that the more years you have as an NP, the marketable you are (=better negotiation with pay).

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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."

Thanks for your response, PsychGuy! Your post made me laugh, haha :-)

I shadowed the NP last Saturday. Although I felt overwhelmed, I can see how this is going to be repetitive for me in the future. We saw lots of patient's with a hx of anxiety and depression. Most are on SSRIs. Although the NP tries her best to start these patients on low dose phentermine and then titrate slowly, the patients are just naturally impatient. Either they have taken the drug before or they are just not losing weight (yup, grapes vs. Doritos). Some even want to be started at the maximum dose! Very tricky. I learned that I have to be firm with patients, if I believe that the drug or dosage is truly unsafe for them.

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Specializes in Internal Medicine.
Thanks for your response, PsychGuy! Your post made me laugh, haha :-)

I shadowed the NP last Saturday. Although I felt overwhelmed, I can see how this is going to be repetitive for me in the future. We saw lots of patient's with a hx of anxiety and depression. Most are on SSRIs. Although the NP tries her best to start these patients on low dose phentermine and then titrate slowly, the patients are just naturally impatient. Either they have taken the drug before or they are just not losing weight (yup, grapes vs. Doritos). Some even want to be started at the maximum dose! Very tricky. I learned that I have to be firm with patients, if I believe that the drug or dosage is truly unsafe for them.

Did you see the NP prescribe Contrave to anyone? It's a newer player to the market but it's not a controlled substance (which is rare) and I've seen great results in my patients. I've even written it for some overweight coworkers with positive results.

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Did you see the NP prescribe Contrave to anyone? It's a newer player to the market but it's not a controlled substance (which is rare) and I've seen great results in my patients. I've even written it for some overweight coworkers with positive results.

I will ask her next week but I haven't seen her prescribe that last Saturday. I read the clinic's standard protocol and the major prescribed drugs are phentermine and phedimetrazine. Otherwise, we have drugs that are marketed as "natural" products but are still dispensed as prescription drugs. I honestly have not heard of Contrave (have heard each drug though with different indications) but I will read more about it (just in case a patient asks me about it). I don't think we can prescribe outside of our protocols though. Good to know that Contrave is another alternative. Thanks!

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Specializes in Internal Medicine.

Yeah it's a combo of wellbutrin and naltrexone. Pretty interesting. You can also be on it long term, which isn't possible with the other weight loss drugs, and there's no tapering. Because it's branded, it's pricey but like all brand drugs they have coupons for commercial and cash pay patients that significantly reduce cost.

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Yeah it's a combo of wellbutrin and naltrexone. Pretty interesting. You can also be on it long term, which isn't possible with the other weight loss drugs, and there's no tapering. Because it's branded, it's pricey but like all brand drugs they have coupons for commercial and cash pay patients that significantly reduce cost.

Wow! Long-term? That's great! Phen is only good for 12 weeks per recommendations. I will definitely mention it to our boss who owns the business. I'm sure he might already know about it but I am curious to know why he is not selling it yet. I'm sure it's all about the money :-)

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