How do we prevent Nurse Practitioners from undervaluing themselves?

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ThePrincessBride, MSN, RN, NP

1 Article; 2,594 Posts

Specializes in Med-Surg, NICU.
2 hours ago, MentalKlarity said:

Or option 3 which is demand a higher wage instead of being taken advantage of?

 

45 hours per week x 52 weeks a year at 96K is $41 an hour.

I'm going on 40 hours per week.

A new grad is not in the position to demand anything in a market filled to the brim with FNPs

Specializes in Psychiatry.
6 minutes ago, ThePrincessBride said:

I'm going on 40 hours per week.

A new grad is not in the position to demand anything in a market filled to the brim with FNPs

The quoted position was 45 hours, as it was 8AM to 5PM 5 days per week. So again, 41$.

 

And this attitude is exactly why so many nurse practitioners accept low paying jobs. They come to sites like this for support and instead of saying "wow, that's a horrible salary they are taking advantage of you!" and advocating for our fellow providers, you have people who instead go into the "Eat the young" mode and say that a new grad is in "no position" to ask for an ethical wage and should just eat whatever scraps they are offered. I completely disagree. We are providers, and a "new grad" is not going to bill any less per appt than an experienced graduate will. If the concern is seeing fewer patients per hour, then the new graduate NP can ask for a base salary +bonus based on RVUs or # of patients seen per quarter. This will allow the NP to increase salary as they become proficient. These days of paying an NP $40 an hour to see 5-6 patients and billing out $300-400 worth of services per hour on behalf of the practice need to end.

ThePrincessBride, MSN, RN, NP

1 Article; 2,594 Posts

Specializes in Med-Surg, NICU.
5 minutes ago, MentalKlarity said:

The quoted position was 45 hours, as it was 8AM to 5PM 5 days per week. So again, 41$.

 

And this attitude is exactly why so many nurse practitioners accept low paying jobs. They come to sites like this for support and instead of saying "wow, that's a horrible salary they are taking advantage of you!" and advocating for our fellow providers, you have people who instead go into the "Eat the young" mode and say that a new grad is in "no position" to ask for an ethical wage and should just eat whatever scraps they are offered. I completely disagree. We are providers, and a "new grad" is not going to bill any less per appt than an experienced graduate will. If the concern is seeing fewer patients per hour, then the new graduate NP can ask for a base salary +bonus based on RVUs or # of patients seen per quarter. This will allow the NP to increase salary as they become proficient. These days of paying an NP $40 an hour to see 5-6 patients and billing out $300-400 worth of services per hour on behalf of the practice need to end.

Look I'm not saying I agree with accepting pitiful wages (though 96k ain't pitiful) but in my neck of the woods competition is fierce. I know of some stale new grads who now may never get hired because of having zero experience.

Any NP experience is better than no NP experience.

Realistically, the "eat your young" thought is a tad over stated in this circumstance.  I think we all recognize there are clinics are severely undervaluing our training and revenue generation.  And in reality many of us are maybe supplementing MD salaries who are literally seeing the same number of patients per day, yet somehow making much more than the 15% premium their reimbursement commands. 

Our wages come under fire from a number of ways:

1. Oversaturation allowing employers to dictate their own terms of wages because simply put; they have a number of applicants for significantly fewer spots.

2. NPs not knowing their value or the revenue they could be generating; thus taking the first offer.

3. Poor negotiation skills often influenced by Nursing traditionally being a billet spot that follows rigid hospital pay structures that are granted by experience and little room for negotiation.

4.  New NPs (specifically pipeline NPs) who compare their wage to what they would have made as a new RN (vastly miscalculating their perceived value). The "40 bucks an hour is twice the rate I would have made without my MSN" mentality.  

The problem is at least alleviated from both educating new NPs and persistently advocating for people to understand what they are worth.  It is also important that more states grant further autonomy that may allow NPs to go alone in circumstances where the clinics won't meet their pay expectations. That avenue isn't for everyone, but it may clear the clinic space of the NP glut and improve wages as fewer are in a spot where they HAVE to accept less than.

I don't frown on new NPs taking jobs in the 90s or something less if it is some form of residency, there are bonuses for hitting goals, or there is an expectation that within a year either the salary or the bonuses will reflect the volume they are seeing.  Not all new NPs (or sometimes even experienced) will see 20-30 patients a day right from the start.  Most clinics expect the first year or so to be a building year for that provider's practice. Some are more lenient with their initial offers while others don't want to be.  I don't begrudge them for them wanting to minimize loss.  There is a give and take on all sides. 

FullGlass, BSN, MSN, NP

2 Articles; 1,718 Posts

Specializes in Psychiatric and Mental Health NP (PMHNP).
8 hours ago, ThePrincessBride said:

It is a new grad residency program. If you have zero NP experience, you get 70k plus bonus. If you have one year experience, it is 80k plus bonus.

$70K for a new grad RESIDENCY program is excellent!  What do you think MD residents make?  They don't make much, either.  

Personally, I think a lot of NPs have an overinflated sense of what a new grad NP is worth.

It can be perspective and load. Imo a new NP should be able to see 10 patients a day minimum starting. Depending on level of care, that’s easily 190k a year brought into the clinic. Not factoring in the likelihood that their load will increase throughout that time. So depending on the overhead, 100k a year is an easy target even for a new NP. Sadly things like billing and revenue are rarely covered in school and I make a point to bring it up to my students to be aware of. If it’s an honest residency where there is a level of education and appropriate number left with hands on oversight, 70k is great. But some can be deceiving and they use you in the same capacity as a standard provider. 

FullGlass, BSN, MSN, NP

2 Articles; 1,718 Posts

Specializes in Psychiatric and Mental Health NP (PMHNP).
2 hours ago, djmatte said:

It can be perspective and load. Imo a new NP should be able to see 10 patients a day minimum starting. Depending on level of care, that’s easily 190k a year brought into the clinic. Not factoring in the likelihood that their load will increase throughout that time. So depending on the overhead, 100k a year is an easy target even for a new NP. Sadly things like billing and revenue are rarely covered in school and I make a point to bring it up to my students to be aware of. If it’s an honest residency where there is a level of education and appropriate number left with hands on oversight, 70k is great. But some can be deceiving and they use you in the same capacity as a standard provider. 

MD residents make about $60K per year.  Their salary is paid by Social Security.  There is no way NP residents are going to make more than that.

https://www.ama-assn.org/residents-students/resident-student-finance/6-things-medical-students-should-know-about-physician#:~:text=As a physician%2C you will,training year rather than specialty.

Specializes in Psychiatry.
23 minutes ago, FullGlass said:

MD residents make about $60K per year.  Their salary is paid by Social Security.  There is no way NP residents are going to make more than that.

https://www.ama-assn.org/residents-students/resident-student-finance/6-things-medical-students-should-know-about-physician#:~:text=As a physician%2C you will,training year rather than specialty.

I mean, the VA Medical Center has numerous official NP residency program in almost every state. They are one year long, take 3-5 residents per year, and provide a combination of full-time work experience combined with mentorship and enhanced didactic. They are what NP school clinical hours should look like and end up helping a new graduate gain an extra 2,000+ supervised hours. 

 

They have full benefits, health insurance, vacation, and often pay between 70-85K depending on the specific VA despite the fact that you spend 1-2 days per week doing didactic.

Specializes in CCRN, CPAN.

It is nearly impossible to find an NP job in Southern California for a new grad starting out. I've been out of school for 3 years now, worked 1 year perdiem in an Urgent care where I was the only provider on site as a new Grad. The physician that owns the practice has 5 clinics, with one NP or PA at each clinic,  and requires the provider to  call him with each patient and come up with a plan of care. This is very inefficient and a big patient dissatisfier. There were other unsafe practices in that clinic that could have potentially put my license on the line, so I quit and have not been able to find a job since and now I think too much time has gone by.  Every job interview I've been on, wants the NP to have experience, and be ready to see patients with out any kind of mentor-ship or orientation period. In school, the student is left to find their own preceptor, which is very difficult and very few NP's are willing to take students. Some physicians are willing, but  they don't really take interest and ownership in teaching. I don't feel my school adequately prepares students for readiness to work.  I think residency programs would really help, but none around my area. I'm feeling very sad and discouraged about this. It was not what I expected.  The schools need to do a better job in education and preparing the student for the work force. Current NP's need to be supportive of new NP's and we need residency programs. I think live classroom with access to clinical rotations it best.

Specializes in Psychiatry.
3 minutes ago, C.Love said:

It is nearly impossible to find an NP job in Southern California for a new grad starting out. I've been out of school for 3 years now, worked 1 year perdiem in an Urgent care where I was the only provider on site as a new Grad. The physician that owns the practice has 5 clinics, with one NP or PA at each clinic,  and requires the provider to  call him with each patient and come up with a plan of care. This is very inefficient and a big patient dissatisfier. There were other unsafe practices in that clinic that could have potentially put my license on the line, so I quit and have not been able to find a job since and now I think too much time has gone by.  Every job interview I've been on, wants the NP to have experience, and be ready to see patients with out any kind of mentor-ship or orientation period. In school, the student is left to find their own preceptor, which is very difficult and very few NP's are willing to take students. Some physicians are willing, but  they don't really take interest and ownership in teaching. I don't feel my school adequately prepares students for readiness to work.  I think residency programs would really help, but none around my area. I'm feeling very sad and discouraged about this. It was not what I expected.  The schools need to do a better job in education and preparing the student for the work force. Current NP's need to be supportive of new NP's and we need residency programs. I think live classroom with access to clinical rotations it best.

Sad to hear this. There is a residency program in primary care in West LA you could apply to?

irvine123

55 Posts

5 minutes ago, C.Love said:

It is nearly impossible to find an NP job in Southern California for a new grad starting out. I've been out of school for 3 years now, worked 1 year perdiem in an Urgent care where I was the only provider on site as a new Grad. The physician that owns the practice has 5 clinics, with one NP or PA at each clinic,  and requires the provider to  call him with each patient and come up with a plan of care. This is very inefficient and a big patient dissatisfier. There were other unsafe practices in that clinic that could have potentially put my license on the line, so I quit and have not been able to find a job since and now I think too much time has gone by.  Every job interview I've been on, wants the NP to have experience, and be ready to see patients with out any kind of mentor-ship or orientation period. In school, the student is left to find their own preceptor, which is very difficult and very few NP's are willing to take students. Some physicians are willing, but  they don't really take interest and ownership in teaching. I don't feel my school adequately prepares students for readiness to work.  I think residency programs would really help, but none around my area. I'm feeling very sad and discouraged about this. It was not what I expected.  The schools need to do a better job in education and preparing the student for the work force. Current NP's need to be supportive of new NP's and we need residency programs. I think live classroom with access to clinical rotations it best.

90 Percent of NP schools do not prepare students. If you have been in at a clinic with other PA's or MD/DO students you would know that most NP's don't know much. It is embarrassing and will lead to the role of the NP meaning nothing in due time. If the AANP, ANCC and state boards do not enforce certain entrance exams for schools and make the board exams more stringent this will lead to NP's becoming a joke. Especially when you have around 30000 students graduating each year compared to 7000 PA's.

Specializes in CCRN, CPAN.
13 minutes ago, MentalKlarity said:

Sad to hear this. There is a residency program in primary care in West LA you could apply to?

I wish I lived close to LA, I'm a few hours away. I'm still curious about the program though. My friends in the LA area found better job opportunities.

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