I've been an NP for a while, and I am happy and proud to be one. I am well aware of both our shortcomings and our successes. I think we fill a need in the world of healthcare, and "going to see my NP" has become a normal phrase in American households.
For all of our successes, we seem to have a problem with consistently selling ourselves short when it comes to compensation. I have been reaching out to colleagues and previous students, and I have also been serving as a mentor for some new NP graduates looking for advice. As they navigate positions, one common theme is they do not know how much they are worth, and do not understand that as a provider they are revenue producers! We should be paid as such!
Case in point: last week I had a new graduate FNP telling me about a job in a specialty office she intended to accept. She told me she was satisfied with the salary and benefits and shared them with me. It turned out to be a salaried position at $96K annually working 8 AM to 5 PM five days a week. Vacation was 2 weeks paid going up to 3 weeks after FIVE years. It included all the usual benefits but there was no 401K match and no CME.
Sometimes I feel like nurse practitioners are not being taught about healthcare economics at all. Maybe instead of 4-5 classes on research and "NP roles" we should be teaching a dedicated course on billing and reimbursement? I see NP after NP working for peanuts while the practice that employs them is making hundreds of dollars per hour off of their work. The long-term effect, of course, is that all NP salaries will start to flatten out. Those that do the research and demand a salary that reflects what they bring to the practice will be laughed out the door while those who do not know their worth will end up taking their place.
Does anyone else notice this in the NP world? What can we do to bring awareness to it? Let's Discuss! ?
What is all this belly-aching about pay? My goodness, a potential NP should know their earning potential in their desired area.
My first NP job as new grad in rural CA - $125K first year in a VERY low cost of living area (rented a 2BR house for $750 a month!). Second NP job 18 months later - $150K+ per year in a major metro area. Oh, and I didn't have the RN experience some of you mistakenly think is required for a primary care NP. Yes, I took a first job in an area many would consider undesireable, but the experience was incredible.
There are many rural areas in this country desperate for providers, and many of them are within a 1 hour drive of a city! My goodness, if you want this career bad enough, a long commute for 1-2 years is hardly unreasonable, especially in the West.
People, grow up and put on your big boy or girl pants!
I have NO sympathy for NP new grads who whine they can't get a great-paying job in exactly the right location. Too bad.
This harshness is the last thing any NP needs to be hearing in this climate. We need to be more encouraging. Yes, this market is very difficult especially if you've been an RN for 30plus years. Im not able to relocate, but willing to travel, interviewed a lot and never got hired. And, I notice that the more I read this blog the more discouraged I get. I also noticed while in school the lack of support from the NP community. How can we thrive if we are not supportive?
This harshness is the last thing any NP needs to be hearing in this climate. We need to be more encouraging. Yes, this market is very difficult especially if you've been an RN for 30plus years. Im not able to relocate, but willing to travel, interviewed a lot and never got hired. And, I notice that the more I read this blog the more discouraged I get. I also noticed while in school the lack of support from the NP community. How can we thrive if we are not supportive?
I thought the same thing! Good grief. We’re on the same team here.
This harshness is the last thing any NP needs to be hearing in this climate. We need to be more encouraging. Yes, this market is very difficult especially if you've been an RN for 30plus years. Im not able to relocate, but willing to travel, interviewed a lot and never got hired. And, I notice that the more I read this blog the more discouraged I get. I also noticed while in school the lack of support from the NP community. How can we thrive if we are not supportive?
If the room is cold and all you do is complain and look to people to support the complaint by chiming in to validate the cold room...but then a person or two says to get up and turn on the heater, are they not supportive? Offering a possible solution is just as supportive if not more supportive then just saying “it’s cold this sucks”. It’s not as easy to hear though.
I took the AANP exam last month and was surprised how simple it was. It was kinda ridiculous that most of the questions were one liners and just asked you to remember facts, very little critical thinking involved. Which is a reason why the NP profession is going downhill with so many online diploma mills where anyone can just grab a degree, now to your point about NP's undervaluing themselves, its because we are undervalues, there so many of us and anybody that studies a test bank can pass the tests, thats how easy it was. LOL and Doctors and PA's know this and is quite embarrassing especially in clinicals when I saw other NP's didn't know how to do a McMurray test.
Not knowing the advanced assessment skills can be traced entirely back to the school. I had to look up the advanced assessment skills on my own, particularly in orthopedics, in order to learn them through videos online when I was taking our advanced health assessment course. That's even for my school that has on-campus skills labs, as they only focused on the basic essentials for a primary care assessment. There was a big focus on teaching how to cram everything into the 15-minute time slot.
Not knowing the advanced assessment skills can be traced entirely back to the school. I had to look up the advanced assessment skills on my own, particularly in orthopedics, in order to learn them through videos online when I was taking our advanced health assessment course. That's even for my school that has on-campus skills labs, as they only focused on the basic essentials for a primary care assessment. There was a big focus on teaching how to cram everything into the 15-minute time slot.
We had a good assessment class and very strict on passing. University of Phoenix at the time was live classroom, but they were terrible at the clinical portion, our assessment class was good. Actually the live models were very helpful for the uncomfortable exams. I still think a residency program for the first year after program completion is the way to go, and I'll be we start seeing more of those around.
If the room is cold and all you do is complain and look to people to support the complaint by chiming in to validate the cold room...but then a person or two says to get up and turn on the heater, are they not supportive? Offering a possible solution is just as supportive if not more supportive then just saying “it’s cold this sucks”. It’s not as easy to hear though.
True, but if the person keeps trying to warm the room and every time they try to get to the heater there is yet the same obstacle that keeps getting in the way and they keep trying and trying while obtaining advice and genuine support from the others who have been in the same situation or who were more successful at getting the room heated, it gets discouraging. It would take wisdom on how to impart advice, so it's good to know who you can trust, someone who is kind, wise and not harsh or arrogant.
We had a good assessment class and very strict on passing. University of Phoenix at the time was live classroom, but they were terrible at the clinical portion, our assessment class was good. Actually the live models were very helpful for the uncomfortable exams. I still think a residency program for the first year after program completion is the way to go, and I'll be we start seeing more of those around.
I was glad my program included the professional models and even standardized patients for us to learn with. Many programs out there do not have any of these experiences at all. We also had time with the cadaver lab, suturing, microscopy, and radiology. When they merged with a state college, the state college is already talking about trying to get rid of these on-campus offerings to cut costs. They didn't offer them to their DNP students. Our MSN program brought them with us and fought to keep them in the program and several of the DNP students actually switched to the MSN program after the merge. Of course, they're talking about cutting these needed parts of the program again now. I don't object to a residency at all. Schools would also do well to stop tying their MSN NP programs to their MSN nursing admin programs and instead look to modeling after our colleagues in the CRNA programs. These programs are meant to educate future advanced practice practitioners who will be managing patient care. The actual application of skills should be included.
Specializes in Psychiatric and Mental Health NP (PMHNP).
On 4/18/2021 at 1:16 PM, HarleyvQuinn said:
Not knowing the advanced assessment skills can be traced entirely back to the school. I had to look up the advanced assessment skills on my own, particularly in orthopedics, in order to learn them through videos online when I was taking our advanced health assessment course. That's even for my school that has on-campus skills labs, as they only focused on the basic essentials for a primary care assessment. There was a big focus on teaching how to cram everything into the 15-minute time slot.
A new grad NP is not expected to know advanced orthopedic assessment. The truth is, these issues will be referred to ortho. Some places will offer OJT. Or you can take a seminar for CE on orthopedic assessment.
What exactly is advanced orthopedic assessment? There’s a range of tests that are easily handled in the primary care arena before ortho is even involved. Knees, shoulders, hips, and back especially have a range of tests and maneuvers that can help narrow differentials down. These are things we covered in our checks before we started clinical. Positive findings can guide us toward imaging, pt, or both without even needing specialty involvement. At the very least, things like lachman tests, Hawkins test, empty can test, straight leg raise, etc are basic graduate level knowledge. Some May not do them regularly, but I’m unsure what exactly is more advanced assessment wise. The only thing I like ortho for is if the patient needs surgery or more advanced imaging than X-rays where I’m expecting surgery to be the likely therapy.
Specializes in Psychiatric and Mental Health NP (PMHNP).
10 hours ago, djmatte said:
What exactly is advanced orthopedic assessment? There’s a range of tests that are easily handled in the primary care arena before ortho is even involved. Knees, shoulders, hips, and back especially have a range of tests and maneuvers that can help narrow differentials down. These are things we covered in our checks before we started clinical. Positive findings can guide us toward imaging, pt, or both without even needing specialty involvement. At the very least, things like lachman tests, Hawkins test, empty can test, straight leg raise, etc are basic graduate level knowledge. Some May not do them regularly, but I’m unsure what exactly is more advanced assessment wise. The only thing I like ortho for is if the patient needs surgery or more advanced imaging than X-rays where I’m expecting surgery to be the likely therapy.
We learned some of the maneuvers and tests like Lachman, but there are a boatload and a new grad or primary care NP is generally not expected to know all of them. My mentor on my first job (primary care) was an MD who did an ortho residency at Mayo Clinic and he said there was no need for all primary care providers to know all of these. The reason is that if there is joint pain, you do a basic PE and then send for appropriate imaging. If there is a problem, you are likely going to send them to ortho and/or PT anyway, and they are going to perform advanced ortho assessment. At least that's the way we did it.
Specializes in Psychiatric and Mental Health NP (PMHNP).
On 4/17/2021 at 4:30 PM, C.Love said:
This harshness is the last thing any NP needs to be hearing in this climate. We need to be more encouraging. Yes, this market is very difficult especially if you've been an RN for 30plus years. Im not able to relocate, but willing to travel, interviewed a lot and never got hired. And, I notice that the more I read this blog the more discouraged I get. I also noticed while in school the lack of support from the NP community. How can we thrive if we are not supportive?
I am not being harsh. I am being realistic.
One of the great things about a nursing career is flexibility. NP is NOT the only path for RN advancement.
Southern California, especially San Diego County, is a very tough job market for ALL healthcare professionals, including MDs. San Diego County tends to pay less than other parts of California, as well, and that goes for MDs, too. I think the reason is that it is a beautiful place to live, so a lot of people want to live there. In addition, due to the heavy military presence, there are a lot of military spouses that are healthcare professionals. Finally, a lot of military folks retire there, and many are in their late 30s or early 40s, and that includes a lot of healthcare professionals who are ex-military. This leads to excess supply versus demand. That means jobs are harder to find and pay less.
It is easier to find a job in the LA area than in San Diego County.
I previously suggested this, but here is what you can consider:
1. Moving to an area with a lower cost of living and that likely will have higher pay.
2. Finding a job within a 4 or 5 hour drive that allows you to do 4 ten-hour days or 3 twelves, then rent a room where you work and commute home on weekends for 1-2 years.
3. Look for a job within a 1.5 hour drive of where you live and do a long commute for 1-2 years. In SoCal, a lot of people have commutes this long or longer.
There may have to be some short-term pain in order to obtain long-term gain.
The past year, the job market for NPs has generally sucked due to COVID. Many RNs, NPs, MDs, have been laid off, but the job market is picking back up again as life returns to normal.
You may also wish to research Health Professional Shortage Areas (HPSAs). Find HPSAs within your commuting area and focus job search there.
Don't just look at job listings. Make a list of all the possible employers in your area and apply even if they don't have a job listing. Federally Qualified Health Centers (FQHCs) are a good option.
HRSA has virtual job fairs. Google this. They occur about every 3 months and have employers from all 50 states. Attend and apply to any in your area, whether or not they have active openings.
Finally, due to COVID, there are more telehealth providers for primary care. Telehealth is well-suited to many patients for certain conditions. This means an NP can work remotely. Research such companies and apply to them. You could obtain an NP license in FPA states in order to make it easier to work for such companies.
The harsh reality is that it may be necessary to make some sacrifice for the first NP job. Once you have 1-2 years of experience, it will be MUCH easier to get a job.
One of the great things about a nursing career is flexibility. NP is NOT the only path for RN advancement.
Southern California, especially San Diego County, is a very tough job market for ALL healthcare professionals, including MDs. San Diego County tends to pay less than other parts of California, as well, and that goes for MDs, too. I think the reason is that it is a beautiful place to live, so a lot of people want to live there. In addition, due to the heavy military presence, there are a lot of military spouses that are healthcare professionals. Finally, a lot of military folks retire there, and many are in their late 30s or early 40s, and that includes a lot of healthcare professionals who are ex-military. This leads to excess supply versus demand. That means jobs are harder to find and pay less.
It is easier to find a job in the LA area than in San Diego County.
I previously suggested this, but here is what you can consider:
1. Moving to an area with a lower cost of living and that likely will have higher pay.
2. Finding a job within a 4 or 5 hour drive that allows you to do 4 ten-hour days or 3 twelves, then rent a room where you work and commute home on weekends for 1-2 years.
3. Look for a job within a 1.5 hour drive of where you live and do a long commute for 1-2 years. In SoCal, a lot of people have commutes this long or longer.
There may have to be some short-term pain in order to obtain long-term gain.
The past year, the job market for NPs has generally sucked due to COVID. Many RNs, NPs, MDs, have been laid off, but the job market is picking back up again as life returns to normal.
You may also wish to research Health Professional Shortage Areas (HPSAs). Find HPSAs within your commuting area and focus job search there.
Don't just look at job listings. Make a list of all the possible employers in your area and apply even if they don't have a job listing. Federally Qualified Health Centers (FQHCs) are a good option.
HRSA has virtual job fairs. Google this. They occur about every 3 months and have employers from all 50 states. Attend and apply to any in your area, whether or not they have active openings.
Finally, due to COVID, there are more telehealth providers for primary care. Telehealth is well-suited to many patients for certain conditions. This means an NP can work remotely. Research such companies and apply to them. You could obtain an NP license in FPA states in order to make it easier to work for such companies.
The harsh reality is that it may be necessary to make some sacrifice for the first NP job. Once you have 1-2 years of experience, it will be MUCH easier to get a job.
C.Love, MSN, NP
48 Posts
This harshness is the last thing any NP needs to be hearing in this climate. We need to be more encouraging. Yes, this market is very difficult especially if you've been an RN for 30plus years. Im not able to relocate, but willing to travel, interviewed a lot and never got hired. And, I notice that the more I read this blog the more discouraged I get. I also noticed while in school the lack of support from the NP community. How can we thrive if we are not supportive?