Members are discussing negotiating salaries as new Nurse Practitioners, the importance of building relationships with physicians, the value of sharing salary information for negotiation, the impact of pursuing a Doctor of Nursing Practice degree on earning potential, and the reputation of certain online schools for nurse practitioner programs. Additionally, members are seeking advice on transitioning to a career as an NP, the differences between working in a community clinic versus a hospital, and the potential for career advancement in the field.
My reasons why I question going for a Nurse Practitioner license.
Working with some seasoned nurses in the ER over the last couple of years, they make more than starting NP's do.
Two doctors and a nurse who did recruit and hiring for a couple of years all stated that it was not worth it.
If I don't jump on the bandwagon right away...the rumors of the dreaded 2015 DNP may come true
The Drawbacks:
Increased liability without enough pay
Overworked and underpaid for their work. In our ER, the PA's do most of the work while the physicians kick back
PA's are preferred in hospital settings (which is my major interest...though I'm sure an office setting will be great later in life)
Again...financial. They did not agree that 2.5 years of schooling was worth a mediocre increase in salary (even long term). They collectively felt that working a 4th 12hr shift each week was better than spending another 2.5 years an lots of money for an NP degree.
The Positives:
Increased autonomy
I can do a full time NP program and still work
There are 2 great NP programs near me (TWU and UTA)
I believe I can get in without to much hassle
In state tuition is affordable
Self satisfaction
I understand that financial compensation is not all there is to a job though it is a necessity. Increased autonomy is very important to me and the main reason I would like an advanced practice degree. Med school would be great, but being hundreds of thousands of dollars in debt and taking 4 years off is not appealing to me.
So to the current NP's...
Would you NOT get your degree if you had to do it again?
Was it worth it more than just personal satisfaction?
What do you get 1 hr per 1 patient? That's not fair comparison. We do not have easier job at all. FNPs do not deal with lengthy documentation and trying to get patient with poor historian b/c of psychosis/tangential thoughts/ manipulation to give you needed info. They do not get yelled at. They do not have to call family for collateral info or dig into the chart for more information. They do not walk the grey line of suicide assessment. That's what the extra time assessment time is for. Psych is not as great as people think. Glass (you mean grass don't you?) may seems to be greener on the other side with exaggeration.
That's what we want you to think. Actually primary care sees more psych patients and prescribes more psych meds. They are also more likely to hear of SI. Even at my location most suicidal patients present to the ED so the ED doc gets them first. I get 30 minutes for rechecks and 1 hour for initial assessment. This is ample time to get a great history and really find out about the patient. Any psychosis/tangential thoughts/manipulation is considered by us to be much less distasteful than treating snotty nose kids or sticking our finger up someones butt. It's what we do so we can handle it. We can bill and get paid for review of records so that's no problem. I dictate so my documentation is not an issue. I'm never behind with it. Life is so sweet...and my salary is so big.
Hahaha. Any time someone posts on here that psych is a good specialty I know a post from harmonizer insisting that psych sucks will soon follow. I think it really depends on your location. Where I am (west coast), psych looks pretty great in terms of job opportunities and pay, even for new grads. After talking to professors, employers, current psych NPs (including new grads), and students from my institution and in my area, it sounds like psych is a great career move. :)
Also, people I know in primary care get yelled at all the time, deal with drug seekers, feel the pinch of a 15 minute visit, deal with SI, charting nightmares, etc. I'm not sure any specialty area is immune from these scenarios.
What do you get 1 hr per 1 patient? That's not fair comparison. We do not have easier job at all. FNPs do not deal with lengthy documentation and trying to get patient with poor historian b/c of psychosis/tangential thoughts/ manipulation to give you needed info. They do not get yelled at. They do not have to call family for collateral info or dig into the chart for more information. They do not walk the grey line of suicide assessment. That's what the extra time assessment time is for. Psych is not as great as people think. Glass may seems to be greener on the other side with exaggeration.
Huh? Digging for collateral, gathering information and synthesizing into a plan to help a client is what I actually enjoy about my job. Now getting yelled at, cursed at.... not the happiest moments. Then again I was a psych RN and am used to it. I have much respect for the FNP's out there. They are busting their butts daily and providing great care. I prefer FNP (ANP) over an MD as my own PCP any day of the week!
That's what we want you to think. Actually primary care sees more psych patients and prescribes more psych meds. They are also more likely to hear of SI. Even at my location most suicidal patients present to the ED so the ED doc gets them first. I get 30 minutes for rechecks and 1 hour for initial assessment. This is ample time to get a great history and really find out about the patient. Any psychosis/tangential thoughts/manipulation is considered by us to be much less distasteful than treating snotty nose kids or sticking our finger up someones butt. It's what we do so we can handle it. We can bill and get paid for review of records so that's no problem. I dictate so my documentation is not an issue. I'm never behind with it. Life is so sweet...and my salary is so big.
Amen brother! Preach on!
(not sure about billing for review of records at least where I've worked but I agree with everything else)
Interesting thread. Short answer, yes, it is absolutely worth it. I have an independent practice with complete autonomy. I work 3/4 time and earn in the neighborhood of $140K. I make my own hours, come and go as I please.
I personally hate my psych patients, lol. I groan when I see chief complain "depression" or anxiety." I can not stand needy whiners. I'd rather do a DRE any day! Let's get it over with, you go on your way and we do not ever speak of it again, right? I do not want to have to see you and hear about your sucky life and stupid imaginary problems every month for the next year. (Google the Bob Newhart youtube video "Stop It") In that sense, psych NP would be highly preferable to FNP because I suspect most of Zen's patients have genuine behavioral health problems vs. just a failure to cope with normal life challenges, which is mostly what I see labeled as "anxiety" and "depression." Suck it up Buttercup. Get some exercise, get some perspective. A prescription is not going to fix what ails you.
I do get yelled at occasionally, but here is the thing: I am there to treat a medical condition, no to pander to them or enable them. When people are inappropriate, I get up and walk out. The visit is over and I won't see them again.
I do see a variety of fascinating things and meet a lot of very interesting people, most of whom are very pleasant. I really love seeing patients that do what they are supposed to do and whom make good progress toward goals. I don't like seeing people that don't follow directions/advice, make no lifestyle changes. I usually cut them loose after a year of no progress. They need to find someone that inspires them to make healthy life change, if I can't I'm not the right provider for them. I 'm not going to just keep writing scripts for the same conditions if they won't even try to do anything for themselves. Besides, they get tired of hearing me harp on the same things and are ready to be done with me too, lol.
29/30 days work pass by pleasantly and without unexpected complications. Most of my grief comes from insurance companies. The words "prior authorization" sometimes make my blood boil, lol. My least favorite part of the job is paperwork. I can't stand filling out FMLA paperwork and endless forms for nursing homes, home health, physical therapists, etc, but at least I can bill for it. I take a half day a week to do nothing else and I don't enjoy that day very much, but it must be done. I usually treat myself to a nice lunch to give myself something to look forward to that day.
I like 75% of my patients, my career trajectory, , my day to day office life, my colleagues and my salary. I'd do it all again.
And I spent 20 mins on the phone with an insurance company yesterday who was refusing to pay for a standard of care, while three people waited in rooms.
That is precisely why I only do them one day a week Boston. I can't keep people waiting for that sort of thing, it isn't fair to them or me. I do paperwork on Thursdays only. I have actually had patients drop things off and ask for it the next day . They actually think I'm going to take it home with me and do it that night. As if. A two week turn around is promised and delivered, every time. Life threatening emergencies and telephone calls from other providers (professional courtesy) are the only reason I deviate from the schedule. I don't even take calls from my own kids, lol! If that means someone has to wait longer for their million dollar med or their "free" power chair from the dog blazed Scooter Store (those people all ought to be in jail for fraud IMO), so be it. The upside is, no one waits for their appointments, because I stay on time! I had one patient "fire" me because I couldn't promise to complete her workman's comp paperwork in less than a week. You can guess how heartbroken I was about that.
I know I'm extremely late getting to the party on this one, but here goes.
It all depends on where you are. I am an NP in the worst state to practice in. (Alabama). I am also in the largest city, (Birmingham) which happens to have 2 universities pumping out NP's almost on a monthly basis. The market for us is not good here and due to the limitations the state puts on us, it makes practicing extremely difficult. My wife and I went to NP school together and have struggled over the past year since graduating NP school. I currently do contract work for a large insurance provider, that is zero challenge and zero clinical use. I worked for an orthopedic straight out of NP school, but he had no idea how to use an NP and I left d/t the fact of spending over half of my time each week on the phone talking to patients about MRI results or listening to them explain to me why a 30 day supply of Lortab only lasted 10 days. Not a good use of my time or education. I'm not saying I'm above doing this job, I have done a lot harder work for a lot less money. I'm just saying I did not spend 2 1/2 years of my life and more/less a second mortgage on a graduate degree to sit on the phone 4 hours a day when you could have an RN or even a medical technologist handle what needed to be done.
Another thing I learned, and I have heard this from well seasoned NP's as well. Finishing NP school is a lot like finishing RN school. You have a lot of knowledge, but you have to learn how to apply it. From there you grow into a well educated RN. Unlike the hospital that has an orientation program to bring you up to speed as a new nurse, I have yet to find an NP situation like that. I'm sure there are some out there, but the dealings I have had, doctors have "thrown you to the wolves" and it is sink or swim time. Not a very comfortable situation. Doctors are people just like you and me and they all have their "own" personalities. Some are excellent teachers and others couldn't tell you how to pour **** out of a boot with directions on the heel. If you go through with it, or have gone through with pursuing NP school. The kicker is finding a good physician that will take the time to bring you up to speed. Just like becoming a good RN and getting comfortable takes a couple of years. Becoming a comfortable NP is about the same.
Is there any way of you guys moving? That does sound horrible. I work in an independent practice state with great opportunities but have gotten the sink or swim type orientation. I was use to it since I was a travel RN for a good portion of my RN career just wish there was of an orientation since I was coming from a different state. Alabama sounds horrible.
I do not want to have to see you and hear about your sucky life and stupid imaginary problems every month for the next year. (Google the Bob Newhart youtube video "Stop It") In that sense, psych NP would be highly preferable to FNP because I suspect most of Zen's patients have genuine behavioral health problems vs. just a failure to cope with normal life challenges, which is mostly what I see labeled as "anxiety" and "depression." Suck it up Buttercup. Get some exercise, get some perspective. A prescription is not going to fix what ails you.
zenman
1 Article; 2,806 Posts
That's what we want you to think. Actually primary care sees more psych patients and prescribes more psych meds. They are also more likely to hear of SI. Even at my location most suicidal patients present to the ED so the ED doc gets them first. I get 30 minutes for rechecks and 1 hour for initial assessment. This is ample time to get a great history and really find out about the patient. Any psychosis/tangential thoughts/manipulation is considered by us to be much less distasteful than treating snotty nose kids or sticking our finger up someones butt. It's what we do so we can handle it. We can bill and get paid for review of records so that's no problem. I dictate so my documentation is not an issue. I'm never behind with it. Life is so sweet...and my salary is so big.