a. I accepted a once per week job doing PRN disability exams on Sunday's. I signed a contract as a 1099 worker that did not specify any damages for breech, but said I could be terminated if my exams were not up to industry standard. It takes up to six weeks to get paid.
b. My "main job" was to pay me a 10K bonus which they concluded I was not in fact eligible for and will not be paid. Since I was "counting" on this income until my PMHNP practice was built up I am forced into the position of finding "part time" work. Thus, I was offered a Psych RN position on Friday, Saturday, and Sunday at $57.00 per hour. This would more than "pay the basic bills" until my practice on Monday, Tuesday and Thursday filled up.
c. I wrote the "disability exam" place and stated that I would not be able to start next Sunday week for the above reason (I need to earn money to pay my bills I need cash flow). I literally only have money for one more month's rent. They said I didn't have "an emergency" I pointed out that not only was I going to go late on my credit cards (for the first time in over a decade), but that I literally faced being homeless if I did not generate cash flow.
d. They stated they would pay me 50% of the $110 per exam when the exams were performed (the rest later), but that they considered me under an "ethical/legal" obligation" to perform all shifts signed up for (through the end of May) unless they could find a replacement (these exams are located all around the state of Washington). Furthermore, they said since patients have been scheduled for these appointments that failure to perform the exam would result both in civil litigation (for damages without regard to what the contract says which does not specify damages) and direct action against my license. They said that "unlike being an RN your obligation starts when you agree to do the exam" since I pointed out that as an RN the obligation started once you had accepted report.
e. I said that while I disagreed with their perspective (specific performance to perform work is generally considered to be a 13th Amendment violation which is why you can force someone into a Chap Seven, but not a Chapter 13 bankruptcy, basically you would be requiring them to work to pay their debts and this had been found to be unconstitutional in most cases-child support being a noted exception). Still, I pointed out that I had moved from Florida to Washington and did not even have the resources for an attorney so I would "go along" as they don't seem to be giving me a choice. I re-read my contract and there is nothing about damages for non performance. But that doesn't mean they couldn't take action against me anyway or with the Washington State Board (especially since they are a contractor to do disability exams for the state of Washington).
f. What if someone became ill or their spouse or child suffered a situation or they found they just couldn't do the job? Would they face sanction against their NP licenses? If someone can be held on the hook for disability exams three months down the line it seems a bit like involuntary servitude. Part of me just wants to "shut up and take what's due me for a poor decision", but the other part finds it difficult to take. Still, there is a point that people are expecting to show up starting next Sunday and see someone for their disability exams.
Specializes in Psychiatric and Mental Health NP (PMHNP).
13 minutes ago, myoglobin said:
I’m not sure about the greed part. I just want to be able to take my time with patients and focus on the lifestyle and CAM aporoaches that many MD’s would never let me emphasize. If I make enough to pay my minimums and occasionally take a walk/hike and maybe read a book I’m fairly content. I doubt anyone will ever consider me a great (or perhaps even good) charter but my clients will likely understand that I never give up on anyone and will see virtually anyone even if they cannot pay. Look I just drove 3500 miles over four days (last week) to take jobs that I spent months to get credentialed for, spent thousands, and discussed with numerous individuals. I hope you can understand my being reticent to throw all of that away especially when I have essentially zero leads on a salaried position anywhere close.
You deny greed, but turned down a good FT permanent job in NY because you thought this weird job in Seattle was more money. I don't know what kind of MDs you have met, but the ones I have worked with support proven CAM and lifestyle changes, in primary care and in psychiatry. A responsible NP would choose their first job based on what provides the best learning opportunity at a fair wage. Being a good PMHNP is not just about following algorithms and pushing your personal favorite CAM and lifestyle approaches. It is about doing what is best for the patient and requires developing clinical judgment and intuition, as well as "science" of psychiatry. Now I know why some MDs are so down on NPs.
I appreciate your perspective but would encourage you to consider that there are multiple perspectives as well that may be valid. I would ask that you consider that there are multiple paths to ultimately becoming a reasonable provider. For example I explained how my SO has been a PMHNP since 2016 and started in telepsych with essentially no support. I would argue that she provides top notch care considering the resources she has to use (her clients are mainly Medicaid in Arizona, most with substance abuse issues, and no access to counseling). Also as I previously explained the New York job didn't make an offer for almost two months after I interviewed. They didn't like the fact that I would be moving without my family. By then I was far along the process for the Seattle job. There was also the fact that my SO said that if I took the New York job I could essentially forget her even coming to see me once per month from Oct to May as she doesn't like the cold.
Of course being a good NP is more than about following algorithms and I'm sure there are excellent MD's who understand that. However, many of the ones that I worked with at least in central Florida were forced to see a "mob" of patients in 15 minute intervals for medication management who were often on multiple benzo's, often combined with opioid medications, muscle relaxants, antipsychotics,, and other medications. At my clinical site patients had to often wait two hours to be seen and we literally had to put them by the elevators because our office was so full. My preceptor didn't take a lunch, and usually worked at least one to two hours after close (and the patients still backed up). If your experience has been better then I'm grateful for that. However, it is difficult to imagine the mental health challenges in the Kissimmee Florida area without being here. Having said that I was mainly asking for help with a specific situation with Pontum (could they legitimately hold my license to task for not starting a job). I did read the contract and there was absolutely nothing about notification terms for quitting. The advice that you gave concerning my other jobs while appreciated was non responsive to my main concern. I really like Mindful and they are one of the leading mental health care providers in the greater Seattle area. I also really like LightHeart (the job I hope to work on Friday and Saturday's). True, the bonus issue is unfortunate, and something of a red flag, but to me it doesn't overcome all of the many other positives (great pay, ability to control who I see and for how long, nice working environment, good office support). Again, to me your response would be like a came to the doctor to ask about a sinus infection and instead you're telling me I need to move to Arizona to live out my final days with TB. If I didn't have the "Pontum" issue having Sunday's and Wednesday off to focus on "lagging/learning" issues from my other jobs would be mostly sufficient. Especially, since I have literally nothing else to do here (in Seattle) besides work, and exercise. I don't mind putting in 100 plus weeks toward my job(s).
Specializes in Psychiatric and Mental Health NP (PMHNP).
8 hours ago, myoglobin said:
Again, to me your response would be like a came to the doctor to ask about a sinus infection and instead you're telling me I need to move to Arizona to live out my final days with TB.
These conversations tend to meander. However, while you worry about the disability jobs and ethics, you aren't addressing the root cause of your troubles.
At any rate, from your previous posts on other topics and this thread, you are all over the place and do a lot of things that don't make sense to most of us. You also keep changing your story - first it's all about making money, then you say that's not true and so forth. Your current situation, as described, of working 3 PT jobs, basically, and not being an actual employee is a recipe for disaster for a new grad PMHNP and shows a serious lack of judgment. Previous posts on other topics also show a lack of judgment.
Working 100 hours per week as a new grad NP is not sustainable and is dangerous to your health and also means you will not be able to provide good care to your patients.
You are headed for disaster and I just hope you don't harm any patients in the process. Good luck to you.
These conversations tend to meander. However, while you worry about the disability jobs and ethics, you aren't addressing the root cause of your troubles.
At any rate, from your previous posts on other topics and this thread, you are all over the place and do a lot of things that don't make sense to most of us. You also keep changing your story - first it's all about making money, then you say that's not true and so forth. Your current situation, as described, of working 3 PT jobs, basically, and not being an actual employee is a recipe for disaster for a new grad PMHNP and shows a serious lack of judgment. Previous posts on other topics also show a lack of judgment.
Working 100 hours per week as a new grad NP is not sustainable and is dangerous to your health and also means you will not be able to provide good care to your patients.
You are headed for disaster and I just hope you don't harm any patients in the process. Good luck to you.
I have been a member here for almost ten years and my posts while not perfect stand for themselves. Yes, I am a new NP, but I've been an ICU RN for over a decade. Also, I think I've been clear, I owe alot of money between credit cards and school loans so yes earning a sufficient income is important. I don't think that wanting to pay that down (or at least be able to pay it plus send my SO the money that she came to rely upon when I was working as an RN) is greed it is rather a matter of trying to meet my responsibilities and be in a position financially to meet the ongoing need of my family (and my clients).
I'm not sure why you are so against 1099. the last ten years of my nursing career as an RN have essentially been 1099 (W-2 non-benefitted). Keep in mind that I only want to work ONE part time job. Pontum threatened my license for trying to cancel what would be the SECOND part time job (three jobs total). I would also point out that virtually every resident (dozens to hundreds ?) that I worked with at Osceola Regional over the last five years (since we became a teaching facility) was working almost (or in some cases more with outside employment) 100 hours per week. Having said that my full time job with Mindful and my Part time job(s) with LightHeart would total about 50 hours per week. The additional shifts with Pontum are a challenge (note the disability exams are at least computerized and the records review perfunctory mostly a matter of listing the records you reviewed, the dates, and authors and they are all online and attached to the fill in the blank computer files that I complete for the exam). My point is that I moved not only to make money for bills, but also because it is something of an "immersion" experience. No TV, no friends, no family, I already practice IF only eating in a 4 hour window and I am done with school for now so my ability to dedicate a great deal of time towards work isn't overstated. I'm sure that I will make mistakes with my clients (just last week for example I wrote for Trazodone and didn't realize that it didn't come in 25mg tabs only 50 mg meaning the script had to be modified but at least she was started on CBT-I which is available at Mindful, and Trazadone rather than the Ambien with no therapy which was the norm where I did clinical in school), but I will learn from these mistakes and improve. Also, consider that in the case of many of my clients they have been waiting for ANYONE who can prescribe anything for in some cases over a year. Perhaps, my best efforts will be "worse than nothing", but that is not probable. Also, keep in mind that I have worked through thousands of cases with my SO and will discuss most cases with her individually on a nightly basis (in general terms with privacy protected). Several of the people that I graduated with in 2019 who work in non IP states tell me that they maybe get to talk to their collaborating physician "once" per month if they are fortunate and then it is more about administrative than clinical matters. Also, LightHeart has a DNP in the office next to me and mandatory biweekly clinical meetings. The point being that there are abundant opportunities to improve my practice. Perhaps not completely ideal, but still better than what many have/had (including again my SO who no one but me to consult with when she was new).
I have been a member here for almost ten years and my posts while not perfect stand for themselves. Yes, I am a new NP, but I've been an ICU RN for over a decade. Also, I think I've been clear, I owe alot of money between credit cards and school loans so yes earning a sufficient income is important. I don't think that wanting to pay that down (or at least be able to pay it plus send my SO the money that she came to rely upon when I was working as an RN) is greed it is rather a matter of trying to meet my responsibilities and be in a position financially to meet the ongoing need of my family (and my clients).
I'm not sure why you are so against 1099. the last ten years of my nursing career as an RN have essentially been 1099 (W-2 non-benefitted). Keep in mind that I only want to work ONE part time job. Pontum threatened my license for trying to cancel what would be the SECOND part time job (three jobs total). I would also point out that virtually every resident (dozens to hundreds ?) that I worked with at Osceola Regional over the last five years (since we became a teaching facility) was working almost (or in some cases more with outside employment) 100 hours per week. Having said that my full time job with Mindful and my Part time job(s) with LightHeart would total about 50 hours per week. The additional shifts with Pontum are a challenge (note the disability exams are at least computerized and the records review perfunctory mostly a matter of listing the records you reviewed, the dates, and authors and they are all online and attached to the fill in the blank computer files that I complete for the exam). My point is that I moved not only to make money for bills, but also because it is something of an "immersion" experience. No TV, no friends, no family, I already practice IF only eating in a 4 hour window and I am done with school for now so my ability to dedicate a great deal of time towards work isn't overstated. I'm sure that I will make mistakes with my clients (just last week for example I wrote for Trazodone and didn't realize that it didn't come in 25mg tabs only 50 mg meaning the script had to be modified but at least she was started on CBT-I which is available at Mindful, and Trazadone rather than the Ambien with no therapy which was the norm where I did clinical in school), but I will learn from these mistakes and improve. Also, consider that in the case of many of my clients they have been waiting for ANYONE who can prescribe anything for in some cases over a year. Perhaps, my best efforts will be "worse than nothing", but that is not probable. Also, keep in mind that I have worked through thousands of cases with my SO and will discuss most cases with her individually on a nightly basis (in general terms with privacy protected). Several of the people that I graduated with in 2019 who work in non IP states tell me that they maybe get to talk to their collaborating physician "once" per month if they are fortunate and then it is more about administrative than clinical matters. Also, LightHeart has a DNP in the office next to me and mandatory biweekly clinical meetings. The point being that there are abundant opportunities to improve my practice. Perhaps not completely ideal, but still better than what many have/had (including again my SO who no one but me to consult with when she was new).
I’m sorry, but at this stage, are you trying to justify walking away from a job you committed to, justify to us why you’re keeping a job, or asking something else? Because the initial question of ethics becomes a personal reflection issue more than a what we (This community) thinks issue. Companies may or may not go after your license for a broad range of things and that concern is something you need to sort out with your BoN as has been pointed out multiple times. Ethics is personal. If I committed to a company and they pulled out a previously discussed payment, then I wouldn’t Continue to commit to them. If I choose to be down at one time and still signed a contract, I’d honor my end of that. That’s me because integrity.
So at the end of the day, I’m not sure what you’re looking for. Because as you’ve disclosed some painful and concerning choices in life, you are neither setting yourself up for any empathy or views that you have any real capacity to be the person who should manage the care of others. what exactly are you hoping to gain from this post?
Very simply I was rather shocked when Pontum threatened my license on an ethical basis for wanting to pull out of the disability exams. Shocked to the point where I basically told them “I disagree, but maybe I’m wrong and cannot afford to be wrong so you win I will do my best to do the exams as you request”. However, it continued (continues) to eat at me which is why I posted here. Thus, I thought someone might have experienced a similar scenario that would perhaps shed light upon my situation. If the overwhelming opinion was “there is no way the BON would pull your license for not doing the exams” well then I might tell Pontum “sorry no I will do this week and no more as I need to focus on my main jobs”. I might still worry about a breech of contract lawsuit and what implications it might have for my Liability Insurance rates. But I would worry less. As to whether anyone thinks I “have what it takes” to provide adequate care that is a different matter ( and not a question that I asked for an opinion upon). I have met the requirements for the states of Washington, Florida, Colorado, and Arizona and will do my upmost to provide the best evidence based care of which I am capable. I don’t really care about empathy, sympathy or friendship just perspectives that may improve my ability to make the best decision with Pontum given the less than optimal facts and circumstances. At this point I haven’t walked away from anything. In fact I’m four hours away from Seattle staying in a cheap Airbnb (but with nice cats) and planning on getting up at 0500 to do Pontum’s exams which I will somehow find about 12 hours or more to write up this week and or end up turning in late and at a standard that is less than optimal.
Specializes in Psychiatric and Mental Health NP (PMHNP).
1 hour ago, myoglobin said:
I will somehow find about 12 hours or more to write up this week and or end up turning in late and at a standard that is less than optimal.
And you wonder why I expressed concern over your ability as a provider? These disability exams are very important to the claimants. They are depending on them to get their disability benefits. The paperwork has to be done just right in order for this to happen.
The medical community has moved away from 100 hour work weeks for interns and residents because it was found to be unsafe for the patients, bad for the providers, and was not conducive to learning.
Specializes in Psychiatric and Mental Health NP (PMHNP).
Personally, I don't care if you have bad credit. Lots of people have bad credit for a variety of reasons. It is not a reflection of moral character, contrary to what some self-righteous types like to believe.
I strongly urge you to get into Dave Ramsey's program. I also recommend First Stone Credit Counseling to repair your credit. I used them several years ago and they were very helpful.
I worry about being able to do well on the exams as well which is why I tried to quit the job over a week ago. It would have been one thing to have done the exams when I was only working three 10’s with Mindful (thanks to the bonus money), but quite another with the additional two days with Lightheart. One would think that Pontum would care as well since they have been doing this for almost a decade for the state of Washington and have many, many providers doing these all over the state. At least the disability clients can count on getting the most favorable interpretation of their symptoms that is possible based upon the facts. In general I believe that if someone is sufficiently desperate to apply for disability that they probably deserve it. As for the residents they have often told me that they are scheduled for six 12’s per week with additional call responsibilities and with other coursework are often well over 100 hours per week (this is through UCF) in Florida. Also not to complicate matters further, but I also have a psych RN offer at a place called Wellfound for $57.00 per hour prn working Friday and Sat. in patient from 7pm to 7am (probably less than the 70 percent of insurance that Lightheart they said most of their NP’s earn well over 100.00 per hour once credentialed, would pay and there would be no 3 k advance, and obviously I would have to run afoul of Pontum since Wellfound would need me in two weeks. Still $57 is much more than the 42.00 that I was earning as an ICU RN in Florida)
Also not to complicate matters further, but I also have a psych RN offer at a place called Wellfound
Are you seriously talking about / considering a 4th “job” now? You need an intervention. Something is not right here, you simply cannot be this financially incompetent at your age.
The 4th job would replace the other two it would thus be my second job. I thought that since I was moving across the United States with no friends, family or credit that I at least should have several job opportunities lined up. One reason that I chose Seattle is because of the relative high demand for PMHNP’s, along with RN’s, public transport, and abundant affordable housing (at least when it comes to Airbnb). I also felt that it was possible that the Mindful 10k bonus wouldn’t happen (which I was correct about) and that the Pontum job wouldn’t therefore work. Also Lightheart told me that they couldn’t even start on my insurance paneling until Mindful had first paneled me with their companies. It turns out that they already have me booked with at least 5-10 clients willing to pay cash and their only other prescribing clinician isn’t taking any more clients. I was kind of subscribing to the “in the land of the blind the one eyed hermit can be king” philosophy or at least sufficiently successful to gain experience and pay down debt. Also someone mentioned Dave Ramsey. I’ve probably read and listened to him enough that I could teach one of his courses. However, the fact that my SO (of about 25 years) and I maintain separate finances and have fundamentally different long term goals creates unique challenges to implementing his approach (starting with the fact I won’t work as an NP or RN in Florida and she won’t live anywhere except for Florida since our 19 year old son just started college there).
FullGlass, BSN, MSN, NP
2 Articles; 1,960 Posts
You deny greed, but turned down a good FT permanent job in NY because you thought this weird job in Seattle was more money. I don't know what kind of MDs you have met, but the ones I have worked with support proven CAM and lifestyle changes, in primary care and in psychiatry. A responsible NP would choose their first job based on what provides the best learning opportunity at a fair wage. Being a good PMHNP is not just about following algorithms and pushing your personal favorite CAM and lifestyle approaches. It is about doing what is best for the patient and requires developing clinical judgment and intuition, as well as "science" of psychiatry. Now I know why some MDs are so down on NPs.