I am a new grad NP who took a job as a cardiology NP for a smaller, private practice. My background has been both inpatient and outpatient cardiology for the past 6 years. But obviously this is a new role to which I need to acclimate. I have been here for 5 weeks so far and I really have my misgivings LOL. Not sure if I am crazy, if my experience is the norm or whatever. But this just doesn't seem right.
My first day, right as I walked in, I see mounds of papers on my desk. Patient studies, surgical clearances, device interrogation reports etc. The senior MA placed them there and said that the Dr. said to look them over. I have NEVER given surgical clearances. While I have given test results, the verbiage on these reports are vague and different. And I never really dealt with interrogation reports. And this is where it starts.
From the second day, I have been seeing patients in clinic by myself, with little to no guidance or oversight. Yes, my supervising MD is there, but he is also the owner, so he does business related stuff during clinic. He also comes late and schedules patients before he gets there and I am expected to see them. Even when he is there, I am told how to what to do, but I have no training or instructional time to develop my clinical judgment. At some point, I will expected to make these decisions autonomously, so I need to know the "why?"
Then I find out my credentialing for a local LTACH is complete and I am told I will start going there with another doctor in the practice. I get ONE afternoon and then I am told to go alone. These patients. are medically complex. The supervising MD is available by. phone, but not always right away. And when I do speak with him, his responses to me sound really condescending. Needless to say, of course, I've made a couple of mistakes like contradicting myself in a note and I missed an abnormal result on a study.
I take ownership and I felt awful. Conversely, it is my opinion that like medical errors, there are user (individual) issues and systems issues. Basically I have not been given the adequate training, oversight, and guidance that I believe would lead to success.
I am terrified to think that my hospital credentialing will be complete next month. My greatest fear is that I will be left to my own devices in the inpatient setting. which will lead to more serious errors.
Another big problem of mine is that I am not a good advocate for myself. I either am too timid or come off too aggressively. Any experienced NPs that can help to provide some insight? Is this experience typical for a new grad NP situation? Should I be able to handle this? If this isn't, how do I express my concerns.
Specializes in Tele/Interventional/Non-Invasive Cardiology.
1 minute ago, Numenor said:
I personally advocated my school change its curriculum and I have also personally precepted dozen of NP students (where I pushed fellowships/residencies) in addition to teaching current NPs in a residency program. I have done my part.
I am not crapping on anyone, I am pointing out the obvious. I am not going to close ranks on a money-driven academic pyramid scheme. I am not going to support substandard RNs becoming providers because they hate bedside or they want the provider title while doing the least/ most "flexible" sort of education.
Your ire shouldn't be at me, it should be directed at the myriad of schools across the country and lazy/entitled RNs wanting to be providers all the while putting in the least effort possible.
The NP profession has created a monster where a mediocre RN with an online BSN and a deposit can essentially get into most NPs schools out there. Programs with no on-campus visits, no monitored clinicals and part time (one class at a time) programs to cater to single parents or whatever. Imagine if med schools or even PA schools pulled this stuff. Not EVERYONE is in the needed life position or has the academic/mental fortitude to be a provider.
This affects me because it makes the profession look like a circus. Sucks going into every job having to prove yourself first because the NP who came before you was awful.
First off, I have no ire towards anyone. You commented on MY post. You and others are making broad based assumptions on ALL NPs because SOME, hell I'll even be generous and say a plurality, suck. You mentioned advocating for residencies. That is great. I feel like that residencies should be a mandatory part of NP training. And you are making my original point. Even if you went to Ivy League A+++++ DNP In-Person program, most are not 100% ready to be a provider IMMEDIATELY after school. (nor should you be in my opinion).
It has been well researched that "role transition" is difficult for new NPs across the board. You mention the quality of NP programs/NP students, that is only ONE side of the equation. How about fixing the system that cuts all APPs short of mentoring or additional training, just so more patients can be seen (read: more billing)?
Specializes in Tele/Interventional/Non-Invasive Cardiology.
2 hours ago, Numenor said:
Unless NP and RNs accept that not every RN can be a provider, class sizes to need shrink, standards to increase in every facet possible, clinical hours need to be 2k, residencies need to be required and advocacy groups need to hush for 5 min...all of that "role transition" meaning is just as much fluff as the majority of NP school.
NP programs need to look towards CRNA programs as a first start then go from there.
Role transition is not "fluff." It has also been studied with new grad RNs. The research goes back to the"good old days" before the advent of online learning. In addition, despite all you advocate you cannot change how an employer perceives the NP role or how to utilize an NP. Most employers don't give a rat's behind if you went to Yale, had 5 residencies and studied at the Sorbonne. They only care that are a less expensive way to create revenue. We are NOT physicians and we will NEVER be seen as colleagues due to the healthcare hierarchy. Which is okay, I am not an MD, I realize the limits of my training and I wanted to be a NURSE.
While I agree that clinical standards should be beefed up and nursing "theory" classes should be reduced, I don't think the CRNA model is realistic. First, CRNAs don't do a residency, but they do have more clinical hours and have a more rigorous curriculum, no doubt. However, CRNAs while smart, valuable and much needed, they are not being called upon to meet access to care gaps in rural areas, underserved urban areas, etc. NPs are being tasked with doing this.
This does not excuse diploma mills, direct-entry MSNs, etc. I think that there should be more clinical hours, less "theory classes," certain mandated residency or mentorship, and certain # of hours working under an MD before allowing independent practice.
I am sorry you have come across all these terrible NPs. Not sure if it is due to your location, employer, etc? Maybe it's your perception of NPs? Most of the NPs I have come across are thoughtful, intelligent, and hardworking. There is certainly a way to advocate for improving NP studies without sounding like "I am too cool for school"
Specializes in Tele/Interventional/Non-Invasive Cardiology.
15 minutes ago, Numenor said:
In addition it is a fantasy notion that NPs are clamoring for rural and underserved population positions. Majority of grad either stay exactly where they are area wise or go where the most money is.
Plenty of rural positions sit open because it’s a meme the nursing machine pushes that NPs are somehow in it for more altruistic reasons. It’s all linguistic propaganda.
There was some areas in which we had common ground. But now I realize you are not grounded in facts. And by the way, when I meant the rural role, I meant as primary care providers or even helping to smaller specialty practices in underserved areas. CRNAs by TRAINING cannot fill these roles either independently or collaboratively.
You are providing conjecture about "nursing memes", "fluff" etc. I am glad that NPs suck. Maybe you were rejected from a CRNA program or upset you didn't go that route. Good luck and good day. I am sorry, we as a profession. don't meet your approval.
Specializes in Former NP now Internal medicine PGY-3.
CardiacRNLA said:
"NP turned MD/DO" means what exactly? I have met plenty of crappy MDs. The thing is though, that MDs close ranks and protect each other (even at times when they shouldn't). Juxtapose that with nursing, and suddenly everyone is an "expert" or thinks that him or her is better than their profession.
Instead of crapping on your colleagues on an anonymous blog, why not actually do something to help the profession if you feel so strongly?
I don't think most nursing professionals can tell half the time if a provider is good or not. They usually judge adequacy based on the way they talk to patients and staff, which really doesn't mean he or she are any decent. it can be difficult for different specialties to tell if another is actually good or not, as guidelines change quickly and non proceduralists do not know the ins and outs of proceduralists procedures. On the medicine side, many things that are "normalized" (PRN blood pressure meds, fecal occult bloods on an inpatient setting, etc) but are actually completely worthless, are used to judge residents and nurses who do not know the guidelines think we are "dumb" for letting that blood pressure stay a little high inpatient wise.
So I always balk a bit when a nurse says a physician is crappy, they usually do not know which metrics are actually meaningful.
I would say the stem of the issue for the job is physicians probably assume new NPs have some sort of competency and those who have not previously worked with them likely overestimate their ability to function, especially in speclialties. As numinor said above some of the NPs in specialist groups are good, some are not. I feel they are more useful in niche roles, versus "generalized" medicine, which actually requires quite a bit of knowledge
Specializes in Tele/Interventional/Non-Invasive Cardiology.
Tegridy said:
I don't think most nursing professionals can tell half the time if a provider is good or not. They usually judge adequacy based on the way they talk to patients and staff, which really doesn't mean he or she are any decent. it can be difficult for different specialties to tell if another is actually good or not, as guidelines change quickly and non proceduralists do not know the ins and outs of proceduralists procedures. On the medicine side, many things that are "normalized" (PRN blood pressure meds, fecal occult bloods on an inpatient setting, etc) but are actually completely worthless, are used to judge residents and nurses who do not know the guidelines think we are "dumb" for letting that blood pressure stay a little high inpatient wise.
So I always balk a bit when a nurse says a physician is crappy, they usually do not know which metrics are actually meaningful.
I would say the stem of the issue for the job is physicians probably assume new NPs have some sort of competency and those who have not previously worked with them likely overestimate their ability to function, especially in speclialties. As numinor said above some of the NPs in specialist groups are good, some are not. I feel they are more useful in niche roles, versus "generalized" medicine, which actually requires quite a bit of knowledge
Like your partner in crime, you seem to make so many assumptions about nursing. Again I'm glad you found a profession where your brilliance can shine.
You are incorrect in that most physicians overestimate NPs abilities. They don't care. Because sadly for most NP roles, only patient volume and being delegated grunt work is what matters to physicians. I wish physicians did make positive assumptions about NPs.
Anyway, I agree there are a lot of medical professionals who lack knowledge. But you seem to reflect this on nursing only. So when cardiologist (practicing for over 20 years) says to order a Lovenox bridge for a patient on a DOAC...am I the dumb one for knowing the guideline or is he?
Specializes in Former NP now Internal medicine PGY-3.
MentalKlarity said:
Agreed. I think the FNP specialty should require 2000+ hours of clinical and perhaps even more credits, and focus only on primary care. FNPs should then be able to work only in primary care. Again, the other specialties are generally fine at legit schools as most do not stick to the minimum hours (my school had something like 1200 hours of clinical) and having 1000+ hours in one specialty and sticking to that speciality is, IMHO, superior to having 2000+ hours in multiple specialties. A PA who rotates through 10 specialties doing 100-200 hours in each does not have as much preparation in pediatrics or psychiatry as a pediatric NP or PMHNP who does 1000-1200 hours in those specialties.
In other words, I think nurse practitioners have one very valuable strength and that is specialization! We are the only medical providers (PA, MD/DO, NP) who have specific programs focusing on one specialty.
Yeah we have to do fellowships.
move probably forgotten most peds and OB things. At least I hope so.
Yeah we have to do fellowships.
move probably forgotten most peds and OB things. At least I hope so.
Yes, I meant as part of school training. Obviously residency/fellowship is specialized but in terms of PA vs Resident vs NP the NP is the only one who comes out of school specialized in their field with a program catering to a specific population. That's a real strength but again it is squandered by FNPs with 500 hours who go work in cardiology or neurology or even primary care with so few hours. The PMHNPs with 1200ish hours in dedicated psychiatry training and dedicated psychiatry courses come out well prepared. The WHNPs I have met have been very well-versed in women's health right out of school. CRNAs know anesthesia inside and out. Specialization is the only valid argument for less schooling/hours but is rendered useless if NPs try to do too much with vague training.
I was so happy to graduate as a NP, almost 3 years ago. First job I was given keys to an office , boxes to unpack . I set u my computer, printer, exam table .I was named administrator and provider and started seeing patients. I thought it was crazy, but I learned to love being on my own and seeing veterans. No prescribing, learned a lot. Unfortunately it was a contract and ended in a year .
I scrambled to be without work and not go back into travel nursing. I paired up with a holistic practitioner, whom owned a building. I was to have my own family practice. What it ended up being, she had no "practitioner degree", no medical education or nursing. I was triaged her sick patients that needed medical care. Others she didn't want having antibiotics or medications. I ended up contacting DEA because there was a script I did not write on a patient the clinic , I actually saw. When I got it off my license and had it investigated, the holistic practitioner said grab your things, thus us working out. So there went another year.
I was actively looking daily and out of work 4 months before 3 positions came available. A Hospitalist position, my goal job. This was 2 hours from home and would require 7 on 7 off . I would have to rent in a town that is not so well of a reputation. The other choice was a family practice way under paid., an hour from home.
The third choice, which I took is 35 minutes from home, a correctional , prison setting. The hourly wage is still not live able , I thought well if overtime I could make it up. They capped me , as an exempt employee and I'm salary , even though hourly. Nurses and assistant and health services managers make more than me. I am the only provider at the facility. Everything comes through me. Prior to me there was a Dr and a NP that both retired at the facility. There is a Dr fir me to call if I have questions at a different facility.
I am beginning to think the NP is way undervalued, in fact I'm not sure the uppers even know what a NP is- are they thinking we are LPNs in the pay scale or just. Mother RN....maybe I'm just a sh!@ magnet.
CardiacRNLA, BSN
165 Posts
First off, I have no ire towards anyone. You commented on MY post. You and others are making broad based assumptions on ALL NPs because SOME, hell I'll even be generous and say a plurality, suck. You mentioned advocating for residencies. That is great. I feel like that residencies should be a mandatory part of NP training. And you are making my original point. Even if you went to Ivy League A+++++ DNP In-Person program, most are not 100% ready to be a provider IMMEDIATELY after school. (nor should you be in my opinion).
It has been well researched that "role transition" is difficult for new NPs across the board. You mention the quality of NP programs/NP students, that is only ONE side of the equation. How about fixing the system that cuts all APPs short of mentoring or additional training, just so more patients can be seen (read: more billing)?