Is being an NP REALLY like i'm reading?

Jules A, MSN · Feb 22, 2015

How much did you know about being a NP before you decided you wanted to be one? There can be some flexibility but it sounds like your vision was a bit unrealistic. The FNPs I know in outpatient practice crank them out every 15 minutes. I work in a hospital so my hours aren't the norm but I'm on call 24/7 with rounds from about 8am-5pm for 3 days straight. I have a part-time OP job that has business hours with 20 minute appointments. I work 9 hours but it reminds me of floor nursing with barely time to go to the bathroom or choke down a yogurt. I absolutely love this profession and make a nice living but will say it is harder both mentally and physically than I could have ever imagined.

SydneyJo1 · Feb 22, 2015

It isn't a cake walk, but in my experience it is far less taxing than being a floor nurse. I guess I would say it can be stressful, but in a different way. The buck stops with you as a NP, so that level of autonomy and responsibility can cause its own type of stress. As far as work hours go, I have it pretty good--60 minute evals and 30 minute med follow ups (I work OP psych). I usually see about 9-13 patients per day, depending on the mix of new patients vs. follow ups. It may not turn out to be quite as idyllic as you are picturing, but I have no regrets at all. I love it.

allennp · Feb 22, 2015

I think there is so much varability you can not average what a NP does, plus just pulling data from folks complaining on a Internet forum skews the data a bit also...

I have a totally cool job flex hrs, great team, mostly inpatient, bit of clinic, OR, when I think I need to, time in my weeks for research, CE work, Interesting patients, pay is good, I am in a independent state, and a fare amount of jobs are around, we are even looking to hire another NP!

i think primary care has to crank them out to make the bills, hence Doc's are getting out of it and you see other providers getting in it. did you see in Missouri they have voted in a new type of provider, it's a medical student graduate who did not match, they spend a couple of months shadowing in a Ed and then go work rural, called a Assistant Physician, just heard this the other day.

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zmansc, ASN, RN · Feb 22, 2015

as a NP student, i have read a LOT online about NPs in practice. there seems to be a LOT of discussion about VERY long hours (50+/wk), malpractice, and seeing inordinate amounts of patients daily.
is this REALLY what it's about? i have always had this vision of being a small-town provider, getting to know my patients well, providing lots of preventative education, etc. Maybe i'm just a dreamer, but I don't want to be this practitioner-mill type provider.
Please tell me about YOUR practice, what your days look like, hours, etc. thanks!

When you think about it, the providers at a practice are the ones generating the product, so the more efficient they are, the more revenue the practice can generate. You can increase revenue by having each provider see more patients in a set period of time, or by increasing the number of providers. Increasing the number of providers, increases costs much more than increasing the throughput of the providers. So, from a practice management perspective, the best way to maximize profits is to drive the providers as hard as you can. Now, that's an overly simplistic perspective, and of course there are tradeoffs, turnover, provider satisfaction, quality of care, etc., but that is the state of healthcare today.

Thus, there is a natural tendency for practice management to be worried about maximizing throughput on a per provider basis, and for providers to want to push back for all the reasons mentioned above and more. The management and structure of the practice will play a big role in determining how much of a fight this is. Some practices are more "provider friendly" than others. Sometimes it's specific to an office in a practice.

There is a very large practice in town, that has many satellite clinics. If you work in the main office your time is micromanaged and providers are very rushed. If you work in one of the remote clinics, well, your out of sight out of mind so to speak.

I have a friend who drives 35+ miles each way daily because she gets to work in the middle of a bunch of ranches and take the time she wants to with her patients. Her colleagues who can walk from their houses to the main clinic, don't have the commute, but also rarely get any kind of lunch break and take alot of documentation work home at night.

Another friend recently quit that clinic after working there for a 10+ years to start her own clinic where she gets to set her hours, determine the patient mix, and how long appointments are scheduled for.

I believe if you take a look back in time on this forum you will find many threads where long time posters describe how they fit into their practices. Some feel abused and used, some own their own practices and there are many at each step between those two spots on the spectrum. Finding the position that meets your needs, professionally and otherwise is vital to being successful in this and any profession.

BirkieGirl · Feb 22, 2015

wow, great feedback threads so far. I truly thank each of you for the time you have taken. I am in the midst of making a truly difficult decision whether I will continue straight a-way in the FNP option or stop with a MSN and later do the FNP. All of this feedback is very helpful to me.

coast2coast · Feb 23, 2015

as a NP student, i have read a LOT online about NPs in practice. there seems to be a LOT of discussion about VERY long hours (50+/wk), malpractice, and seeing inordinate amounts of patients daily.
is this REALLY what it's about? i have always had this vision of being a small-town provider, getting to know my patients well, providing lots of preventative education, etc. Maybe i'm just a dreamer, but I don't want to be this practitioner-mill type provider.
Please tell me about YOUR practice, what your days look like, hours, etc. thanks!

you ou have described my reality. I have realized the dream of knowing patients, seeing families, providing education. In order to do that, I see 24-36 patients per day and routinely work an hour to 90 minutes past the end of my shift. It's exhausting, but wonderful.

i have thought a lot about why this happens. A lot of it is due to inefficiencies in the system, but it suspect most of it is inherent to primary care. When you set yourself up as someone who can meet needs and provide good care, you get a tidal wave of humanity, with umpteen thousand needs, breaking down your door. It's the nature of primary care in particular, I think.

if I could find a way to do the same work with less effort I most assuredly would!

pardon my typos, allnurses doesn't get along with my ipad.