Is this standard treatment for a new NP?

ParalyzeDragon · Sep 14, 2008

I wish i knew what to tell you but I dont know. Maybe it is only temp and will get better. Maybe stick it out a little longer and see what happens. But then I am more of a timid person and this is what I would do. If you are bold and very good with persuasive words then maybe do waht you think you should.

jrprthd96 · Sep 14, 2008

I am pretty bold but more importantly I want to make a good professional impression individually and for my profession. I don't want to "take it" if it makes NPs look like "less than" but I don't want to "Make a big deal" if it makes NPs look petty.

JDCitizen · Sep 14, 2008

Do you have a contract? Did one or all of the doctors sign your protocol? Have they told you to report to the office manager or to them (ie do you work for the office manager or the doctors)? Sounds like they may be working you into the practice but early ground rules apparently need to be clarified or things will probably get worse. It may be an honest group of simple problems that need ironing out or it may be symptoms of things to come...

I was employed by a group once and a couple of months later I was replaced by a doctor. Took me all of one week to find out the head doctor had personality problems.. Would have been really sour deal but I met a lot of great folks and the opportunities to network/interact with other providers was great.. Story is deep so I won't go into it any further... :yawn:

jrprthd96 · Sep 14, 2008

Thanks for the reply...I do have a contract but the only thing in this area that applies is that I will perform the customary duties and responsibilities of a nurse practitioner. Also I work for all three MDs and not the office manager.

jer_sd · Sep 14, 2008

i started out as the first np in an outpatient radiology office, I did everything bring patients back, prep, history exam, perform the ultrasound, chart, transcribe ect.....

it has gotten better in 3 years, i have a full scheduale, there is a transcrptonist, the RN helps me alot but the tech aids ignore me since i am not a doc. I just pull help when i need it now. I even make the manager stand by when i do thoras occasionaly. You will probably never get the equal suport of the doc but it will get beter if your progresses like mine did.

westcoastgirl · Sep 14, 2008

I think you're getting a good deal $$$ wise but I don't know where you live, my neck of the woods is saturated and new NPs take just about anything they can get. That said, it's hard to be the first mid level provider in many settings so I'd give it some time.

You will have more bargaining power once you pass your boards and will 100% be there. Could you wait until then to re-assess things? I share the RN resources with all my colleagus, MD or PA-C.

jabrn56 · Sep 14, 2008

I started as a PNP in 1994 & was the first mid level practitioner for a solo Pediatrician. Since he saw more pts than I did, the LPN's/Med Techs loaded his rooms first in the mornings followed by my pts. The staff treated me like a provider from the get go. I interfaced with the office manager but I spent more time with the MD to discuss clinical issues/questions. If I remember correctly, my schedule was filled quickly with well visits, interspersed with acute care visits .

On occasion I called a pt back and weighed, VS, etc if we were real busy and staff was behind in keeping rooms loaded; I let the staff know what I needed done on the pt (immunizations, rapid strep, etc) and they performed the task. I treated the staff with respect and they reciprocated. We added a second physician and the staff worked hard to keep all of our rooms loaded & flowing so everyone got out for lunch and @ the close of the business.

I no longer work for this practice because I moved south, but the solo pediatricians office has grown with more physicians and 3 mid level providers. You are paving the way!! Best of luck to you on your new position.

ANPFNPGNP · Sep 14, 2008

This may take a while and this is my 1st post so please forgive my rambling. I completed NP school in August and started a new job on Sept 1st. My "big test" is on the 22nd. My job is at a clinic with 3 MDs who have never had an NP there and if I were not a male I am not sure I would be there. These guys are 65, 52, and 40 and are old school in many ways. The pay is a salary of $78k plus 15% of each dollar collected including lab and x-ray. This seems like a great deal to me. The benefits package is not great other than the retirement which is a profit sharing of around 15% per year plus a 100% match on a 401k up to 5%. Now to the point. I realize the beginning of any new job with a new position is not seamless. I got to work and didn't have an office, I was given a patients room that "we just won't use" but this would only be temporary. The three MDs each have an RN and there is an LPN that floats on the others weekly days off. I have been getting paid to see the overflow and call-ins as well as study for my test. This past week I saw 3-6 patients a day. At times I would bring them back and do the VS and current complaint as well as the appointment all at one time. No big deal right, I'm slow now anyway. If more than one was there at a time, a nurse would bring them back for me, or if I was treating with an injection the nurse would handle it. Friday the office manager calls me in and says that I needed to get my own patients and deliver my own meds and leave the nurses alone because they work for the doctors. So I'm slow, "What's the big deal?" I am unsure if I should approach this like the temporary office thing and say "well, its only temporary and we will eventually get a nurse when I am busier" or is this a professional identification thing and I need to assert myself as a primary care provider and health care professional and say "I was hired to perform the task and duties of an NP not a clinic nurse. There may not be a problem since I am not that busy, but it isn't a big deal for them either." I need some professional advice please. You guys got me into school, and through the process and I have been able to just read thus far, but I haven't found another post like this anywhere. I also think it is worth saying, I don't know if the MDs are aware of this and I imagine their response would be that we need a group effort to take care of the patient but I don't want to make waves on something that will pass with time. HELP!!

First off, I think you've landed a great job with great pay! Considering you're only seeing 3-6 pts per day, I don't think you should mind doing all your own "nursing" stuff. I've worked at several clinics and every place is different. At my urgent care job, I'm "it"...no docs around and I have a staff and office of my own. At the primary care job, I'm there with 4 docs and a PA and NP. If we start getting behind or if we're short on staff, I pull my pts back, get vitals, etc AND SO DOES ONE OF THE DOCS I WORK FOR!

That being said, one of the fulltime PA's there told me she feels that the docs think of us as the "nursing staff" and not colleagues. I'm treated a little differently b/c I'm an independent contractor. She is a fulltime employee and she does a lot of the nursing stuff, like return calls, call in meds, etc (I've never been asked to do any of that). I have a little desk in one of the doc's offices (so does the fulltime NP & PA), but I rarely sit at it b/c I can't see when patients are brought to the rooms. Therefore, I hang out at the main desk where the nurses/MA's are. I don't have a problem with it, but I'm sure other midlevels wouldn't like it.

Most of the midlevels I know have their own office and MA. However, I have a good friend who decided that he wanted to get his own patients, get vitals, injections, etc so he told his boss that he didn't need a MA, so they got rid of her and they gave him a raise!

allnurses Guide · Sep 14, 2008

I am not yet an NP.

However, since you just started, now would be a good time to speak to your bosses about the ground rules. Play dumb if you don't want to make waves. Just ask if it is their expectation that you complete nursing tasks or NP tasks. If the latter, perhaps a group meeting with the staff to explain your role is necessary. It may be that the office manager simply does not understand the NP role.

Joan Z · Sep 14, 2008

One of my NP preceptors said she was expected to do nursing tasks since she was "also a nurse". Which was fine for 4-6 pts a day, but then things got busier. She went to the clinic director and said, well, what do you want to pay me for? Eventually she did get a nurse of her own. It takes time to room the pt, run your own UA or rapid streps, get VS and call in Rx.

I used this information when I negotiated and said I wanted my own nurse because even if I was slow (both in terms of #pts and my own speed) I figured things would pick up. They are picking up faster than I thought and I am very glad to have someone doing the work for me!

You need to go to the people you work for who are paying your salary and ask them what they want to pay you $78K for--being an office nurse, or being a primary care provider. It sounds like the rest of the staff is looking at you like an office nurse plus also, and to change this may require reinforcement from above.

There is a great book out there "A Kernel in the Pod", written by a PA (I don't remember the details). He had some issues but a lot seemed to revolve around staff not understanding what he was able to do.

Good luck!

core0 · Sep 14, 2008

One of my NP preceptors said she was expected to do nursing tasks since she was "also a nurse". Which was fine for 4-6 pts a day, but then things got busier. She went to the clinic director and said, well, what do you want to pay me for? Eventually she did get a nurse of her own. It takes time to room the pt, run your own UA or rapid streps, get VS and call in Rx.
I used this information when I negotiated and said I wanted my own nurse because even if I was slow (both in terms of #pts and my own speed) I figured things would pick up. They are picking up faster than I thought and I am very glad to have someone doing the work for me!
You need to go to the people you work for who are paying your salary and ask them what they want to pay you $78K for--being an office nurse, or being a primary care provider. It sounds like the rest of the staff is looking at you like an office nurse plus also, and to change this may require reinforcement from above.
There is a great book out there "A Kernel in the Pod", written by a PA (I don't remember the details). He had some issues but a lot seemed to revolve around staff not understanding what he was able to do.
Good luck!

The book is by Mike Jones:

http://www.amazon.com/Kernel-Pod-Adventures-Clinician-Top-level/dp/1401054293

To the OPs issue its a balancing act. On one hand you don't want to demand to much, especially when you are new, but on the other hand you need to set boundaries and expectations up front. Like the other suggestions, I would sit down with the docs and find out what they expect. Explain that you don't mind pitching in, especially when you are new, but that as you get more experience this will inhibit your ability to see more patients. Get ready to put some numbers in front of them, after all they are making 85% of anything extra you make. For example if it takes you 30 minutes to see a patient or 45 minutes if you room them and do the labs and stuff then they are losing $60 every 90 minutes (assuming average intermediate follow up patient 99213). Thats essentially $100 every three hours coming out of their pockets. In reality its more complex but if they actually signed a contract like you described then they probably won't understand anything more complex.

Put it in plain dollars and cents and they should see that it pays to hire an MA.

David Carpenter, PA-C