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!!
Thanks David. This has been very helpful for me to see how you guys look at this. I think I will just go and better define my line of authority and communication chain. Then after I pass boards I will set some goals and submit them for approval that will allow for planned growth and have a back up plan for those surprise busy days. Meanwhile, when business is slow, I will do all that I can and treat it like marketing and try to impress my patients in order to gain repeat and referral business.
Well, here is the thing: You are new, and you are an employee.
I am wagering that when your deal was "cut" that this was factored into your salary. They may not have been able to pay you as much if you had to pay part of what you brought in, into the practice, and pay for the secretary, the lights, the rent, the nurses, all of the equipment, etc.
The physicians are who brings that money in and pays for all of that...that is probably why they want you to do your own patients.
Now, when you become established, and get so busy that you can't take more patients b/c you are doing nursing stuff...trust me, they will probably be renegotiating your deal to where you'll have a nurse, but you'll be expected to pay part of that cost, but with more patients, you'll well be able to afford it.
Thanks David. This has been very helpful for me to see how you guys look at this. I think I will just go and better define my line of authority and communication chain. Then after I pass boards I will set some goals and submit them for approval that will allow for planned growth and have a back up plan for those surprise busy days. Meanwhile, when business is slow, I will do all that I can and treat it like marketing and try to impress my patients in order to gain repeat and referral business.
Just out of curiosity how can you see patients before being certified?
i think you are on the right track... see what happens once you are certified, talk with each of the physicians to determine their expectations, and if possible, you all should get together to discuss this so everyone is on the same page. i was the first np at my job as well, and it may be that they simply need some education on what you can provide. like david said, put it in "money terms." that makes them listen. :)
here is the thread i started a while back when i started my job... lots of ups and downs which you may be able to relate to. click here to view my vent!
I too am a new NP, just beginning to practice. I did a rotation with a pediatric NP that worked with 2 pediatricians. She did most of her own stuff, room patients, injections, throat swabs, etc., and her patients LOVED her. They would wait as long as it took to see her and she quickly became known and people started to bring the kids to her because of word of mouth. When the clinic gets really busy then the nurses do help her and room pts, but she still did her injections and so on.
She did mention the part about not seeing as many people (less $$ for the practice) but she liked it that way and the docs were OK with it. I think there can be two sides to the story. Not letting them take advantage, but at the same time we need to remember we are nurses and we do patient care. NPs are not the same as a bedside RN, but more personal care may be a good thing.
If it were me I would like the idea of seeing less people and doing everything at first anyway until you are very experienced. I may be wrong because I am greener than grass but that is kind of how I see it.
jrprthd96
8 Posts
Thanks David. This has been very helpful for me to see how you guys look at this. I think I will just go and better define my line of authority and communication chain. Then after I pass boards I will set some goals and submit them for approval that will allow for planned growth and have a back up plan for those surprise busy days. Meanwhile, when business is slow, I will do all that I can and treat it like marketing and try to impress my patients in order to gain repeat and referral business.