Low stress job vs more challenging job vs higher income??

[Tony1790, BSN, MSN, NP]

Hi,

I work in a federal facility, and I'm a newer (1 yr) FNP but an Older NP (51yr), so I'm weighing my options and trying to figure out the best work/life/income/career balance.

Do I focus on a low stress job or do I focus on a job that will make more annual income as I'm getting nearer to retirement or do I fine tune it as much as possible??

1. Low stress decent/not great salary: Currently working in Seattle WA state doing arthritis/rheumatology in a slow paced, relatively low stress job, mostly 4 days/week for $97,000 year. Everyone is great to work with, low stress boss, I work with 4 MD's as the only NP. Great job, but pay could be better and I'm located far from family.

2. I have a pending job offer in TX in orthopedics with the same federal agency, doing pre/post surgery care/follow ups/consults. 5 days per week, outpatient office for $108,900, which should be low stress, better pay, etc. I'd be the only orthopedics provider in the facility, the main hospital is 110 miles away (hence the need for outpatient clinic).

However, I've not been able to speak to any provider in the surgery service line, my phone interview was done by 3 RN's, so I've not been able to get any specifics answers to my questions that I have as a provider, so I feel as though that the service line folks (surgeons) don't appreciate me as a potential provider to even bother to be a part of the interview process or to return my phone calls (I located the department head and talked to his secretary multiple times on the phone). Meanwhile HR keeps calling to verify if I will accept the position............I'm thinking that this might not be where I need to go.

3. Emergency department: I have a pending offer in SC, but the pay is horrendous, at $83,000 annually and I'd have to pay state income tax, which I don't in WA or TX.

4. Emergency department: I turned down a job in NV with the same agency as the pay was the same as in WA, however Jan 1st brought a pay boost to this facility and now I'd be at $114,000 base pay. And the position that I turned down has recently been re-opened, however, I'm doubtful if they will give me the time of day now :-(

My main goals career wise:

1. Stability, guarenteed employability, and with the ability to retire at 65 yo or sooner

2. Income of $100k annually

3. Settle down in/near the area that I want to retire to, which is TN, but there are few openings there as the market is overflowing with hungry NP's driving the wages down, $62,000 for the local health dept as an NP :-0

What do you all think? What makes the most sense for an newer but older provider, (I'm the oldest in my service line, older than the MD's)

I've done mostly orthopedics: with 5mo as chronic pain management of mostly orthopedics patients with injections, braces and of course Narcotics, 5mo of Arthritis/rhem with joint injections/aspirations, braces, PT, and eventually consults to Ortho for surgery. Which makes sense why I was offered the position to do the Ortho consults now.

Thanks,

Tony

p.s. I thought I had finally decided to start where I am currently (I had asked for advice before) however, it's not helping that I live alone in a 1 bedroom apartment on an inflatable mattress with all of my stuff still in storage in TN, so I don't feel grounded at all.

And I had applied to so many jobs before, that the offers are still trickling in, which puts me back into indecision :-(

[Ruby Vee, BSN]

I'm sure you already realize that 100k in Nevada may go a lot further than 100k in Seattle. And 83k in SC may go further than 100k in Seattle. Take a look at cost of living rather than just salary.

[Tony1790, BSN, MSN, NP]

The job in Tx not only has a higher salary than Seattle by $12,000 the cost of living is way lower, but I"m mainly concerned by the lack of response and lack of involvement with the MD's in the hiring process.

My personal cost of living is way small, I'm single, I work/sleep/eat and that's about it. Living small and saving money for a home at some point.

[Jules A, MSN]

I think you are wise to be wary of the job that made you interview with RNs without any physician contact. At best dismissive and worst you will be relegated to doing their grunt work. I don't accept positions that fall under nursing, I work as medical staff. In my experience when you are aligned with the physicians everything is better.

[RNGrad2006]

Are there any jobs in your area to work with Physical medicine. My experience is that pays well and with your experience doing trigger point injections that may be a good fit for you. In AZ that pays pretty well.

[wondern, ASN]

What do you want? More money or more peace of mind? Wait is that like an oxymoron?

[blue bag nurse]

Where in SC? Just curious since I live here, maybe could give some insight on that. And with cost of living, it's abt the same.

[Tony1790, BSN, MSN, NP]

Where in SC? Just curious since I live here, maybe could give some insight on that. And with cost of living, it's abt the same.

Columbia, SC

[Tony1790, BSN, MSN, NP]

What do you want? More money or more peace of mind? Wait is that like an oxymoron?

Both, lol

[blue bag nurse]

Columbia is pretty inexpensive. I was worried you'd say Charleston, which has just gotten stupid expensive and crowded. I grew up in Columbia....lexington actually. Currently in Charelston!

[ms_sgr, BSN, NP]

I live in Dallas, TX and it's too hot for me. I'm not sure what area your are going to be moving to but Texas is starting to get expensive. I'm actually relocating to a rural area in WA that is 1.5 hours from Seattle and will be making more that you which is surprising. The company has great benefits. Free housing for 6 month, paid medical, pension, loan repayment, 4 day work week, 6 wks PTO, $2000 CME with 1 week, sign on bonus and relocation expense. If you're interested in working with Geriatrics, I will be more that happy to give you the company info.

[KatieMI, BSN, MSN, RN]

There is a thing about NP trade:

- NPs skills, experiences and "views" of patients, by nature of our trade, are limited. By itself, it is not a problem as 90% of cases in every given specialty come under "routine" definition. But, as I can see it, NPs who start in specialty and continue in specialty for a few years, became WAY more severely limited than physicians specialists. They never get this "see the patient as a whole picture" idea, or they continue to hang onto classic nursing concerns of having daily BMs and such instead of instantly grabbing clinical picture and critically accessing it. When they encounter a problem which doesn't fit into their "routine", even if it is something ordinary, they overlook it much easier than physicians.

There is only one way to battle this, and it is to work, at last for a time, into an area which provides great variety of patients and abundance of clinical scenarios, preferably with higher than desired level of stress. This is practically the only way to constantly get your brains running, to master quick clinical assessments and critical thinking and to humble yourself to the level when you feel safe yet constantly on alert for sudden changes and new information. Once a medical professional gets on this level, the skills thus mastered will stay for life. After that, being an ortho NP, you won't send an absolutely unprepared, severely anemic and malnourished patient with preterminal organ failure for hip replacement only to see him getting worse with every passing day and wonderign why the great job you and your boss M.D. did doesn't turn out the way you intended.

Pay, being near family and everything else is important, but, as with every other trade, the first few years are going to be one far from smooth learning curve. It is not a good idea to make these formative time cushy one.

Just my IMH(umble)O.