4 months in as a new FNP

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Specializes in Cardiac, Home Health, Primary Care.

I am almost 4 months into my FNP career. I stalked these boards religiously in the months leading up to graduation and the certification exam. I still browse them every couple of days but NOTHING like I used to. I remember reading once how somebody wished the NP's would return with an update as they seemed to quit posting after they passed their certification exams. I figured it might be nice to give a little update for the others who are a little newer than new little me.

I work in 2 clinics. One is pretty large with several MD's and a PA. I see overflow/walk-ins but I am also a big part of the chronic disease management team. The other clinic I work in is more rural. There is one MD there part of the week and I am there the days he isn't. It's a nice mix. I enjoy the variation and of course the bump in pay from my RN position. It's stressful and busy, sure, but not overly. These patients aren't life or death (usually) like in inpatient situations. I am loving the independence, detective work, and realizing that I AM DOING IT. When people ask how the new job is going I typically say "Well I haven't killed anybody yet" and that is kind of my goal.

In my state I have to have a collaborating MD. I have one for each clinic and both finished their schooling less than 5 years ago so they seem to understand my nervousness as a new grad. One of the MD's seems to have a good bit of experience in ortho which I am thankful for as it's a weak spot for me. The other MD's in the office are helpful as well and I know which ones enjoy teaching more than the others.

I have most of my reference books at the office where I am alone. I have several apps on my phone and am thankful I paid for more Lexi-Comp before I graduated so I got the student rate (SOMETHING TO THINK ABOUT YALL...get that student discount!).

As I am getting more experience I am getting my "go-to" meds I use. I am getting my "viral vs bacterial" speech perfected. I am realizing primary care may not be as petrifying as I thought it was initially (I wanted a job in a cardiology clinic so I'd only need to know a fraction of what I need in primary care). I currently have a limit of 20 patients a day but once I get my meds down better and get the EHR down pat I will bump myself to 25 (maybe for my 6 month-a-versary?). I have adjusted thyroid meds, diagnosed diabetes, educated educated educated, given people not so good news, and gotten thanks you's and hugs.

I think if I give it a bit more time I'll really come to enjoy the experience and hopefully get off my Lexapro.....

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Specializes in Nursing Education, CVICU, Float Pool.

It's so nice to hear an honest survey of your experience as a new NP. It's also refreshing to see you have a good sense of humor too! Thanks for the update! I seemed to notice that some stopped posting as much after getting certified. I'm sure there are legit reasons why. I like how you explained the complexities of your job as a welcomed challenge.

Sent from the iPhone of PatMac10, RN

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Specializes in Family Nurse Practitioner.

I think if I give it a bit more time I'll really come to enjoy the experience and hopefully get off my Lexapro.....

I personally believe SSRIs should be piped into the public water supply so no big hurry on discontinuing the Lexapro, ok? :D

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Specializes in Outpatient Psychiatry.
I currently have a limit of 20 patients a day but once I get my meds down better and get the EHR down pat I will bump myself to 25 (maybe for my 6 month-a-versary?).

Before you see 25, if you already haven't, negotiate a productivity bonus and see 30 a day!

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Specializes in Cardiac, Home Health, Primary Care.
Before you see 25, if you already haven't, negotiate a productivity bonus and see 30 a day!

I get a bonus once I "pay for myself"! After that I get so much per RVU. I hope to be able to handle 30 a day sometime but I'm not trying to push it to where I'm staying over to finish charting.

It's also a little complicated cause my chronic care visits take a bit longer so it's not JUST the number to consider. But I like the chronic care visits for the pt education (I was in home health before. LOVE pt education)

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Specializes in Cardiac, Home Health, Primary Care.
I personally believe SSRIs should be piped into the public water supply so no big hurry on discontinuing the Lexapro, ok? :D

I tapered off a few weeks ago thinking "maybe my stress was more due to the cert exam, finding a job, etc." uhhhhh no go.

It would be nice if it was put in the water. Maybe some Xanax brownies too for those rough days.

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Really loved this thread :) Thank you.

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Specializes in NICU.

I'll add in my experience- have been practicing as a neonatal NP for approximately 6 months now at a Level 4 regional NICU.

I love it. There is so much learning opportunity for where I am at and I never feel "alone." There are always people to ask questions and I feel confident enough on my own to handle the majority of problems that RNs call me about, but it's been great having such good mentorship from my NNP colleagues and my attendings to go to for questions when I know that I'm in over my head.

I had 6 years of RN experience at a similar facility where we had a lot of autonomy (we made ventilator changes with the RT on our own pretty much, although we did call the fellow/NNP if things were going downhill) and I think that really prepared me for this role. On the flip side, I have to remind myself that the RNs where I work now don't have as much autonomy and there is a lot of issues that they call me about that really don't need a phone call (my favorite at 3am: "the glucose is 77" me: "is the kid on insulin or are we watching it carefully for some reason?" "no, it's just the daily glucose, wanted to let you know"), but I do enjoy teaching them (in a kind way) and tell them my rationales for not doing some or doing something. If they do have a concern about a physical exam finding, I do always go to the bedside because I don't want them to feel like they are being ignored- the worst thing is for an RN to have a concern that turns out to be a major problem that they don't want to "bother" me about.

I also enjoy the fact that I don't have to "ask" for permission to go to the bathroom or try to set up my lunch hour with my RN colleague since somebody has to "watch" the kids. It's also much less emotionally taxing because I don't need to be at the bedside with a demanding parent at all times.

The procedures are also pretty cool- I'm checked off on a few, but need to get a few more in to check off on everything. We don't intubate with stylets, for example, so it's been a little more difficult for me, but I'm getting very close to getting checked off.

Schedule wise, I still do three 12s a week, which is amazing, and even though I know I'll be doing holidays every other year for my career, I love what I do and wouldn't have it any other way. The pay and the overtime pay is also nice :)

Lastly, one of the things I've noticed (and was told by my program director) is that there isn't so much "blaming" and making you feel stupid moments as a NP. It may be just at my facility, but everyone has been so helpful and never made me feel stupid for asking a question- you know that attitude of you should know this even though you haven't learned it (and don't know where the resource is) and I refuse to help you- and it's been great. I didn't experience that very much as a RN, but when I did, it felt horrible. I still asked all my questions because I didn't want something bad to happen to my patient (like when I floated and took care of a patient on a heparin drip actively titrating that I had never done before), but I hated the second guessing of whether or not I should really ask the questions I had.

Overall, I wouldn't trade my job for any other job in the world. I feel very blessed to be in my field, doing what I love.

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Specializes in Cardiac, Home Health, Primary Care.

Love the response babyNP! Glad to hear I'm in about the same boat

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