I am a new grad NP. I am currently working in a pediatric private practice . The doctor wants me to work alone in the office after 60 hours of "training". My training was a 8 hour shadowing, and starting to see patients myself. The doctor would come over and double check after I am done seeing the patients. He would tell me to go to the other room to see another patient while he double checking. During this week, the doctor gave me feedback, saying that I am too slow and I should be able to see patients on my own by now.
Because the doctor has two offices, he wants to put me in one office by myself with a MA, so that he can be in the other office. I told him that I don't feel comfortable yet. He was upset and telling me I am wasting his time. He said he has already gave me a lot of training. He wants me to give him a timeframe to let him know when will I be comfortable to work solo. I feel that I am rushed to finish training and I don't feel safe at all. I told him my feeling and he said I will not be able to be a provider since he thinks that I don't have confidence.
Also, the MA in the office only does measurement, such as weight and head circumference. She also prepares vaccines. I need to do all the blood drawn which I think it made me slow down on seeing patients. Since I need to hold down the fussy kid in order to take blood.
I am thinking about quitting, but not sure if this is a good decision. Any advice please? Thank you. (English is my second language, sorry for any grammatical mistakes)
Yes, literally he told me that these people cannot understand, so just call yourself a doctor. He said he cannot understand why he needs to spend time with me to discuss about this.
I also don't like the idea of "fake it to make it". He told me this is unprofessional to tell patients that, "I am not sure the answer, but I will find out for you." He does not have respect to me, to the NP profession, and to his patients. I will definitely move on and hopefully can find someone who is supportive. Thank you for your encouragement.
Wow. I've never met a scuzzy pediatrician before! Call me naive. I wonder if this person is even competent to work themself. Something is terribly wrong here.
I did it. I resigned. He wasn't happy. He was questioning how could I be a nurse for 10 years with this confident level. Whatever he wanted to say...I am so happy and feel good about making this decision. Hopefully I will get a better job soon. Thank you for all the encouragement and advices.
I did it. I resigned. He wasn't happy. He was questioning how could I be a nurse for 10 years with this confident level. Whatever he wanted to say...I am so happy and feel good about making this decision. Hopefully I will get a better job soon. Thank you for all the encouragement and advices.
He's not happy he has to try and find his next victim to be the one he throws under the bus. You did the right thing. Never sacrifice your values, mental health, dignity, or ethics. I'm rooting for you. I'm also a new grad NP, but I'm not looking for pediatrics, even if I was encouraged by my peds preceptor. ?
NP education is a huge problem. Entry to a NP Program should be limited to RNs with previous clinical experience. No open book exams and choosing your own clinical preceptors. It may be too late though because a lot of people are upset about the end product of these schools.
Should NP programs close? No, but entry requirements should be stringent. The education should involve enough clinical hours to make graduates able to succeed.
I think this situation is naturally working it's way out. I doubt this physician will hire a new grad NP again. Most MDs assume a new NP to be able to basically function seeing patients, but sadly schools and our professional organizations are not ensuring minimum standards are met. I do think NPs who go through the process of licensing, getting a NPI #, controlled license, etc. should know what they are getting themselves into. I really want to say if you do not want the responsibility and lifelong learning (think uptodate and journals) then please stay in RN role where there is inherent provider (NP, PA, MD) oversight.
I guess you misunderstood what I meant. I did not say I don't want the responsibility and lifelong learning. My problem here is not being able to meet the doctor expectation which is able see full load of patients (average of 25 to 30 patients) a day after my 60 hours of training. And I don't feel comfortable yet to be in the office by myself to handle full load of patients. I know it takes time to be comfortable as a provider... Maybe you did not need a lot of support when you first started, however, for me I do need some time to transit the role from RN to NP. I found that a supportive environment and employer will help me during the transition, however, I did not feel it at this work place. Thanks for your advice.
Specializes in Cardiac, Home Health, Primary Care.
I think most employers expect a NP to be ready to go. It's a totally different role than as a RN so I don't think anywhere will give you much training. I also had a few days with the doctor and started seeing people on my own. They did try to only give me 1-2 an hour for the first few days I was on my own but after that I was going full force with 15-25 people in a primary care clinic per day....sole provider in the office. Yes I called the doctor if I had a question and did fairly regularly at first.
It does sound like this probably wasn't a good fit and the doctor was a bit much so I can't blame you for your decision but I am not sure if anywhere will give you much time to "transition" honestly. Being a NP is scary at first. I remember the first day I felt competent and made a mental note that I was 9 months into my position.
Biggest advice is to know your resources and use them. Definitely act confident when speaking with patients but even now I am not afraid to say "let me double check this dosage" or "let me make sure my thinking is on track" and I go look at UpToDate...sometimes in the room with the patient. If you are still iffy as far as physical assessment or ROS goes make a brain sheet like many RN's do. Eventually you'll be able to do it without much help at all. Time, repetition, and experience build true confidence and chances are you'll have to get all of that as an independent provider.
Also wherever you land make sure you know how to work the EHR to save time. Many have templates you can build and customize to make your workflow easier.
Good luck in finding your happy place but just remember you will NOT feel confident for a while (again, took me 9 months to feel like I kind of knew what I was doing) but it will come with time.
Thisis why residency should be mandatory. We market ourselves as population experts equal to other providers but we DO require a long orientation to transition from school to practice. ...
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I'm curious. What type of residency, and how long of an orientation and transition period do you think would be appropriate?
I guess you misunderstood what I meant. I did not say I don't want the responsibility and lifelong learning. My problem here is not being able to meet the doctor expectation which is able see full load of patients (average of 25 to 30 patients) a day after my 60 hours of training. And I don't feel comfortable yet to be in the office by myself to handle full load of patients. I know it takes time to be comfortable as a provider... Maybe you did not need a lot of support when you first started, however, for me I do need some time to transit the role from RN to NP. I found that a supportive environment and employer will help me during the transition, however, I did not feel it at this work place. Thanks for your advice.
I am in total agreement that we need support when we start. I moved across the country to establish with a group that was committed to training, essentially a residency with weekly education and I had to do research...it was intense and organized and I studied as if I was still in school. Started working with a MD or NP at my hip for the first few weeks. I sought this and quite a large personal and financial expense...I had never been to the city I moved to. So the condescending sense of not needing support I do not deserve. I was a straight A student at a moderately rated brick and mortar/online school (UC) and passed my board exam with low end of questions. YET, I knew I was NOT prepared to function as a clinician independently, and my patients deserved that of me. I was honest in my interview about this, and I was hired I think in large part because of this. My point was quite clear about the lack of this kind of education in NP training, while the roles we share with PAs and MDs who start out just like us are (I suppose some would say arguably) prepared to function from day one by their respective schools and professional organizations. They simply invest higher standards, full commitment, and give in return hours of clinical training. This is not personal, a matter, I will say again, related to professional standards which is ours (as a profession) to set.
I'm a new grad NP. I am in primary care now, my orientation was 1.5 days of shadowing the doctor at the very busy practice seeing 45 patients in 8 hours. It was hard to grasp anything or learn as it was very face paced and wasn't enough time in my opinion. I was completely on my own after day 2 and had 7 patients. There was another doctor in the practice with me to ask questions if I had but she was often times super busy and in patients rooms and was not there for me to ask the questions. I emailed the practice manager after day 1 asking if I can have additional guidance, support or training since I had questions but found it difficult to find anyone to ask and assist me. The practice manager told me that she isn't here to teach me medicine and I shouldn't need additional training, that I should have learned medicine in school and if she needs to "teach me medicine" she will have to renegotiate my salary. I told her I just wanted some extra guidance being a new grad NP and that I if I had questions I just wanted someone else to reach out to.
it's now my 4th day seeing patients on my own and the start of week 2 and I'm still so nervous and have no idea if I'm doing my job right or wrong as no one is offering me any input. I saw 14 patients today and was extremely fast paced and often double booked. I am not sure if this is normal in all new positions or if it's just the practice I'm at but I'm seriously debating on quitting
I'm really sorry you're experiencing this in your very first NP job—this is definitely not normal and sounds like an unhealthy work environment. Expecting you to manage patients without any questions on just your second day as a new grad NP is completely unreasonable. It sounds like they not only lack concern for your growth, but also for the quality of care their patients receive. If you're not asking questions, you're not learning, and if you're not in a supportive environment, it will only hinder your development as a provider.
It's clear they aren't prioritizing patient care if they expect 45 patients to be seen in an 8-hour day in primary care. That's not only unrealistic but also unfair to both the patients and you. Providing quality care in those circumstances is nearly impossible, and it puts your well-being and ability to practice effectively at risk. In my experience working with numerous primary care providers, the average patient load in an 8-hour workday is typically between 14-20 patients. While a few might manage slightly more than 20, I have never—never—worked with or seen a PCP take on 45 patients in a single day.
The response from your office manager is especially frustrating. Saying you "should have learned those things in school" shows a lack of understanding. Every provider, whether NP, PA, MD, or DO, commits to lifelong learning. No one, regardless of their education, leaves school knowing everything. Transitioning into real-world practice comes with a steep learning curve, and support from colleagues is crucial for success.
My advice: Have a direct conversation with the doctors who hired you to express your concerns. If they can't offer the support you need and are already pushing an excessive patient load (14 patients in your first week is far too much), it might be best to consider other opportunities.
Feel free to DM me if you need more advice or support!
subee, MSN, CRNA
1 Article; 6,113 Posts
Wow. I've never met a scuzzy pediatrician before! Call me naive. I wonder if this person is even competent to work themself. Something is terribly wrong here.