New NP Job Not What I Thought...

MierKat · Aug 12, 2017

I come from a management background so my comments are applicable to almost any job where the reality doesn't match what was promised or if the reality changes. It can be compared to growing pains and doesn't absolutely mean it's not going to work (unless they whole organization is disfunctional or the people are crazy).

First, who is your boss or who has the most control over the position? Alternately, if you don't have a clear boss, whose life is going to be made easier if your job goes well? Identify the person who is most likely to be able to address these issues.

When you were being hired, did they have a job posting or job description? Most big hospitals/clinics do have some sort of job posting or objectives statement. At this point, if you don't have a job description you're going to have to advocate for yourself and write it.

Think back to the interview. Write down the parameters of the job as described. Now write down the reality. Then write down what YOU would like the job to look like.

Regarding the car and home visits: Was that mentioned during the interview? Did they say you would need a car? This is a big ask, especially in a metro area with bad traffic. Most jobs where you need a car, the job posting will say "Applicant must have their own vehicle." If it didn't, that is a factor in your favor. Some companies have a pool of vehicles that employees can check out (although it's less likely for hospitals than say, banks or insurance companies). Some companies use ZipCar or other car rental/car sharing companies, so they would just pay a membership for you.

After you've gone through this exercise, write your ideal job parameters, your must haves and your no-way deal breakers. Then ask to meet with the person (or maybe two people) that have the power to address these issues. Ask via email and propose a few times to meet. Bring your lists and give them to the people. It's very common in new jobs for this type of issue to occur so say "We all knew going in that this was a new position. Now that I've been here for X weeks, I've been able to see what is working well and what is not working given the staff/patients/systems. I'd like to talk these over so that we can develop a job description that really benefits the department or that solves the problems you're seeing or meets the objectives that we talked about when you were interviewing me for this position. Here are the things I think are "must haves/must dos" and here are some things that are not working. I've started a draft Job Description. For example, this position ..."

See what happens. It's negotiation but you have power here. They hired you, they need you, they want it to work and they probably don't want to go through the hiring process again.

If it doesn't work, then at least you tried. It's not uncommon to have this type of issue in a new position or a growing department.

Good luck!

Trauma Columnist · Aug 12, 2017

Wow - what MierKat says!

I echo ask the boss - this is kinda a bait and switch tactic.

psych.nurse · Aug 12, 2017

So, here's an example of what's been happening. On Thursday, the nurse in charge of home care approached me and told me she'd like me to see some patients for one of the home care nurses who was out. The home care division is apparently having a huge staffing crisis right now; they can't keep up with their patient load. She asked me what supplies I had. I didn't have any, because I don't do home care nursing. She loaded me up with supplies and told me I'd be fine. I told my supervisor that I wasn't entirely comfortable with this, and she told me she thought I'd be fine. So, I got up super early to go and see these patients, had to figure out their dressings on the fly, and then had to head back to the office so the home care nurse could check my documentation. I did what I could and then waited three hours for her to approve my documentation. She told me that I had to go back and enter a full ROS for each of them, which I was not told. I left exhausted and angry. She was not happy when I told her that I didn't feel this was in line with my intended responsibilities. My supervisor sees no reason why I shouldn't be pulled to do whatever: "You're an NP; you should be able to do any of this."

I can't afford a car right now. I'm stressed out and upset. I see a therapist for depression, and without having some predictability in my schedule, I don't know how I'll be able to keep that up.

I'm sorry if I sound like a baby.

This just isn't what I was told it would be.

allnurses Guide · Aug 13, 2017

Wow. Um, have you ever done any home care nursing before now? I

mean, I actually know zilch about being an NP so maybe I should keep

my trap shut, but... it seems unreasonable to me to expect you to just

start seeing patients at home if that's not what you DO. Just because

you are now an NP, you should suddenly know all of the ins and outs

of home care nursing? Home care nursing is a HUGE undertaking, a

nursing field all of its own, and I can't imagine just asking ANYONE to

just, "here go see these patients at home", if that person has no

home health experience. I don't care if they have been to APRN

school.

Jules A, MSN · Aug 13, 2017

Totally agree with MeirKat's sage advice. It sounds like a great job on the surface and since it is a new position there is likely to be some role confusion that needs to be discussed. Remember for future negotiations that vague things like home health visits "occasionally" need to be clarified especially since it doesn't sound like you were ever in a position to do them anyway.

After reading your second post I'd add: You are a psych nurse, start setting some boundaries immediately. I have to wonder if you are working under the nursing department rather than medicine? I only take jobs working as a member of medical staff because there are major difficulties in trying to be both a provider and a nurse-hybrid which rarely happens when working for a physician who wouldn't ever even consider expecting a NP to empty the trash cans because the EVS person called out sick and yet with nursing...

Good luck, this will be uncomfortable but a valuable experience for you.

allnurses Guide · Aug 14, 2017

You're a psych nurse, now having to do dressings in home health? What is your NP certification? I agree I would clarify the role responsibilities in your job description. I certainly would not be acting outside my education and certification/legal scope. I am also in a new position and the first NP in this type of role. Some confusion and having to feel your way around is normal, but switching your clinical responsibilities, doing the work of a home health RN is not normal. Better to have the wrong job for a month than for a year. If it's not changing, I'd start looking elsewhere.

nursetim, NP · Aug 17, 2017

Psych NP are in high demand. One of the thing we nurses are horrible at is saying NO. We need to start practice saying it when appropriate and it was appropriate in your situation.

psych.nurse · Aug 17, 2017

Thank you for the support, everyone.

So, here's what happened.

On Monday, I ended up taking the day off work because I was feeling so stressed out and overwhelmed by everything that I didn't feel I could function at work that day. I sent my boss an email saying that I felt some things were going well, though I had concerns about some aspects of the job--specifically, the ones that weren't consistent with what was described to me when I started. We met today, and came to the mutual decision that this is not a good fit for me. She complimented me on my skills and abilities, and expressed that she felt I'd do better in a position with more structure. I agreed with her, and decided to resign. She said she'd support my seeking another position within the medical center.

So...I guess that could have gone a lot worse. Still, I am very scared and distraught about becoming unemployed. I was offered another position before I took this one, and I saw online that it hasn't been filled yet...so maybe I'all reach out to them again? I have enough resources to stay afloat for a couple of months, but this is still scary.

MierKat · Aug 21, 2017

She said she'd support my seeking another position within the medical center.
So...I guess that could have gone a lot worse. Still, I am very scared and distraught about becoming unemployed. I was offered another position before I took this one, and I saw online that it hasn't been filled yet...so maybe I'all reach out to them again? I have enough resources to stay afloat for a couple of months, but this is still scary.

I think that this is your first job after you got your NP license, correct? You probably do want to have your first job be one with more structure, and perhaps in an environment where you have experienced providers on whom you can model your day-to-day work, ask questions and get your practice off to a strong and successful start. Find a job where there was an incumbent who had the job before and was successful: In other words, not a newly-created position, not a satellite office, not a job where the person before you was let go or was not successful and resigned. Look for a stable, mature staff and a strong but not abrasive office manager or head nurse or whatever. Realize that if you're a new graduate you are not going to have all the answers so approach the work with an open mind, ask questions and give it your best. Communicate and especially don't wait until things go wrong to speak up.

I would take the old manager up on it and see if there are other positions at the medical center that might fit you.

And yes, call the other job and ask them if they're still looking.

Good luck!

allnurses Guide · Aug 22, 2017

Good luck. And remember next job - get all these pre-employment promises in writing!