NP Schedule

[dncc, DNP, APRN]

I’m new to this board and not sure if this is the right place to write this. I am a NP with a little over 1 Year experience. I work at a busy rural health care clinic. I am really considering leaving and maybe working as an NP part time. Reason:

1. I feel like all the non compliant, uncontrolled patients are transferred to me from the other NPs and even my manager. Most of these patients have been coming there for years and have never been controlled.

2. Many of the patients I’m seeing have multiple comorbidities, including HIV, Leukemia etc. I replaced the one Dr. who left. I have the least experience of the NPs I work with.

3. One of the NPs is out on maternity leave and I am seeing all her patients. (My manager discussed none of this with me)

4. For the first 7 months I’ve worked there I was doing double work because my MA is lazy and acts like he doesn’t know what to do or help. I later found out the NP he was working with left because of reasons like this.

5. I commute 1 hour each way daily

Do you guys think I’m overreacting? Is this the norm?

[AnnieNP, MSN, NP]

I would leave if there were no changes made.

[traumaRUs, MSN, APRN]

Have you had a sit-down with the manager? If not, this needs to be done. This is a business and you need to address these issues. All places of employment have issues - some can be resolved, some (like your 1 hour commute) can't. If THAT is the main reason, I would say start looking.

However, the other issues are resolvable:

1. Noncompliant pts require careful documentation. All practices have these pts. You can't care for them more than they care for themselves. Your documentation will cover you.

2. If multiple co-morbidities are concerning you, since you are a primary care practice, you take care of the complaint of the day and turf the other stuff to specialists. Leukemia care to the oncologist, HIV to the ID folks, etc.. Again, if you need dosing assistance or drug interaction info, ask the pharmacist, call the other care providers.

3. We currently have 3 pregnant providers - I've gained another 40 pts to see weekly - however, I am compensated.

4. MA - document and fire them if they don't want to work.

In order to be thought as an equal provider, you have to look at this as a business. The manager does, I assure you. Either make changes that you can make or leave. However, be very aware that every practice has issues.

Best wishes - let us know what you do....

[dncc, DNP, APRN]

Thank you for the feedback. I’m aware no place is perfect. I have talked to my manager about a few of these issues, like the issues with my MA. Some of this other stuff that’s occurring is because my manager is trying to appease the other 2 NPs because she doesn’t want them to leave. I say that because when I first started there the other NPs were so concerned with my schedule, how many patients I had etc. they state the Dr. I replaced was seeing about 4 patients a day and they were taking the brunt of the work. In a quest to fill my schedule up, my manager told them to give me some of there patients. Of course they gave me the non compliant patients or they ones they wanted to get off there hands. I would see a person once during walk-in clinic and then I would be listed as the usual caregiver. Which also meant I was getting refill requests and everything else I didn’t see the patient for.

[Oldmahubbard]

You are new at the game and still learning a lot. Think of that in a positive way. You are gaining very valuable experience. No joke!

You will need to set boundaries and not write refills if the patient hasn't been in. You need to model expectations for the support staff.

Uncontrolled diabetics may need an endocrine consult. Don't quote me, I'm psych. Of course we know they have a horrible diet.

Every job probably has some of these issues, at least occasionally, but if you can find a job closer to home, everything else being equal, that would be preferable.