NPs help me please!!

ANPFNPGNP · Sep 10, 2008

So, my department has had an open position for an NP for 18 months! I just became involved in the interviewing process about 6 months ago, although I knew the previous RNs/NPs in the role (one left to industry, and one went to have triplets and doesn't work FT anymore!).
It's a really interesting position, very busy but a lot of room to make the role their own. There is acute inpt stuff, patient/staff education, outpatient clinic, clinical research/study involvement. Really a varied position, with a very interesting patient population. The CT surgeon who'd be the collaborating physician is good to work with and personable, as are the other engineers and nurses in the team.
The employer is a huge hospital system, with what seems to me to be average-good pay for this area. We're willing to train a new graduate if they are the right candidate.
I guess what I want from you, experienced NPs, is to know what we're doing wrong!? We often get people interviewing/shadowing, then calling to say they're not interested. I assumed NPs would be type A personalities who weren't so intimidated by a busy job... but maybe we're scaring them off? [it's an artificial heart program, which scares some people although it's basically advanced heart failure/device management].
Surprisingly, a lot of candidates admit they didn't want this job in particular, just "any" NP job - I can't believe they admit that to an interviewer! One even emailed saying her preferred job "fell through", so now she's interested in an interview (she had turned an interview down when we initially tried to schedule one after she applied as she was interviewing elsewhere).
What makes you say "I want to work THERE"? Any pointers? (I know it's hard without knowing the people involved).
Thanks for any help! (And if there's any NPs with an interest in cardiac/HF/mechanical support, PM me!).

Personally, I like diversity. I get bored very easily and I get to see everything in my jobs in urgent/primary care. I've worked in a "specialty" setting before and even though the money was extremely good, I was bored out of my mind. I'm not willing to work for nothing, but I'm willing to work for less b/c I know primary care has a lower reimbursement...it's just the way it is.

You mentioned that job pays better than the "average," it had better pay a LOT more than that b/c of the specialty area. Where I live, inpatient NP jobs are going for 120k per year and that's just for seeing patients on the SNU unit. ER NP's are pulling down 130K per year with full benefits. What exactly is that job paying?

emtneel · Sep 10, 2008

What state is it in??

i knew one ANP who preceptor'd, me who knew she wanted to do Cardiac and had only been a Cardiac NP.

I think (and many NP's even experienced one's confirm this) that NPs are scared of Cardiology.

I describe for example when i hear a murmur what it sounds like. I've had NPs tell me NOT to do this because i don't know what i'm doing. I explain then that i'm just describing what i hear, i'm not diagnosing a particular murmur or condition...

The position sounds like it would be intimidating unless someone had been in cardiac before or really was interested in Cardiac.

allnurses Guide · Sep 10, 2008

Hmm.. it's definitely not a job to get bored in - it's a special specialty! There's a lot of diversity, a busy transplant/MCS program and I can't see a lot of boredom setting in. You get to see ICU pts/floor pts/outpts - all sorts of interesting things.

I don't know the annual salary, only the hourly range. It's in Pittsburgh, though, and I seriously doubt the pay is anything like 120kpa - I doubt our program director earns anything like that!

hello101 · Sep 10, 2008

I have been a cardiac RN for over 10years before getting my APN degree and functioning as an NP. I thought for sure that I will work as a cardiac NP but I came to realize that I wanted to challenge myself more ("something out of my comfort zone box") and worked with a Physcian who specialized in Infectious disease. Let me tell you..I do not regret it!! It's been great. We have great repor. I teach her Cardiac and she teaches me infectious disease. I am just glad to find a physician who was open minded and accepting me. My fellow classmate who works with a cardiac group..very busy like any other practice. The other NP I know does research stuff and the other NP I know works for the hospital but she has variety of roles (education, teaching, see's x amount of patients..she's doing a lot that I think she's bringing work home..so I don't think she'll last long). The good thing about being an RN and/or NP is that we have options to go elsewhere.

ANPFNPGNP · Sep 10, 2008

Hmm.. it's definitely not a job to get bored in - it's a special specialty! There's a lot of diversity, a busy transplant/MCS program and I can't see a lot of boredom setting in. You get to see ICU pts/floor pts/outpts - all sorts of interesting things.
I don't know the annual salary, only the hourly range. It's in Pittsburgh, though, and I seriously doubt the pay is anything like 120kpa - I doubt our program director earns anything like that!

I'm curious, what's the hourly wage? It makes me ill to think they are paying less than 120K per year for a job of that magnitude. Do you know how much revenue that job would generate? My goodness, inpatient care,

heart transplants, etc...that generates big $$$!

I have a NP friend who worked in derm. He billed 700K per year, but was only paid 70K per year. After he had lots of experience under his belt, he got another derm job that paid a BONUS...now he's making 6 figures (something like a 60K pay raise)!

I guarantee you that all those job applicants are looking at that job and wondering why the heck it doesn't pay more! Unbelievable!

Trauma Columnist · Sep 10, 2008

I work in a subspecialty (nephrology) area and here is what I look for:

1. I'm definitely a type-A person and need diversity and fast-paced.

2. If I was to cross over to another sub-specialty, I would want a thorough orientation - I had four months in my current job.

3. I like clear objectives as to what my role is....for my current job I have a very detailed list of duties.

4. Since CME's are required to keep us up to date, I would like a generous allowance for that - I get $1500 and 40 hours a year.

5. Gas allowance if you are required to travel....current govt rate is $0.585 a mile.

6. The chance for further research and/or some type of advancement. That is where my current job lags - this is my job and its what I do.

7. Fair compensation. This is very dependent on the area you work. I work in central IL where the cost of living is very reasonable and I definitely make in the high end of salary spectrum for my area.

Advanced Practice Columnist / Guide · Sep 10, 2008

So, my department has had an open position for an NP for 18 months! I just became involved in the interviewing process about 6 months ago, although I knew the previous RNs/NPs in the role (one left to industry, and one went to have triplets and doesn't work FT anymore!).
It's a really interesting position, very busy but a lot of room to make the role their own. There is acute inpt stuff, patient/staff education, outpatient clinic, clinical research/study involvement. Really a varied position, with a very interesting patient population. The CT surgeon who'd be the collaborating physician is good to work with and personable, as are the other engineers and nurses in the team.
The employer is a huge hospital system, with what seems to me to be average-good pay for this area. We're willing to train a new graduate if they are the right candidate.
I guess what I want from you, experienced NPs, is to know what we're doing wrong!? We often get people interviewing/shadowing, then calling to say they're not interested. I assumed NPs would be type A personalities who weren't so intimidated by a busy job... but maybe we're scaring them off? [it's an artificial heart program, which scares some people although it's basically advanced heart failure/device management].
Surprisingly, a lot of candidates admit they didn't want this job in particular, just "any" NP job - I can't believe they admit that to an interviewer! One even emailed saying her preferred job "fell through", so now she's interested in an interview (she had turned an interview down when we initially tried to schedule one after she applied as she was interviewing elsewhere).
What makes you say "I want to work THERE"? Any pointers? (I know it's hard without knowing the people involved).
Thanks for any help! (And if there's any NPs with an interest in cardiac/HF/mechanical support, PM me!).

I work in the Cardiothoracic Surgery ICU with a group of 7 NP's. We are looking to hire at least 2 more to complete our team of NP's who provide 24-hour coverage of the ICU. At this point, we're not in a hurry to fill the vacancies as we are surviving fine. However, it took us a while to build up our numbers. Part of the reason for that is our being selective by only interviewing applicants with soild CVICU or any other critical care background. The other part is that we have had applicants withdraw because of the rotating schedule required. However, I think our biggest draw is that our NP's get to do invasive procedures and have a lot of autonomy in terms of patient management.

Our hospital also has a VAD and heart transplant program and let me tell you, we've also had a hard time finding an advanced practice nurse to work in that department. We once had postings for a nurse practitioner to work in that service and although there was some interest in the role, not many applied and those who did were not ready to assume such a demanding role. We have an easier time finding RN's as Transplant/VAD coordinators because many ICU nurses who have good experience with this population apply. I also think many RN's view this as the perfect opportunity to work in a highly specialized and autonomous role without having to go to school for an advanced practice degree.

I agree that a NP in a VAD/Heart Transplant role can be very exciting. I also don't understand why we never found any NP to assume the role when we posted the opening. But I think we are just not finding the right applicant. I think part of that too is that there are only two ACNP programs in the state and many grads from both programs get jobs right away in highly sought after roles such as general cardiology, internal medicine, and Pulmonolgy/ICU.

allnurses Guide · Sep 10, 2008

Thanks Trauma and PinoyNP - those are very helpful points.

ANPFNPGNP - I really don't think the pay is that huge of an issue - in fact I don't think we'd even got to the point of talking $$ when a few people removed themselves from consideration. I don't really understand your points about billing and revenue - we currently have fellows doing the inpatient coverage when the NP isn't there. How will an NP bring in more money? (I know they can bill 85% of the doc's fee for outpt clinic vs the

Interviewed someone today who looks like a potential. She really said the main drawback she could see was the intimidation factor of a new specialty she's not hugely familiar with, and then responsibility required. Lots of reassurance given, and took her around to meet the team. We really do have a supportive team and the points about a structured role and formal orientation are great.

Thanks again, everyone.

Advanced Practice Columnist / Guide · Sep 11, 2008

I'm curious, what's the hourly wage? It makes me ill to think they are paying less than 120K per year for a job of that magnitude. Do you know how much revenue that job would generate? My goodness, inpatient care,
heart transplants, etc...that generates big $$$!

It may surprise you that a heart transplant/VAD program is not a huge revenue generator for most hospitals who offer the service. Patients who end up receiving a ventricular assist device are very sick. Some have been living with heart failure many years of their life and have exhausted all monetary resources. Many are insured by public insurance such as state-funded Medicaid programs. These patients tend to stay in the ICU for a long time costing the hospital millions of dollars.

Rehabilitating them after a long hospital stay is also an issue. Not many rehab places accept a patient with a mechanical device that pumps their blood because their staff are not familiar with how to care for them. Placement is a big issue for those who need rehab-type placements. Some get stuck in the hospital while they get stronger when they could be getting physical therapy somewhere else.

A fraction of VAD patients are bridge-to-transplants, some are on destination therapy. Once a patient gets the mechanical device, they become patients for the long haul - they may come back with complications later on or may need a device change. They are literally stuck with the hospital for regular follow-ups. Those who end up with a transplanted heart do well in our experience. However, they also require a large amount of hospital resources to keep them healthy.

There are not many hospitals who offer a VAD and heart transplant program and one reason for that is the high cost of running one. For the ones who do offer the service, many do so mainly for the prestige of being able to offer the service.

ANPFNPGNP · Sep 11, 2008

Thanks Trauma and PinoyNP - those are very helpful points.
ANPFNPGNP - I really don't think the pay is that huge of an issue - in fact I don't think we'd even got to the point of talking $$ when a few people removed themselves from consideration. I don't really understand your points about billing and revenue - we currently have fellows doing the inpatient coverage when the NP isn't there. How will an NP bring in more money? (I know they can bill 85% of the doc's fee for outpt clinic vs the
Interviewed someone today who looks like a potential. She really said the main drawback she could see was the intimidation factor of a new specialty she's not hugely familiar with, and then responsibility required. Lots of reassurance given, and took her around to meet the team. We really do have a supportive team and the points about a structured role and formal orientation are great.
Thanks again, everyone.

One of the docs in our clinic hired a PA to see his hospitalized/nursing home patients. He told me that his income doubled after hiring the PA. I guess he was able to see more patients at his clinic due to the fact that the PA was rounding on patients.

Trauma Columnist · Sep 11, 2008

I was thinking about this post today and wanted also to say that one of the things I value at my current position is the ability to have a flexible day. I am required to work at least 40 hours and do so every week. However, I do like to work 10-12 hours on Mon-Tues and then take off early on Friday. So....this is one of the intangibles of my job.

Personally, I think the job you are talking about sounds wonderfully interesting.