First Job, Unsure of Role

Specialties NP

Published

My first NP job ever, and they are opening a new clinic, which is where I'll work, though I'm training at one of their current clinics. When I was interviewing, I was told that they would have 1 new doc, in addition to 2 current docs, plus me. First NP in an organization of about 60 docs, spread across multiple clinics (Physician owned group). They did also ask if I was interested in patient education, which I said I love educating my patients, esp new dx, like DM.

Fast forward to my first week, and I've trained all week on the EHR, which is a good thing. However, an MA showed me the plan for the clinic (new building), and now apparently they have hired 2 (not 1) new docs. There are 4 doc offices, each doc with their patient rooms nearby. I have no office, no patient rooms...there's one triage room, far away from all the doc offices, where I'll see patients. It's next to the storage area. Additionally, they were not going to give me a lab jacket until I asked. The HR lady was surprised that I might wear one. The docs each get $1000 q3 yrs to decorate their areas. I don't know how I would ever meet my RVU goal for bonuses having one patient roomed at a time.

What I have going for me, is that they did not give me a contract. I feel like I am being lumped in with the front office/supportive staff. My onboarding packet looks like what every one of them is given. I only need to give 2 weeks notice, and My EHR trainer told me that she knows they will utilize heavily, but she knows the docs are unsure of exactly how to use me. I honestly feel like it will be humiliating to show up, feeling like I'm a provider, yet only have 1 room in the corner, in the opposite area from the other providers, doing God knows what. I don't know what to do...wait and see what's in store when we move to the new clinic 2nd week of August, or talk to them now? don't have a job-description, but I don't want to be treated as an RN. What to do?

Sounds like some flexibility and assertiveness will be needed, and a learning situation even if it doesn't work out

Specializes in Family Nurse Practitioner.

Sounds like you handled it beautifully and smart not to start doing RN duties now or that will never end. Many are hesitant to set boundaries initially due to not wanting to make waves or "be a team player" and it is a big mistake. Trust they didn't ask the new physician if she'd room her own patients or give injections even on an interim basis. It is also excellent that the nurse manager is supporting you as part of medical staff not nursing staff. As hard as it can be to separate ourselves from our own kind it is important we align with physicians with regard to practice or the lines blur.

No need to avoid being the first NP at a facility although it is more challenging for a new grad. If you set up appropriate expectations it can be a wonderful experience for you to shape to your preference. Like you noted that many have worked there long term is an excellent sign. You are negotiating like a pro so they will expect you to operate like one when you start practicing. Best wishes and please keep us posted.

Specializes in Family Nurse Practitioner.

duplicate, sorry!

Update: I had a sit-down with the CEO. She explained how a doc that they had given an offer letter had gone MIA until a day before the offer was up, and suddenly appeared and accepted her offer out of the blue, so they had to take her :sarcastic: . So now they figure it won't be fair for me to try to compete with 2 MD's in trying to build a patient panel (plus I just know they have no room for me there).

Fast forward to a week ago, I'm asked if I want to go to a different clinic with 2 MD's. I'm excited cause it's 10 minutes closer to home. Lo and behold, one of the MDs is unsure of a "mid-level," as he's never worked with one. Turns out they now want an MD there, even though they had told me they couldn't afford an MD there just yet. So a different clinic has 2 out of 8 MD's out for the week, do I want to go there for that time? Yes, I say...I'll be with an MD that I precepted with and that I like...I show up 2 days ago, only to be ambushed by the CEO, and end up signing a new collaborative agreement with an MD that I knew nothing about. Apparently it's now the permanent solution. I didn't find out until after the realization that as the MD is talking to me, the plan sounds permanent. I did make it clear, that I don't want to be stuck doing all HRA and Medicare annual wellness assessments only, which the MD wants me to help her with. I've never done them, but they told me that they take long, (as long as an hour), have higher RVU's (for my bonuses), and I would do maybe 2 in the morning, and 1 or 2 in the afternoon. I plan on doing a couple before I can agree on how many I want to do per day. I made it clear that I need to get experience in seeing regular patients, and they agreed. Also, they would convert a certain area if the building for me into an office, and 3 patient rooms each, for me, and another doc that is moving there. I fully intend to ask for the $1000 to decorate my area/rooms (plus they ended up also giving me 2 lab jackets, just like the 2 new MDs, though the finance person was quite surprised that I would also need one. I got 2, just to show that i expect to be treated pretty similar to other providers..yay for small victories). The nurse manager told me later that she thought this may be the best bet for me. She didn't like how things had been handled so far, plus once I proved myself, and had more MDs understanding how useful an NP could be, I could probably move to another clinic, if I so wished. They are willing to work with my schedule so I can come in earlier, and leave earlier on one day of the week, as this would more closely have mirrored my original schedule that I was hired for. Btw, an MD at this clinic that sees over 40-50 (yes, forty-fifty, plus hospital rounds) patients/day is retiring at the end of the year, so it might work in my favor as most MDs see about half as many as he does.

I'm meeting with the president, CEO, and COO for lunch today, and I'm wondering whether I should let them all know how I think their communication skills suck, or just shut up, see how it all goes, and jump ship after I get experience if I don't like it in a year. The new location is about 5 min farther than the previous one, which was already about 10 min farther than where I was hired for. Sigh...

I would probably not comment on their communication skills at lunch. I would be appreciative of the opportunity and talk up your ambitions for patient care and improving the clinic by what an APRN brings.

Specializes in Nephrology, Cardiology, ER, ICU.
I would probably not comment on their communication skills at lunch. I would be appreciative of the opportunity and talk up your ambitions for patient care and improving the clinic by what an APRN brings.

Agree with this. You know the communication is bad - either get used to it or leave. It sounds like they are "sorta" working with you. Since you are new, I would push forward but with the realization that you will be expected to negotiate for anything you want. Best wishes and thanks for the update

Specializes in Internal Medicine.
I would probably not comment on their communication skills at lunch. I would be appreciative of the opportunity and talk up your ambitions for patient care and improving the clinic by what an APRN brings.

Definitely this. It seems they are more ignorant than anything, but it looks like they mean well and have worked with you to get you set up properly. In all fairness too, it seems like you accepted a job without having a clear idea what the expectations for you were, which is interview question #1 for me.

Either way, there are going to be some growing pains and learning curves on both ends, and in the end I think it'll work itself out.

I too was the first NP in a practice when I got out of school, but after a while it all sorts itself out.

Specializes in Emergency Dept, ICU.

Let us know how lunch went

I hope everything worked out for you and you come back with a better peace of mind about your future with the company.

Specializes in Emergency medicine.

I'm so confused. How on earth did you get to that point in the hiring process without even having a job description? Or knowing what your duties will be? I'm glad you got things sorted out a little bit, but I definitely wouldn't criticize their communication skills.

Update: lunch went well. They talked about how they we're looking forward to me seeing patients, and having my own office/rooms, apologizing for how they've not really been organized, and thanking me for my patience with them. It was mainly pleasantries, and the president telling me not to ever hesitate to reach out to him should I need to.

Fast forward...I've been seeing patients for about 4 weeks now, but the most I've seen in a day is 5 patients (not by choice, that's all that's been put on my schedule). I'm not sure how quickly other NPs usually have their patient numbers go up. I'm looking on the bright side, and taking my time to thoroughly prepare and research patients that I'm going to see.

Problem; because my numbers are not up, they want me to start off without an MA once I move to my own area next week (I've been using my collaborating physician's staff, or those of whichever doc might be out). I've been totally opposed to this, and I'm waiting to see how it plays out. The nurse manager, and COO agree that I need one, but I guess the docs who are partners in the organization feel that it's not financially feasible since my numbers are not up. But I know my numbers will never be up if I have to do everything by myself, not to mention that if all the 60 docs have an MA, and a nurse, I should at least have an MA.

I'm so confused. How on earth did you get to that point in the hiring process without even having a job description? Or knowing what your duties will be? I'm glad you got things sorted out a little bit, but I definitely wouldn't criticize their communication skills.

I did not have a written job description. However, during the interview process, I asked what exactly a day would look like for me, and they basically described what I felt described an NP role...seeing patients. I didn't ask about MA's because I have never not known any providers to not have one. Maybe that was my rookie mistake.

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