NP Work life balance

Trauma Columnist · Feb 23, 2018

I am in the same boat: I changed jobs in December and specifically stated in the interview I wanted more of a 40-45 hour work week. Well...I'm up to 60 hours and counting!

I just don't know what to tell you - personally I think many facitlities take advantage of APRNs....

allnurses Guide · Feb 23, 2018

My job isn't terrible. I work in a private specialty practice which is not affiliated with a big medical group or hospital. I'm usually finished no more than 15 minutes late. It's busy, but not so crazy that I don't get lunch or spend hours at home finishing notes. My boss can be a little intense and bottom line focused, but it's his practice and he's generally a benevolent monarch.

Jules A, MSN · Feb 23, 2018

I am in the same boat: I changed jobs in December and specifically stated in the interview I wanted more of a 40-45 hour work week. Well...I'm up to 60 hours and counting!
I just don't know what to tell you - personally I think many facitlities take advantage of APRNs....

Girlfriend, let me take you to lunch. :) You are right on at least for inpatient work. In my experience, almost every facility has attempted to take advantage by trying to get me for a low rate and dumping on additional duties down the line. It might be easier in psychiatry because I can tell them exactly, with minimal variation, how many patients I can safely treat a day and I set this tone prior to starting. While I am extremely collegial with regard to assisting my physician colleagues with coverage as needed I do not allow admin to increase what we initially agreed upon without additional compensation.

OP, good luck finding a slow ED.

Jules A, MSN · Feb 23, 2018

My job isn't terrible. I work in a private specialty practice which is not affiliated with a big medical group or hospital. I'm usually finished no more than 15 minutes late. It's busy, but not so crazy that I don't get lunch or spend hours at home finishing notes. My boss can be a little intense and bottom line focused, but it's his practice and he's generally a benevolent monarch.

That sounds pleasant and fair. I have found the outpatient jobs in my specialty to be more reliable with regard to M-F day hours if the person is reasonably skilled and organized.

Goldenfox · Feb 23, 2018

Not every job is terrible. But, I do believe that most are. Some are more terrible than others. There were 3 staff positions that I had that were excellent as far as clinical stuff, pay, and benefits go. What ruined them was the office politics and the unrealistic expectations and the excessive number of unpaid hours. In one situation the doctor's family members were the staff...his wife was the office manager, his daughter was the assistant office manager, his son was the administrative assistant... And all of these people felt that they had to tell me how to be a nurse practitioner and what to prescribe for my patients and when. I was the 4th NP he hired in less than 2 years. It didn't take me long to see why the others left. I lasted there 8 months. I'm surprised I stayed there that long. There were a LOT of unethical and illegal things that that doctor was allowing his family members to do---including logging on to the EHR with his password and writing electronic prescriptions for patients under his name. I didn't yet have another job lined up when I left that place. But it was scary dangerous. I heard that the NP who he hired after I left stayed there less than a month.

I had another staff position with a specialist. Brilliant doctor, very nice guy too. But he had just recently married the office assistant (who he was having an affair with while he was married to someone else---and the someone else was the office manager). I did not know what I was walking into when I accepted that job. At this place there were 2 NPs working there who abruptly resigned shortly before I was hired. It didn't take me long to find out why. They were both young, attractive women. And the doctor's new wife didn't like that at all. It was drama and fireworks every single day. Big fights and screaming between the new wife and the former one---in front of the patients. And they were trying to get me to get involved in it and to take sides. The administrative assistant was the doctor's niece and the the biller was the doctor's sister, and both were loyal to the former wife and were always trying to involved me in petty gossip. When I refused to get mixed up in their nonsense I was targeted for being 'anti-social'. I had to leave that place too. Those family members were ridiculous. On top of that, he expected me to round in 4 different hospitals all over town then come in and see a full roster of patients everyday while he and his new bride would cruise. They often left the office on extended lunches and at time just disappeared together. I had a ridiculous patient load everyday and was having to stay hours after the office closed just to get caught up with documentation.

I had yet another position with an internal medicine practice. Again, I did not know what I was walking into. It just seemed too good to be true. I was suspicious that there were 3 other NPs who left the position within the past year. I later found out that this doctor had a penchant for getting into relationships with his staff. He was involved with the previous office manager who had also just left, and he was involved with the current office manager who used to watch my every move and was always trying to tell me what to do as a nurse practitioner even though this person had no clinical background whatsoever. But things go really weird there. And I am pretty certain that that doctor was on drugs. He often called out from work, or came in very late, or suddenly leave very early. And I was often having to take care of both his patients and mine. At times he would come in looking disheveled and smelling like he hadn't showered in days, and obviously stoned. There were days when we had the waiting room full of patients and I would walk by his office and see him just sitting at his desk, burning incense, listening to music, and staring at his mood lights like he was in some sort of trance. There were a lot of things going on at that place that were questionable and illegal too. After that I decided that locums was the way to go. If the place sucks you only have to put up with it for a while and then you move on to the next gig.

A long time ago, when there weren't that many ARNPs our profession was treated with more respect. Now, the hospitals and doctors that most of us work for take advantage of us because they mostly view us as lackeys, or, in the vernacular, the doctors' [b-word]. We are expected to accept being taken advantage of and remain silent about it because we are supposed to be grateful to even have a job at all. I've seen this in most jobs I've had as an NP, and I have done both staff and a lot of locums in different parts of the country. Its much better in the more rural areas though since you're less likely to encounter the over-aggressive, self-important personalities. The low pay is just a part of it now. To [them] you are 'just a nurse' no matter what title your education or qualifications bestow upon you. Interestingly enough, in an increasing number of areas you will find that certain RNs are earning more than NPs. The reason is because there now is a real shortage of experienced RNs in many places. Many of the older ones among us are retiring, and many of the rest are becoming or have become NPs. I haven't worked as an RN in years, but I still get emails from RN recruiters and some of the specialty positions in some areas pay more than what I was earning at my last few locums NP jobs. Locums NP jobs used to be plentiful and they used to pay better. But that has mostly dried up too. As far as the money goes, I believe that we're going to continue to see stagnation and in some cases even a decline in pay across the board. They can do this because they have many NPs to choose from.

If you like ER but don't like the hospital set-up then you might consider working in an urgent care. Similar activity but when the day is done, its done. Last patient in by a certain time---unless its a 24-hour operation. You might go over a little bit but this is generally strongly discouraged. If you decide to do locums urgent care you will find that there are plenty of options for experienced NPs.

Advanced Practice Columnist / Guide · Feb 23, 2018

OP, this is the reason why the bulk of my NP career has been spent working 3 12-hr shifts a week in an hourly position. I started out working Mon-Fri in a supposedly 40-hr work week that ended up being 60 hrs with staying over for late admissions. The job wasn't hard but I felt like with the salaried classification, I was either working extra for free or making less per hour than when I was an RN at the bedside if I divide the hours I put in with how much I was getting paid.

In my current job, we do stay over for sign out which takes around 30 mins. If I have to be called in to work an extra shift, that's time and a half. There are busy days or stretches of days that wipe me out but I have enough days off after to recharge and take my mind off of being annoyed with the kind of days I just had. I can even take a short trip somewhere. I have picked up moonlighting gigs here and there outside of the hospital I work for and that has helped with having extra disposable income and getting a perspective of how things are done in other places.

ToFNPandBeyond · Feb 24, 2018

Not every job is terrible. But, I do believe that most are. Some are more terrible than others. There were 3 staff positions that I had that were excellent as far as clinical stuff, pay, and benefits go. What ruined them was the office politics and the unrealistic expectations and the excessive number of unpaid hours. In one situation the doctor's family members were the staff...his wife was the office manager, his daughter was the assistant office manager, his son was the administrative assistant... And all of these people felt that they had to tell me how to be a nurse practitioner and what to prescribe for my patients and when. I was the 4th NP he hired in less than 2 years. It didn't take me long to see why the others left. I lasted there 8 months. I'm surprised I stayed there that long. There were a LOT of unethical and illegal things that that doctor was allowing his family members to do---including logging on to the EHR with his password and writing electronic prescriptions for patients under his name. I didn't yet have another job lined up when I left that place. But it was scary dangerous. I heard that the NP who he hired after I left stayed there less than a month.
I had another staff position with a specialist. Brilliant doctor, very nice guy too. But he had just recently married the office assistant (who he was having an affair with while he was married to someone else---and the someone else was the office manager). I did not know what I was walking into when I accepted that job. At this place there were 2 NPs working there who abruptly resigned shortly before I was hired. It didn't take me long to find out why. They were both young, attractive women. And the doctor's new wife didn't like that at all. It was drama and fireworks every single day. Big fights and screaming between the new wife and the former one---in front of the patients. And they were trying to get me to get involved in it and to take sides. The administrative assistant was the doctor's niece and the the biller was the doctor's sister, and both were loyal to the former wife and were always trying to involved me in petty gossip. When I refused to get mixed up in their nonsense I was targeted for being 'anti-social'. I had to leave that place too. Those family members were ridiculous. On top of that, he expected me to round in 4 different hospitals all over town then come in and see a full roster of patients everyday while he and his new bride would cruise. They often left the office on extended lunches and at time just disappeared together. I had a ridiculous patient load everyday and was having to stay hours after the office closed just to get caught up with documentation.
I had yet another position with an internal medicine practice. Again, I did not know what I was walking into. It just seemed too good to be true. I was suspicious that there were 3 other NPs who left the position within the past year. I later found out that this doctor had a penchant for getting into relationships with his staff. He was involved with the previous office manager who had also just left, and he was involved with the current office manager who used to watch my every move and was always trying to tell me what to do as a nurse practitioner even though this person had no clinical background whatsoever. But things go really weird there. And I am pretty certain that that doctor was on drugs. He often called out from work, or came in very late, or suddenly leave very early. And I was often having to take care of both his patients and mine. At times he would come in looking disheveled and smelling like he hadn't showered in days, and obviously stoned. There were days when we had the waiting room full of patients and I would walk by his office and see him just sitting at his desk, burning incense, listening to music, and staring at his mood lights like he was in some sort of trance. There were a lot of things going on at that place that were questionable and illegal too. After that I decided that locums was the way to go. If the place sucks you only have to put up with it for a while and then you move on to the next gig.
A long time ago, when there weren't that many ARNPs our profession was treated with more respect. Now, the hospitals and doctors that most of us work for take advantage of us because they mostly view us as lackeys, or, in the vernacular, the doctors' [b-word]. We are expected to accept being taken advantage of and remain silent about it because we are supposed to be grateful to even have a job at all. I've seen this in most jobs I've had as an NP, and I have done both staff and a lot of locums in different parts of the country. Its much better in the more rural areas though since you're less likely to encounter the over-aggressive, self-important personalities. The low pay is just a part of it now. To [them] you are 'just a nurse' no matter what title your education or qualifications bestow upon you. Interestingly enough, in an increasing number of areas you will find that certain RNs are earning more than NPs. The reason is because there now is a real shortage of experienced RNs in many places. Many of the older ones among us are retiring, and many of the rest are becoming or have become NPs. I haven't worked as an RN in years, but I still get emails from RN recruiters and some of the specialty positions in some areas pay more than what I was earning at my last few locums NP jobs. Locums NP jobs used to be plentiful and they used to pay better. But that has mostly dried up too. As far as the money goes, I believe that we're going to continue to see stagnation and in some cases even a decline in pay across the board. They can do this because they have many NPs to choose from.
If you like ER but don't like the hospital set-up then you might consider working in an urgent care. Similar activity but when the day is done, its done. Last patient in by a certain time---unless its a 24-hour operation. You might go over a little bit but this is generally strongly discouraged. If you decide to do locums urgent care you will find that there are plenty of options for experienced NPs.

Lol, I thoroughly enjoyed reading this! Very entertaining, yet insightful. I will say, however, that there is a theme in the experiences you've mentioned, and it's worth noting and paying attention to, for anyone who encounters something similar. When we interview for jobs, we need to ask the right questions, and go with our intuition when something doesn't feel right, to avoid these type of situations. Doesn't mean it won't ever happen, but more times than not, it can be avoided.

LadysSolo · Feb 24, 2018

My first NP job was great, but the MD hired a partner after about a year, didn't need both of us so out I went. Second NP job was even better, but another NP in the practice made a bad comment about the CEO's mistress, so all the NPs in the practice were fired the next day. Oh, the joys of an "at will" state! Next NP job, I was the first in the practice, MD re-did everything I did, put up with that for 18 months (he was in his 80s so I hoped he would figure it out, he didn't.) I quit, current job is better than #3 but not great. I work 5 days/week, we are on call 24/7/365 (we work out of our homes but have "productivity" requirements,) computer charting program sucks, salary is supposedly based on a 10-hour day but realistically I chart on average 4 to 6 hours/night after working all day. As soon as I am Medicare-eligible I am going back to the floor to work 4 8-hour shifts so I can have a life!

Goldenfox · Feb 25, 2018

Lol, I thoroughly enjoyed reading this! Very entertaining, yet insightful. I will say, however, that there is a theme in the experiences you've mentioned, and it's worth noting and paying attention to, for anyone who encounters something similar. When we interview for jobs, we need to ask the right questions, and go with our intuition when something doesn't feel right, to avoid these type of situations. Doesn't mean it won't ever happen, but more times than not, it can be avoided.

It wasn't that I didn't ask the right questions. Also, just because one asks certain questions during an interview doesn't necessarily mean that the given answers will be the truth. There are many examples of this that I could post, but I will give just one: In one NP job that I had, the physician who owned the practice promised me the moon and the stars when I was hired. Yes, it was in the contract that I signed that I would receive benefits and a small raise after a 90-day probationary period. Of course, after the probationary period I received neither the benefits nor the raise, and when I asked about them he got mad. Then he began to nit pick and criticize my work for the silliest of things. I was told that we were in an 'At Will' state and that if I wasn't happy I could leave. I stayed there another 4 months and put up with him and his abuse because I didn't want to be looking for another job so soon, and I knew it wouldn't look good on my resume. It was a very difficult 4 months. [The stories I could tell about my experiences when I first started in this profession... Some of them were extremely bad]! In one case, it was another NP who screwed me over to make me look bad to the physicians because she was afraid that they were going to let her go and keep me in the practice. I learned a lot from THAT experience, too.

I posted that long-winded comment for a very specific reason. I have read many comments here from new grads who are either having difficulties on their first job (or first couple of jobs) or who are having difficulty finding a job. And, they feel obliged take whatever comes up and put up with a lot of BS because they are desperate to have a job as an NP. Its probably unrealistic to expect that there won't be at least a small amount of BS in any workplace (unless you are your own boss); but, in some cases its just not worth it.

aprnKate · Mar 1, 2018

lol... sounded like my first permanent job as a NP. loved the patients and co workers for the most part. hated the drama. there always has to be an office manager married to the boss and the boss having some type of affair with the front desk personnel/medical assistant. Ugh!not a good work place environment. I agree. Locums is the way to go if you are burned out. has some flexibility with schedule and you get to try out different places before you settle with one you like.

Jules A, MSN · Mar 1, 2018

Lol, I actually had a patient complaining about their previous provider because the Drs wife was the office manager just yesterday. Fortunately I haven't been in that position but there are definitely many practices in my area that roll that way. In light of your post that will go on my list of red flags for future jobs.