The NP who can't function in the role

Specialties NP

Published

I have heard of this a few times over the last 20 years. People who graduate with their NP degree, and never have the confidence to function in the role.

Right now I know of two people, an NP and a PA who are not functioning in their role. Neither are new grads, both have several years of experience, at least on the books.

One has already given notice, and the other is waiting for the ax, because she doesn't meet minimal productivity standards.

It could be that LTC work is not their niche, but the work is at one's own pace, unlike a clinic, and the expectations for productivity are quite reasonable.

If you cannot see 12 patients a day as an NP, and keep up with the associated documentation, I am not sure where you can work. You are probably unemployable in the field.

I haven't analyzed either of these individual's work habits in depth, but I have observed they often get bogged down in details, and misunderstand their role in the LTC setting.

It isn't like previous nursing jobs, where the pay comes by sitting in a chair for 8 hours. The pay only comes from billing.

The NP must shift into a mindset where they focus on providing good care, and billing for it. A boring meeting is an opportunity to pick up referrals. And bill.

Well, this is my rant for the evening.

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I once read of a PA who was laid off and could not find new employment after more than two years. However, nothing was said about the individual's work performance. One does wonder.

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Specializes in Hospice.

Totallly OT, but LTC nurses do not sit in a chair for 8 hours. Just thought I would clarify that.

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Ha ha, so true. I am always comparing everything to state jobs.

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Specializes in Psychiatric and Mental Health NP (PMHNP).

Wow! One of my best preceptors is an NP at a nice LTC. It was one of those humongous campuses with independent, assisted, and then full care of various sorts. Every day she had a list of patients that needed acute care (cold, flu, new complaints, etc) along with a list of patients that needed routine checks. Boy, did we do a lot of walking! LOL However, I thought she had a great job - she just had to see the patients on the list and deal with any new problems, but other than that had total autonomy. She was out the door at 5 pm every day because she was very organized and completed charting as she went. it's a shame the folks you wrote about couldn't make it work.

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Well, yes, I don't get it. I keep my own list for the follow ups, but I get additional referrals for mental health symptoms. I am in an independent state, have autonomy and move along at my own pace.

I am usually done by 1 or 2 pm, and have to do an hour of paperwork at home.

I don't get why people are getting so hung up.

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Specializes in Hospice.
Ha ha, so true. I am always comparing everything to state jobs.

I worked at a state hospital for 11 years (the only dedicated AIDS unit in New England through the height of the epidemic). My colleagues and I didn't sit much then, either. But I understand your point so I'll stop with the de-railing. Carry on ... :up:

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Ha ha, so true. I am always comparing everything to state jobs.

This really made me LOL...I worked in state government in three states. Not to say. I didn't work really hard at times...but other times, not so much!

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Specializes in Internal Medicine.

OP, You're describing an NP I worked in my first job at a fast paced internal medicine practice. She had 10 years experience and was lucky to see 12 or 13 patients in a day. For every 1 patient she saw, I would see 2-3 patients. Our practice would schedule nearly 40+ patients a day, plus accept walk ins for 3 providers. I remember one week when our boss went out of town and it was just us two, I saw 32 patients one day, and she saw 11. I was livid.

I eventually left and shortly after I did learned she had gotten fired to lack of productivity.

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I think some NPs or PAs have heard too many vague statements in school about "good patient care" and "appropriate documentation". Statements like these are open to vast interpretation.

A few haven't had good role models,but most have persisted in an unworkable, and inflexible pattern of behavior.

"If it weren't for this damn forest all around me, maybe I could cut down a tree."

Eleven patients in a day is first week on the job for an NP.

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Specializes in Internal Medicine.

I agree. School also doesn't really teach you the business aspect of healthcare, and physicians certainly aren't any better about telling you what you're bringing to the table. The only time they tell you anything is if you aren't doing enough. They're nice and quiet though when you're pumping their practice full of revenue.

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Specializes in ICU, LTACH, Internal Medicine.

IMH(umble)O, the problem is that many NPs (and PAs as well) never lose that narrow-mindedness which comes with type of education they get, associated with permanent fear of missing or not documenting something. in case of NPs, it also gets complicated with typically nursing developmental defect of "being task oriented".

The education NPs and PAs get is normally more limited as compared with one of MD/DO school. That by itself wouldn't be a problem - after all, we all know doctors who, being wonderful specialists in one area, seem to be not aware of pretty baseline facts from another. The thing is, though, that training of MDs/DOs, especially in residency, teaches them to have a broader and more complex view of things. Even if they not know something, it is much easier for them to integrate new facts into a picture once they get them. This, the proverbial "seeing patient as a whole" in medical point of view, is not a skill which can be taught by books. And I see PAs and NPs missing it. Instead, they seem to concentrate of problems which wouldn't even arose for and MD. A patient who is hypothyroid, on Norco 10/325 Q4h PRN home + dilaudid 1 mg Q2h PRN in house, poorly mobile and "dry" overall (with limited oral intake postop for urgent ortho case) can reasonably expected to be constipated. As long as he is completely asymptomatic, doesn't need GI workup for any other reason, etc. everything that needs to be done is ordering standard bowel protocol on admission. After all, he might have a BM once weekly at home and nobody will be greatly concerned for it. Being "dry" and poorly mobile is WAY more important problems to treat. Yet, I'd seen GI consultant fuming about called just for such patients, as well as loading poor dude with insane amount of laxatives for the sake of getting him goin' and documenting "daily BMs".

It is OK for an RN to fret about that (not at 3 AM and not calling Ortho Surgery on call for that, though). It is, again, IMH(umble)O, NOT OK for someone acting on provider level to do that instead of figuring out why this dude refuses PT/OT or what is better way to control his pain woth not that much of narcs, or what is the best way to hydrate him or why his TSH is sky-high while T4 is WNL and only one symptom of hypothyroid he seems to have is constipation.

Perhaps, all that "Nursing Research" and "Role developement" fluff and buff of NP schools should be substituted for 2 courses 12 credits each: "Advanced Clinical Thinking" and "Business of Healthcare 101".

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