Unhappy with first NP Job, need advice!

jennylynn_1983 · Nov 4, 2012

*Dump things, not dumb things* oops!

zenman · Nov 5, 2012

Sounds like you are learning a lot with the varied jobs. Is that correct? Anything you can do about being unhappy?

Trauma Columnist · Nov 5, 2012

What I've found since being an APN and working with docs is that I must be concrete. To say "I'm unhappy" won't cut it in most practices. When I've had issues, I write them down, I gather the stats I need to prove my point and I propose a very concrete solution and an acceptable second concrete solution. I'm getting that you don't have clearcut job duties. What I would do is; "Okay it looks like you need to be RNFA (not necessarily an APN role BTW) on Mon-Tue, Wednesday lets have wound clinic. On Thur/Fri I can round and update doc on what to expect for the weekend call doctor.

Trauma Columnist · Nov 5, 2012

I definitely wouldn't quit as you are going to have issues in any and all practices.

Advanced Practice Columnist / Guide · Nov 7, 2012

I think the problem lies with your sentence "I have never had a clear idea of what my role really is". This tends to be one of the pitfalls for new grad NP's especially when joining a practice as the first NP in the group. Your expectations of the job and the physicians' expectations of what you are there to do seems to be disconnected. I suggest sitting down with the head honcho (the chief or the main collaborating physician) to discuss your "unhappiness". Compromise may still be reached. I agree with TraumaRUs that your post is very vague and as a reader of your post, I'm not entirely clear what you do not like about this job. Is it the constant shifting of responsibilities that are overwhelming you? is it not being able to make clinical decisions? is it burn-out? is it the constant scut-work?

Surgical specialties such as Cardiothoracic Surgery operate in an entirely different manner as what you were trained to do as an FNP. Patients arrive with an established diagnosis that require surgical intervention and surgeons are busy in the OR fixing it. NP roles are typically pre-op teaching, first assisting, and post-op management both in in-patient and out-patient settings. Your provider skills come into play in how you can address post-operative issues and complications that could arise and establishing patient follow-up. Many NP's thrive in this setting (as do PA's). Is there just one particular aspect of this role continuum that you want to focus on? If that's the case, you should bring that up with the physicians and see how they feel about it.

goofeegirl · Nov 8, 2012

Juan... If I could follow your posts I would. You always have something good to say.

Good advice for the OP!

jennylynn_1983 · Nov 11, 2012

Thanks for the responses. I am learning a lot. My main problem, I think, is the fact that there is really no consistency in the role. I don't know where I will be or what I will be doing until about 9 PM the night before. And I'm also doing a ton of driving which is getting old really fast. This particular group sees patients at 8 different hospitals. When I first started I was in the clinic, then I was in wound care, now I'm in the OR - it seems they can't figure out what to do with me and I feel as though I'm just in the way. I also feel that a lot of what I'm doing - Rx refills, taking patient calls, first assist, are RN duties - not necessarily NP duties. I guess it's just not what I was expecting, and I'm feeling a bit let down about it.

BlueDevil,DNP, DNP, RN · Nov 11, 2012

I think you, and they, are both learning your new role. They don't know how to best utilize you either. You may not be maxamizing your capabilities now, but you are on a learning curve and I think it is actually to your benefit that they have been so willing to take things this slowly. While RNFA is not necessarily a APN role, there is huge potential here for you. As someone whom is acquainted with a APN who turned his RNFA into an orthopedic surgery NP dream job, I'm here to tell you it is a huge plum, and one that can really pay off for you in years to come. Look ahead to the future and imagine what an asset it is going to be as an experienced NP with x,xxx hours RNFA in CVT. It could be a golden ticket for you. No, I would not walk away from that opportunity. What I would do, is try to get more hours doing that, as well as the pre & post op up care, and avoid the med refills, lol.

And as usual, Juan is correct. Most of the NPs I know involved in surgical services do all of the post op visits post in hospital, and in -office. This is due to the universal billing issue (follow up care being included comprehensively in the procedure cost), and the fact that the surgeon's time is simply best spent cutting. They lose too much money doing follow ups, and it is simply inefficient. If they are willing to take it a step further and letting you open and or close to save additional time (i.e. money) that is a wider skill set for you, and I wouldn't turn that down at this point. And Trauma's point about pinning them down to some sort of routine is also well taken.

I'd try to work something out so that you are not so frustrated, but I'd give it three years before giving up on it. In my mind, three years ought to be the bare minimum amount of time any new graduate spends in their first role (be they RN, APN, etc). You cannot reach competency in less than that time, especially in specialty practice; leaving sooner is suspect.

Good luck!

Goatie · Mar 28, 2017

I had a job like this in the past, where I felt like a glorified RN. However the good news is that I hope you are getting paid with an NP salary for doing a lot of RN work, lol! And you are a jack of all trades, and you will never be bored! All joking aside, it sounds like you are frustrated because you don't have a set panel of patients in an office setting like primary care. Well, primary care isn't all that great because you have to see pts every within 10 minutes. Like a factory line. Then good luck doing charting. With set office hours, you cant grab lunch nor even take a walk for a break, you are stuck in the office. Ive worked as an NP for 20 years, so move on if you are not happy after about 6-12 months, or if the job makes you ill (Ive had NP jobs that caused chest pains, headaches, and insomnia). I do home health now, and I can shop and eat and do whatever I want in between visits.