VivaRN

Thanks SappyRN and Amanda.RN for these great suggestions!

Congratulations Amanda.RN! I am excited to see how it goes and I'm sure you will do very well!

Just wanted to update this thread to say that I am loving my job! Oddly enough I have always been someone who I felt had more anxiety than others, mostly around wanting to be sure I did the right thing. It made me a good clinician but it wasn't always a pleasant way to feel. This is not something I would have expected at all (as I very much fell into this role), but management so far has been a great fit. When I see a problem, while I have the responsibility I also have the power - hey, it is my JOB - to get people together to solve it. I would have thought the increased responsibility would be more stressful (and in the moment, it can be), but I really like having more control over my environment. I don't feel anxious at all like I used to. I like that I have the power to be a good boss, direct the work-flow and give people a break when they need one. It helps that my boss is excellent as well... maybe I am finally in a good work environment! Just had to share my happiness with you ~ thanks and please add your insights!

I was fired nearly a year ago and, while it still impacts me in my weaker moments I can honestly look back and say it was a positive. It got me out of a job I was clinging to more for stability than because I enjoyed it. I was completely open about being fired in interviews (although it was very difficult) and ended up getting an even better job than the one I was fired from! I'm a manager now and looking back, I can see how different I am (in a good way) from the manager who fired me. It was such an awful work environment. I felt very anxious about being fired again at first, then I met MY new boss and saw that she would never target me the way that old manager had. Working with good people goes a long way. To the OP: you will be fine. Being fired is more common than you think. If your new job is good and you're supported, it shouldn't happen again.

Admittedly I am a new supervisor so perhaps those with more experience will have a different perspective, but I would not think badly of you. You were honest and transparent the whole time. You were only doing staff nursing for a month. You have been a successful educator on that unit for many years. Your manager wants you to be happy and doing what you do best. There is nothing wrong with trying and then realizing your strength is in something else, that is life. Don't make it an issue and it probably won't be one. If anyone asks you about it you can tell them that, while you enjoyed and appreciated your staff nursing experience, you realized that education is where your heart is.

I am an HIV NP through and through and through and through and... (well, you get the idea). 1) I love the patient population 2) Talking about sex and drugs is part of my job 3) Guidelines change all the time and there is always something new 4) Strong social justice and advocacy/policy component 5) Many opportunities for education: patients, families, and the community Things I don't do: peds. The soundtrack of screaming sick children is not my cup of tea. At present I am also terrified of touching a pregnant woman without excessive consultation (ah! the liability!), but I could probably learn if I did it every day. Also don't do critical care. I did that as an RN and, while it was ok, I like patients who talk and opportunities for prevention. I'd rather keep them OUT of the ICU than do the whole adrenaline thing.

Why should the term "Nurse" in NP be demeaning? We have had so many strong nurse leaders in our profession - here are some of my faves: Lillian Wald, Margaret Sanger, Bobbi Campbell, Mary Breckinridge (please google these people if you don't know who they are!), and many contemporary nurse leaders making a huge difference in the world. They are researchers, they have founded clinics, they are advancing health policy. It is partly because of their legacy that I am proud to have the NURSE in nurse practitioner and to consider myself a nurse. I would also stipulate that as nurse practitioners, we do incorporate elements of the nursing approach and philosophy into our practice. It reminds us to focus on the patient's response to illness vs. being trained solely in the medical model. I would argue that it is partly our roots in nursing that allow us to be such skilled educators and primary care providers. Being connected to nursing also helps us integrate more smoothly into global health arenas. PA's do not have an international equivalent, which can make finding this type of work a challenge. For example, doctors without borders can accept advanced practice nurses but not PA's. Our job is to improve the image of nursing, share our stories, talk about the great work that nurses do every single day, and educate the public about our role as nurse practitioners. SkiBumNP, I am curious to hear more about why you feel the way you do? I am sure there will be a lot of perspectives on this.

I've been an NP now for a little over 3 years. Just like being an RN, you have to find your niche and a job that is good to you, but that is true in every profession. I've changed jobs a few times, paid my dues as an NP and finally found a job that is a great fit. I refused to settle for less. I've never regretted being an NP and would choose it any day because of the opportunities and flexibility.

I'm all for having a sit-down with the nice doctor and/or the practice manager. They invested in you enough to bring you in and it is in their interest to keep you. I would be very upfront about your learning needs and need for precepting, your desire to attend conferences and access further training in ENT, and that you will not be doing conscious sedation until you are certified to do so. Sometimes practices without experience working with NP's don't know what your needs are - speak up and try to improve the situation before you quit. If you make your needs known and nothing changes, start job searching. Make sure the good doc at least will give you a good reference.

Thank you, I was thinking if the individual acts out again to say very firmly "personal attacks will not be tolerated. We can meet to discuss privately after the meeting."

Hello, Looking for advice without giving too many details... I am a new supervisor and one of my duties is to chair a committee of interdisciplinary staff ~ about 20+ people. At a past meeting, before I was hired, one committee member stole the floor and engaged in personal attacks against one of my employees. From what I can gather nothing was done. The employee was very hurt and is fearful of this individual. We will have repeated interactions and meetings with this individual in the future. How would you handle this? Has this ever happened to you? I want to be proactive but I don't want to escalate the issue further. Thanks

lol, every time I think I've "arrived" a situation will come along to challenge me. But hey, that is what life is all about! Though I did feel my life was complete when I dx'd pharyngeal gonorrhea, rectal gonorrhea, and of course gonorrhea from the member (all different patients). I felt like I should win a prize!

Thanks so much for replying, I want so much to do well and step into my role with confidence. Mentoring is a great idea. I will follow up on that! Do you have any advice for how I should approach the employees as their new manager? You said your first year was rough - is there anything you know now that you wished you had known (or that someone had told you!) then?

Hello, I recently accepted a supervisor position because it was the one that was open of two positions I've had my eye on for a long time. While this job is not directly clinical it deals with evaluation of a large-scale clinical program. One position is supervisor (myself), one is not. I will also supervise one other employee who I've heard through the grapevine has some insubordination issues. I'm a bit younger (28) and while I'm experienced clinically I've never been in a managerial role as part of my job. I've coordinated things as a volunteer and as part of my professional organization, but I need some resources to prepare me for this new role. How do I learn to be a good manager? Any advice is appreciated! Thanks in advance.

Honesty is always best. I know of a candidate at another facility who had an outstanding interview but failed to mention a termination. It was uncovered by HR. He was not selected for the position because the hiring manager felt this candidate was dishonest and should've addressed it in the interview. On state applications you can always say "will discuss at interview" as your reason for leaving instead of termination. At the interview, take a deep breath and say "I need to let you know I was terminated from this position." Then explain why, take responsibility and let them know how you've grown since then so it won't happen again. It's a hard thing to do but people respect honesty and a person who is able to grow from mistakes. They are more likely to give you a chance vs. finding out after the fact.

I completely agree! This is why I want the person with more experience to be the supervisor/leader until I'm ready to take that on. I'm just not sure how to say that gracefully or if I should even try.

lol, all of the above! I have worked with the person in position #2 professionally and personally. I am also a lot younger than that person and don't have as many years of experience. I have never been anyone's direct supervisor so that would be a new role for me. Who knows, maybe supervising the person in position #2 would not be as big of a deal to that person as it is to me! I would just feel awkward knowing that I got a job that that person wanted despite their years of experience (should I be offered the position)... and then to be that person's supervisor... maybe I'm caring too much about what other people think.

There is a job I want where two people do the same job, but one is a supervisor and more of the leader (position #1) and one is not (position #2). A position was posted that didn't differentiate between the two. I applied for it and later realized that it was position #1 and that the person currently in position #2 is also interviewing and wants the job. This person has been in position #2 for many years and is very experienced. I'm worried that if I interview for position #1, and was offered the job (which I may since I have more school and credentials), I would end up supervising this person in position #2... which would be very awkward for me. Ideally, the person in position #2 would be given position #1 and I would get position #2. Then I could grow in the position instead of being in a supervisory role over someone with so much more experience. Initially, I planned to say this during the interview (I have an interview scheduled in a few weeks), but I recently spoke with someone I trust who advised me NOT to mention it. She claims that if I say I want position #2, and that the experienced person should get position #1, the panel will think I'm not qualified and not offer me EITHER position. I'm so confused now and not sure what to do. What do you think? Any feedback is greatly appreciated!

I have a friend who went through almost this exact same situation. She made the mistake of waiting too long before accepting the new job, then was fired in the interim (this all took place during suspension) and had to explain that to the new employer. The new employer didn't think it was an issue. No harm done in the end, but now she has that termination in her work history that didn't have to be there. If you think termination is in the future, or as you said, you don't want to go back - WITH OFFER IN HAND accept the new position and then call your old job to give your resignation. If you've accepted the position chances are the new employer won't contact the facility. Still, if I were you I would be upfront just so it doesn't look like you were hiding something if it comes out through the grapevine. There are ways to say it diplomatically. "I did want to let you know I made a documentation error at my last facility. It was a hard lesson, but I learned from it and became a much more detail oriented nurse going forward." Then leave it. These things are soooo common in nursing (along with overzealous HR departments) all future employers want to know is that you took responsibility and learned from it. That is life. Good luck!

Just wanted to say congrats as well! And I second the idea about having some kind of little notepad, that way you can write things down so you don't have to ask for things to be repeated.

I will keep you in my thoughts and prayers. Are you getting interviews?

Just wanted to update all of you. I started my new job and so far it has been going great. Everyone is so nice, the other providers I work with are patient, good humored and supportive. I can't see this place as one that fires people. It is so delightful to feel valued at work and experience success. For example today I was seeing patients with an MD and I got a pap on a patient who said her cervix was difficult to find. Victory! I'm sure I'll have my share of challenges, and difficult days, but being fired feels more like a bad dream now than something that affects how I see myself in the workplace. I don't think I realized how much my old workplace was dysfunctional in a soul-sucking sort of way. Glad I am out of there! Thanks again everyone for your help and support, there IS life (and maybe even a better life) after being fired!

I hate to be so jaded but it's the reality in a right to work state. They can let you go for whatever silly reason(s) and there is no way to appeal. I used to think that nurses/professionals in general were fired only for completely outlandish behavior like drug diversion, being inappropriate with patients, or repeated call-outs, but lately it's been like a witch hunt. New management: 5 nurses on one unit fired within the year. Good nurses, too. I was fired for something very small in the grand scheme of things. Within a few weeks one of my friends in another part of the facility was fired as well. It is surprising once I started speaking up about it how many nurses had been fired at least once in their career. This is difficult for people from other professions to understand. Nursing is different. Oddly enough, being fired is so common in this right to work state the nurses I know (including myself) found jobs in a very short amount of time. It's taken for granted that if you were fired it was probably something stupid as long as it's not a pattern. Isn't that strange? I was so afraid to interview after being fired, and I was 100% upfront about what happened - no one cared AT ALL. It's changed my whole outlook on nurses who have been fired, what it means to be fired, and then to seek employment. It's not a rosy answer but it's an honest one.

Hello, I'll be starting a new job soon where the patients are healthier than the practice I left, and therefore higher expectations for numbers. While I've juggled between 2 patients before this was rare, and not something I did all day. So here's my questions for you high-octane NP's: How do you stay organized? How do you make sure not to forget something while seeing multiple patients at a time? What do you do if you get behind or someone has a more serious problem? What's the most you see at once? When do you document? How do you structure going between rooms as far as H&P, labs, assessment/plan? Thanks for your help!

This could cause huge problems if the patient was ever hospitalized and the hospital providers requested the patient's pharm records to do med reconciliation. There is enough confusion about meds without introducing this. The decision ultimately rests with the prescriber, who should write his/her own script if the RN disagrees... but as a prescriber I would not agree to it. Too risky, even if both persons on the script were patients (meaning info about allergies and health hx). I'm all for helping out the uninsured and do so on a daily basis. There are just better ways to save.