DucatiNP

+1 on having an MD evaluating your practice. My "admin supervisor" does my eval at my hospital and it's a nightmare. It's this way because my consulting MD is only paid 1 hour per week to take my calls (he is not on site).

Pain management, yes. It was so nice there and you can tell the profits from the practice were bring put directly back into the practice and not someones pocket. Derm, yes. the Derm MD used to have an office across from mine and he actually requested me to work with him twice. But the hospital beaurocracy (we work for the same hospital) gave him an RN for cost savings. The small occ health practice my friend works at, no. But if they somehow agreed to pay me average, then yes. But I don't think that was going to happen. Large hospital occ health with high NP turnover, no. But if they paid me higher than average and knowing I'm still going to leave because of the high NP turnover, yes. The manager position, yes. So my answer is pretty much yes to everything because the NP school I went to emphasized being a "rounded" scholar. The NP's had to take a the speaking and debate class reserved for the MBA (Masters in Business Association). And the MBAs had to take psycology. Mandatory. So I would take any of the 5 to become more rounded and become proficient in that part of medicine.

Thanks for the reply Cardiology EP NP. I’m an FNP and you’re right, those jobs weren’t a perfect fit for me. But I entertained the interview to really find out they weren’t for me. But if any of those 5 wanted to hire me I would do it for about 3 years to master that part of medicine, round of my skill set and make me more marketable in the future. I took a peek at my current medical directors CV and she jumped jobs (and climbed up) every 3 years for 15 years to get where she is today. I think she is a good example of climbing up the corporate (medical) ladder. Thank you both for the perspective. I’m only on my 5th month of hard searching and I’m happy to see that this is about average in todays job market.

An anticoag practice.

If you have the financial means to job search for the job you want full time. Do it. Especially while your in the "student finances" mentality. I feel like I've been "pigeon holed".

I've read all the "interview do's and don'ts" I can google but I've had 5 NP job interviews and no offers. Is this normal to have that many interviews and no offers? 1st interview: at a pain management practice. I made it to the 2nd day of interviews only because the first day I was interviewed by a PsyD. And he saw through all the ******** the other interviewees were presenting. I was beat out by a Spanish speaking MD. 2nd interview: at another NP position at the current hospital I work at. I even have a friend who works there as a medical assistant (I'm pretty sure that's why I landed the interview). I was beat out by an NP with dermatology experience (I have no derm experience). 3rd interview: at a small private occ health place my friend (a NP) works at. According to her I nailed the first interview but they never returned my calls / emails for the 2nd interview. Possibly because they could only match the current (below average according to salary.com) pay I was getting. And they couldn't pay me average like I requested. 4th interview: at my current hospitals occ health place. I heard it was a really bad place to work, overwhelmed manager, you work 10hours a day (everyday) and only get paid for 8. High NP turnover. I didn't follow up too hard. If they want me for that hard job they would have to pay well for the hard work done. 5th interview: a managerial position, to manage the county's public health nurses (8-9 of them). I was surprised they wanted to interview me, but the interview confirmed what my resume (doesn't) say. I have never been a manager of nurses before. Currently I manage 2 medical assistants and before that I was a head waiter managing 18 waitstaff. I sure they hired someone with experience managing nurses. I'm sure my resume is perfect (it's landed me 5 interviews). But did I blow my interviews somehow?

Any Nurse Practitioners work at a Medical Marijuana Referal Clinic? Please share your experiences, I'm going to interview at one to see what it's all about, some / any info will help. Thanks.

I have taken every college Spanish class my university offered and aced them all, even Spanish for healthcare professionals. But Spanish isn't my 1st language and when it comes to something important like diagnosing abdominal pain I would really rather get the history in English. I'm more comfortable with English, its faster and safer. I want to practice in Spanish, and I'm great at classroom Spanish but using it in practice is intimidating. So... Where to practice your Spanish before you practice in Spanish?

Thanks TX RN. What do you ride? Some of my 50 year old patients say that your body will want to give up motorcycles (sportbikes) as you get older (they used to ride). It just gets too hard and no longer becomes fun. I'm going to wait for that to happen to hang up my helmet.

Thanks TX RN, I'll look at usajobs.gov. I ride a Monster 696, I think I was turned down from a NP position at a Spine Rehab place because I mentioned I had a motorcycle.

Anyone know how the job market in the Bay Area, CA is? From my point of view its pretty tough. 15 applications sent out. 4 interviews (3 of which I only got because I had a friend working there). Interviews went fine. For 1 position I got beat out by a Spanish speaking doctor. 2nd position low balled the salary - according to salary.com and payscale.com the average (highest part of the bell curve) pay in San Francisco should be $49-$50. Since I'm currently an FNP at a big hospital with a very limited scope of practice (so limited I want to leave) I settled for $44 because I know I'm new, But now I'm not new (4yrs experience now) and now I want at least average. Still waiting for the results of another interview but I'm losing hope because I have no dermatology experience. I landed the Derm interview because of my patient satisfaction awards from my current job (and I have a friend working there). I landed an interview at an Occ health place but they worked my friend so hard he is usually able to return my calls / emails in about 1 week (we are at the same hospital) and he has gained ~30lbs from the stress. But he has way more skills than me because of the diversity in Occ health. I'm slow to follow up with them because 9-10 hour days (and getting paid for 8) are the norm. I'm frustrated. Am I asking too much for average pay and a position that will actually let me diagnose something?

Thanks for your reply WestCoastGirl. About patient volume and satisfaction; the lazy NP sees about 8 patients a day, and does recieve complaints. The manager turns a blind eye to it. For volume, the Lazy NP actively seeks out new easy part time NP jobs while she's at work! One of the first things she says is, "I'm looking for a practice that's not too busy and slower paced." They hire her for some reason and let her go within 6 months. This process repeats about once a year and she always says, "She has trouble keeping her patients". I'm thinking, "Wow, other managers know that patients to not want to see her, her patient volume is down and she is "let go" or all her hours are cut from that practice. What the hell is wrong with my manager!? My manager is turning a blind eye to her decreased patient volume for some reason. WestCoastGirl, you're right. This is very demoralizing and so unfair. Thanks for your reply.

Thanks Sunray, Your #1: Thanks for pointing that out. That just confirms Gator's response that the manager is making excuses for the lazy older NP. Your #2: I am in a larger organization and I probably am on the higher end of the pay range. But I don't think money is the primary issue (but it's always a main issue). I want to have trust in the management. I want to know the management will manage fairly, acknowledging brilliance and incompetence, hard workers and lazy people. I want my manager to reward excellent work with anything other than more work. Or if he/she cannot reward much, at least provide a transparent view of the next higher step of the "corporate ladder" (if that can apply in the medical field). Gator is right, I know what I want now and I'm going to find it.

Thanks Gator, When your new employer asked, how did you word your bad situation into something constructive? And how many months or weeks notice did you give resignation to your old employer? Thanks.

Management favors the other NP in the practice I work at. The manager lets the other NP get away with surfing the internet for half her day. I feel like that's letting her get away with too much, like the lazy NP is almost stealing from the practice. I'm the NP she goes to with extra projects because I am a hard worker that gets the job done right. The manger gives me more work / important time consuming projects and she's ok with the lazy NP barely getting stuff done. The only good thing that comes out of working harder is a good review at the end of the year WITHOUT a larger raise than the lazier NP. I've confronted her about including the lazy NP in the extra projects I do but her response is, "She's not good with computers, I have to work with her on that." Or "I have to work with her about her customer service." I love to negotiate raises, my first and second years at this clinic I treated the raise like applying for a new job, showing accomplishments, production, glowing reviews from patients, etc.. The manager insists her hands are tied when it comes to altering how much the raises are and how mobile I can be within the organization (a HEENT surgeon wanted me to join him). My manager has kept me in the same position and let me "expand my role" by giving me extra projects. I think there is also some reverse ageism. It seems the lazy older NP gets less work. Maybe she is afraid that if she gives older NP more work they will quit / retire (because she is almost there) or she's rewarding the older NP for not jumping jobs like younger people do. I feel like I'm ready to jump jobs, but in this economy, I don't want to go from bad job to worse job. And managerial favoritism is everywhere, right? Managers are human and it almost can't be avoided. Am I expecting too much? Is this normal in workplaces everywhere? Thanks in advance for your responses.

I'm in my 1st NP position and from what I learned in school, all you needed to practice was a Standardized Procedure which is about 2-3 pages in length. Now my Admins are requesting me to make my Practice Protocol and Drug Formulary for them. Typing out what I can do in my practice is like re-typing a 1,000 page textbook and drug guide!!! I hope this isn't the case. Please help, hopefully with some evidence to help me avoid all the unnecessary typing.

I'm content with my clinical preparations from school. A physician once said to me, "So, your in year 8 of Medicine. I remember that year, the steep part of the learning curve is still ahead of you." I think that is true. The more I know about Medicine, the more I realize I don't know. It is overwelming, but I am not under prepared.

Great point, I am held to the NP standard of care! I was trying to put that into words when (without warning) the admin RN had me 'watch' / orient to the advice nurse position. I said to my administrator, "You know, I CAN do the workup for the problem presented to me." She said, "just watch the advice nurse, this isn't an orientation or anything." I'm thinking, (then why am I watching). Come to think of it, when I called the patient with the advice nurse for a follow up lab (for another doctor), I signed with an NP behind my name. Now I'm nervous that I did something wrong. Thanks so much for posting! This board is so great, you all are really helping me out.

Thanks Selke, 1) I'd think it would set a bad precedent for you to start "helping out" the MAs/RNs in the clinic; they will come to just see you as a glorified nurse and expect you to fill in whenever THEY feel you should, and the administrator will see you as a quick fix for her staffing issues. The precedent has already been done. My administrator already expects me and the other NP to do MA stuff when we don't have one. My administrator makes sure the ENT surgeon and pediatricians will always have an MA or actually have an RN do their MA work. The NP's always get the short end staffing. 2) First APRN in this facility? I'm the 2nd APRN in this facility, the 1st one is a GYN NP. And she doesn't mind doing whatever the boss says (shes been there for 27 years and shes going for 30). 3) I wonder about interpreting the "working cooperatively with others" as filling the RNs role, vs working well with other team members? I have a feeling since she wrote the job description, and she cuts the paychecks, she gets to interpret it. 4) Staffing the RNs/MAs isn't your responsibility to help the administrator resolve; it's her job. That's just how I see it. That's how I see it too, I would like to tell her that. 5) I don't have experience with this situation and would like to hear from other APRNs who might read this, too .... That's why I posted this here, hopefully I'll have more views / wisdom from NP's with experience.

She evaluates me because I'm the main healthcare provider at my anticoagulation clinic, the MD is just available for consult by phone. I also get evaluated by the MD. RN duties are not in my contract. But 'working cooperatively with other health team members' is in my contract. "I are a primary care provider, an APRN, NOT a nurse." I really want to say this to my boss/administrator who happens to be an RN, but how? (I have some ideas but other views help) 1) be constructive and positive. 2) be willing to state facts without emotion 3) have alternatives suggested. 4) approach this like it is something you want to resolve and fix. 5) Be willing to state that wish to help, but you want to make sure...yada, yada, yada... (Thanks Jal)

I'm just asking because my admin sees that I have some breaks in between patients, some almost an hour long, and while I can do 'backburner' things for my clinic (my job), she wants me to go the Outpatient Medical and act as an RN when they are busy. That doesn't sit well with me. I already brought my dissatisfaction up to her on my evaluation, she asked me, what things have you done that aren't in your job description? I mentioned the Outpatient Medical and she said 'ummm, noooooo' (I knew she wanted to say, 'It's in your job description because I said so.' Am I just being 'spoiled' by doing only NP things, do all NP fill in for the RNs when needed? Just want to get your views.

Hek no. When I prescribe I know enough about the med (it would be unsafe not to). It's just nice to get answers to off the wall peer reviewed study questions. I don't need their info, the stuff is really really nice / helpful.

How do you politely tell a drug rep to shut up? What really gets me is when they tell me to check to DNS box! If the patient wants brand name they'll ask the damn PharmD! Other than that my interactions with drug reps are good, they are knowlegable about their drug, they give me free stuff (expensive lunches, dinners, very nice pt education handouts). But sometimes when eating I think, 'In the hour I'm sitting here taking about drugs, which feels like work, if I was working I would have made more than enough to pay for the same meal for me and my girlfriend. Just a ranting NP.

What is a USP?

~ $70 dollars per hour right? Wow, I'm behind.