mangopeach

Patients who are taking stimulants in combination with benzos and sometimes. Ambien. Or Seroquel, Gabapentin or Lyrica in the mix. I would never start a patient on this kind of regimen. I have acquired some patients recently who had previous providers within the practice who have left. Recently was asked by office manager to see a patient whose provider left and he was assigned to another provider who looked at his med list and said Nope, not seeing him. Office manager wanted to know if I would be willing to prescribe those meds. I responded in kind that I would not prescribe that combination either. When I have new patients that are brand new to the clinic, and have this complex med list. I tell them at the initial eval that I don't think their med regimen is safe long term. I let them know that we will work to simplify their regimen and I will help them wean off some of these meds and we will work to find alternative solutions. Some are agreeable, others not. From an ethical standpoint, is it ever OK to refuse to see these patients? I seem to recall reading somewhere, that checking PDMP and then refusing to see a patient because they are on a long list of controlled substances is a no no.?? Thoughts??

I used a recruiter. As others have mentioned, if you are flexible and open to relocation, there are lots of jobs out there. If you use a recruiter, just make sure to use a reputable one. Use one that will listen to you and cares about what you are looking for. It can be daunting dealing with recruiters as a new grad. They get paid by the employer, not by you. It's a lucrative business. Some will try to get you to go wherever, so they can get paid. No attention paid to whether this is a good fit for you or not. It can be like dealing with used car salesmen that want to sell you junk. Once I decided I would relocate for work, I settled with the one I felt most comfortable with. There were the ones that wanted to place me in the most remote rural places. Not a bad thing to work in a rural clinic. I'm a city girl and just did not want that. I did not want to be in the boondocks and far away from the closest city. I was making this move on my own and already knew it was going to be a difficult transition as a new provider and living in a new environment by myself. In the end, the recruiter I worked with helped me to secure a job in a location that I absolutely loved. It was an 8.5 hr drive from my home state. Not too bad of a drive. I knew I could make that drive a few times through out the year, and by air, the flight was less than 2 hrs. That way, the home sickness wasn't too much of a factor, I could get back home for a few days without too much difficulty. I am now back in my home state. Sadly the job did not work out as I would have liked. I loved the city I was placed in though. Small enough, not a big city, but still had somewhat of a city vibe and I was within 3 hrs or less drive to the major big cities in the state. I could drive to Miami in a little over 2 hrs for a day of fun, shopping, restaurant hopping, sight seeing. I decided to leave the job, after a bit over a year. I was surprised how much easier it was to get interviews with just a bit over a year's experience. I got a job within 3 weeks after I started sending out my resume. I only sent it to 3 places, got 2 interviews and was offered the job at both. Point is, I don't regret relocating to get that year's experience. I would absolutely work with a recruiter again, if I wanted to relocate or had trouble finding work locally. You can Google NP recruiters, to see what's out there.

I was tempted to resign immediately from my currently employment. Things have gone downhill over the last few months. I tried to do some research on this matter and I am still not clear what does and does not constitute patient abandonment. I had a lot more clarity on this matter as a bedside RN. I need to be more educated about it as an NP. As a result I gave them 30 day notice. I read some information similar to what Neuroguy posted. I also read info on this site. The writer here seems to think reporting the provider (MD) to board was appropriate https://www.jucm.com/the-consequences-of-a-medical-provider-quitting-without-notice/

The benefits offered at my current job are excellent indeed. I suppose that is probably the main reason some people stay. The health care plan aIone is unheard of anywhere else that I've worked. I contribute very little to my healthcare plan. It's paid for mostly by my employer. I have decided to move on to private practice though. Well, don't want to count my chickens before they hatch. I have a 2nd interview next week so hoping it all goes well. I am a bit disappointed to be going back to my home state. Almost feels like a loss, that I didn't make this work but looking forward to the next opportunity.

I'm a psych NP. Had an interview this morning. I have a little over a year's experience as an NP. Towards the end of the interview, they asked me what salary I was looking for. I gave them my salary range with the lowest number being what I currently make to the highest number - my current salary plus 10K - Thinking that there would be room to negotiate somewhere in between. The look they gave me was kind of " are you serious, look". They asked me if I would be willing to negotiate. Negotiate as in lower. I don't think I responded well. I told them I am not willing to go lower than what I am currently making. Program director said, "well you wouldn't be on call or anything, nobody would be bothering you after 5pm and its 4 days a week.". The way she said it, I sensed that she was not happy with the salary range I was looking for. I'd be going to 2 different locations, which I don't mind. Its in my home state and the cost of living is higher than where I am now, so it doesn't make sense to take a lower salary to live in a more expensive state. Seems like they were really interested until salary came up. Was there a better way that I should have handled this? They haven't said no. They said they are still interviewing and would get back to me. However I sense that I won't hear back because they are not willing to pay what I am looking for. They have never used an NP. I would be the only NP and there's one MD.

I relocated for this job. I just recently hit the one year mark. I was not going to leave before my contract was up. I have not signed a new contract yet. Still contemplating if I will. It's not like its a job from hell where I get up every day hating it. However, there are definitely things I dislike so that's why I try to get feedback here from others to see if I am overthinking, what's the norm, what's not, see if I can get ideas about what I should ask for, should I choose to stay another year and renegotiate my contract.

Thanks for the reply. There is no flexibility in the schedule. No admin time, which is my biggest gripe at the moment. I also work at a FQHC. I get a ton of daily phone calls. Before Covid, I would get maybe 2 perhaps 3. Now some days I have 5-6, or maybe more. Refill requests, meds not working, side effects, to family member concerns about pt not taking meds, pharmacy phone calls about one thing or other. More paper work, Forms sent by patients to be filled out. Then there are labs to review as they come in. There is no time in my schedule allotted for those things. Every single minute of the day is assigned to seeing patients.

Psych Eval is 1 hr and Med management is 20 mins - I get that this is standard at most places. However is every bit of your time booked to see patients? So 8:00 am, 8:20 am, 8:40 am, 9:00 am and so forth. No time in between? I've been practicing for one year and some days I feel like I am being taken advantaged of. If patient A is supposed to get 20 mins that ends at 8:20 - By the time they are out of the office and patient B is in the office its 8:22 or 8:23. We are still working remotely but things can sometimes get even worse with doing things remotely because some patients have technical issues that can put us behind. Am I being petty here, or is this the norm?

I have been looking at Telehealth and doing my research on the various companies. Some that I've looked at say they want 2 yrs experience, I only have 1 yr so I don't know if that is set in stone. I am going to start the licensing process for other states to get the ball rolling.

I've been a working NP in an outpatient community mental health clinic for a little over a year now and some days I really dislike it. I worked in a hospital my entire RN career. I'm at a cross roads to be honest about where to go from here. I miss being in the hospital and I miss working 3 days a week. Every now and then I picked up an extra shift but to to go from working 3 days a week to 5 days has been challenging. I find working 5 days a week really draining. The documentation is never ending. It's not a 40 hr/week job. Its a good thing I am single with no young kids. I don't have a healthy work life balance. I relocated for this job so I don't want to throw the towel in just yet. Trying to stick it out for another year. But I keep looking. Recently considered a hospital position with a 7 on 7 off schedule. I procrastinated and did not apply for it.

I used the Epocrates App when I was in school- the free version. I'm a psych NP so I use the Stahl's App more than anything if I need to look up med dosage, how to start or stop meds. However I still use the Epocrates App especially for looking up drug interactions and contraindications.

Do you have a Linkedin profile with resume? If not do so. Just be prepared to get a bunch of recruiters contacting you. Someone I know, got hired directly by an employer via LinkedIn. But it will be mostly recruiters that contact you. Which is not a bad thing. I got my present job through a recruiter. Even though I am contemplating leaving(I've been here almost a year), I would still use a recruiter for my next position, especially If I make a move out of state. Just do your due diligence when working with recruiters. Work only with one you feel comfortable with. Some will come off sleazy like used car salesmen. Their job is to make a sale. They get paid by the employer. Some of them are not concerned if its a good fit for you. The recruiter that I worked with, listened to my needs and didn't try to place me in the boondocks or with children. I was a new grad and she directed me to employers that were new grad friendly. You can also just Google NP recruiters. I can only speak to the work ethic of the one that I used, so do your due diligence. Good luck!

Thank you for all the responses, Verene, I can't afford to reduce my hours. I really just want a balance in my life. I worked 40 hrs in 3 days for most of my career as an RN, so long work days don't bother me. It's doing it every day, and now even on weekends as I find working from home, even more time consuming. The EHR we use has its own template for psych evals and med management and its awful and cumbersome. They are supposed to be replacing it with something better soon so we shall see. Never thought about dictation software. I am not sure if I can use it though. I would have to get IT to install it. Before Covid, I would sometimes be able to document as I was seeing a patient. Now that we are working from home, Its hard to do that now with Zoom since I am on a totally different screen with Zoom and would have to switch screens for documentation. Landolakes, I would love to go back to working 3 12s! Hi Erin, Good luck in your job search for 4 10s. I think I am going to polish up my resume and start looking. It's too early in my career to feel this burned out. Thanks again for all your replies.

I am approaching the end of my first full year as a psych NP. I am not sure I want to renew my contract. I work at a FHQC mental health clinic. I was hoping to stay here for awhile and perhaps get loan forgiveness. But I am finding myself overwhelmed these last few months. I knew the transition from RN to provider would be challenging but I don't like feeling burned out this early! Things have gotten worse since Covid19 and we have been working from home. At first, I thought I would enjoy working from home, but I have found it more time consuming and we have not gotten any more time in between patients. I feel like I am always working. Even before the shutdown, I never left the clinic at 5. I was there till 6-7 pm. I start seeing patients at 8:00 am. I miss working 3 days a week! I find the slog of working 5 days a week draining. Maybe if I left the office on time, it wouldn't be so bad, but that never happens. I even spend my lunch hour doing documentation. I just knew when I started working as an NP that I would only work outpatient. Now I find that I miss working in the hospital setting. I was looking forward to never having to work holidays and weekends ever again. But I think I would prefer that if I could have some semblance of balance in my life again. I have seen some positions posted, though not many for positions with 10 days on, 10 days off, or 15 days on and 15 days off. Does anyone work a schedule like that? I think I would prefer that schedule than 8:00 am to 5 pm (which is more like 8am-6 or 7pm) 5 days a week. Maybe things would be different in private practice. I don't think an NP in private practice has to do all the things we have to do - So maybe working in private practice would be an option, but like I said, I just find working 5 days a week such a drag. Thanks for reading.

I work in community mental health. I've seen as many as 19 patients in a day. Though my average is around 15. Med management is 20 mins. New patient 60 mins. I am salaried so get paid the same if only half of my patients show up or all of them show up. We have a lot of no shows. We do walk ins to compensate for the no shows. Which makes your day really unpredictable! I've been a working NP for less than a year so things take me longer than some of my co-workers. Its very rare the person that comes in that is psych med naive. Many have tried "everything and nothing works" so sometimes coming up with a regimen takes more time and goes over 20 mins. I used to dislike walk ins, but I am warming up to the notion now. While I am salaried, we do get production bonuses so having walk ins help. As we have gone telemed due to coronavirus, I am liking that option more as well. We have a contract with the local county jail so I was already doing telemed with jail patients 2hrs, once a week. Now that we are strictly telemed, I like that option more as well. So many clients ask for late evening or weekend appts. We close at 5. Many of our clients don't have PTO, so asking them to come in when they have to work, is really difficult. Looking to ask the powers that be if they will add late evening and weekend tele-med service. But I'm waiting till its time for me to renew my contract and ask not to be salaried at that time. Maybe those ideas may be helpful to you. Consider walk ins and tele med.