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.

I relocated a few months ago and I don't regret it one bit. I didn't get as much as some others posted for relocation though. I got $3000 for relocation. They paid for my hotel, flight, rental car when I came for the interview. When I first started working with recruiters I considered some places that were not ideal at first. I love the city I'm in now. Great weather, beautiful beaches, its not in the middle of nowhere, still not a big city but only 2 hrs away from the closest big city. And its only a 8.5 hr drive from my home state so not too bad. I think I lucked out with this one. I'm getting some good experience here. Not sure if I will stay after 2 years. I am thinking of moving west, but who knows. I may end up staying here. I'm glad I took a chance on moving though. I had to sell my home, but you know not being a home owner, feels a bit "freeing" right now. My son is grown and out of the house so I can pick up and go wherever I want to.

Not unreasonable to ask about mentoring and having a lower patient load while you get up to speed IMO. This is my first psych NP job. I work for a community mental health center. To be honest, I would have liked more time before getting a full patient load but it is what it is. The first month I did not have a full patient load. I was not paid less during the time I did not have a full patient load. I don't think you should expect to be paid less. But someone with a lot more experience may have some more light to shed on this. The documenting in the allotted time is what I struggle with so I am no help there. I don't have to deal with any of the insurance details where I work.

So I've been on the job now for 2 months. This is my first real NP job since graduating last December. I was supposed to start another position in June but that did not work out. In any event, I work at a community mental health center. Overall, I love the job. It is a super busy clinic. We service a lot of people in the county. My issue is I work through my lunch break often and I'm at work an hour sometimes 2 after the clinic is closed! finishing up documentation. I see a lot of new patients. I get an hour for new patients. Med management is 20 mins. I find the EMR, burdensome, so that's one reason. The form is not exactly user friendly IMO. Of course I've gotten better with using it since I first started. So maybe this is a silly thing that I carried over from my days of being a floor RN that just will not work as a working NP. Whenever I did my assessment as an RN , I always wrote my notes on paper then typed them up. I never liked talking to the patient and typing at the same time. I see, that will not work for me as a working NP. Way too many patients to see. When I look at the initial psych eval and med management notes for the patients I have inherited, they tend to be a lot more concise than mine. Sometimes in a good way and sometimes not. Maybe its newbie jitters. I took over the patient load of a doc that recently left. I'm actually shocked at the brevity of her documentation. I'm just afraid if I don't have it all down, that I will miss something. Which of course leads me to be at work for an hour extra. Help! Any pointers for improving to documentation to make sure you get all you need while being concise?

I have. I had a great experience - I used MedSource Consultants -

This all day every day. I'm a new grad NP. I spent over 7 years in patient psych. It is my opinion that anyone that wants to be a psych NP should be a psych nurse prior to becoming a psych NP. Just my opinion. I was always gobsmacked at some of the things some of my cohorts that never worked psych would say. Rest assured that I would run the other way if I took my loved one to an appointment and walked into an office and saw one of them sitting in that chair. In time, I suppose they will be great clinicians , but I think there are things you learn when you are exposed to actual psych patients that you don't learn in a book. I can't imagine being a cardiac NP without ever setting foot on a cardiology unit. Again, JMO. We didn't give IV meds on my unit but I gave levothyroxine, insulin, metformin, you name it blood pressure meds, coumadin, anti, biotics, nebulizer treatments, on my unit, made sure chest x-rays got done, etc. Psych patients do not check their medical issues at the door. In fact, just as they do not take their psych meds, they do not take their medical meds so they come in with uncontrolled blood sugar, blood pressure etc. Psych patients tend to have shorter life spans. They tend not take care of themselves.

Hugs to you. I am a new grad NP. I have been a detox/psych nurse for over 7 years prior to becoming an NP. I plan to continue my work in psych/addiction medicine. I've lost clients over the years. Some have been successful at being able to stay sober. But the battle for their sobriety is hard fought. The crisis was there for me on my unit- long before the media was talking about the crisis on tv. There is not enough money for long term treatment. There are not enough providers. I am relocating from my state to another state for my first NP job. I am still getting calls from clinics in far flung places desperate for providers that have experience with addiction. I was delighted to read an article recently that some medical students were choosing Addiction as a specialty. It is its own beast under the umbrella of psychiatry. I don't want to get on my soap box here because I believe that there is a lot that we can do to stem this crisis. Its like a lot of other things in this country. Its a matter of what our govt prioritizes. Our politicians, make wonderful speeches but never put money where their mouth is.

I'm a new grad NP - I just went through a whirl wind series of interviews and phone calls. So glad all that's done! So I had some varied experiences- The job I eventually took- First contact was a phone interview - This was with the Community outreach program president Then I was told to fill out an application online -then HR manager contacted me and had a 2nd phone mini interview - Then they offered to fly me in for interview ( This is in another state) Day of interview - I met with the MD in charge of the the out patient clinic, practice manager, HR manager and Community outreach program manager -All separately. Total of a 3 hr interview It was a pretty laid back interview though. It really was more about what the organization was about and seeing if I was going to be a good fit. I sent everyone a thank you email after the interview. They sent me an offer letter by email a week later. On other interviews Job#1 I interviewed with only the practice manager - that one disturbed me - but hey I'm a new grad so what do I know? I figured I should be meeting with an MD or NP as well. So I was turned off by that. I asked who would be my direct supervisor and she said me. I found it all Strange. Job#2 Interviewed with HR manager and Medical Director - this was the job I almost said yes to. HR manager contacted me first. I had a phone interview with HR manager then 1 week later went in for in person interview. HR manager asked the usual Tell me about yourself, Greatest strengths, weaknesses, etc questions. Medical director asked me clinical questions - /diagnosis/meds. This was the only time I was ever asked those questions in an interview. Job#3 Interviewed with a solo practitioner- I knew I was not going to take that position- He bad mouthed his current NP during our interview. Her contract was expiring and she did not want to renew. I wonder why? Anyway - we talked on the phone a few times before I went in for the actual in person interview. Our conversations were really friendly prior to me going in person. I was just really turned off about the way he spoke about his current NP. As far as Thank you emails - I would send it to everyone you have been in contact with through out this process, including the people that interviewed you over the phone. Good luck!

Hey all, just to update everyone, I did not take the job with my preceptor. I ended up taking a job out of state! I am so excited and can't wait to start. I had a few offers in town and almost accepted one of them. Then a recruiter I had been working with contacted me about a position with an organization that checked all the boxes I was looking for and seems like my dream job! They flew me in for the interview and everything fit. The MD and everyone I met were so supportive. Its right up my alley. There are other seasoned NPs here. I feel a sense of calm. (Not that I am not nervous about my first NP job, I'd be lying if I said I wasn't)- I just feel at home at this clinic. Its a big step moving to another state but of all the places I interviewed, I feel I would be most supported here and the clinic seems to fit my values when it comes to addiction and mental health treatment. The benefit package is awesome and I was a bit surprised that they offered me more than some of the places here in GA. It was not a whole lot more, but still more. I'm moving to Florida. So much to do. But they are giving me time to get it done and giving me some moving expenses. Thanks again for your input. I am so happy for this board and you all. I am so happy I made the decision to go with my gut and keep interviewing.

Forget Elizabeth Warren. There is a ton of data on this matter. Lots of research, journal articles. Are you offended by their conclusions? So many have concluded - that yes -

Do you know any professionals at your facility? My references have been physicians I've worked with, other staff RNs, MSWs. These are people I've known over the years at work. They don't have to be direct supervisors.