treeye

Thanks for the insight! Only thing changed is that the sub-specialty position is now opened back up ( They need an additional APP). Management wouldn't offer me that position previously. I guess they still could give me patients from other specialties if I don't have enough patients in this subspecialty.

I am at my current job for 2 years now. Overall the job is good with good hours . There are some flexibilities but everything is so tied to the attendings ( I am inpatient). I could wish for better pay and better coworkers but they are OK. I think I am more marketable if I stay here. I loved my previous job in the same organization. I left because they gave the job I was already partially doing to an external candidate whose Dad had the connections there. I did not like the arrangement they gave me and the way they treated me so I left. It turned out to be a good decision. Now my previous job needed more help and a second position opened up. I am attempting because I loved the job previously and loved the ppl I worked with (some have already left). I may be able to get even better hours than my current job but I doubt I will get a pay raise. I also like having my own schedule and not working weekends and holidays. I am hesitating because what happened in the past. The leadership and collaborating drs are nice but they really do not care. I am not saying my current job has better culture but I think my current job has better structures set up. I am reaching out to get more info and I guess I don't really need to leave unless I get the hours and the type of work I wanted. Any thoughts? thanks.

I made to almost 1 year at my current NP job. I had thought about leaving since day 1 due to toxic coworkers and unfair pay. Only reasons I am thinking about waiting is that I am gaining valuable inpatient experiences, relatively good hours and I actually like the type of work. I have not seen many better opportunities popping up. Monopoly here. To go to a new job, I have to learn a new specialty from the beginning. I could still ran the risk of working with toxic people again, and I may not get a pay raise. Any thoughts? thanks in advance!

I think a perfect job for me will be 1. sustainable work hours and stress level, fair compensation that reflect the nature and hours of your work. 2. good boss who cares and nontoxic coworkers. 3. supportive collaborating physician(s) and/or good structures. 4. interesting field of work (not as important as 1,2,3) I am still on the look out for my perfect job every day. I know I may be settling on an imperfect job now but I will keep on working on my skills set and being patient. I believe a "perfect" job exists, life is too short to stay forever on a mediocre job out of fear. My first job out of school was near perfect for 3.5 years and I loved every minute of that job. Please share what makes a perfect job for you. Have a vision will help with the daily grind!

I worked as a NP in an outpatient clinic for 4 years and just started a new inpatient NP job 3 months ago. Two of my current 3 coworkers are leaving for another specialty shortly after I started. They are offered >10% raise for same if not less busy work. I realized that my current pay after being an NP for 4 years equals to a new grads' starting salary in my current department. Additionally, I realized that my priority has changed in the past 6 months ( I need a new car and a new house, LOL, good timing!). The last but not the least, I learned that one of the reasons my other coworkers left is the difficult coworker who I need to work with everyday. yuks... I actually like my job but I don't think I am compensated well for the busy work and I will no longer have stellar coworkers to work side by side. Would you stick to the new job for 1 year if it's you? I am torn about if I should be applying for the same job others are going to now for more money and better coworkers instead of waiting for 1 year... what do you think?

thanks all for your replies. I have worked in-patient for two weeks and would like to give some input and hopefully will get this thread going. In my opinion, inpatient is definitely more fast pace and stimulating comparing to outpatient. I am learning a ton every day. I like the fact that there are always layers of support/supervision. I like having all my notes signed by an attending and discussing plans of care as a group. I like coming across many talented ppl in other specialities. I also like the fact that after you are done with your shifts, you are done. I feel that in outpatient settings, I am always patching things up and there are no endings to that. Let's face that, most chronic illnesses have no cure. My perceptions of drawbacks of inpatient world are unpredictable work flow. You can get no consult or 8 consults. Your schedule is somewhat tied to the attending's schedule. If they round late, you'd likely not going home early that day. Additionally, inpatient is higher acuity and in translation, higher risks. Sometimes I am thinking is it worth the risks without additional pay?

I am now a NP for almost 4 years and did not miss a minute of bedside nursing. I enjoy the responsibility and rewards of being a provider. Being exempt is also nice. I was never very good at procedures and so I find specialties without a lot of procedures fit me better. I envy your RN background. why not try ICU NP? they do 3 12 hr shifts and does tons of procedures. I am sure you could travel after a few years and make even more money.

I am hoping that I have made a good decision switching to inpatient consult service from an outpatient clinic in the same health system. I did not really have a choice because my boss is awful. Could you share your thoughts on the pro and cons of outpatient vs. inpatient consulting service? Since I only had one job in the past 4 years in the outpatient clinic, I'll start with outpatient clinic (in a large academic center) Pro: I enjoyed the flexibility (admin time) and the easy schedule (30 min per patient and sometimes half of the patients do not show up ? Cons: most diseases are chronic and there are no cures, so you are always patching things up. There will be endless patient messages.

I know this post is one year old but the topic of autonomy and collaberation has always been on my mind. I believe physician collaboration is paramount to APPs because we do not have the same amount of education and training as docs (I guess this impression may change as I gain more experience as a NP?). Being in neurology for 3.5 years, I see patients mostly independently including small amount of new epilepsy patients. Ideally I would like all my new patients being staffed but my attendings refused (probably since they don't get RVUs and they can be busy with their own clinics). I also would like the possibility to send refractory patients to the doctors to evaluate once a while but the answer for that was a "no" as well. I envy the clinics in which docs see new patients and send returns to APPs. I think that will be a good model as well. My admin really does not care, so I'm looking for a new job hopefully finding my niche and the balance between autonomy and collaberation....

Neurology. I took the only job available to me after graduating and grew to like this specialty a lot. Neurology is about longitudinal management. A lot of neurological problems do not have a clinic pictures but the problems mostly can be managed and you form long term relationships with your patients. I am just frustrated at the lack of structure and appreciation at my workplace. I think I could grow to like another specialty as well. If there are well defined structures, there may be a chance I could find my niche and a life-long career... Sometimes I wonder if there are personality traits requirement for certain specialties such as urology vs neurology.

I am on the fence about leaving my current specialty all together due to poor management and lack of physician collaboration. To stay in my current specialty I am going to have to move which is not feasible. I do love my current speciality and had learned so much in the past 3.5 years. I am looking for a new job but keeps on wondering if I should stick longer to see if things are getting better with more experiences. Could you please share the reasons that prompted you to get into a new specialty? I guess I have nostalgia and needs some encouragement : ) thanks in advance!

I called HR today regarding to the above question. They think that 0.5FTE+0.5FTE (in the same company, two different departments) equal part-time benefit. They are not entirely sure and will get back to me. Anyone has any experience on this?

I totally agree with you, each job has its pros and cons. The only reason I still did not leave my current job is the two 4 hour admin time. I do like my field, however, no one cares at my work. Anyway, I wish I could have started looking sooner because good jobs are only open for very short period of time. You should as well.

thanks for sharing! How were you trained into this role? Are you overall happy at your job? I actually was offered a position in an outpatient orthopedic surgery clinic seeing patients who are non-operative. I turned down that job partly due to hours and culture, partly due to the feedback from the person who used to hold this job. She told me that a lot of pts insist that they need surgery although they were not good candidates and she got tired of being yelled at.

Hello all, I came across a few surgery APP positions during my job hunting process. These positions do not require RNFA and are mostly clinic based. What do you think of working as a NP in clinic based surgical specialties? I do not have any OR experiences and am not interested in getting RNFA. I do not want a job in which I will act more of being a scribe. I think autonomy is linked to more job satisfaction. I am tempting to apply but not sure what these jobs can help me achieve over the long run. Anyone in surgical specialties please sheds some lights? Thank you!

thanks! anyone knows the following question? if a patient says he has no immediate plan of self harm but had thought about plans at times and the patient is calm cooperative and is asking to get help, do we need to call security or rapid response or the patient can be escorted to ED by a staff member.

We never got briefed with what to do when a clinic patient voiced suicidal ideation and a plan. The patient told me that he has a plan but he would like to get help and agreed to go to ED. I perceived that he has no immediate danger of hurting himself so we called RRT and had the pt was escorted to ED with no incident, however we received incident report that the pt was left alone before RRT arrived. Just wondering how big of a deal it is to have left the pt alone. Of course we did not do this intentionally.

Just wondering if you have any flexibility in your current NP job? if so, what's your specialty? one of my coworkers went to medical weight loss and got to work remotely one day a week. I believe some employers will work with you as well (work through lunch, start at 7a or 9a as long as you get the hours in). My current job has pretty good hours. I work 8-4 most of the days and has a total of 8 hours admin time per week. The administration really does not care about anything so the morale is low and there are no long term career prospects but the hours are good. I like getting out of work at 4pm so I can go to my kids' practices and lessons. I have gone to 2 job interviews and had to turn down both offers because APPs at one job work 50-60 hours per week with admin time, the other job is 8 to 5p with 4 hour admin time. Both of these jobs are better structured and APPs have a lot of support but the employer wouldn't budge on either hour or pay. It is really difficult to knowingly choose to work 8-12 extra hours per week and make the same amount of money. I thought everything is negotiable but so far everything I have asked has been shot down. I don't think working 40 hours a week is a problem if there are some flexibility built in. I have suggested working through lunch hour, starting at 7a, take a pay cut to work 36 hours per week but no one wants to budge. I want to leave my current job but feels that I'll be stuck there for a very long time. Any thoughts?

I have dealt with this situation a lot when I first started. I think people tend to associate MD title, male gender, and white hair with experience and authority. If a patient has had bad experience with APPs in the past, he/she tends to generalize the bad experience to all APPs. I tried not to take it personally but this does affect my egos from time to time. As I gained more and more experience, I notice the "MD complex" affects me less and less. I think patients can tell if you have enough knowledge and experience to take care of them and as time goes on, they can decide whether they want someone who is qualified and who cares or someone who is a MD and nothing else. I still has patients preferring MDs although I have done everything right. It is OK, I am fine with whatever the patients are comfortable with. Ultimately it is their care.

I am supposed to see patients from 8am to 12p and 1p to 4:30p on my full work days. Most of the time, I only take about 30minutes for lunch. Wed and Thursday afternoons are my admin days. If I have finished all my work, I typically will go home and check messages one more time at home later on. I don't think I'll ever be able to go back to schedules with 0-4 hr admin hours per week. If I ever change jobs and 8 hour admin days are not possible, I think I'll request 36 hour weekly work hours and a pay raise to offset the salary loss (I hope my thoughts are not too naive)

I'm looking for a new job in our health system (probably clinic positions) but most positions come only with 4 hours of admin days per week. My current management sucks but NPs have 8 hour admin days per week which is really nice. It's really difficult to negotiate admin days with new positions especially other NPs already there have only 4 hours. Just wonder how many admin hours do you have per week? Whether it is OK to inquire with current NPs about admin days prior to applying for the job?

I'm 37, nursing is my 2nd career. I have worked in a small hospital for 6 years and loved my work. Finally I got my dream job in a large hospital ICU and started there 2 months ago. Things are going well but... Most of my coworkers/preceptors are in their early to mid 20s, one charge nurse actually graduated the same year but he started right from ICU while I worked in med-surg. I sometimes feel self-conscious for being "old" but "new" in the field. I know I should always push myself to learn, and I always wanted to work in ICU. I am graduating from NP school in 2 years. Sometimes I wonder why I'm switching to a new field for two years. It's so much easier to do what I already know and be where I was already comfortable. Just venting, I guess, so much to learn and still nervous.

Thanks for the great advices. I did go in and worked my last day. Surprisingly someone went to get a huge cake, pizza and pop and threw me a party. I got to say goodbye with everyone. I was so glad I did not call off. Six years went by so fast and I did not know how attached I was to my workplace till my last day.

I have given my two weeks notice in and I'm tempting to call off on my last day. I was wondering why my coworkers have been doing this but now I totally understand. I was treated very differently in my last two weeks: People order lunch take-outs without asking me, they sit at different tables during lunches. One day, I was the only one without an orientee. Those who I considered "my friend" are distancing themselves. I have always been considerate for my coworkers and I get along with most people at work, this does hurt my feelings. In addition, the morale at my work is very low. I am the 5th nurse quit on my floor in the past two months. We lost more than half of our staff in the past two years. The administration does not care. We worked short for so long and now they finally brought in agency nurses. anyway, I don't want to burn any bridges but now I know why it has been a tradition at my work to call off on the last day. I love my job but I just hate to be there.