BeachFNP

Our scheduler is trained to explain to people who they will be seeing when they come for an appt. this is usually only an issue with new patients, because once they are seen they prefer to stay with the same provider. In my practice we have 4 providers: 3 NPs and 1 physician. They are told "you are scheduled in the (location) office with (provider)." So it shouldn't be a surprise when they see who they were told they were seeing. You'd be surprised how people still react to it though.

I would definitely bring up your concerns to the supervisor. She is probably going to need a much longer orientation then they thought. I used to orient all the time so I get the frustration. My main thing was to keep the supervisor informed with specific examples of why a felt a person needed more orientation or if I honestly felt they were unfit to practice. All you can do is make your concerns known. I would also be up front with the orientee as well. She should know if she's not making huge progress or if she needs more orientation. That way she's not blindsided.

I get this occasionally. Mostly it's a sideways glance and a "is the doctor coming in?" If it's his day here I just hand them over to him and he is totally fine with it. Most of the time they turn out to be VERY self absorbed anyway so I'm glad to be rid of them. Occasionally it's a day that he is not here and I have to explain to them that he can't be in all 3 offices everyday. They usually let it drop at that point and by the end of the appt they ONLY want to see me in the future. Occasionally someone will get all indignant and reschedule with him. Fine by me. I've got enough to do than deal with your annoying ass.

I'm not offended- I actually thought the same thing when I wrote it. Honestly- in all the codes I was involved in we never had to actually wait more than maybe 2-3 mins for a dr, np, or pa to show up. It was a relatively small hospital so there was always someone within a few mins walk/ run of where we were. It usually took that long to get code cart, hook of defib, ect. So maybe I was just never in one where anyone had to actually make a decision prior to a provider showing up.

This is an interesting discussion. I only rarely prescribe for family/ friends. And I mean rarely. I have done a controlled substance ONCE for a friend who was having intense anxiety issues- but- told her if she needed any more she would need to follow up with her pcp. I occasionally prescribe for my son who has issues with repeated ear infections but I'm always discussing this with pediatrician prior to that. We have a good working relationship so he's always fine with whatever I want to do. He will be getting his second set of tubes in a week so hopefully I won't have to do this anymore here soon. I'm not sure what the regulations in my state are, but I will be looking them up now. Every provider I know is super casual about this so I can't imagine it's very stringent regulations.

And just to add... When I say "when I used my ACLS" I meant in a capacity as an RN. I'm currently an FNP but not in a hospital setting.

When I responded I was simply letting OP know what part of that scenario would have bothered me personally. I have ACLS training myself and know what it's for. I was just saying that I would have felt slightly uncomfortable about doing that with no further direction from a physician. When I actually used my ACLS training in a hospital setting we always waited for a physician to show up before actually administering any meds- we would always start CPR, ect if needed but never actually administered meds until a physician was present or gave orders. I understand in this situation that's not really feasible (although other posters have expressed that you actually can get orders from a physician on the ground apparently). I forgot to add to my first post that it sounds like a crazy situation and I probably would have done the same thing as OP. So kudos to you, OP, for helping that patient out of a tough spot.

Personally I would be the most worried that I gave epi without an order, even with ACLS training. If they were carrying epi on a plane who would be the person trained in administering it?? I guess I don't understand how they would even be allowed to carry it if the flight attendants aren't trained in it- but I don't really know much about what training they get.

That sounds like a really good idea. Thanks for this suggestion!!

Thanks. That's helpful! I'm relatively young (28) but I don't plan on working this much at my current job in a few years. I'm thinking getting my foot in the door this way would be nice to pull in some side money when my son is older and I'm not working as much (my husband and I plan on me cutting my hours so a parent can always be there for games, school functions, ect). So in the back of mind I'm thinking adjunct would be nice if I ever decided to completely stay home. I understand the always being on and available thing- although I'm not sure that particularly bothers me (yet). I guess I'll see how it goes and report back to you guys. Lol

It's all online. It's turned in through the schools online blackboard system- so yes, I'm thinking quite a bit of time on there, plus emailing and discussing things with students. I hadn't thought about the gas to get from site to site, so that will be something to think about. I have no plans to stop working at my current job- I love it too much. So anything I make doing this would be extra, which is nice but I'm not as disillusioned as my husband to think it's going to be some amazing amount of money. Lol

True- I hadn't really thought about that. None of the other NPs I work with work full time either (all by choice). So I never really equated what I make with a full time gig. I guess it makes sense that it would be around that much though for a specialty office. Like I said I have one friend working full time in long term care and she hates it with a passion but she stays for the money. She's always on call, making rounds on weekends, ect. Sometimes she gets calls even when she's not on call because the nurses know she won't bite their heads off like the MD she works with. I told her no money in the world is worth being miserable.

Thanks! I appreciate the response. I know for a fact I would not have any office hours or need to come up with teaching plans. Like I said, I'll be a clinical visitor. So I'm basically given a rubric to follow for grading of case studies and soap notes and have to check on the students at least once during the semester where they are having clinical rotation. Like I said, she asked me to co-teach an actual class and I said no. After reading that over, however, I'm beginning to think that a clinical visitor might not even be considered adjunct? I mean, I won't be actually teaching a class. Does that make sense? I'm sure I will have to deal with some students complaining about grading and things like that, which I think I can handle. But I think my husband is underestimating the amount of work load I will have. Depending on where they are in the program I might have 3-4 case studies to grade each week per student, which I'm now realizing is quite a lot.

That's awesome! I wish I made that much. lol We are a 3 office practice in a pretty rural area. We are pretty much the only specialty like this in the area, however it's not exactly like patients are knocking down the door. We are exceptionally slow at the moment, but come fall we will pick up again r/t asthma flares, allergy symptoms, ect. The other 2 offices are pretty busy, but they have established client bases and have for years. Honestly NPs don't really make above 100k in this area. But like I said, think exceptionally low cost of living. The only person I know making more than 100k (like 115k maybe) works in long term care and she HATES it. I'll take my cushy job and less money. I have no issues with that.

Allergy, asthma, immunology.

So I'm not sure if this was a great idea or not, but I have agreed (at the repeated requests of my former clinical coordinator) to return to my FNP program to be an adjunct. My husband thinks it sounds AMAZING and like easy money, but I am slightly concerned it is going to take all my time up. I have a 2-year-old son and I work 3.5 days per week in a specialty office. I know I'm not working a ton at my current job, but I just worry this will be a TON of paperwork and I'll regret it. On another note, I am looking forward to helping new NPs find their footing. I remember how awkward it was at first to move from the RN mind frame to that of a provider, so I want to help others with this transition. Any tips? thoughts? I will be a site visitor, so I'll be checking up on clinical students and grading case studies, SOAP notes, ect. I don't know anything about students yet (like what level they are, how many, ect). I do know I would need to make at least one site visit to each student during the semester. She wanted me to co-teach a class but I told her no on that- I feel like I need to get my feet wet first and see if its even something I want to do.

Just jumping in to say I work in a specialty office and we may only see 7-10 patients in a day. Part of this is because I am the sole provider in a new office (one of 3 offices for the same practice but I'm alone 2/3 days in the newest office)- so we are currently building a client base there. A busy day for me would be 12-15 patients. But- this includes maybe 3-5 new patients and each new pt appt can take up to 2 hours due to work up, testing, ect. SO.. there are NPs out there who are employed when they are only seeing 7-10 patients a day. That being said, most of my codes are at least 4's or 5's, depending on the circumstance. Usually everyone I see is a 4 depending on testing that was done. PLus we get reimbursed for the testing, and thats where we make the most money. I make just under 100K but I only work 3.5 days per week so I'm not complaining there. Plus I live in a very low cost of living area, so thats actually quite a bit for where I live.

I didn't get my score either, but 105/150 is considered passing for the test (or so I was told). It just made me feel better going in to say that to myself:)

It depends on what you do. I work in a specialist office setting and only work 30-32 hours a week (usually 3 8-9hour days and a half day). This is by choice, the money allows me to not have to work full time. No holidays, weekends, or call. I love it. I liked my 3 12's too, but this is still great.

Took the ANCC on Monday for the first time and passed, thank goodness. Can't imagine having to study again for it. Personally, I felt it was just different. I recommend you brush up on theory, politics, licensing and credentialing, ect. I looked at the first few chapters in the ANCC Family Nurse Practitioner book that I borrowed from a friend. This stuff (plus therapeutic communication) is 50% of the test. So try to at least look it over. Its not as hard to comprehend as clinical stuff, so I made sure I just reviewed it a few times. I mainly felt the bulk of it was therapeutic communication, which is hard to study for. I also took a Marye Kellerman review course, studied from her binder, an APEA book of questions, and a Fitzgerald review book with questions. The FItzgerald was a little too in-depth for this test, but it was helpful if I needed clarification or a better understanding of pharm or patho. All in all I probably studied seriously for 3-4 weeks once I actually signed up to test. I was terrified but about 20 questions in I started to calm down. Remember, you only need 105 out of 150 questions right to pass! Good luck everyone! I will absolutely answer any questions anyone has.

I feel your pain. I also had a terrible experience my very last semester of NP school. Felt very belittled and as if the physician expected me to know things that were completely above my head... Thank goodness they were not hostile, but instead of feeling great about finishing up school and moving on, I was feeling like a complete idiot. I spoke with the director of my program and she quickly agreed I needed to find something else (our institution made us find our own preceptors). I ended up leaving after about 4 weeks and I simply told this physician that I felt I needed to be with an NP to finish out school because I needed to understand more about that role. I also said I appreciated the time they put in and I sent a thank you card. Honestly I can't believe I even stuck it out for 4 weeks. I came away every day I was there in tears. So I totally understand how you feel. Hopefully you can find someone else who doesn't belittle you. I ended up having a wonderful semester with an NP who informed me I was not a moron. I recently passed the ANCC and now work for a physician in a private practice who is WONDERFUL and loves teaching the specialty. My point? This too shall pass. Don't make any physician make you feel inadequate. Yes, we do not get as much training as they do, and yes, they know more about biology and chemistry. But we are just as valuable and bring another skill set to the table- compassion, empathy, and caring (stuff they don't learn enough about in med school). Good luck and keep on trucking!!!

As someone who assists my manager in the interviewing process, let me just tell you that I know it is very frustrating. However, my manager likes to see that someone is interested in our specific specialty more than how many years of experience they have. Managers want someone who will be staying for awhile, and not leaving or transferring to a different department 6 months down the line. If you can get an interview, make sure you express that you will be in it for the long haul (if you are). As far as actually getting in to an interview, I am not sure what to tell you. I work in Maryland, and certain areas are requiring experience to even apply (my facility does not for general rn positions like med/surg.) look for facilities that are expanding. And really, if all else fails, you can always do long-term care for a little while until something else comes up. Just keep trying and don't give up!!