Combative

Excellent article, and pretty much exactly what I was looking for. I will have to decline the offer. There are far too many risks, as I thought there would be. It's sad, because I'm good with this population and I know I could improve care and outcomes for many, as meeting psychiatric needs of patients is always in high demand. However, we need to protect our licenses too. Thanks for the reply.

Greetings fellow NP’s and colleagues, I am an AANP certified FNP working in New Jersey. For the last 3 years, I have worked full time at an urgent care center. I love my job and I’m very happy with my income and work-life balance. Recently, a friend who is a PMHNP, asked me if I wanted to pick up some extra time in her office and see psych patients who have been referred from sub acute/rehab settings, primary care offices, and/or group homes. I would take the “lightest” cases; things like anxiety, depression, ADHD, etc. Is there any legal pitfalls I need to be aware of given the fact that I would be seeing purely psych patients as a family NP? Everyone I’ve talked to locally has said no but I would love the insight and advice of this forum. Thank you in advance, Combative NP-C

Update: Thank you to everyone for the replies. I read each one of them and I am working on my counter-offer. I would just like to clear up a few things that should be considered in this offer. 1) This is a small community hospital. I will not see 18 patients everyday. In fact, there will be a lot of days where I only see 8, 10, 14, etc. patients. However, because I am a novice NP, I expect to be putting in some long hours in the beginning until I get over the learning curve. 2) The job is 4 days a week, but I am not required to stay in the hospital. If I arrive at 5 AM, round early, and get all my documentation done, I have the freedom to leave when I want. I can use that time to do additional work, such as round on nursing home patients (and take off that 5th day). I do have to come back to the hospital for a new admit under my service though. I also have to be on call 2 days a week and work every 3rd weekend. 3) I will not be managing dialysis patients on the floor. He will still be there to do those patients. I will only be seeing patients under our service that are admitted to med/surg and telemetry. I will not be covering the ICU. 4) The $80,000/year was derived from a 5-day a week starting salary working in the hospital at $100k/year. However, I am only there 4 days. The 'non-defined' work is a 60/40 split on the 5th day, where I will be covering the local nursing homes in the area. This work can be done quickly and I should make $45-50k/year doing it. So realistically I will probably make $120k/year my first year working 5 days a week (some long, some shorter). This is a small group (1 physician and 1 nurse practitioner), and the business model is still being discussed/developed. I know both members in the group and have a good relationship with them. I would still like to counter the base salary for the hospital though, as I think it is still a bit low. I consider the nursing home extra, and whatever money I make doing that just benefits the collaborating MD anyway.

Hi everyone, I have recently passed my AANP exam and I have been offered a job working for a doctor who I have the utmost respect for, and who I have worked alongside for years in the acute care setting. He emailed me a contract that he wants me to consider. I am posting this here to hopefully get advice, guidance, and wisdom from those who have been in similar situations, and understand the value of what I can bring to the table better than I do. I will try to keep the details direct and to the point, but if I leave any pertinent information out, please point it out and I will reply. Background: I will be joining a small group consisting of the physician and another NP. am a FNP by trade and the job offer is primarily in the acute care setting, where I will see patients on a general medical floor and a telemetry floor. Eventually, I may see "our" patients in the ICU, but there are usually intensivists there. The other NP primarily does nursing homes, rehabs, and home care, but she will be in the hospital once a week. The physician is a nephrologist, and we work for a small community hospital in the Northeast. He usually sees the most patients, due to the fact that the family doctors in the community have a deal with him where they admit their patients under his care, instead of the not-so-reliable hospitalist group. Therefore we manage the total care of the patients (H+P's and medicine follow-ups) as well as all of the renal consults. The Contract: The contract has headings called "Defined Work" and "Non-Defined Work." The Defined Work heading states that I will be rounding on patients, doing notes, and taking calls for the hospitalized patients 4 days a week. I will also have to be on-call for 2 nights a week, every 3rd weekend, and 2 holidays per year. Additionally, the contract states that I must see at least 18 patients per day in the hospital (I'm not sure what that means because I have to see all of the patients we have in the hospital, whether it is 18, less than 18, or more than 18). It further states that I am responsible for doing dialysis rounds on 3 shifts of dialysis patients at the dialysis center (2 miles from the hospital). The "Non-Defined Work" is the work I do that is not in the hospital. This includes the patients I would see in the nursing home, subacute rehab, assisted living center, and home (yes we do home visits too via the transitional care program). Adding this to my schedule will now mean I am working 2 more days a week in addition to the 4 days I'm in the hospital. Compensation: Here are the compensation details of the contract: Base salary: $80,000/year - and compensation will be bi-weekly Base salary after 1 year of employment = $85,000/year Base salary after 2 years of employment =$90,000/year I must see 18 patients in the hospital. For each patient I see over 18, the incentive is $25/patient I will receive 60 percent of the collections for the Non-Defined Work I do (nursing homes, rehabs, home visits, etc) Employer will contribute 50% of cost towards my health insurance plan per year. 3 weeks paid vacation per year. Employer will pay the cost of my hospital dues, DEA registration, liability insurance, professional licensure and certification fees, and $500 towards CME's. Negotiation Questions: Is this acceptable to anyone? I would like to negotiate for a higher base salary as I feel $80k/year for 4 days a week in the hospital seems low...especially if these pay-scale sites for NP hospitalists are accurate. Also, N.J. usually has higher salaries compared to the rest of the U.S. I was making really close to $80k as an RN working 3 days a week and my per-diem job on the 4th day. I would also like a 401k with match, and 80% towards my health insurance plan (i'm a single male with no kids). And $25 incentive pay for each patient over 18 seems low as well. I know I could make a lot of money if I work 6 days a week doing 4 days in the hospital and the other 2 in the nursing homes, rehabs, home visits, dialysis rounds, etc....but, at the same time, I don't want to burn myself out early. I'd like some work-life balance. Other Thoughts: We would be a very small group so I can't say I don't want to do the "Non-Defined Work," because I need to share that responsibility. I always liked the idea of a 60/40 split too, but he told me that it is hard to make that work in the acute care setting and that's why he would rather do a salary. I appreciate any and all input on this matter as I'd like to go in to the negotiation meeting prepared and with a better understanding of the value of the nurse practitioner than I have now.

What part of her post suggested she is an LPN? To answer the OP's question...check out smaller, community hospitals outside of the city. They will usually hire new grads for their telemetry or med/surg floors. It's clear that you want acute-care experience so stay determined to land a job in the hospital. Additionally, you will need that experience before you can do travel nursing/agency. Good luck!

^This I graduated from an ADN program in May. All of the local hospitals in NJ said they are not hiring new grads unless they have their BSN. And even with a BSN, you aren't guaranteed employment if you lack experience. If you are currently in nursing school you should definitely focus on getting a job as a CNA in a hospital. My class graduated with 38 students, and only 4 of us have jobs in hospitals. 3 of them got their job because they started out as a tech in the hospital they are working for. I worked as a tech for 3 years, but I left that job before I started nursing school so I didn't have an 'in' so to speak. The hospital I used to work for will only hire BSN's now, so I had to look elsewhere. I targeted 5 hospitals total, and went after this one that I really enjoyed being at during my clinical rotation there. I found out who the hiring manager was and harassed her to death. I was polite of course, but definitely persistent. I told her that why I wanted to work for her hospital and that I would be the most motivated employee she ever had. It's important to demonstrate poise and confidence when you are talking to these people and let them know that you are the right person for the job. It wouldn't even hurt to be a little bold and say something like "So I see you have an RN position posted for the E.R. When can I come in for an interview?" You need to call and bug them until they flat out tell you 'no' and to stop calling, or until they offer you an interview. Let's be real here...what do you have to lose? I know job hunting can be frustrating...but it doesn't have to be. Don't just throw 50 applications out there and expect to get a call back. You need to follow up, and more importantly, you need to be ASSERTIVE. I'm not saying you should be rude....just know your strengths and use them to your advantage. Being persistent is important because getting a nursing job is usually about luck and timing. If all of the sudden there are 3 positions that need to be filled and you call that day, the hiring manager might tell you to come on in. Good Luck!

Hi rn/writer...would you mind telling me where a good place to start would be for finding professional liability carriers? I am a new grad RN in New Jersey. Thanks in advance

I graduated from my nursing program the 3rd week of May. I sent my application out on June 4th and didn't hear anything for a while. I started calling the board around the 2nd week of July. The people who work in the processing department there are useless and provide no help at all. They kept telling me about how they have a new system in place and it will take 30 business days to process my application. I called back at that point and they tried looking my information up and said it wasn't in the system yet. They couldn't even tell me if my application was in the building. They said they will email their supervisor and that it would take another 15 business days to get a response. After she said that I almost lost it. Oh and this is after they have been transferring me to these supervisors that always have full voicemail inboxes so I can't even leave a message. Finally I keep calling back until I reach Executive Director George Herbert. I get his secretary on the phone and she transfers me to a voicemail in which I am able to leave a message. The very next day I get my ATT. All that time I kept thinking my application got lost in the mail. I ended up taking and passing my NCLEX-RN on August 8th, but I didn't get fingerprinted until August 20th. So now I'm waiting for a license number that usually takes 4-6 weeks after you pass your boards to obtain. By the time I finally start practicing as a nurse I'm going to forget everything I learned in school. =\