Goldenfox

I have lived in Florida most of my life. I have a business here. I chose to stay in Florida only because of family obligations, but were it not for that I would have left. I have young children, and I am self-employed. Otherwise I probably would be unemployed here. I love everything about Florida---except the lousy health care system and the terrible ways that NPs are treated here. It is a backwards state. It was the last state in the union to grant NPs the autonomy to write prescriptions for controlled meds. Even so, NPs in Florida are looked down upon and greatly disrespected. If you do find a job here the pay and conditions are typically horrendous. I personally know many Florida NPs who have left the state for all the aforementioned reasons. Susan at the Florida Association of Nurse Practitioners works hard to change things in the state capital, but the politicians are hardcore believers in the status quo, and the physicians view us as the enemy and as nothing more than their B-word. Its difficult. There is a bill in the House now proposing full practice autonomy for NPs. The hearings begin next week. If you want to stay here you will find jobs in the northwestern and south western parts of the state. Just know, going in, that the pay will not be good. They can do that because there are a ton of unemployed NPs in Florida right now and relatively few jobs.

Seriously, take the gay out out of it. Just be a professional. Your personal life is your business. No employer, patient, or co-worker is entitled to any type of disclosure from you. And even if you want to disclose, its none of their business, so don't. Share with your family and friends and always remember that many who encourage you to divulge your personal business on the job are not your friends, they're just ridiculous people who want to know your business. Be prideful and keep the personal stuff personal. Just be a good nurse. Don't let yourself get dragged down into negativity and gossip ----which, unfortunately, is one of the not so great things about nursing. Keep your private life private. Do not feel obliged to disclose your personal life to anyone on the job, even if you can. The less you do so the better your career will be.

Some here lie and troll about the reality of all this (for their own purposes, I'm sure). I used to give advice to younger and newer RNs and NPs based on my own experiences over the many years that I've been doing this. I try not to do this anymore. I am tired of being attacked by know-it-alls and trolls. Some of us will have to learn the truth the hard way, the old-fashioned way. BTW oldma, you are dead-on. I have a doctorate degree...a real one. The DNP is not a real doctorate degree. I used to be in a DNP program and dropped out because it was mostly just ridiculous nonsense regurgitated from the RN program. No need to pay a college thousands of dollars for that. They will give you a piece of paper with a title on it, but it means nothing in reality. Do I regret being an NP? Yes and no. If I had to do it all over again, I wouldn't. If I had to take out large amounts of student loans to do it, I wouldn't. I came into this at a time when when it was worth doing and when there were plenty of decent opportunities. Now, everybody and their mother is an NP. It is very easy to get into the NP programs and very easy to pass to pass the boards. Pay and opportunities are in decline across the board. Many lie and say that the opposite of this is true. I know NPs in my home state who consistently lie about their earnings to impress others. I would never do that. One of my big weaknesses is that I like people too much to lie to them about things that I know will hurt them later, but that is not what we are cultured to do in this world. If you decide to become an NP you will find out what is true for yourself. If you decide to become an NP, do it because you really want to become a clinician, not because you are burnt out on bedside nursing. If you do it for the latter reason you will be a disappointment to the patients who look up to you, and worst of all, to yourself. The reason I like being an NP is because I now have the opportunity to help people who really need help in ways that I never could as an RN. You don't even begin to understand the importance of this until you've worked in a state that affords full-practice autonomy. But to really take advantage of this you need to know your Sugar, Honey, Ice Tea. If you decide to become an NP because you really want to be a clinician, do it. Don't expect that you're going to get rich or that you're going to land a great job easily. You're probably going to have to move to get a job that pays a half way decent salary. If you have to, and you can, do it. Reality is that there just aren't many good paying clinical NP jobs out there anymore because, thanks to the easy online colleges, NPs are a dime a dozen now. Still, the really good clinicians among us will stand the test of time. The patients and the supervising physicians will quickly figure this out. NO matter what, don't sell yourself short. Be a real clinician. Don't take those home health assessment jobs that are now being advertised in overabundance online. To the OP, you're probably never going to make bank if you're in a big city where there are hundreds of other unemployed or underemployed NPs who are willing to accept a crappy job and low wages. I quit doing locums a while ago and my NP colleagues who are still doing it tell me that it is getting harder to find jobs and that the pay is trending lower. Do your research. Don't just accept the sunshine, lollipops, and rainbows BS that you hear from some. Troll attacks incoming... 3....2....1.....

David, 27 patients is not high for pain management clinics. I worked in one as a locum and I was seeing an average of 40 a day. If you're having trouble finding a job and this is all there is for now, take it so you can gain some experience, but go into it with both eyes wide open. Most people who own/run pain clinics are greedy and unethical. Always be on the lookout for anything that could jeopardize the license that you worked so hard for. The state government and the DEA will have you under a microscope. There are legitimate pain clinics...a few. Most are still pill mills. Get some experience but don't plan on staying in this venue too long. It is not respected by the medical community because of all the fraud and fake clinical practice associated with 'pain management', be looking for your next job as soon as you hit three months. Its kinda like the home health risk assessment type jobs that are everywhere now. You really don't want that stuff occupying too much real estate on your CV because it doesn't impress anyone. The clinic I worked in was owned by people who had no clue. They had no health care training or background. They told me they are businesspeople who went to a seminar about the best way to make good and quick ROI. And pain management was it. They were greedy, but not entirely bad people. I had to teach them things. Many things....things that would make their clinic financially successful---BUT, that they had to make it real, and actually do the workups, and provide service that can be rationalized and not just be giving out candy to drug seekers. They wanted me to stay on there. I was making them a LOT of money, and they offered me a really good salary to stay. But if you are a serious clinician you need to move on after a while. It becomes rote, and there is no real challenge to it. If you are prescribing narcotics, take the time to do your assessments, order the appropriate diagnostics, and make sure to review the drug screens. Anything or any patient that you have a bad feeling about always trust your instincts. Don't be afraid to set limits with your patients. Some of them will try to bully and manipulate you. And document everything objectively. If the DEA shows up for an audit you must have no reason at all to worrying about anything. $100k is low. I would ask for more. Also, in pain management its not so much the contract that you have to watch out for its the ethics of the place itself. Do they follow the law? Are they serving patients who have real pain management needs or are they just doing easy assessments and writing prescriptions. You will quickly figure this out.

How much do you like this job? My experience in dealing with these types of private practices where family and nepotism hold sway is that you will not win if you try to take them on. They will always choose their family and close friends over you. 'Putting your foot down' is not an option because they don't care at all about your opinion on the matter---not enough to ask you anyway. Of course the office manager approved it. He/she does whatever the practice owner says. You won't like hearing this but they have already made the decision. You will eventually be making a decision of a different type....whether to stay and be treated like a rug or find a better opportunity and leave.

Why do you really like this company? Think, for a moment, about why they would put that particular language (about the $30,000) in the contract? Is it for any other reason than to screw the unsuspecting NP who accepts a job there then later figures out that the place sucks and decides to leave? Whenever you approach relationships of any sort with any employer always remember one thing---they are not your friend, so keep it professional and be discretely looking out for your own interests as much as they look out for theirs (and they are ALWAYS looking out for theirs). Do not sign that contract. If the place was so wonderful that no one would want to leave after 3 months that language would not be in it.

Even if you are not a person of faith, I wish you God's blessings and much success with your plans to start your own business. It is so very rare that I encounter other NPs who are even thinking in this direction. It is one of the best decisions you will ever make. I recently started myself. The freedom...the potential... First thing - don't talk yourself out of doing it. Second thing - don't let other people talk you out of doing it. Expect that a lot of envious and ill-wishing people will try to discourage you. Ignore them. Everything depends on which state you plan to practice in. The laws vary considerably. It is best if you don't plan on doing this in an anti-NP state that puts many unnecessary restrictions on NP practice (if you live in one of those, move). This is not the same as requiring physician collaboration. Even in states that don't require physician collaboration you will find that you still benefit from a collaboration arrangement for a number of reasons. Start with a resource guide like Carolyn Buppert's book on NP business practice and legal stuff. She gives very good advice on how to make up a simple business plan to do exactly what you are thinking about. Invest the needed time to do research and to write up your business/marketing plan. Look for inexpensive office space that is off the beaten path but easy for people to find, and preferably one in which the landlord is willing to include buildout at no additional cost to you. You can set up the place very simply and inexpensively and it still looks good. Since you're doing psych you won't need to buy or lease expensive equipment for diagnostics or procedures. Budget for a full-time office assistant and a part-time mental health counselor.

You seem a bit judgmental. I remember a time when college education was much more affordable. I also worked full time while I was in school and paid my way through my RN and BSN degrees. But that was all a very long time ago. Most available non-professional jobs these days don't pay enough for young people to work and fully pay for today's college costs out of pocket. And newer accreditation rules no longer allow most health science programs to give students very long to complete their credits anymore either. So, dragging things out while you work to save and do a class here and there in between is no longer a strategy that works for most in modern academia. If a student hasn't finished the degree within x number of years the validity of certain credits become null, and the student has to re-take these credits in order to meet the graduation requirements. According to you, if a student inquires about student loan forgiveness programs before applying for a loan this means that the student doesn't intend to repay the loan. This is not true. You pride yourself on being a good planner, so you should appreciate that good financial planning means carefully researching all of one's options before making major financial commitments. Student loan forgiveness programs are not a freebie for the new graduate. He or she is trading part of payment for their labor in exchange for a reduction of their student loan balance. This deal works ok form some, but not so great for others---for a variety of reasons. Students are still being sucked in by the misinformation about college education and student loans. The law requires that they are educated about borrowing this money before they receive it but most still don't really understand. The lenders are charging interest on the loan amounts from day one, and a few thousand dollars easily becomes many thousands of dollars after several years. And a big surprise is waiting for the borrower after graduation when the payments become due. We don't know for a fact that most graduates default because they never intended to repay from the start. It is possible that many looked for a long time and couldn't find jobs that pay enough for them to pay back the loans AND live on without having to scrounge, so they gave up. Sure, many nurses make decent money---IF they can find a job. In many areas getting a job as a new grad RN isn't so easy anymore. And the pay isn't always so great either. Also, many, MANY new RNs decide after only a short time that they hate bedside nursing and either go back to school or quit the field entirely and take a lower paying job doing something else that they like more. But they still have to pay back the loans, perhaps with even less income, or take out new loans to pursue a different career. There are many variables. For-profit, or not, college, and the co-conspirator textbook publishers, and the student loan hawks are a major con job on the nation's youth. And government intervention to prevent delinquent borrowers from earning an income was an extremely bad idea, but I'm not surprised that it came from Florida---the worst state in the union for nurses.

I used to do both. There are reputable companies out there that post these jobs (there used to be, anyway). You apply to them just like any other job. As a locum, you will be traveling to the location, but be certain its in your contract that they are going to pay all the logistics costs. Many of them now want the NP to pay the travel and housing costs out of an all inclusive rate, and the hourly pay is often not enough for this. Telemedicine, in my experience, is a waste of time. A few of these companies are actually good. Most are not. These days its usually a company that figured out a way to make big money off selling DMEs though they typically only pay you a relative pittance ($20 to $30) for each one that you prescribe. If you decide to do this make sure that you are licensed to practice in whatever state your patient lives in. And if the state requires a collaborating physician you are typically required to bring your own.

A word of advice...look for a cheaper school. Avoid taking on that much more debt. As a nurse you may not be privy to the terms that these student loan programs make available to physician students. Also consider that subsidized graduate loans are capped. Beyond a certain amount you will be paying higher interest rates...and it does add up over time, even if you are in forebarance. But as a CRNA you can pay this off and do well income-wise. How? Open your own pain clinic. You'll be swimming in the money.

Without revealing exactly where you are, do you mind saying which state you are in? Despite what you describe as YOUR personal experience with finding a job, someone will soon show up and say that there are plenty of high paying jobs and that you just need to look harder. Count on this. If pulling up roots and moving your family to where you may find a fairly decent NP opportunity isn't an issue, then fine. The way things are now with the job market you may have no choice but to move if you want to find work as an NP. But always remember, that when it comes to pay you should ask for more than what you are actually willing to accept. Many times, they will lowball and expect you to accept it due to the way the job market is in some areas. Also keep in mind that $100,000 is not a lot of money for an NP. Ask for more. Also weigh the pros and cons of moving. Its not always what it looks like. More pay is often a wash if the place that you're moving to has a significantly higher COL. This job that you are interviewing for, do they pay for your malpractice? You didn't say. I would also ask for that. If they don't provide this then you will have to provide funding for it yourself. No benefits, no malpractice, and low pay is the offer de jour lately.

No its not just you. Its just that some of us are in serious denial about whats really happening to this profession. It is a slow decline that's not yet as visible in certain areas, but the creep is on. I don't believe that most nurses who became NPs expected to be earning less as a provider than they did at the bedside...especially the ones who went into large student loan debt to become NPs. I cannot imagine why any self-respecting person would be satisfied with 'relatively low pay' after spending all that time and money on NP school. Its one thing to accept a low paying job because you are in a bad market and the pickins are slim, but quite another to be satisfied with crappy pay, zero benefits, and horrible working conditions by choice. I wouldn't put much faith into what the health publications say about NP salaries because I know for a fact that some NPs do not tell the truth about their actual earnings when responding to these surveys. I have seen this a lot. Bingo! When one is willing to accept and settle as less than then that is how one should expect to be treated. Its just the way the world is. Why would an employer pay more to an NP who is willing and satisfied with working for less? In places like south Florida its cut throat competition for some of the most ridiculous NP jobs, but the employers love it because at the end of the day they know that they will be able to pick and choose and offer low pay with nothing else---and there will be a whole lot of NPs there willing to take it.

If you have to stay in Florida then do not give up your RN position. Available NP jobs there don't just pay low and require you to put up with a lot of crap, they also typically come with little or no benefits at all. And if you need health insurance that you have to buy on your own that is another amount that ought to be deducted from the already pathetic wages. Seems to me that the choice is already clear based on economics and the reality of the situation in the south Florida market. But, ultimately, its up to you.

If you mean that you are thinking about doing locums work as an NP I can give you some tips, as I did locums for a while towards the end of my time working for other folks. It is definitely better to work as a locum and travel to areas outside of south Florida if you get the opportunity to do so. I understand the OP's post well. I am from that area, and I know exactly what he was talking about. University of Miami Barry University Florida International University Nova Southeastern University South University Florida Atlantic University Kaiser University St. Thomas University University of Phoenix Chamberlain University and the list goes on a lot longer... In the 78 mile radius from Miami to West Palm Beach there are way too many NP schools putting out new grads every 6 months. The jobs just aren't there to sustain it. There are MANY NPs there who can't find jobs. When an opening does pop up there are typically dozens and dozens of applicants. They pick people who have experience and who are willing to work for low pay. Its a very tough place. Salaries and working conditions are usually not good. Some NPs are not going to tell the truth about this, but I know it for a fact. I used to be one of them, and I have many NP colleagues and friends in the area. Many have left the area and moved on to greener pastures in other states. But not everyone can leave---for various reasons. The southeast Florida area sucked so bad that I did exactly what the OP did and got into locums work. But that has its pluses and minuses, too. Locums NP opportunities and pay have also declined significantly in recent years. I watched that happen also. There used to be plenty of jobs. Now there aren't that many anymore, and I mean nationwide. The recruiters (if they are honest) will tell you that the employer prefers somebody local because they don't want to pay for the logistics. The contracts often have an escape clause that allows them to terminate, and if they find somebody local they may cancel your contract. It allows them to save thousands of dollars on what they would be paying in housing, rental car, and air travel for a locum. This actually happened to me once. It taught me how to better prepare the next time. You may see lots of listings on the job boards but some of the jobs posted on those boards are duplicates, expired, or never-existed. Always a good idea to have at least 2 or 3 recruiters with different agencies looking for you (some of these agencies are owned by the same company). And have some savings set aside to tide you over between contracts because there will be times when things are totally dead. And you have to start looking for your next contract right after you start your current one. Credentialing times for a position can be be quick but it is often very long----sometimes it takes several weeks or even months. Not telling you these things to discourage you, but to prepare you for what its actually like. I liked working locums elsewhere better than working for doctors as an NP in south Florida. Its wasn't just because of the money, its about respect also. Locums work is a great way to see and experience different parts of the country, and to expose yourself to better opportunities that may arise if and when your circumstances do permit you to move.

Hi, I'm curious to know how this has worked out for you. You got pretty good advice already, but I want to add that you can appeal the DEA thing in federal court---even if you had surrendered the license voluntarily. There are attorneys that specialize in exactly this sort of case. Things might look bleak now but as long as you really didn't do anything illegal or unethical while you were working at the clinic you can appeal and be heard. I am sorry that this happened to you. These types of DEA actions are happening even in places that wouldn't typically be regarded as pill mills now. I had a discussion about something similar with an NP colleague who found out only after she had been hired that both the physicians who hired her for the practice where she now works lost their DEA licenses and have actions on their medical licenses by the state board of medicine, and they are using HER name and license to do things---recipe for disaster. I have encouraged her to leave that place but she doesn't seem to take it seriously. Not yet. I hope that this turns out well for you.