Jump to content

Real learning happens after graduation

Specialties NP Article   posted

Has 19 years experience. Specializes in Hospital medicine; NP precepting; staff education.

Despite so many decent threads and pieces of advice from fellow nurse practitioners and experienced peers, so much about the process of testing, job searching, and waiting to work was over my head, just out of reach. My points below outline my recently gained insight and just how much further I still need to go.

Real learning happens after graduation
Share Article

1. Self-Care is not just a buzz-word phrase.

For the two years I was in NP school I worked full time and managed my course load. The last year of that I also managed clinical hours, exceeding what was required. This often meant sleepless nights and only one day off, if that. But even my days off were fraught with finishing studies and just getting the family fed or the house cleaned. Fortunately, I had an amazing support system. This priceless commodity of my spouse, his mom, and my teenagers felt amazing . . . and made me feel quite guilty.

I had several crying jags when I felt as if I were neglecting the very same individuals who want so much for me to succeed and who also sacrificed so that on rare occasions I could sleep in, or instead of resting themselves, were tending to duties I could not. Some resentment on their end was felt, but it passed and I reconciled the fact that this, too, will pass.

When their mental and physical well being suffered, mine did too, and vice versa. Losing my father my very first quarter left me bereft. Each milestone along the way was bittersweet because he was one of my biggest fans. But it also motivated me because I set goals long before he was sick and I wanted to do what would make all of us (him, me, family) proud.

But I was not well. I gained 20 pounds or so. I felt more agitated, more morose, less content. Motivation waned and much-needed breaks were filled with completing things neglected during the term. The demands on a graduate student are much, and that is not the only hat we wear.

All too often we hear ourselves telling family members caring for ill and debilitating family or friends that if they don't take time to care for themselves, they won't be any good to the patient.

Well, what's good for the goose is good for the gander, as they say. I had to force myself to develop a pattern of relaxation if even for a few minutes a day or every other day. I tried to exercise because the lack of it was taking its toll on my mental and physical health.

Since graduating in May I have lost almost all of what I've gained in weight and resumed a regular-ish pattern of fitness and even though I am back in school, I've resolved to maintain that because I'm not getting any younger and I can already tell the difference in tolerance and stamina from just two years ago.

Mindfulness, healthy eating and fitness habits, and the integral support network of family and/or friends is precious and all of these must be fostered.

2. Studying does not end once the diploma is in your hand.

Okay, this might seem like common sense, but I feel its importance might bear accentuating. Once you graduate you still need to take boards (a few take theirs prior to graduation). I was one of the last in my circle of classmates to test, but I was not ready. I continued to review and not just by testing (which in my opinion is not the best way to solidify a competent knowledge base).

I thirsted to understand the processes and treatments better and to learn to practice by synthesizing the rationale for why we do A, B, or C and how to fine-tune it for patient-centered care.

A myriad of resources are available and each student/graduate must find what works best for them. There are live reviews, online reviews, review books, testing books, question banks, and who knows what else. A healthy balance of moderate study day by day reinforces learned content and allows the graduate to hone in on what deficits need to be reinforced.

I am not ashamed of testing 5 months after graduating. Do I wish I'd done so sooner? Yes and no. Being done earlier would have been great, but I knew I wouldn't have done as well. Know thyself.

3. Know thy job market.

Region and setting define what demand is available for your new role. For far too many there is the rose-colored glasses belief that there are plenty of jobs and for so much that is simply not as true. Do the research to see what the median salary is in the area. Look at your local NP group and see if there is any documentation from their archives about salaries, jobs, et cetera. My group had a survey from the previous year that showed years of experience, settings worked, benefits and salaries offered, as well as degree attainment.

With the understanding of who and what you are against, you can be forewarned and armed with much more data so that you are not a timid doe seeking that little slice of NP heaven. Fight for what you can appropriately attain. Don't be afraid to negotiate. There are plenty of threads here with such similar (and better advice) than mine on that topic.

4. It is ok to turn down a job.

This is not the time to "play nice." You need to be business minded. If an offer is not working for you and negotiations don't yield what you must have, then turn it down. This is so much harder than it should be for several reasons. There are those I've heard say that nurses are usually too altruistic to succeed without ruffling feathers.

Folks, wake up. Unless you have no other choices or you'll be homeless, don't settle for less than you are worth and don't be afraid to say, "No thank you. I will keep you in mind for future opportunities." (Remember you really shouldn't burn bridges. The medical community is small, unforgiving, and has a long memory.)

5. Credentialing takes a really long time.

I asked during my interview how long the process took and was told straight up that it took 6 months. Even knowing that, despite signing the contract in November, I'm told today that my start date is postponed. I shouldn't be surprised or discouraged, but it is a little bit of a bummer. I'm really excited to start, but I have to be patient.

Be. Patient.

Also, this process can be daunting and redundant. Just have all of your ducks in a row. Make sure you have your professional liability information, your vaccination information, and so many other specifics that you'll need readily available for dissemination to various entities. In my case it is the contracted organization and facility who each need my data. Fortunately, there are members of this team whose sole jobs are to be liaisons between the facility and our employer.

6. OH! And DON'T QUIT YOUR RN JOB!

I turned in my notice last week with a generous 8-week head start. (Minimum of 4 weeks required). Today I had to rescind it. It is left open and pending confirmation of my newly placed start date. Remember #5? Credentialing takes a really. long. time. On the bright side, my current coworkers were happy that I'm not leaving them yet. I heard a lot of, "Well YAY!" today.

I still have bills to pay and counting my FNP eggs before they hatch is a bad idea.

I look forward to others' input and pearls of wisdom.

1 Article   2,077 Posts

Share this post


Link to post
Share on other sites

traumaRUs, MSN, APRN, CNS

Has 27 years experience. Specializes in Nephrology, Cardiology, ER, ICU.

So agree with this article. Clinicals in APRN school are a better preparation I think to practice but still lack the realism and responsibility that the APRN will have.

And...credentialing does take a long time. And...if you have been licensed in multiple states as an RN and/or APRN be prepared to cough up the dates and that will also lengthen the credentialing process.

Great post...thanks! Congratulations on perservering and reaching your goal. I'm in my first semester and the end just seems so far away.

My school did not do so well at letting us know the process after graduation. We received a few handouts about interviews and some recommendations regarding scope of practice. the credentialing process was frustrating and took forever. Actually, everything seems to take forever.

I moved after graduation and applied for my RN in my new state six months ahead of time and it took nearly six month for them to grant the new license. My NP license I learned from another student can be started prior to graduation as well as applying for boards. Finally, RN license, Board testing approval, and NP license started there was more paperwork more waiting and delays. DEA, NPI and finally job hunt.

All that was cake compared to submitting hundreds of papers for credentialing and doing so several times for varies facilities within the system. I made the mistake of listening to my recruiter and quit my job early only to sit around waiting for the process to be complete. Two additional months without working. Good thing I am a believer in maintaining a healthy saving account.

I keep thinking it must be hard to switch jobs as an NP due to the long time it takes for credentialing. As an RN I can quit tuesday and be working within 2 weeks. The NP thing would take months.

Jules A, MSN

Specializes in Family Nurse Practitioner.

I keep thinking it must be hard to switch jobs as an NP due to the long time it takes for credentialing. As an RN I can quit tuesday and be working within 2 weeks. The NP thing would take months.

This hasn't been my experience and after the first time you will have all the documents ready for subsequent jobs. The hold up I have experienced is waiting for the hospital board's monthly meeting to approve privileges and depending on how eager the department is to get you boarded can result in a quickie meeting or last minute addition to a scheduled meeting. My average, and I work multiple jobs, is 30-60 days from written offer to seeing patients. I totally agree about having a healthy savings regardless for everyone in all professions.

WKShadowNP, DNP, APRN

Has 19 years experience. Specializes in Hospital medicine; NP precepting; staff education.

My DHEC finally came through and DEA is pending. It was an exciting milestone and showing proof to my employers felt great. One of my PA colleagues informed me she had been hired by this group but her offer was rescinded at the last minute. It was the same parent company but at a different setting.

I have no inkling that this will be my fate. I suspect not as they were looking to fill two slots, one is still vacant.

May will arrive, eventually.

Riburn3

Has 10 years experience. Specializes in Internal Medicine.

Credentialing length is probably the biggest thing people don't realize. For any NP it takes a significant amount of time just to get boarded, licensed, and all your DEA stuff. I graduated in mid December, took and passed my boards 2 days after graduation, and between the time it takes to send transcripts around, I wasn't licensed by the State of Texas until late January. From there it took another 5 weeks for my DPS license to be issued (no longer required in Texas), and another 2 weeks for my DEA license. From graduation to having all my stuff was 3 months. Thankfully I was working in a private practice and didn't need credentialing at a hospital, but when that time came, it was another 8 weeks.

I would tell most people planning on working in a hospital after graduation to expect another 6 months post grad in your RN job.

WKShadowNP, DNP, APRN

Has 19 years experience. Specializes in Hospital medicine; NP precepting; staff education.

Riburn, that's a perfect time line. Plus I studied for boards for 6 months. My start date is approx 6 months from that.

Jules A, MSN

Specializes in Family Nurse Practitioner.

I was offered a job early May, graduated mid May, tested 3 weeks later started 3rd week in July at a hospital, DEA, NPI and CDS in hand.

Aromatic

Has 3 years experience.

oh yeah i remember, i got called fora job after i graduated, actually when walking back to my car after having to sit through that stupid emotional "omg you accomplished something great, welcome to uncle sams collection club" ceremony they call graduation.

Also, we celebrate wayy too much in this country, its like we need a perpetual pat on the back for every little accomplishment we make...

Riburn3

Has 10 years experience. Specializes in Internal Medicine.

Riburn, that's a perfect time line. Plus I studied for boards for 6 months. My start date is approx 6 months from that.

Hachi machi! Definitely don't recommend waiting that long after graduation to take boards. Boarding within the first month or so yields the best outcomes. Either way, glad you passed!

Jules A, MSN

Specializes in Family Nurse Practitioner.

oh yeah i remember, i got called fora job after i graduated, actually when walking back to my car after having to sit through that stupid emotional "omg you accomplished something great, welcome to uncle sams collection club" ceremony they call graduation.

Also, we celebrate wayy too much in this country, its like we need a perpetual pat on the back for every little accomplishment we make...

I didn't go to any of them no pinnings nothing. Not big on fanfare. Got married at JOP back in the day and wasn't even knocked up, lol.

BCgradnurse, MSN, RN, NP

Has 11 years experience. Specializes in allergy and asthma, urgent care.

I didn't go to any of them no pinnings nothing. Not big on fanfare. Got married at JOP back in the day and wasn't even knocked up, lol.

I went to graduation. It made my mother happy. I didn't go to my first Master's grad and I was told I deprived her of a moment of pride and happiness..LOL

There are definitely advantages and disadvantages to both. You certainly sound like you did your homework and picked the choice that would make you the happiest!

×

By using the site you agree to our Privacy, Cookies, and Terms of Service Policies.

OK