5 8s, no thanks!

[ThePrincessBride]

Question: I am an FNP student who actually likes the idea of a three or four-day work weeks.

I know retail clinics offer 3 10s, but they are every other weekend (which I don't want). I know there are urgent cares. Any other ideas?

Or I doomed with every other weekend or five 8s? My dream job would have 3 10s or 4 8s...is that realistic?

[ThePrincessBride, MSN, RN, NP]

I guess my concern is that I plan on having children in the next couple of years and I don't want to work 60 hours per week like it seems many 40-hour positions demand of NPs. I wouldn't mind 4 10s...if that is an option.

[djmatte, ADN, MSN, RN, NP]

Lots of NPs have children and still carry a full load. Whether you're working 4 tens or 5 eights, or any derivative therein, it won't make a difference on what your work-load ends up being. Regardless, you're putting the cart before the horse. Get through school, learn your craft, then worry about your schedule down the road. Kids will happen regardless of your schedule and you may not easily find someone very flexible (if ever). That's the reality of this business. Unless you are in independent practice, you are at the behest of whomever your employer is and their goals.

[ThePrincessBride, MSN, RN, NP]

6 minutes ago, djmatte said:

Lots of NPs have children and still carry a full load. Whether you're working 4 tens or 5 eights, or any derivative therein, it won't make a difference on what your work-load ends up being. Regardless, you're putting the cart before the horse. Get through school, learn your craft, then worry about your schedule down the road. Kids will happen regardless of your schedule and you may not easily find someone very flexible (if ever). That's the reality of this business. Unless you are in independent practice, you are at the behest of whomever your employer is and their goals.

I understand but it seems as though the NPs I talk to have a crap work-life balance. Plus with clinicals (which my school arranges), we get the opportunity to try out different settings to see what it is we like. I think I would be miserable if I had to work five-six days a week. My future babies come first.

Plus, I am not getting any younger. I get needing a year or so of full-time experience before going part-time, but I definitely want to be able to lean out as my kids need me more.

[ToFNPandBeyond]

1 hour ago, ThePrincessBride said:

I understand but it seems as though the NPs I talk to have a crap work-life balance. Plus with clinicals (which my school arranges), we get the opportunity to try out different settings to see what it is we like. I think I would be miserable if I had to work five-six days a week. My future babies come first.

Plus, I am not getting any younger. I get needing a year or so of full-time experience before going part-time, but I definitely want to be able to lean out as my kids need me more.

I don't think what you are asking for I unreasonable. There are some places that will allow you to work 4 tens. So long as they have the staff (and hours of operation) to cover. Inquire about it during your interviews, etc.

I'm sure you can even find jobs posting for part time work. I've seen several in my area at least...

[myoglobin, ASN, BSN, MSN]

You will find the best opportunity for the schedule that you seek in places with higher demand/pay. This might include locations like Washington (state), New York State, Conn, Mass, Oregon, and California. You might also find it in the places that pay a "split" (typically 60/40 with 60% going to you). This arrangement will likely pay you more money (maybe 150-175 1099 veres 120K-130K W-2), but typically won't guarantee a salary. I think four 10's is becoming more and more common and will eventually emerge as the "standard", not just for NP's but many professions.

[FullGlass, BSN, MSN, NP]

In primary care, 8 to 5 is the norm. There are clinics that offer 4 10's, but not as many as the typical 5 days a week.

My first few months were rough because I was not yet efficient. Once I became more efficient, I was able to complete my charting easily. I started at 8 am and did not usually take a lunch. I was usually out the door by 5:30 pm with my charting all done. I accomplished this about the 6 to 8 months mark. Once in awhile I would be charting until around 6 pm. I also had a laptop so I could go home at 5 pm and complete my charting at home. This was typical of the other providers in the clinic as well.

[ThePrincessBride, MSN, RN, NP]

2 hours ago, FullGlass said:

In primary care, 8 to 5 is the norm. There are clinics that offer 4 10's, but not as many as the typical 5 days a week.

My first few months were rough because I was not yet efficient. Once I became more efficient, I was able to complete my charting easily. I started at 8 am and did not usually take a lunch. I was usually out the door by 5:30 pm with my charting all done. I accomplished this about the 6 to 8 months mark. Once in awhile I would be charting until around 6 pm. I also had a laptop so I could go home at 5 pm and complete my charting at home. This was typical of the other providers in the clinic as well.

Are there any jobs available to FNPs where taking one's work home isn't considered the norm? Urgent care, possibly?

2 hours ago, myoglobin said:

You will find the best opportunity for the schedule that you seek in places with higher demand/pay. This might include locations like Washington (state), New York State, Conn, Mass, Oregon, and California. You might also find it in the places that pay a "split" (typically 60/40 with 60% going to you). This arrangement will likely pay you more money (maybe 150-175 1099 veres 120K-130K W-2), but typically won't guarantee a salary. I think four 10's is becoming more and more common and will eventually emerge as the "standard", not just for NP's but many professions.

I really hope so because let's face it: 8 hours rarely is 8 hours, even in acute care. It ends up being 9.5-10 hours in reality.

[adventure_rn, MSN, NP]

28 minutes ago, ThePrincessBride said:

Are there any jobs available to FNPs where taking one's work home isn't considered the norm? Urgent care, possibly?

I'm not an expert, but I feel like what you've described is the trade-off of becoming an NP, especially in an outpatient setting. Unlike inpatient, where you literally hand your patient off to another provider, you're responsible for everything to do with your patient, including writing your notes, reviewing your labs, following up when things are abnormal, and potentially even basic stuff related to insurance and billing (i.e. pre-auths). Those things don't go away just because it's after 5, and there's nobody to hand it off to; you can go home and push it off until the next day, but it still has to get done.

Perhaps you'd be a little better off in urgent care, but that doesn't change the fact that you wouldn't be done until all of your ducks are in a row (notes finished, etc.) That might mean staying late or working from home to finish up what you need to finish up, especially if you're in a super-busy urgent care setting.

In a perfect world you'll have time to do it throughout the day as you're going along, but if you're slammed, you may have to either stay late or take it home with you. Like @FullGlass said, you should become much more efficient as you gain experience.

It seems like the dream work setting you've described is working as an acute care RN, where you can drop down your FTE fairly easily and you can clock out/walk away at the end of your shift without any additional responsibilities. Unfortunately, that doesn't seem to be how outpatient care works, and you may need to adjust your expectations.

[FullGlass, BSN, MSN, NP]

One of the doctors in the clinic was very efficient and he was literally out the door at 5 pm and he also took a 1 hour lunch. He charted as he went. His chart notes were good, too. So it can be done, but that will take experience and practice.

But as a new grad NP, you are going to have a steep learning curve, so it will likely take you time to become efficient.

As others have said, Urgent Care seems to be a better fit with your desired lifestyle, but Urgent Cares generally do not hire new grads - most require 1-2 years of experience. However, there are exceptions.

The truth is, that as a new grad you aren't in a position to be real picky. The exception to this would be if you are in an area with a shortage of NPs. Then you would have a lot of negotiating power. You might want to start putting out feelers and doing research on the NP job market in your desired area.

NPs are professionals, and in California, where I am, they are very well paid. Professionals do not generally work only 8 hours a day. I used to be a business executive and I worked far more hours than I do now as an NP. You will need to devote some personal time to staying abreast of new developments and research. Personally, there were some patients that had very complex conditions that I took an interest in, so I would do research on my own time to improve my care and treatment of them. A new grad should expect to be doing a fair amount of that. For example, one of my patients was a paraplegic, something I didn't have a lot of knowledge about, so I did "homework" Part of it was also that he was young, had been through a horrible time, and I developed a personal interest in helping him and his family. The providers in my clinic would also occasionally visit patients that had to be admitted to the hospital. It wasn't expected, but we did it because we came to care for them. One of the doctors made house calls on a few elderly patients just because he is a nice guy and he knew it was really hard for them to get to the clinic. For me, I had about 5-6 patients that I put extra effort into.

[djmatte, ADN, MSN, RN, NP]

At the end of the day, if you work in primary care or a range of situations where your are a provider, you own that patient. You are a gateway to their health improving or not. Too few people recognize this level of responsibility and think their time stops when they leave the office ( regardless of work being done well or poorly). Doctors In local clinics long before us and newer models of care did house calls, rounded in hospitals, and had exceptional rapport with their patients. If you want the responsibility of an NP, it’s that level of altruism you should strive for.

You haven’t even graduated yet and all I’m reading is me me me. At the end of the day, you aren’t just some nurse who can go home and maybe never have that patient in your care again. You will be responsible for the meds you prescribe, the labs you order, documenting patient responses to your therapy, and will go home hoping they got their son a cardiac echo because the dad Doesn’t believe you and thought it was a waste of time.

You won’t be able to do this profession during normal business hours only all the time because simply put there’s too much to keep track of. Be it labs, adequate charting, orders, paperwork, HRAs, refills, prior auths, fmla forms, disability applications, cme, And “oh by the way can you see Johnny while he’s here because he has a fever of 103 this morning and you were fully booked and I couldn’t give up my appointment“. This will be your life in most fnp jobs and it will spill over to your home life no matter how many days/hours you work. Understand this going in because the most egregious thing to me is patients suffering because their provider is too good to consider their work in their downtime.

[db2xs]

On 11/18/2019 at 6:07 PM, ThePrincessBride said:

I guess my concern is that I plan on having children in the next couple of years and I don't want to work 60 hours per week like it seems many 40-hour positions demand of NPs. I wouldn't mind 4 10s...if that is an option.

Then maybe work full-time first and then when you have kids, go down to part-time?

[myoglobin, ASN, BSN, MSN]

I know that in the PMHNP world that four tens while not "common" also are not rare. I have had multiple places offer me a 60/40 split (1099) and advise me that I can "set my own schedule" working three or four 10's. Several said that their NP's earn between 150 and 220K working 4 10's. I just turned down a local offer in Florida (known for poor pay and worse working conditions) that would have been 4 ten hour days that paid a 125K base with about 15K in realistic bonus opportunity (and I'm a new grad). I believe that it can be done as an FNP. All it will take is an independent practice state (examples include Washington, Oregon Wyoming, Iowa, Nebraska, Arizona, Montana, Maine, New Hampshire) to name a few and an office that will pay you a "split" (which also means 1099). Even in a restrictive practice state all you need is a "collaborating physician" (usually available for about 10% of your gross collections). I honestly think that in the "right" market (say near Disney World, Vegas, or a big city like Seattle) you could do three 12's (say 9am to 9pm) on a 50/50 split and still earn at least 150K 1099. Many patients would appreciate being able to see a primary care provider "after hours". It is amazing to me that I live 20 minutes from Disney World and after about 5PM there are few options (for primary care) other than an Emergency room despite us hosting millions of tourists every year.