Salary, days off and hours

core0 · Apr 25, 2010

For those that are on salary...if you need a whole day off for whatever, do you have to take PTO (or wathever it is called in your organization) or do you just take the day off and you still get your regular salary?
Also...how many hours do you normally put in for an 8 hour day or a 10 hour day? I mean if you are doing 5 - 8 hour days per week how many hours are you really at work during that day?
I am a newly practicing FNP and doing primary care and find that my 5 - 8 hour days keep me as busy and in the office the same length of time as my PA colleague that is doing 4 -10s. I realize part of it may be that I am new and things take me much longer to complete. So I am wondering how long does an 8 hour day take you and how long does a 10 hour day take you?
Thanks.

There's a couple of things about salary. One is that you are paid to do the job not do the time. The time is however it takes you to the job. If you have xyz to do and it takes 30 hours then you still get paid for 40 hours. On the other hand if it takes you 50 hours to do the job then you still get paid for 40 hours. It rewards efficiency.

The second issue is time off. You cannot take partial days off. The employer can choose to give you either days off or hours off depending on the system they use. However, if you work a partial day, they have to pay you for a full day. For example if you come in and become ill and go home, as long as you have worked at least two hours they have to pay you for a full day. So if you need to take a couple hours off for something then they have to decide, is it better to lose the entire day income wise or let you take a couple hours off?

As for the schedule one thing that you have to make sure of is are you being scheduled correctly. With new providers my former practice would block off holes in their schedule. Lets say you are using 15 minute slots. We would block one 15 minute slot per hour so that they could catch up. After a month or so we would block off one 15 minute slot every two hours etc until they were up to full speed. The other thing is make sure you are comparing apples to apples. Are you seeing more complex patients which take longer, while your PA colleague who has been there a while has a stable of previous patients where they already understand the problem and are just doing follow up? Finally a lot of places use 10's for admin time. You schedule 8 hours of patient time and two hours of admin to go over labs, approve refills, get your charts done etc. One of the reasons that I like 10's.

I work inpatient now so its highly variable. Sometimes I scoot out early and most of the time my 10's are 10 hours. Occasionally a 10 hour is 12-14 hours. When I did outpatient we had a system where you saw patients from 8-5 with a one hour lunch. The other two hours were yours to do with as you wished. I would come in at 7am and work on auths and labs for an hour, then I would leave right at 5pm. If I left at five my drive was 40 min. If I left at 5:15 then it was two hours. I would go home and finish charts on EMR after dinner so I still did my 10 hours.

The other thing is not to estimate the value of a good MA on your schedule. A good MA will mean that a 8 hour shift is 8 hours. A bad MA means its 10 hours.

David Carpenter, PA-C

ruralnurs · Apr 25, 2010

coreo,

thanks for taking the time to respond. the time off is as you explain it. if i work 2 hours i get paid for the whole day but if i need a whole day off i have to take pto.

as far as 8s or 10s. i am not sure…

my pa colleague that i mention sees a huge variety of things but does as you mention see lots of stable people for follow up. i do lots of women’s health so that can take a while. i also am the one that does most of the “walk-ins” so it can be a sore throat or an “abdominal pain” (and we know how long that can be to tease out). we both start at 8:00 and see people till 5pm. we both take short lunches (trying to catch up on things) and we both seldom get out of there prior to 6-6:30 pm. during this time calling pts, writing referrals, follow up, dictation that did not get done at the time of exam, etc.

so i see that we are there about the same length of time, but he is on 10s and i am on 8s. i do know that he has much more experience than i and is an amazing provider so i am not comparing myself to him at all except in time. our boss does not like the fact that he is on 10s (he was hired and put in place prior to her taking over). i have asked for 10s but she told me that will never happen. he does see way more people than i do (he sees about 18-20 per day and i usually see 15 or less).

i just have the feeling that i may be being taken advantage of. another thing is that i am currently in school to get my post-masters as a family psych np so will have two degrees. the organization is eligible for student loan repayment but other than that they are offering nothing to help me with school. none of my time off needed for internship (about 5-6 days per month) is given to me, i have to take pto.

this is an organization that is in a remote county that has only one psychiatrist that comes to the whole county once per month. so i know i will have a population that will come see me and my organization will see the financial benefit. they are right now exploring how i can come into the hospital (under the same organizational umbrella) for ed mental health crisis as there is lots of money out there for mh crisis for remote and critical access areas. there has also been discussion about me being available to our long term care (attached to the hospital) and hospice as a consultant when done with my mental health degree.

when i graduate in august there will be no wage increase. i don’t think i make very much but i really am not concerned about the money that much, it is my time that is more important to me. i feel i should get more time off for my internship time and not have to use my own pto as it is my organization that stands to gain much when i am a psychiatric mental health nurse practitioner in addition to a family nurse practitioner.

i know that as a new np one needs to be humble and not expect the world, but i kind of feel i am not appreciated, at least my potential abilities when i am done and the need i have (time to do my school stuff) to get there.

i really like it here, this is where i live and i feel very supported by the 3 pas i work with (two work in the two different clinics i work in and one is in the ed and helps whenever i call with a question). i feel it is a good place to learn as far as my peers, but i am not happy with all the time i am putting into school and have no support.

as far as an ma, i don't have one. i "share" an ma, lpn, or rn that "belongs" to another provider. because i am a nurse at heart i often do my own nurse things. i often do my own throat swabs, ua dips, breathing treatments, iv insertion, etc.

core0 · Apr 25, 2010

coreo,
thanks for taking the time to respond. the time off is as you explain it. if i work 2 hours i get paid for the whole day but if i need a whole day off i have to take pto.
as far as 8s or 10s. i am not sure...
my pa colleague that i mention sees a huge variety of things but does as you mention see lots of stable people for follow up. i do lots of women's health so that can take a while. i also am the one that does most of the "walk-ins" so it can be a sore throat or an "abdominal pain" (and we know how long that can be to tease out). we both start at 8:00 and see people till 5pm. we both take short lunches (trying to catch up on things) and we both seldom get out of there prior to 6-6:30 pm. during this time calling pts, writing referrals, follow up, dictation that did not get done at the time of exam, etc.
so i see that we are there about the same length of time, but he is on 10s and i am on 8s. i do know that he has much more experience than i and is an amazing provider so i am not comparing myself to him at all except in time. our boss does not like the fact that he is on 10s (he was hired and put in place prior to her taking over). i have asked for 10s but she told me that will never happen. he does see way more people than i do (he sees about 18-20 per day and i usually see 15 or less).
i just have the feeling that i may be being taken advantage of. another thing is that i am currently in school to get my post-masters as a family psych np so will have two degrees. the organization is eligible for student loan repayment but other than that they are offering nothing to help me with school. none of my time off needed for internship (about 5-6 days per month) is given to me, i have to take pto.
this is an organization that is in a remote county that has only one psychiatrist that comes to the whole county once per month. so i know i will have a population that will come see me and my organization will see the financial benefit. they are right now exploring how i can come into the hospital (under the same organizational umbrella) for ed mental health crisis as there is lots of money out there for mh crisis for remote and critical access areas. there has also been discussion about me being available to our long term care (attached to the hospital) and hospice as a consultant when done with my mental health degree.
when i graduate in august there will be no wage increase. i don't think i make very much but i really am not concerned about the money that much, it is my time that is more important to me. i feel i should get more time off for my internship time and not have to use my own pto as it is my organization that stands to gain much when i am a psychiatric mental health nurse practitioner in addition to a family nurse practitioner.
i know that as a new np one needs to be humble and not expect the world, but i kind of feel i am not appreciated, at least my potential abilities when i am done and the need i have (time to do my school stuff) to get there.
i really like it here, this is where i live and i feel very supported by the 3 pas i work with (two work in the two different clinics i work in and one is in the ed and helps whenever i call with a question). i feel it is a good place to learn as far as my peers, but i am not happy with all the time i am putting into school and have no support.
as far as an ma, i don't have one. i "share" an ma, lpn, or rn that "belongs" to another provider. because i am a nurse at heart i often do my own nurse things. i often do my own throat swabs, ua dips, breathing treatments, iv insertion, etc.

first of all i would agree that you are being taken advantage of as a new grad. as to the issue that you should be given time off for your school i would disagree, unless all other employees have the same benefit. one thing that i have learned about benefits is that its usually a mistake (and sometimes illegal) to offer a benefit to only one person. on the other hand since the pa is being allowed to do 10 hour shifts there is probably an issue there. also 4x 10 hours would solve many of your internship problems.

given the workload you describe a 10 hour shift is more appropriate (although depending on complexity both your numbers are on the low end for fp). i've seen fp practices that routinely see 30+ per day. you also talk about your boss. is this a physician or some other manager?

in addition the theoretical benefit from a pmhnp may be largely theoretical. many fps consider basic psychiatry to be in the realm of fp. if you are going to practice more advanced psychiatry it does not appear that you need any physician collaboration but you do need a qa plan with either another phmnp or a psychiatrist. this would be outside the scope of an fp clinic. so this many explain their ambivalence about your pmhnp degree.

given the information you've posted i'm guessing you work in a rural health clinic. many rhcs have a reputation of having longstanding "administrators" with a rotating cast of pas and nps to keep up with the requirement to have an np or pa on staff. if that is the case there may be little you can do and there are probably not many jobs in the area. if you do want to continue with the pmhnp then hopefully you don't have a non-compete.

david carpenter, pa-c

Dixiecup · Apr 27, 2010

I am not working as a NP yet (still trying to pass the test!) but I have a friend who has been working in a rural clinic similar to yours for a couple of years now.

She was an ANP and went back to get her FNP and they paid for literally EVERYTHING including milage for classes, meetings, etc. Even meals and they totally paid for a live review course plus the room and milage there. But she did not get paid salary for time off required for clinicals.

If she needed a day off for somethng personal, she told me she either had to take a vacation (or PTO) day or use a CME day. They gave her 10 days a year in addition to vacation time for CME's so she said she always had plenty of time if she needed to take off.

She is only expected to see 20 patients a day. she says the physician sometimes will only see 15 and they are always on him to increase it to at least 20 but he doesn't really like to work that hard!

I am currently trying to get a job with this company because of the loan repayment as I owe about 80K in student loans! My friend had about 50K and they just paid it 100% in full.