Seasoned FNP tell me the truth....

[jaznia15]

I am graduating this May....(in 107 days to be exact) and I am so torn. I have always longed to move from this small town since obtaining my BSN. I ultimately didn't make the move because a staff nurse's schedule was not kid-friendly for a single parent with no close family nearby. I don't regret my decision because it led to me pursuing my MSN degree (a little sooner than originally planned). Now at the end of my journey, I long to move again if I'm able to secure a 9-5 M-F position with no weekends, holidays, or on-call. It's doable after a little sifting through the many job advertisements that don't require experience.

BUT....I have fallen in love with the practice that I am currently completing my practicum at. My preceptor definitely wants to hire me, but nothing is set in stone as of yet. He is a great doc and open to training mid-levels (wife is a PA). His dream would be to utilize all the mid-levels between the office and the other docs within the hospital so that we would be trained in all areas. His wife has been a PA for 5 years (EMT for several years prior). She has worked in the ER (solo "under hospitalist"), performed several small procedures in the office, and now is taking over the stress test at the hospital. The new NP who graduated this past May (started working in August) is now working in wound care center two days a week as well as the office and SHE LOVES IT. I'm sure their prior experience has helped catapult them into specializing, but I just love the freedom doc gives them. Speaking with the new FNP, doc trusts her to admit patients under his care based on her clinical judgement and she loves that he has her back.

I completed my Adult 1 clinicals with him and am now coming back for my practicum. He's promised to give me experience in every avenue allowing me to spend one day with the surgeon to watch procedures. One day with him or his wife at the ER. One day with the FNP at the wound care center (she's promised to teach me to suture and learn certain procedures). He's also had the radiologist agree to let me work with him one day to learn to read films (something we are not even taught in school). He's doing all this to help me build my resume whether I take a job with him or not. Although I am a student he trusts me with his patients and will follow my suggested plan of care. Even if he does not agree, he's so patient and doesn't mind explaining things in-depth.

My dilemma is, I don't want to stay. Its a small poor town, pay is not comparable to national average and frankly its full of people going nowhere fast. The experience and the fact that I would receive excellent training and could even specialize to an extent is the only reason I want to stay. I'm so scared of trying to move as a new FNP and being thrown to the wolves by a practice or not having a nuturing environment.

So experienced FNPs, what do you think is more important as a new graduate? Would you sacrifice your plans and income potential for a great MD or would you take the risk and move as planned.

Speaking with the FNP who started in Aug 2013, here are the stats:

Salary: $70k (currently not being paid for wound care clinic days/ supposed to be asking for some type of differential)

Benefits: CME $1000, Health insurance (dental &vision too), 401K retirement, Not sure how many sick/vacation days, malpractice insurance paid by practice

Bonus: Given $5k sign-on bonus

Schedule: 9-5 M-F No holidays, weekends, or on-call. (BUT there are talks of converting part of office into urgent care 8A-8P M-F with weekend hours 10A-4P)

I guess I should mention that the office manager is currently working on getting practice approved as site for national health service corps. The county is rated an 18 on the scale and probably would be approved for loan reimburstment. I have mentioned that this would be big incentive for working in the practice because the program pays up to $60k of loan back up front for 2 year agreement to work at an approved site.

[carachel2]

How old are your kids and what are the schools like ?

[phillycpnp-pc, MSN, RN, NP]

Firstly, I'm not a seasoned NP but a new grad that just got her first job.

It sounds a like a great and supportive practice. Perhaps you can work there 1-2 yrs get some experience and then relocate? I know you want to make a decent salary and want to relocate but the experiences they are willing to offer you sounds invaluable.

[futureeastcoastNP]

Think of try as a paid residency. Get some experience, a very nice salary for a residency, and then move somewhere you'd enjoy armed with all that knowledge and training.

[Dembitz, APRN]

$70,000 in a small poor town is a lot more money than $85,000 in a major city.

[JeanettePNP, MSN, RN, NP]

$70,000 is VERY nice money if you live in a small town (depending on how many children you have).

I would definitely take this job for a few years to get experience. Then you will have so many more options to choose from. Also you won't have to deal with the added stress of relocating when you are starting your first NP job.

[BostonFNP, APRN]

If you love it, stay for awhile. It sound like you will develop a great base there and then, if you decide to move on in a year or two, you won't have any problem finding a new job with that kind of varied experience.

The one caveat would be if your kid is going into school and it's a very poor performance school system.

[2015]

What a wonderful person you are working with. It's rare to find such people. I almost cried just reading about this man's kindness. 70k is not bad if RNs are earning less in your small town. The experience he's willing to give you will take you places. Be patient for another year and get the experience then move to where you want to be. Good luck.

[Road2CNO]

" I have always longed to move from this [COLOR=#009900]small town since obtaining my BSN."

Boy, do I hear ya!!! My goal is to graduate and then hopefully land a job in the state I hope to move to. Although, if I am given this same opportunity, I would have to say the experience far outweighs my desire as a new grad.

[mammac5]

$75K for your first year out of school (salary + signing bonus) is nothing to sneeze at. Especially since this office/practice is a known entity and you could really get into a much worse situation for your first job out of school. Lots of folks here have horror stories of their first jobs out of school, but they had to stay there for a year just to have experience to look good on the resume!

[pinkbubbles31]

Speaking as an FNP 4 yrs out of school. TAKE IT!!. i was in a similar situation, offered a position in a small town with two nice Docs, but moved away to find the bigger and better job- that did not work out. To me the first 2 yrs are the most important ys as it will shape who u are as a provider. if the doc is willing to do all these things for you, you really should think long and hard before you pass this up. Trust me, finding a doc with this level of patience is a pleasure to find. Spending a day with a radiologist? That is invaluable. Also, if the loan repayment deal works out, and you have a decent amt of loans, lets say you have an average of 30K with money you save in interest, your salary is well over 90K a for the first 2 yrs. You will be able to walk away with a great knowledge base , no loans and some money saved.

I personally wished I had stayed and taken that job making 82K after productivity, because with the cost of living so low (my mortgage was under $600 per month) to it now being just under $2000, making mid 90s. its easy to judge which one was the better deal financially. if you value a certain lifestyle that you think you can get somewhere else, i am sure you still would be able to do that 2 yrs from now. So get your experience, save your money, then move. (unless of course the area is really too bad for your kids, however, kids can find the bad crowd anywhere if they are so motivated)

Overall, happy where I am now, but if i were to do it over again, I would have stayed for what it would have done for my career in terms of having that

[TraceyMarino]

Stay in this environment and get the experience. I live and work in a very small town, and I don't have kids so I chose to stay in the small town. Believe me, the experience with these great mentors will mean more in the long run than 10 grand more a year. I have lots of friends who are pa's and np's who work in the "big city" and it is dog eat dog. Coworkers throwing them under the bus every day, everyone hustling against each other, productivity and assembly line type medicine. If you have great mentors willing to teach you, they have the time, they have old fashioned values, you won't get this in the big city. If you decide in a couple years to move on to bigger and greener pastures, so be it. For a new grad, the money they are offering is not so bad but you can't put a price tag on this kind of support early in your career-it will help build your confidence in a way the big city will not!