Should I Leave?! Help!

[sunflower28, APRN]

Hello all,

First time posting but long time follower of allnurses!

I need some advice on my current position. A little bit of background...

I have been an RN for 6 years, 5 of those in a large ER as both a trauma RN and a SANE nurse (I LOVED it). Last year, I finished a Dual FNP/Acute Care Program and took both sets of boards. Last July, I accepted a position at a small rural hospital as a Hospitalist NP. I work a 7 on, 7 off rotation, 8am-5pm, no call. I have two rotating supervising MD's who I can ask questions to and are supposed to round every day on the inpatients, and meet with me to discuss patients each day. This hospital offered me a very enticing tuition reinvestment program when I accepted, plus a fairly good salary. There is no official "contract," only a work days agreement where I agreed to work the set schedule (182 days a year), with no official PTO. I get a good chunk of CME money. Yes, all these perks sound great, but this hospital is literally in the middle of nowhere, and like many rural/critical access hospitals, they struggle to convince providers sign on and stay. Since I have been here for the past year, I have seen four PA/NP's leave the clinic side of the hospital.

So, perks are good. Salary is good. Schedule is great. I love not being on call. However, I'm not loving the job... at all. It's not to the point where I hate what I do yet, but I am definitely not enjoying it. It's not the patients or my immediate co-workers (the floor nurses and CNA's), I actually really like that team and get along with everyone well. Here's whats going on.

This position has taken me about an hour and a half from my beloved old hospital, all my friends, and my significant other. I'm very isolated for the week that I am on. I bought a beautiful, economic little cabin in order to be closer to the job, but it has separated me from everyone in my life. It's been an isolating year. I miss my friends, my old hospital, and the proximity to my significant other immensely. My significant other is a cop and can't reside outside of the county he works in and we are not married. I would be lying if I said that the distance and our combined day shift/night shift work schedules has not put stress on our relationship.

I can deal with all that, but here's the real meat and potatoes. I think there are some systemic issues in this hospital that I am not going to be able to fix and maybe, it would not be wise for me to stick it out in a place like this. This is where I need some advice as to what it normal and what is not.

1. Administration is horrible. My orientation was the most scattered, stressful thing ever. I can never get a hold of anyone. Nobody calls you back. The lack of clear communication about everything from CME, salary questions, malpractice insurance questions... everything... is so murky. It's so hard to get a clear answer out of anyone. For example, due to the COVID pandemic, some of the conferences I had previously scheduled and been given the green light to sign up for may be cancelled. Those conferences and associated fees has cost me $1,500, which is supposed to be reimbursed. I have been getting vague pass along answers when trying to figure out this situation and am now really afraid the organization isn't going to pay me back.

2. I'm worried one of my supervising MD's is not competent. I'm unsure if he even looks at my notes that he is supposed to consign. I have to beg him to come see my patients. Sometimes I can't get a hold of him by using multiple means. Many times he has given me a suggestion or advice on what to do with a patient and when I look it up (like the proper antibiotic, medication dosage, ect) its wrong or there appears to be a better option. I've been told this MD has been reported before for issues by my hiring manager (of course, after I'd been on the job for 6 months).

3. The ER doctor covers the inpatients when we go home for the day at 5pm. They are responsible for the patients until 0800. I sign out to them, and they are supposed to sign back in to me in the morning (rarely, they do). I cannot tell you the number of times in the past year I have arrived to work and stepped into a disaster. Patients in Afib with RVR since midnight, patients with sepsis who are crashing, 1/2 done overnight admissions with no medications ordered for diabetic patients and sugars in the 500's that haven't been corrected, elevated troponins with no interventions, the list goes on. The ER docs will tell the night nurses to, "leave it for the hospitalist in the AM," "I'm washing my hands of this patient now that they are admitted," "The hospitalist will deal with that in the morning. Don't wake me again." This is not to say all of the ED MD's are like this, but the majority are. This is not a secret problem, this is something that I have voiced to my attending MD's. This makes me extremely uncomfortable, and nervous to go to work in the morning.

4. This week, the head MD at the hospital asked if I would be interested in running an on call, "respiratory clinic" in response to COVID and higher volumes in the ED in the hours between my shifts on my 7 day on rotation. I would be on call to take care of all respiratory patients coming into the ED to help "offload" the ED MD from the time my shift ends at 1700 until 0800 when I am supposed to be return as the hospitalist. No other information available, as in pay, PPE information, general information as to how this process would work. I do not want to say yes, but I am worried that I will not be viewed as a team player if I say no. I also live almost 40 minutes from the hospital. I am certain this on call respiratory clinic would become a dumping ground for everything from the ED, I would get called in every night, and would not get the rest I need in between shifts. Maybe I'm being selfish, but I really do not want to do this. In addition, the MD said that this would be a "test run" for her ultimate vision... having the hospitalist be on call all night. That is something I 100% do not want to do.

So this is a novel, but I just need some honest advice. Do I suck it up and stay for a few years to get the most out of the tuition reinvestment program and to get the experience needed to look good for my next job? Or, do I actively start looking for something else if and when this pandemic slows down (obviously, it would not be wise to leave a good paying job during a pandemic), get out of here? I would likely just return to my old hospital, which I loved and have been oddly very nostalgic about. I worry all new NP's go through this and I would be quitting before I have given it a solid change. I also worry that this a "grass is always greener" situation and maybe I am being a bit too sensitive. I however, do worry about the systemic issues in this hospital and that the patients are not the top priority.

Any thoughts/advice would be greatly appreciated! I don't know many NP's that don't already love their jobs and the majority of my friends are RN's (who say... come back to us and get the heck out!)

[LibraSunCNM, BSN, MSN, CNM]

I'm a CNM, not an NP, so you're free to take or leave my advice. But from what you're describing, you've put in a solid year at a hot mess of a job, and have managed to survive. I'd start looking elsewhere for a better job. You're right, many new grads do endure first jobs like this, but that doesn't mean you're required to stay for years and be miserable. I would also say no to the respiratory clinic thing. You have what sounds like excellent experience and will hopefully be able to find something better.

[Corey Narry, MSN, RN, NP]

#3 would be a deal-breaker for me. That is a clear example of patients being put at risk for harm by providers who are just plain lazy. I would hate to be part of an organization where something like that is the norm and nobody is addressing it.

I think it's time to look at other options.

[Guest1144461]

#2 is meh. A lot of MDs will half *** the rounding if know you are handling everything. This isn't uncommon, plus you aren't in a formal residency/fellowship. Everything else teaching wise is just a courtesy from them.

#3 is pretty bad. Also I would be angry as a ED MD to have to handle inpatient situations. Bad idea all around

[sunflower28, APRN]

Thanks for the advice and viewpoints guys. I agree- it is definitely not ideal for the ER docs to not only handle every ER patient overnight but all of the floor patients as well. That’s a lot of responsibility! I think I’m going to allow myself to start looking for a new job... I just needed an idea of what was normal and what is not... and what a new NP should be experiencing versus something that is out of the ordinary. Thank you all!

[Corey Narry, MSN, RN, NP]

On 7/14/2020 at 3:25 PM, sunflower28 said:

I agree- it is definitely not ideal for the ER docs to not only handle every ER patient overnight but all of the floor patients as well. That’s a lot of responsibility!

I agree but the fact that the ER docs know that there aren't any providers managing the patients on the floor and per your quote, their response ends with "...don't wake me up again" tells me that they don't see serious patient problems being ignored a big deal which is bothersome. But who knows, there might have been a prior history of the ER guys complaining about this very situation to the administrators and nothing was done to address it, hence, their apathy. Either way, it's not a great place to be.

[simba and mufasa]

I am not an NP, but after completing my PhD./MSN in education, I took jobs at rural colleges no one wanted to work at, horrible conditions, no support. After 2 years I gained experience and left. Sometimes, when we start new jobs, we scrap the bottom of the barrel to get experience, you did the same. As someone married, do not isolate your significant other for that long, someone out there is looking, with your solid year, you have experience and now you should run out of that place. You worked too hard, now is the time to start enjoying your profession and significant other.

simba and mufasa

[LJPace]

As far as malpractice insurance, get your own. If something were to happen, the institution would have your back. However, after that case the institution could turn around and Sue you. Institutions will tell you that you don’t need your own insurance because they don’t want to have anyone to fight against in the end game.

[TriciaJ, RN]

I agree with getting out as soon as you line something up. Anything going at your old hospital? And don't wait to get your own professional liability policy. Never depend on an employer or anyone else to have your back.