Should I quit if the job doesn't fit??

[RoadRN]

I am miserable at my first FNP job. I've been there 3 months and have absolutely no support, the PA is a jerk and basically wants nothing to do with me, the office manager is a controlling biotch, and there's an MA who is also a total jerk. The problem is is that I work with Medicare patients and there are very few providers that take Medicare (I'm in family practice) in the small town that I live in. I feel like I have an obligation to stick it out for them, no matter how much I hate it (I am the only provider on the family care side, the other providers work on the urgent care side). I'm so torn. Should I stay and suck it up, worry about making mistakes, not having anyone to turn to? Or should I go somewhere else and risk the chance that I might end up in a job that's even worse?? I feel like I haven't even given it much of a chance. Some days I just wish I still worked at my old job as ICU RN

[Buyer beware, BSN]

You are a thoughtful and empathetic person. The issue here is that you work with people that are not particularly supportive or mature enough to have developed your kind of non-toxic collaborative world-view. Many people find themselves in malignant work environments that are devoid of comraderie and people who are capable of good mentorship. There is not one practitioner among us who has not had the good fortune of finding that person. In your case this doesn't seem to be the case. Don't fret. It's not you. Make plans to move on and you will find people of like mind.

[Nursemiriben, LPN, EMT-P]

You worked hard to be in the position to be a little demanding. If you don't love it I say leave it! Congrats on the move up the ladder!

[stupefyingjones]

Drs go through residency and fellowship etc after they graduate....

[TrishaMatthews]

My aunt is an FNP and she was in a similar situation like yours. I would recommend that you work for a year before you apply for other jobs. It's probably not the advice you want to hear but it may be to your benefit since employers like to see that you stuck it out at one place for a while before jumping to the next job. My aunt worked for a year and after, started applying for jobs & ended up finding one at another family medicine clinic & she found out that she really enjoyed it! Good luck!

[sailornurse]

But why? Why shouldn't we come out of school prepared to practice independently to the full scope of our license? Although a supportive environment would be ideal I don't think it should be expected. I have concerns the unreasonable expectations of extended orientations for new NPs hurts our credibility with physicians who expect us to be ready to practice. We have one, not even new just new to our specialty, who calls the physician before ordering a multi vitamin its embarrassing.

.

There is a learning curve of approximately 2 years, this is in general. As a FNP, primary care you see conditions & diagnosis you only read about. The multiple co-morbid conditions combined with polypharmacy & multiple specialists (cardiology/endocrinology/nephrology) for one patient are typically in family practice, along with women's health & peds, all this is challenging for a new grad FNP. Combine this with 15 min appointments, along with referrals, review of labs/diagnostics, prior auths for Meds not covered by pts insurance etc., it takes a while to develop comfort zone where one is safe, thorough, & efficient. Physicians get this adaptation phase during residency.

[sailornurse]

The problem is.......NP school doesn't train you to "hang with the big boys." It barely trains you to assess, diagnose, and prescribe......the first year is all about learning how to research......researching.....and writing about research.......it was a TOTAL waste of my time!

.......

My FNP program was structured differently than yours obviously. First semester was women's health taught by midwives and women's health NPs. We were together with the women's health & midwifery students. The midwife taught us pelvimetry! The WHNP taught us the tiniest details of each day of menstrual cycle, IUD insertion, and we had to know details on OCPs! Second semester was pediatric taught by pediatric NPs. We started doing clinical hours first semester for the specialties we were in. The roles/theories & research class were interspersed along with clinical courses but no I would not say my first year was a total waste of time considering also we were taking Advance pharmacotherapeutics taught by a PharmD the first year. Yeah we wrote quite a few papers for each class but my school was not big on this maybe because all faculty were NPs (program director who is Adult NP taught advanced assessment, 3rd semester) except for the PhD that taught research & one other that taught a Border Health class. So my last 3 semesters the focus was clinicals & perfecting what we learned first year; H&ps, labs/diagnostics, prescribing. They only accepted Ten students per year back then. I applied to this school for DNP, have The Interview 2 weeks. Their DNP is for for APNs only.

Where did you go to NP school?

[Aromatic]

Doctors don't graduate and go straight into independent practice without orientation... why shouldn't an NP go straight in without support??

they do after residency. once done with residency they are expected to perform at the same rate as a 20 year vet doc.

[oystersinmay, MSN, APRN]

best advice

[aprnKate]

Try to stick it 6-8 months and try to look around for jobs. Just make good with them and try to leave in decent terms. You need your co-workers as PA/NP/MD to be references. If you're too scared to settle down for another job just do a couple months of locum tenens work in your state or out of state and you'll see different practices. Then when you are ready to settle down for a perm job go ahead. What I like about locum tenens is that it was a 3 month assignment and I figured out in 3 months if I like the job or not. Didn't like it no worries...it was just 3 months. Liked it? then if they want me to extend i'll extend. Doing locums also made me aware of how other practices ran and I now know what I consider is a "good practice" and a "bad practice." However, anywhere you go there will be politics and always something wrong with the way practices are ran so if you keep that in mind and not expect perfection in every practice you'll be okay.

[adamRn79, BSN, RN]

Tell them all off, leave immediately

[dudette10, MSN, RN]

I'd have to disagree that physicians don't immediately start practicing with little more than being oriented to the computer system which is the reason it hurts our credibility with MDs when new NP grads aren't able to function to their full scope of practice immediately after graduation. My guess is we will see fellowships in the future but since there is no requirement for them at this time the sentiments I have received from Docs who are actually supportive of NPs is that if you want to hang with the big boys you need to be ready to roll.

Then why, every July, do my calls to the interns --for about six months--usually end with, "Let me check with my senior."

[dudette10, MSN, RN]

they do after residency. once done with residency they are expected to perform at the same rate as a 20 year vet doc.

yeah, after THREE YEARS of training in practice. Good lord, most NP educational programs are less than that full time!