1st NP job as Hospitalist? Input wanted

[linearthinker, DNP, RN]

I am about to graduate as a FNP. The CEO of the rural access hospital where I have worked as an critical care RN for 15 years has offered me a job. The hospital has been trying for 5-6 years to recruit a hospitalist, but I guess from a physician perspective, the contract is abysmal -so no takers. The staff physicians are fed up and three out of the six docs in town have given up privileges and stopped seeing pts in the hospital at all. Care is fragmented. reimbursement is in the toilet and morale is low. After a long fight opposing the use of physician extenders, the remaining skeleton physician crew has thrown in the towel and agreed to support hiring NPs to take over the role of inpatient hospitalist. My state does not currently have legislation requiring hospitalist NPs to be ACNP. As it happens, I have been planning from the beginning to return as a post masters to do the ACNP anyway, and now the CEO is saying they will pay for it, so that isn't really an issue at this time.

I have concerns unrelated to salary and benefits.

1. I don't think I'd get any mentoring. The medical chief of staff (until now, the largest opponent of anything and everything NP) would be my collaborating MD, let's all him Bob. I've known Dr. Bob for 15 years, we have a cordial, professional relationship. I'm comfortable with him. That said, Bob is not a NP advocate, and I don't think he'd go out of his way to teach me anything.

2. Unsupportive workplace environment. I'd be working directly with the nursing staff that has largely wished me to fail from the beginning. We can wonder why that phenomena exists some other time and thread, lol, but it does. I will have a learning curve, and I don't think I'd have any more support from nursing than from the medical staff.

3. Is this even a good idea even in better circumstances? I'm a tough chick. I can weather the criticism, disdain and lack of emotional support. I don't go to work to make friends, lol. But is the role of hospitalist even appropriate for a new graduate? I expressed this single concern to the CEO, and frankly, I don't think he cares. He wants to stop the rats from jumping the sinking ship. Keep the med staff happy by hiring someone, anyone, to do the inpatient scut work and relieve them of the burden that pays almost nothing and comes with a bevy of complications they don't want. He said he and Dr. Bob have discussed it and they think I will do fine. "We have every confidence in you," is a direct quote.

There are no NP jobs in this area. If I don't accept this position, I'll likely be driving over an hour each direction to a different community. I don't know where, b/c I haven't really begun the job search yet, but a few possibilities are in offices and health departments 40-50 miles away. (no we can't move, it will take 10 years to get back to break even on our house and we don't have the money for a sale that short, not to mention my husband has a great job here, kids in school, etc etc).

In perfect irony, one of the other NPs thinking of taking one of the 2 NP hospitalist positions (we will call him Ed) works with Dr. Bob, so if Ed does take it, there will be be a primary care office position opening up in Dr. Bob's practice. NO, I really, really, would not like to work in that office. Many reasons, not the least of which being I know it to be an unpleasant workplace environment for reasons totally unrelated to he fact the Bob only uses NPs b/c he must. I know the rest of the office staff, and no, I don't want to work with them 5 days a week. No, I would not seek or accept a position in that office should it become available.

Would Ed mentor me as hospitalist NP? Well I think he would, except that the way the proposed program is set up, we would never work directly together, but rotate. I'd be on my own, a lot.

As a brand new NP, I have a lot left to learn. I just don't see how I'm going to be mentored in any of the above scenarios. Staying in the same town, with roughly the same salary/benies I'd get 50 miles away, paid tuition for the ACNP, with a staff, patient population, work place culture (and computer system!) and routine I am very familiar with is appealing.

I'm inclined, however, to turn it down out of hand for the reasons I've mentioned. I want to be hired into a plae that wants me there, that offers a supportive and collegial learing and practice environment. I want a place to grow, and be allowed to have an impact, not just be a place holder (which is what this particular hospitalist NP position in a 25 bed critical access hospital sounds like). My husband, classmates, professors and friends think I'm being foolish.

What do you think?

[mom2cka]

I'm just a student now, but have thought about taking a hospitalist-NP role within my own organization (HR has already contacted me); the difference would be I would have support, mentorship, a strong contract, other NPs to work with who are experienced, as well as supportive physicians who are current hospitalists and who want to mentor as well. Without that - I couldn't consider it. The liability, the politics, and the difficulties you describe would be enough to scare me away. For your husband and the others who don't understand why there is hesitation - explain to them that one mistake or omission could cost you your license and your entire career. While that could happen to all of us - I can only imagine how quick that environment might be to use you as an example if it were to happen to you (sounds as if they might be only too happy to point fingers right at an NP). Good luck with your decisions!

For what it's worth - I work 45 minutes away from home and plan to continue with that when I'm done with school - the drive is my alone time, I actually listen to audio bokoks during my ride, before returning to 3 kids and a husband, and it's worth it to me, at least right now, to work outside of my own rural community with a critical access hospital and clinic. I can afford to live where I'm at comfortably right now, and pay my mortgage and school loans... and that's where I'm at :) Good luck!

[linearthinker, DNP, RN]

I work where I work now b/c I don't want to drive 45 minutes to the next nearest hospital, lol. I HATE driving. I went into this knowing I'd have to do a lot of it. I drive 90 minutes to clinical each way, and it is killing me. Every day is going to be a seriously big downer. I accept it, but I'm going to hate it. Really, the 5 minute drive is the single biggest appeal. That and not having to learn a new computer system. ;-)

thanks for your response, and god luck to you!

[BCgradnurse, MSN, RN, NP]

As an NP with a whopping 1 year's experience, I have to say that the single biggest factor in my success to date is the support and mentoring I've received from my colleagues. There's no way I could go to work every day and feel good about what I'm doing without the help I received in the last year. I hear what you're saying about the long commute, but do you want to drive to 5 minutes to a place that's not going to support you, and may even set you up to fail? To me, that's exactly what you don't want as a new NP. Just my thoughts. Best of luck to you!!

[linearthinker, DNP, RN]

No, I don't. My point was that the drive is about the only reason I am interested, lol. That and the prepaid tuition. I have always known I'm going to have to drive.

[VivaRN]

That's a tough environment for an experienced NP, let alone a newbie. If you think you could tolerate it you could stick it out, get your ACNP and then go for greener pastures in say, 2 years. But it may not be worth the strain on your mental health. That environment sounds... crazy-making.

If I were you I'd just say NO and look for somewhere more supportive. Being new is stressful enough, sorta like being a new RN - lots of worry about making mistakes or missing something important. You need support. I know you're tough, but I would seriously consider if this job is worth the grief. Good luck in whatever you decide.

[traumaRUs, MSN, APRN]

I think I would tolerate the drive and go work in the city for 2 years, get some solid experience under your belt, then consider the hospitalist position.

Just my $0.02 but your pts aren't going to care that you are new, you are going to be expected to hit the ground running and this just doesn't seem like a good place that would be supportive of your needs as a new NP.

[carachel2]

As a new FNP who had years of cardiac and ER experience, I can say without a doubt the factors that make my first job so wonderful are a supportive and interactive fellow NP AND a wonderful collaborating physician who clearly enjoys teaching and does not mind my questions. I learn something new *every* day and simply cannot imagine being completely on my own in potentially with no designated mentor and a potentially hostile staff. Heck, I would drive an hour OUT of my way to avoid that situation, LOL!