Talk To Me About Being An Inpatient NP

JBMmom, MSN, NP · Sep 29, 2022

I'm still relatively new. I had about eight months in a hospitalist role and I've been in the ICU about month now because my original job was phased out in some organizational changes.

Hospitalist NP: I was an overnight cross coverage provider with about 1-3 admissions per night. For admissions I would see a patient, develop the plan of care and then discuss with the attending. For cross coverage I was responsible for 30-40 patients admitted in step down or the floors. That was often little stuff like ordering tylenol and melatonin, but could be responding to rapids and transferring patients to a higher level of care. I really enjoyed it.

ICU NP: Still new to the role, I'm in a group with 2-3 NPs and PAs working daily. We each have 1-4 patients. We round with the attending and then spend much of the day reviewing tests, labs, consults, etc, and writing the care plan note. Since I'm new, with SO MUCH to learn, my preceptors are giving me either one complex patient or one complex patient with one getting ready to transition out of the unit. When I'm done with orientation I'll be on night shift where it's not as much about the care plan but more about putting out fires. Rapid response team, placing central lines, getting ultrasound IV access for patients on the floors if needed, admissions, etc. There are 1-2 NPs or PAs working overnight so I'll need to be MUCH more confident and independent before I'm on my own. But so far I love this job, too.

Then again, I've enjoyed all my jobs from LTC to med surg to ICU RN and now hospitalist or ICU provider. Maybe I'm just really easy to please. There's just so much to learn everywhere. Good luck!

FiremedicMike, RN, EMT-P · Sep 30, 2022

That sounds pretty awesome!

Guest1144461 · Sep 30, 2022

I am a hospitalist and did an inpatient fellowship (1 year). Jobs vary but my role is pretty independent. I have a supervising MD but I see them once a day. I then "run the list" with them maaaaaybe daily. Some just ask if I am good and that is it.

I have done rounding and admissions. In a 12 hour shift, I can do about 6-7 well-written admission notes and I round on 12-14 patients a day. My hospital is urban with rather complex patients so this can get crazy. I can do procedures but due to the time restraints with the complexity of my patients, I usually defer to residents or IR.

I do not recommend this job for a new grad unless you do a fellowship, my hospital won't even consider a NP unless they have years of experience or did a fellowship actually. The learning curve and level of independence are too high. They expect you to perform like a MD. I really do enjoy my job but the pay is mediocre for the COL. But NP salaries are mediocre regardless, especially with all the RN incentives (some RNs I work with pull 1K plus a shift).

FiremedicMike, RN, EMT-P · Oct 1, 2022

Are 3 12hr shifts per week jobs available?

Tegridy · Oct 1, 2022

21 minutes ago, FiremedicMike said:

Are 3 12hr shifts per week jobs available?

It’s more common to have 7 on 7 off better continuity of care. Personally I’d rather do 14 on 14 off

Guest1144461 · Oct 1, 2022

4 hours ago, FiremedicMike said:

Are 3 12hr shifts per week jobs available?

Possible but much less likely. Unlike the RN world, continuity of care is really important. Trust me, you don't want a new set of patients every 3 days..... it's not fun.

7 on and 7 off is better. I have done 14 on and 14 off but was always burned out by the end.

FiremedicMike, RN, EMT-P · Oct 2, 2022

Makes sense..

I appreciate the input, thanks!

JBMmom, MSN, NP · Oct 7, 2022

As I mentioned I recently transitioned out of a hospitalist group to ICU. Our hospital uses NPs in the hospitalist role a little differently. I was overnight cross coverage and admissions 7p-7a. That was a great job. I had 30-50 patients on service overnight and covered 1-3 admissions per shift. Loved it.

They transitioned the NP staff to 11a-11p for a similar role. They do not round on a full team, but will provide extra coverage as needed by the MDs. They are assigned admissions and in the future may be assigned discharges as well (they're only a month into this model). They take care of death certificates and for patients that are less complex they may be assigned the note/rounding for the day.

This allows more flexibility with schedules and they work 3 12's per week. There may be other hospitals with similar positions out there. As Numenor mentioned, a more intermittent schedule with his workload would be very difficult. But you may find other options out there as well.

KatieMI, BSN, MSN, RN · Oct 9, 2022

I have hospitalist job 3/12, but it is a rare pick where I am. I agreed for this specifically to allow myself to go back to school (FNP, doing AGACNP for coming interstate moving' sake).

The previous job was 4/10 irregular schedule and it was absolutely awful, no quality of life and work at all.

It is not a job for a novice unless either 1) the place has an excellent orientation for good half of the year, or 2) one did a full fellowship. You will be expected to do 90+% physician's job. It might be easier if the place is consultant-heavy (but if it is the case, you might find yourself working for years and not actually treating anything beyond calling consults). In my case, I am considered a full partner and not expected to call supervising physician, who in any case not physically available "too frequently" (read: as rarely as possible).

I enjoy being independent and I am paid pretty well for an NP. But it did not come lightly.

Tegridy · Oct 9, 2022

2 hours ago, KatieMI said:

I have hospitalist job 3/12, but it is a rare pick where I am. I agreed for this specifically to allow myself to go back to school (FNP, doing AGACNP for coming interstate moving' sake).

The previous job was 4/10 irregular schedule and it was absolutely awful, no quality of life and work at all.

It is not a job for a novice unless either 1) the place has an excellent orientation for good half of the year, or 2) one did a full fellowship. You will be expected to do 90+% physician's job. It might be easier if the place is consultant-heavy (but if it is the case, you might find yourself working for years and not actually treating anything beyond calling consults). In my case, I am considered a full partner and not expected to call supervising physician, who in any case not physically available "too frequently" (read: as rarely as possible).

I enjoy being independent and I am paid pretty well for an NP. But it did not come lightly.

There are some docs where I am that consult for everything (when we are on consult service) and honestly it’s pathetic. IDK where they went to residency but must have been a garbage program. Or they don’t care.

Guest1144461 · Oct 9, 2022

3 hours ago, Tegridy said:

There are some docs where I am that consult for everything (when we are on consult service) and honestly it’s pathetic. IDK where they went to residency but must have been a garbage program. Or they don’t care.

Some attendings just don't have confidence in themselves, zero time to think the issue through or are lazy in my experience. I had a few go-getter attendings who refused to consult unless it would involve procedures or in-depth follow-up.