Tell me the downsides.

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I like to be pragmatic.

So please NPs of allnurses. Tell me what sucks the most about being an NP?

I know that everything isn't filled with meadows and butterflies.

Anyone willing to just simply list some of your top complaints and perhaps things you wish could change about the NP industry?

Thank You in advance

CardiacDork, RN (BSN student)

Cardiac ICU Nurse

Specializes in ICU, LTACH, Internal Medicine.
The never ending chronic disease processes!

Yikes - I just wanna treat'em and street'em. It gets boring telling ESRD pts to quit eating phosphorous, watch your K+ intake, don't drink so much.

And...with my HF pts, its watch your sodium intake, take your meds and don't drink so much.

And - for all of them - please think about quitting smoking, losing weight and taking all of your meds as prescribed - not only "ma' pain pills and anxiety pills"!

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Specializes in Critical care.

I am in MSN/FNP program right now. I work and study at the same time. As a result, I sometimes want to give up MSN and just work as a bedside nurse because it is really too much. However after reading this thread, I have more motivation to keep going until I cross the finished line which is have that MSN, FNP title attached to my name. Thank you so much for posting this post. I believe Iw ill be satisfied with provider role too.

Regards,

Youngman, future FNP

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It's maddening to see NPs get paid so little down in the south and have such restrictive authority. For pete's sake, Florida NPs only this past year were allowed to prescribe narcotics! For someone that works with children post-op, I can't imagine not being allowed to order morphine or fentanyl for my patient.

Education not being up to snuff in every institution.

Lack of real world business minded classes in school (to be fair, they don't do this in med school either).

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Specializes in Critical Care.

Thanks everyone. Keep it coming :) Any NPs willing to share, I'm all ears!

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Specializes in Cardiology, Research, Family Practice.

This kind of feels like an open invitation to gripe and moan, which would make us all look really bad, so I'll try to keep it to a minimum :)

The long hours.

Work is never done. You can't give report at the end of your shift and go along your merry way. At least in my practice, my patients are my patients. At 30 pts a day, it can not all be done in 8 hrs. Impossible. Because the 30 pts I saw yesterday, now all of their lab and imaging results are back and have to be reviewed and communicated and acted upon, and some of them have called back with side effects of their meds, or meds are too expensive, or they've developed some new symptom. And the 30 patients I saw 6 months ago now need their prescriptions refilled, and so on. Even as I sit here now I have 36 sets of labs in my inbox (on my day off) and a few dozen rxs waiting to be renewed.

Besides that, I am sick to death patients with BMI 40+, who live on crap food and no exercise, have diabetes or prediabetes, high bp, sleep apnea but refuse a sleep study or refuse to wear cpap, then ask "why am I so tired?" or "why can't I lose weight?". Where I live, that is probably >50% of the population.

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Specializes in Critical Care.
Besides that, I am sick to death patients with BMI 40+, who live on crap food and no exercise, have diabetes or prediabetes, high bp, sleep apnea but refuse a sleep study or refuse to wear cpap, then ask "why am I so tired?" or "why can't I lose weight?". Where I live, that is probably >50% of the population.

Are you candid with them? I would have a hard time NOT being honest. I would do so respectfully but I would say

"Mr Harry, the reason you feel tired is because you are overweight, you do not eat nutritious foods, and you live a sedentary lifestyle. In addition, you refuse your CPAP which is going to lead to great strain on your already weak heart attempting to propel blood through a vessels filled with plaque, and I'm telling you this quite honestly because I could just move on and bill you but I do care"

LOL Id probably eventually get tired of preaching. I'm not sure if I'd enjoy primary care, but I would enjoy wellness clinic. I would do primary if I had to though.

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Specializes in BSN, RN-BC, NREMT, EMT-P, TCRN.

I enjoy your honesty, especially in your second paragraph. I am not an NP, but I find myself talking to peers whose intellectual level is well below mine. I enjoy communicating more with the NPs, PAs, MDs than I do with my fellow RNs. I love discussing therapeutic modalities, pharmacology, etc. with the advanced practioners because my peers don't have the knowledge.

You and I might be misconstrued as "arrogant b*st*ards", but we're not.

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Things I HATE:

#1. Charting. For every minute of face time with a patient there is at least 2+ minutes of pre/post charting.

#2. Charting/Meaningful Use. Even though the patient came in for XYZ complaint. I have to address: colon screening, Flu shot, PAP, check allergy button, check the PMH button, check the Medication button, and check the PMSH button (even though I'm doing this during each encounter).

#3. Charting/labs. Calling patients back getting their voice mail, playing phone tag with lab results, dealing with nurses playing phone tag with patients and then the patient asks a stupid off the wall question which then gets routed back to me to address

#4. Charting/Doc of the Day/covering for other providers on vacation/sick time

#5. Getting my mailbox stuffed with ASININE letters from insurance companies telling me they won't cover a medication OR the patient is not taking their medication correctly OR did I know the patient was on GASP!: aspirin and plavix at the same time....

#6. Fighting with pharmacies on drug coverage. Such as tablet was covered last week but now have to get a prior authorization to pay for tablet. 15 minutes on the phone with the pharmacy and MIRACULOUSLY they cover the medication in capsule form!!!!!!

#7. Peer to peer phone calls. I ordered an MRI. Insurance refused to pay. Spend an hour on hold, finally talk to a doctor and spend 30 seconds explaining case when they give me the approval number!

#8. Getting messages from local Home Health agency from local hospital ALL on the same EPIC charting system sending me HANDWRITTEN NOTES ON DRUG ALLERGIES that I ALREADY HAVE TO CLICK ON a button accepting drug allergies prior to the damn charting system letting me send in a refill...

#9. Charting/EPIC MyChart messages. Patients sending off the wall questions that take time away from seeing patients

#10. The inefficient bureaucracy of medicine. Im able to bill 50-60% of my time (face time encounters with patients scheduled that day). 40-50% of my time is spent on UN-billable time (inbox/refills/mailbox/phone calls/etc)

#11 filling all the patients meds, hit the send button, THEN they ask for it to be printed OR sent to another pharmacy OR asking for a 90 day supply

#12. I once filled out a prescription 5 TIMES for a walker. (1) Patient asked me for a walker. (2) They then asked me for a rollator walker. (3) The rollator walker has to specify 4 wheels and brakes. (4) The rollator walker has to specify 4 wheels, brakes, and a basket. (5) The rollator walker has to specify 4 wheels, brakes and a basket PLUS ensure the diagnosis was attached PLUS date it.

#13. Opioid Pain meds requests

#14. Disability requests

#15. FMLA paperwork requests

#16. Unrealistic patient expectations. For example, seeing a patient who has had 42 back operations over 20 years comes to me with back pain complaint (instead of going back to the surgeon) SMH!

#17. Never getting a lunch because of charting

#18. Never getting a bathroom break because every second of every day spent on being as efficient as possible. Everything NOT addressed during the day rolls over into personal time at home.

#19. Working 36-48 hours a week as a nurse and getting paid for every hour that I worked. Now as an NP, I'm supposedly a professional (salaried) and I put in at least 50-80 hours per week. AND the nursing/ancillary staff wonder why I don't look them in the face (instead of eyes glued to the screen charting)

#20 Dealing with soul-sappers. These are the vampires who will drain your soul dry. They are the non-compliant patients who promise the world but never make any changes. They don't have any money/finances/insurance/homeless and ask for more money/services/free stuff...

Things I love (which makes me go back to working da grind every day).

#1. Making a connection with a patient. I love walking into a room and the patient glances at me with a distrusting and hostile look (because they don't know me). 1/2 way through the encounter they start leaning forward, paying attention to everything I'm talking about. And at the end hearing them say "can I come see you again"

#2. Catching bad things others have missed (cancer/autoimmune/etc) (Again, not that I'm that good, most of the time its being in the right place at the right time to catch the diagnosis.)

#3. Doing the right thing for patients and earning their trust. For example, seeing the wife, husband (farm worker) walks in behind patient with an obvious basal cell cancer underneath eyelid. Whole encounter stops and I focus on him (MOHS surgeon got to him quick enough they were able to save his eyelid...)

#4. Making an impression on a patient THEN start seeing their spouse THEN start seeing their family THEN start seeing their church members (because of #3 above)

#5. Calling and checking up on sick patients.

#6. Hearing 3rd hand on how good the care you've been providing

#7. Bending over backwards for a patient (my usual care) who come to find out is the cousin/family member/church member of administration/employee's and word gets back to you on how they appreciate the care which was provided

#8. Learning new stuff every day

#9. Challenging patients

#10. I LOVE humble patients!!!!!

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I agree with everything medic97RN09 said. While the never ending slog and daily annoyances with administrative tasks and non-compliant patients are very real, I can legitimately say I have had a significant positive impact in many people's lives. And it's nothing heroic or some crazy diagnosis, it's routine stuff. Like recognizing a patient who needs daily controller inhaler for their asthma after they've been coughing every day for YEARS. It's finally finding the right combo of DM meds, fighting insurance for the patient to get them, and getting their A1C from 14 down to 6.5. It's taking a patient off of most of their DM and HTN meds after they actually change their diet in the way you taught them. It's following up with migrant worker with no insurance and and a suspicious lump on her face and knowing what charity to refer her to to have a biopsy, come to find out it was parotid gland cancer, they were able to fully resect it and she is now cured and able to go back to work and care for her kids. It's getting a hugs and thank you from a family for diagnosing their cancer (never expected that but it's happened multiple times). It's putting a parent at ease because I can quickly recognize that their child's rash is simply roseola or fifth disease, when they came in convinced their baby was seriously ill. It's recognizing cholecystitis after a patient was sent home from the ER with "abdominal pain, unspecified" and they come back post-op just to say thank you. It's being able to I&D that abscess or paronychiae and giving a person in terrible pain instant relief. Even simply being able to give a person a note for few days off of work when they really do need it feels pretty great.

I short, find medicine and science extremely interesting and as cliche as it might sound I always wanted to help people using this knowledge. I can honestly say that as a nurse practitioner I have been able to do exactly that. I also can get bored easily, and I feel this job is the right combo of routine stuff but still constantly learning new and interesting things.

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Specializes in Critical Care.

Great posts, love it.

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Specializes in Cardiology, Research, Family Practice.
Are you candid with them? I would have a hard time NOT being honest. I would do so respectfully but I would say

"Mr Harry, the reason you feel tired is because you are overweight, you do not eat nutritious foods, and you live a sedentary lifestyle. In addition, you refuse your CPAP which is going to lead to great strain on your already weak heart attempting to propel blood through a vessels filled with plaque, and I'm telling you this quite honestly because I could just move on and bill you but I do care"

LOL Id probably eventually get tired of preaching. I'm not sure if I'd enjoy primary care, but I would enjoy wellness clinic. I would do primary if I had to though.

Very honest and upfront. I provide honest feedback and recommendations, a total waste of my time and energy considering there is like a 1% chance this pt is going to follow any of my recommendations. The never-ending excuses and unwillingness to be accountable for one's own health...

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Specializes in ED, med-surg, peri op.
Very honest and upfront. I provide honest feedback and recommendations, a total waste of my time and energy considering there is like a 1% chance this pt is going to follow any of my recommendations. The never-ending excuses and unwillingness to be accountable for one's own health...

I think that's a little bit unfair. Yes theirs pt out their that do nothing and don't understand why this or that is happening. And generally don't care, and think everything you saying isn't true. But loosing weight or giving up smoking is much easier said than done. Their are people out there that do try and want to live healthier. Telling them to eat better and exercise isn't enough for most people. They need some one their to help them, show them what to do.

That's why in my country they started a thing called a green prescription. It's completey free course that consist of exercise classes, classes on healthy eating and what to eat and how to cook, plus support from a trained professional for 12 weeks for people who are over weight. It has proven to be very effective. Ofcourse it only works if people go to the classes. But is more helpful than just telling people to lose weight, join a gym, eat healthy ect.

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