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Discussion

The Downsides to being an NP?

I'm in an ANP program and have been hearing things here and there from NPs about some of the negatives. It's hard for me to evaluate since I hear lots of contradictory stuff, so I'm interested to hear others' perspectives. I'm curious about a few things:

1. Do you work more hours as an ARNP than you did as an RN? If so, do you want to work more?

2. For those of you working primary care, do you feel like you have time for your patients?

I worked primary care before being a nurse, and the NP had to see 50 patients a day to break even with medicaid. The amount of prevention and education she could do was pretty minimal and it was pretty hard on her. I've always wanted to go into primary care, but all the MDs and NPs I talk to in the hospital say something similar that basically they work you to death and your interactions with patients are limited by the funding (unless you work VA or with wealthy patients). How accurate is that? Is it more contextual?

3. Do you feel that your job has more pressure, multitasking, and having work dumped on you (from MDs, administration) than as an RN, less, or different? I've been hearing more and more about charting off the clock or after work, labs, and large administrative burden. Nothing probably compares to taking heat from all angles as an RN, but some of the NPs tell me it's the same deal, just with different people giving you problems (mostly MDs). In FL you can't practice independently either so...

4. I hear all the time that the NP job market is weak (especially in FL), and that there's a glut of NPs out there right now. I know long term that should change, if they don't repeal the health care law we might see more money for primary care, etc., but do you have less flexibility and options in terms of where you work, your hours, and conditions than as an RN, the same, or more?

thanks for entertaining my questions!

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    I've been an APN for almost 5 years now.

    Overall, I'm happy with my job. The downside:

    Much more responsibility and much higher possibility of making a mistake!

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    As a provider, NP's can be bound by the same regulatory requirements imposed by insurance companies in terms of revenue generation. The success of your practice depends on your productivity and ability to generate billing for each patient you see. This can be one of the draws for adding NP's especially in some primary care practices so you may find that the pressure to see more patients can get in the way of really having "enough" time to spend with patients. There are no staffing ratios to speak of and your day is over when all patients are seen, notes dictated, and prescriptions called regardless of how long you've been in the office. That's a reality for many providers especially physicians and NP's are no exception. The good things is some practices offer incentives for productivity and it does make it worth the extra time and effort that you put in each day. I honestly believe that my NP collagues would not be doing this work if the financial and professional rewards are not better than before they became NP's.

    It's really hard to make the comparison between bedside/office RN roles vs NP role because you are playing on a different field as a provider. You definitely multitask a lot and juggle between various issues that pop up and the key is to determine which issue is urgent and which ones can wait. I don't really feel "dumped on" as an NP in that sense because you are part of the provider team and like TraumaRUs already said, you are making the clinical decisions yourself and taking full resposibility for them unlike when we were RN's when it's so easy to turf a patient issue to an intern or a resident and write "MD informed" on your note. It's certainly a different ballgame as I just said.

    BTW, I'm not in primary care. I'm an ACNP in specialty practice.

  • Quote
    As a provider, NP's can be bound by the same regulatory requirements imposed by insurance companies in terms of revenue generation. The success of your practice depends on your productivity and ability to generate billing for each patient you see. This can be one of the draws for adding NP's especially in some primary care practices so you may find that the pressure to see more patients can get in the way of really having "enough" time to spend with patients. There are no staffing ratios to speak of and your day is over when all patients are seen, notes dictated, and prescriptions called regardless of how long you've been in the office. That's a reality for many providers especially physicians and NP's are no exception. The good things is some practices offer incentives for productivity and it does make it worth the extra time and effort that you put in each day. I honestly believe that my NP collagues would not be doing this work if the financial and professional rewards are not better than before they became NP's.

    It's really hard to make the comparison between bedside/office RN roles vs NP role because you are playing on a different field as a provider. You definitely multitask a lot and juggle between various issues that pop up and the key is to determine which issue is urgent and which ones can wait. I don't really feel "dumped on" as an NP in that sense because you are part of the provider team and like TraumaRUs already said, you are making the clinical decisions yourself and taking full resposibility for them unlike when we were RN's when it's so easy to turf a patient issue to an intern or a resident and write "MD informed" on your note. It's certainly a different ballgame as I just said.

    BTW, I'm not in primary care. I'm an ACNP in specialty practice.

    I just want to thank you Juan. You are such a thoughtful contributor to this forum. I always enjoy reading your informative posts and I know that you have probably helped many people with your contributions.

    .... sorry OP, didn't mean to hijack your thread.

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    I'm a primary care NP in a busy community health center. I see 28-30 patients per day and I don't feel I have enough time with my patients. The teaching and preventative care take a back seat to dealing with immediate problems. Many of my former classmates work in private practice and see far fewer patients per day. I plan on moving to private practice (primary care or specialty) as soon as my contract is up later this year. But overall, I am happy with my role as an NP.

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