What is your biggest struggle

Jules A, MSN · Jun 2, 2015

On the NP professional level I worry about the present quality of NPs and the likelihood this will be more of a problem as time goes on with the current numbers of students that are being cranked out. Although I take it very personally when I get a patient with history of poor care from a NP, most often evident by their psych medication regimen, I try to keep it in perspective and remember that there are almost as many who come in with ridiculous meds from physicians also. It just hits too close to home when it is a NP because I really strive to have a great reputation among physicians in my community as a competent provider on par with a physicians care.

On a intrapeer level the lack of business acumen and willingness to pick up whatever scraps are thrown in our general direction drives me crazy. We have every right to be respected, make a good income and not take on every ailment even if it is out of our scope of practice because "If I don't help this poor patient who will?"-said with a whine, sigh and back of the hand positioned dramatically on our forehead.

On the patient level the lack of motivation for change, which I know is uncomfortable, frustrates me with regard to lifestyle such as drugs, alcohol, seeking disability and also the lack of medication adherence which of course can be both intentional and circumstantial.

Great topic and interesting in reading my response that it is more about peer relations than the patients. I absolutely love being a NP btw but just hope we continue attempting to improve on both individual and profession levels.

Jules A, MSN · Jun 3, 2015

What a shame and how puzzling that more people aren't willing to participate in this thread. I thought it is a good topic??? On a side note its rather clear that there are a couple of well respected, experienced NP members here who rarely participate unless they feel the need to jump in and "correct" a poster.

synaptic · Jun 3, 2015

I know I was expecting more replies. It seems everybody on here has a struggle or two they like to rant about (which is perfectly fine). But at least prospective np, new np, all np, really could benefit from a thread that would lay out many of the personal road blocks that NP face.

But at least you replied jules, that means a lot :)

rnkaytee · Jun 3, 2015

I worry that my Master's won't be seen as "good enough." I worry about doing a procedure and causing major complications.

Sha-Sha RN · Jun 4, 2015

I have to agree with Jules A on the patient compliance issues. Now as a prescribing provider with my NP job for the last 3 months, I find it difficult that we as providers, Especially NPs put a lot of work and individualized pt care into our plans with some pts verbalizing they will do it, but you know deep down it's not going to happen. However, I have seen many success stories.

I know a major problem for new grads is finding that first job. I have classmates still looking for that first job and we graduated a year ago. Many NPs are trained in primary care, but I have found that most primary care jobs want NPs with at least 2 yrs experience. The people I know who are NPs who got jobs less than a year out of school , including myself, got our start in specialty areas or in doing home assessments/home visits.

Finally, I think we still have a long way to go in getting respect from our physician colleagues. In my 3 months in my current position I had never felt less than equal until today as I'm in my first 3 days with rounding with a different service attending of the month and he questions most of my suggestions, has no regard for my time (we round after 5pm until 7pm and I've been onsite since 8 or 9 am ( of course no OT pay). I've also noticed more scrutinization of my notes vs the notes of the 2nd year residents who are doing an elective rotation with us ( never questions their input or read what they write just writes his addendum and signs - their plans don't usually match - or as the newest resident said to me, he writes something very vague so it wouldn't even matter, somehow some way it will match the attending's plan). I even asked him about his being comfortable with the residents filling out the plans before we do rounds and discuss with him and he said they are 2nd year residents, more than capable to do that. The good news is not every attending feels that way. The kicker today was we were being told a story by the attending about how in the old days before insulin drips how pts received iv pushes of insulin q 1 hr which was probably more effective and really did not see any improved outcomes with the institution of insulin drips. But the iv push days was when pts were being watched, but now no one is watching the pts only watching the computers, then he said the nurses that is. He then remembered I am a nurse and said sorry but he and the resident were looking to me for confirmation that nurses just sit back and watch the computer instead of patients. I said nurses's watch their pts especially speaking for myself.

So as a NP you have to continually prove yourself, that you are a capable and competent practitioner considering you're just a nurse and nurses are lazy.

This is a good topic. I hope to see more thoughts.

Jules A, MSN · Jun 4, 2015

I've also noticed more scrutinization of my notes vs the notes of the 2nd year residents who are doing an elective rotation with us ( never questions their input or read what they write just writes his addendum and signs - their plans don't usually match - or as the newest resident said to me, he writes something very vague so it wouldn't even matter, somehow some way it will match the attending's plan).

But what I love about this, even though it is uncomfortable for you right now, is that if your work is above reproach and he finds you enjoyable to work with you are helping to promote our profession in a positive way! It is what it is and the opportunity to be a NP ambassador will be worth it in the end, hopefully.

Sha-Sha RN · Jun 4, 2015

But what I love about this, even though it is uncomfortable for you right now, is that if your work is above reproach and he finds you enjoyable to work with you are helping to promote our profession in a positive way! It is what it is and the opportunity to be a NP ambassador will be worth it in the end, hopefully.

That's what I'm expecting. I'm here to make myself as well as the profession look great.

MallysMama · Jun 4, 2015

I'm an NP student right now...but I fear that I'll be lumped in with the growing negative stigma about ill-prepared new NPs after I graduate. I expect a lot from myself and it really bothers me that I could be thought of so negatively. I want to be an excellent, well-prepared provider.

Dranger · Jun 4, 2015

Perception of the NP career field by other clinicians, providers and the public in lieu of the glut of programs that accept anyone and everyone.

Trauma Columnist · Jun 4, 2015

I've been an APRN for 9 years now and my biggest obstacle is the time it takes to document defensively.

Barnstormin' PMHNP · Jun 5, 2015

I agree with MallysMama and Dranger. As a PMHNP student halfway through, I know that my program is very difficult and is HARD. I feel the people jumping on board the 'psych wagon' in particular is bothersome in the extreme.

I have a great preceptor who treats me with the utmost respect and collaborates with me, yet the psychologist that collaborates has literally put me down for being on the deans list (I didn't mention it, someone asked me and he heard the conversation, I do NOT brag) He is a concern to me if I work in the unit. He won't address me or include me in conversations with my preceprtor, even when he interrupts us and discusses the same case we had been talking about. sigh.

I have concerns about pay and how to navigate the system. I have yet to find anything that explains the mysterious reimbursement issues regarding hospital clinic vs private practice.

I will move or drive 2 hours before I take crap pay (70,000) like some of my peers who have already graduated.

I worry I will get burnt out and not have the same drive as I do now

I struggle with grad school, I really did not realize how consuming it would be and I am pissed that a bunch of losers going through garbage programs are getting off easy and if they pass the boards will be considered as being my equal.

well......I feel better now.