What can I do now?

carachel2 · Mar 26, 2010

I have no advice but as someone who is waiting and waiting and waiting for all of the licensing stuff to be done in my state, how can you practice and do all of that stuff with no license or prescriptive authority? Does your state let you practice without a license and just with certification?

JALEXSHOE · Mar 26, 2010

I would take the experience you gleaned as an RN and capitalize on that, and use that to get the next job. If you like the area of focus you used to work, that is.

You said you went to derm for this job, and honestly as someone who does human resources for my current employer, I know when my physicians look at their incoming resumes, they scan where they are working and what they have been doing now or just recently. Unless you are trying to get another derm job, this type of job is going to disqualify you for some of the more general positions. So this may be another obstacle to overcome.

You could try writing a cover letter, talking about your strengths and what you bring to the table, also mentioning you are licensed and have all the appropriate things needed, and to cover a jump in fields, you might want to perhaps state you thought to do something different and derm was not broad enough for you or some such. You might even mention you made a mistake, thinking this would be a good fit and just wasn't.

I would not recommend saying anything bad about your employer in the resume, always remember the glass should always be half full.... I would refrain from saying something bad about him in the interview. If you lie about any aspect, and get caught, it validates anything they would say about you. There are ways to address this kind of thing without putting you or him on a spit. I would just say something like it just was not a good fit for you and as you are a positive person, you are looking for the place that is. If the new employer delves deeper, then keep positive and state the things that would make it a good fit, but focus on things not people...Be prepared for this, because they will be evaluating how professional you are and how you might talk about them...

If your current employer will give you a bad reference, then that does make things harder. If you leave them off the resume, it makes it look like you are unemployed and unable or disinterested in getting a job... In this case, I would network. Everyone knows someone... If you know people from school, from church, someone you precepted with, someone...that would give you a personal reference to get you in the door elsewhere.

You might have to apply for a broader range of jobs, you might have to commute. If you are looking locally, the gentleman you are working for might have a "reputation" or local physicians might feel comfortable picking up the phone and asking his personal opinion off the record. There would be no way for you to know this.

The issue and focus is that you want and need to move on. Just try to focus on the positives and open yourself up the possibilities of other options. I don't know your age or situation, but you could also look at places like the armed forces or national health services. You are going to have to rework your cover letter and address your resume differently. If you can get references from former employers, do so, to strengthen the fact, you have had a positive work environment in the past.

The only other caveat I would offer, is to ask you if things are really that broken down between you and your employer? Is there a chance that you could sit down and talk to him and tell him some of your fears or concerns in a positive way? Maybe he is feeling some of the same angst and does not know how to fix it. Not everyone is good at conflict resolution. I have had people do this with some of the doctors I worked with, where there was an oil and water situation, and the employer actually helped them find another position elsewhere to relieve everyone's pain... Sometimes ripping the bandaid off is an option. But only do this, if you think they are the type of person that could be reasonable. You might even be able to fix the things you are concerned about...who knows.

I re-read your post after I hit enter, and I think you may have resigned, so I am sorry, you may not be able to sit down with him and talk as I said. But I won't rewrite the whole thing, as you may still have some contacts. Perhaps the office manager? Was there someone at the former job, who would give you a reference?

Anyway, good luck.

Green turtle · Mar 26, 2010

Carachel2,

The physician did not let me practice autonomously. He saw every patient I saw and billed insurance/medicare under his numbers at his rate. He stayed logged into the computers and had me (and the MAs) chart in the electronic medical record under his name. He did assess and diagnose the patients, he just had me do procedures or closure after his procedure, and charting. This allowed him to see more patients in a shorter time and bill at 100%. As far as I know, that was a completely legal way around having an unlicensed NP.

Green turtle · Mar 26, 2010

Jalexshoe,

Thanks for the response. I appreciate feedback from someone with HR knowledge. My peer coworkers (NP and PA) from that job offered to give me good references. My former employer is not yet established in the area, but has some connections to local physicians. I think I will do as you said and emphasize my pre-derm nursing experience.

Spacklehead, MSN, NP · Mar 26, 2010

Carachel2,
He did assess and diagnose the patients, he just had me do procedures or closure after his procedure, and charting. This allowed him to see more patients in a shorter time and bill at 100%. As far as I know, that was a completely legal way around having an unlicensed NP.

Not that this is the issue here, and I could be way of base for I don't know much about derm - but some of the procedures you stated you did are outside of the scope of a RN which you still would techinically be until you have that NP license (even if you are board-certified as an NP, I believe). Not sure if it was legal at all. Also, wouldn't charting under his name technically be wrong, also? I don't know how it could go down, but what if there is a lawsuit brought up by a patient about something you did but in the chart it was only viewed as being done by him - but the patient states otherwise? I guess that in the end it would mean he would be totally liable, but still, that sounds like a very uncomfortable/scary situation and it is probably a very good thing you got out when you did.

Good luck to you with your job search - I do wish you all the best!

bloviate · Mar 26, 2010

Here's the short version of my story...
I am an experienced RN, but a fairly new NP. I landed my first job shortly after being certified, but prior to being licensed in my state. I was was hired to open and run a new dermatology satellite clinic to be located in my hometown. I had to resign after 3 months because the MD that hired me would not sign a contract or honor the terms of what he offered me at the interview. He pretty much misled me about everything including pay. He gave a lot of excuses when I asked to negotiate a written contract - including saying that he was waiting until I had a licence and provider numbers. Even after I got my license and DEA, NPI, etc, he was unwilling to cooperate and refused to attend the scheduled contract meeting(s) with me and the office manager.
While it is a fact that employees can't trust him (I gave you the short verson...there was a lot more), I respect his skills when it comes to patients. He gave me a lot of training performing cosmetic procedures like botox and fillers, and made me do the closing suturing on most of his outpatient surgeries. This was absolutely not what I was hired to do (not even supposed to be available at the new clinic)... but it made his day go faster to dash in and diagnose, or sell the filler/botox and then leave me to do the manual labor and chart. These are skills that few learn in NP school. I figure that they are valuable to many employers, right?
What can I do now? I need a job, and I am not getting calls for interviews. Should I list this job as NP experience? Right now it is on my resume as "clinical experience". It can take months to get all of the licenses and numbers in my state. I figured that it would be an asset to have those. Does it look bad that I left so quickly? I got more calls right out of school in August.

Hey

Start by checking your references

http://www.allisontaylor.com/

This is a pretty cool service that will solicit a reference from your previous employer. If they're badmouthing you then there are steps you can take to make it stop.

I've used it in the past to see what's going on behind the scenes. I can't say that I really trust anyone in this business.

B

Green turtle · Mar 26, 2010

Bloviate,

Thanks for the link!

Softballmama,

I was okay to suture or perform procedures when it was delegated to me by a physician in the same way medical students and RN first assistants in training are able to perform delegated tasks in this state... I think... :eek: Now I feel sick.

You know that feeling you get when you are almost in a wreck, but aren't? That's the way I felt when I quit, like I had narrowly missed something very bad.

I keep hoping that there is a way to "spin" my derm detour into a good thing for my career, but maybe it is best forgotten...

bloviate · Mar 29, 2010

Bloviate,
Thanks for the link!

You're welcome. My thought in providing the link was that you will have the information your employer is putting out about you and it will help answer the questions you have about whether it's your experience or the previous employer that's causing no call backs.

It's a small price to pay for the answer to that question. I "really" don't trust anyone in this business. Experience has shown me that unfortunately.

Good luck to you.

B

carachel2 · Mar 29, 2010

Bloviate,
Thanks for the link!
Softballmama,
I was okay to suture or perform procedures when it was delegated to me by a physician in the same way medical students and RN first assistants in training are able to perform delegated tasks in this state... I think... Now I feel sick.
You know that feeling you get when you are almost in a wreck, but aren't? That's the way I felt when I quit, like I had narrowly missed something very bad.
I keep hoping that there is a way to "spin" my derm detour into a good thing for my career, but maybe it is best forgotten...

Unfortunately, you are not alone. I think there are way too many new grads who are so innocently eager to get started that they unknowingly take on jobs without absolutely knowing all of the licensure requirements in your state and checking them off the list. If you had already graduated from school, then you were not covered as a student under malpractice insurance. I think a huge portion of the fault here lies with the physician who did not take the time to fully understand the NP role. I know *for sure* of two fellow students who graduated with me who were practicing before their licensure came completely through and I know for sure they are writing scripts without the proper delegation recognized by the medical board..so you are not alone!

Regardless of all of that, I think your skills will be valuable in your next postion and wish you good luck!