I've been advised to go on for my NP. I tend to agree that's a good decision, but I have a few hesitations.
One is that I know that many NPs deal with loads of patients, sometimes 30 or more per day. Which doesn't strike me as much of an improvement over my present med-surg position. While I interact well with people (and have lots of patience with them), I tend to prefer to deal with ideas. The idea of walking into a clinic with dozen of people waiting seems fairly exhausting, especially if they need extensive teaching about their conditions. Trying to explain things to my half dozen med-surg patients is pretty time-consuming and at times frustrating; I can only imagine what it would be like to have to do that with 5 times as many people per day.
I've been told that not all NPs deal with high patient loads, and I'm curious as to who those NPs are. I don't mind working hard or under difficult conditions...I do night shift at an inner-city charity hospital. But people can tire me out, and if I can limit the number I work with, or not work directly with the patients, that might be better.
Specializes in Med surg, cardiac, case management.
Is there a particular population you know you enjoy working with (females, geriatrics, teenagers) already? If so, you might want to expand on your existing preference. Likewise, is there a population you know you DON'T want to work with (for me, that's kids and their parents...) and you can begin the elimination process that way?
Really don't care that much for kids, but as long as it was older kids I wouldn't mind. Don't want to do psych, that's for sure. Don't think OB is a good match either. Not really that big into the elderly, but not a major drawback either.
Something to consider: as our population ages, we have many more elderly that are living longer. I work in nephrology and the average age of my pts is 60 but I have some as young as 17 and some as old as 96.
Dozens of patients in a day in primary care is nothing like caring for patients in ICU. You aren't overwhelmed with a gazillion different tasks all at once. One patient at a time (usually!). I guess it depends on the type of practice you choose, too. There are still old fashioned providers out there who believing in preserving traditional patient care and they don't allow q.15 minute appointments and make sure NPs in the office have the same time allotted. I am VERY thankful to have found such a provider to work with and have found a great mentor and very grateful patients. The most I will see in any given day is 20 and that is a nice blend of easy acute care (sinusitis, cough, etc.) with some good chronic care hypertensive/diabetic patients mixed in.
My days are busy, but oh my word..........NOTHING like working back on the floor.
Specializes in Med surg, cardiac, case management.
If you want to make any reasonable amount of money as an outpatient its either going to be lots of volume or lots of complexity. On the inpatient side its much easier to make decent money (and bring in lots of money) by seeing a few patients.
David Carpenter, PA-C
So, procedure bring in more money than exams, and you have fewer patients in inpatient, whereas in outpatient you need either high acuity or high volume. That's good, I need to understand the business aspects of NPs. I actually have a pretty good head for figures and budgets.
Though I find high acuity tiring as a bedside RN, I might not feel that way as an NP as I won't be providing bedside care. In fact, it might be more interesting. One concern I have about primary care NP is dealing with vast amounts of boring minor illnesses.
Depends on if you work with a population that has (typically) multiple meds to manage and who require lots of teaching. Primary care (Internal Med, Family, Peds) can require lots of patient/parent teaching. Dermatology might not require as intense teaching and the exam is usually more straightforward. Endocrinology would involve LOADS of patient teaching, lab reviews, etc.
Been thinking about this, I don't mind teaching but wouldn't want to have to do a ton of it, so I might skip endocrinology. I'll think about primary care...I know it'll be in demand, the docs don't want to do it anymore...but it would depend upon how much teaching I'd be doing.
So, procedure bring in more money than exams, and you have fewer patients in inpatient, whereas in outpatient you need either high acuity or high volume. That's good, I need to understand the business aspects of NPs. I actually have a pretty good head for figures and budgets.
Though I find high acuity tiring as a bedside RN, I might not feel that way as an NP as I won't be providing bedside care. In fact, it might be more interesting. One concern I have about primary care NP is dealing with vast amounts of boring minor illnesses.
Been thinking about this, I don't mind teaching but wouldn't want to have to do a ton of it, so I might skip endocrinology. I'll think about primary care...I know it'll be in demand, the docs don't want to do it anymore...but it would depend upon how much teaching I'd be doing.
The issue for me and the reason that I don't have any interest doing primary care is the variability.
Lets say you are in an ICU. There are a fixed number of beds, there are all the resources that your hospital has at its disposal. The floor is similar except the bed number is more variable but the possible acuity is lower. Ie if someone goes bad you can punt to the unit. So to me it works out roughly the same.
In the clinic on the other hand its completely variable. In a specialty you at least have the advantage of narrowing the selection. If you work in a GI clinic then generally people show up with GI problems. While you may occasionally have someone with "GERD" who is having an active MI or one of your long term players get sick on you its a relative rarity. You generally have to focus on one area and address that area.
In primary care you have to take whatever comes in the door. As the generalist you are also responsible for addressing their complaints but also the things they aren't telling you. And mixed in with those thousands of "minor" complaints are some real zingers. During my primary care rotations I saw a nine year old who "didn't feel good". Turned out he had HUS secondary to strep and was going into renal failure. I saw someone with a cough and cold who turned out to have viral cardiomyopathy. And with a packed schedule everyone of these complex patients takes time away from other patients. While, there may be practices that triage and schedule appropriately I haven't seen them. In reality, in my opinion, primary care is the hardest part of medicine. You have to look at the patient and rapidly run through a huge differential on multiple systems while trying to extract pertinent information without having all the resources that you have in the hospital. It takes a unique skill set and one that I'm happy to leave to others.
Specializes in Med surg, cardiac, case management.
In primary care you have to take whatever comes in the door. ..You have to look at the patient and rapidly run through a huge differential on multiple systems while trying to extract pertinent information without having all the resources that you have in the hospital. It takes a unique skill set and one that I'm happy to leave to others.
And that's my other big concern about primary care: Some of the patients may have serious medical conditions that aren't obvious. I shudder to think of the liability, really would like to avoid being sued. And then there's the other side of the coin: Most conditions seen in primary care aren't that serious or that interesting. I don't want to spend my days handing out Z-packs for otitis media.
The only positive to primary care is that I've heard that doctors are abandoning the field, which suggests to me that it'll be wide open for NPs and PAs. Real easy to get a job. But is it a job worth getting? Another question I have to consider...
And that's my other big concern about primary care: Some of the patients may have serious medical conditions that aren't obvious. I shudder to think of the liability, really would like to avoid being sued. And then there's the other side of the coin: Most conditions seen in primary care aren't that serious or that interesting. I don't want to spend my days handing out Z-packs for otitis media.
The only positive to primary care is that I've heard that doctors are abandoning the field, which suggests to me that it'll be wide open for NPs and PAs. Real easy to get a job. But is it a job worth getting? Another question I have to consider...
Have you considered becoming a Neonatal NP? I know you said you don't like kids, but an NNP is typically dealing with premature babies who pretty much sleep all day long. Plus the NNPs on the unit get the sickest babies, most of whom are usualy intubated. That leaves them with a 1 to 1 ratio usually. So in a 12 hour shift you might just get to work with only one patient who happens to be paralysed and on an oscillator.
Have you considered becoming a Neonatal NP? I know you said you don't like kids, but an NNP is typically dealing with premature babies who pretty much sleep all day long. Plus the NNPs on the unit get the sickest babies, most of whom are usualy intubated. That leaves them with a 1 to 1 ratio usually. So in a 12 hour shift you might just get to work with only one patient who happens to be paralysed and on an oscillator.
I can say that the last time that I worked in a NICU thats not the way it worked. The RNs may be 1:1 with the preemies but the NNPs certainly aren't. The unit I worked in had 40 beds. There were two NNPs and two MDs on days and one NNP and one MD on at nights plus the transport NNP who helped out during the times they weren't flying. What that means is that each NNP had 10 patients to chart and write orders on in a 12 hour shift as well as attend any deliveries. In all its a pretty busy job.
I think it depends where you work ...when I first started I saw pts every 30 min and this was manageable ...they just have to be willing to work with u
I work in a busy primary care facility and see approx 20 patients daily. It can be busy but it is certainly better than my busy days as an RN in a rural ER.
I'm an NNP in a large teaching hospital. We typically have between 6-8 patients each, but it's usually a mix of pre/postop open hearts, preemies, surgicals, and sometimes cover the delivery room, including admissions and discharges.
All in all it's a busy job, especially when you get a sick TAPVR back from open heart surgery...and haven't written notes yet...and have 2 PICCs to put in before your shift ends. Instead of seeing a stream of patients, you have the same ones all day, or 2-3 days in a row. Is it overwhelming at times? Yes. But I tend to like to stay busy :)
Joe NightingMale, MSN, RN
1,741 Posts
Really don't care that much for kids, but as long as it was older kids I wouldn't mind. Don't want to do psych, that's for sure. Don't think OB is a good match either. Not really that big into the elderly, but not a major drawback either.