Why did you become a NP?

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Hi everyone,

Why did you make the decision to become and NP and more importantly has reality met your expectations? Is what you are getting to do what you thought you'd be achieving when you went back to school?

I have this desire to know more and provide really great comprehensive care. I guess I'm concerned that in the real world I might be saying, "what in the world was I thinking!?" Thank you for your reflections!

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I became a family nurse practitioner because I wanted to be able to provide the type of comprehensive and compassionate care that I wished I could've received as a patient in clinical settings. What I didn't not anticipate, however, is the various beaurocratic BS that governs, and in many ways, impedes on one's ability to provide basic care. It's one of the reasons why I've recently left my employer. For example, a patient presents with newly diagnosed type 2 diabetes and wants education on insulin usage. With only 15 min to provide care and double bookings to maximize profits, in addition to low resources and referral networks, the provider role is at timesreduced to a highly paid, but embarrassingly degraded, glorified admin assistant to the executives.

Lol, I recognize this sounds very negative and bitter. I am a bit bitter, but this experience is not the only. I've had some amazing experiences where my motivations for pursuing this profession was actualized. However the business end of our profession is not heavily focused in our educational system, and it's a shame because the business dictates your practice.

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Thank you for your reply ToFNPandBeyond. I suspected that might be the case which I definitely don't look forward to. But, I hope you found something better. Your response has definitely given me something to think about when I look for jobs in the future. Thank you.

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Specializes in Nephrology, Cardiology, ER, ICU.

I'm not an NP but rather an adult and peds CNS and I practice in the APRN role. I furthered my education because I knew that at 60 I couldn't keep up with the demands of a level one trauma center ED. (However, I wish I could!)

I had no great ideas of curing the ills of the world - I wanted more money and more autonomy and I got it.

Great topic

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TraumaRUs,

Thanks, I love your answer. I'm trying to write my entrance essay now and I've been trying to avoid saying I want more money. But, it is true. I want to be able to take care of myself and I dont want to be in a clinic making ends meet until I retire. I do want to make a difference and be meaningful to my patients as well but I appreciate you saying that. What do you get to do as a CNS on a daily basis?

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Specializes in Critical Care.

Less than a year as an NP in a surgical ICU. I perhaps wanted more autonomy. I enjoyed the ICU world and wanted to continue in it with my profession. Considering the future also pushed me to advance my education as I wanted to preserve and protect my body.

So far my expectations have been my reality. Certain things I dislike, such as cocky and ridiculing Attendings, are part of the job for now and situational. I enjoy my new role and most importantly it is something I can see myself doing for the next 20-40 years.

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I became an NP to help expand my knowledge to better help patients something I could not do to my highest potential as a RN. My expectations are different than the job and I agree with FNP and beyond....unfortunately working has been trying to see the most patients possible and this does not allow for proper care....

I am very sad about this ! expectation of seeing 24-26 primary care visits in a 8 hour shift is not fair to the patient care at all but it makes more profit..

I am bitter as well and I am not the type to become bitter...I feel bitter at this time :( Not trying to be negative but additionally consider if you are working with a physician you should follow their way of treating I will give you an example

If a patient comes in who usually follows the doctor but no room on his schedule. The patient comes to you and wants refill on sumatriptan- a medication that helps treating migraines. you review the chart- notice they are 60 y.o. w/hypertension...triptans increase blood pressure...and there isn't established safety of taking more than 4 tablets a month- but doctor was giving this patient 30 tablets/month w/refill < can't remember if that is the exact amount but obviously that is TOO MANY you tell the patient sorry can't do this and the patient gets upset with YOU because ur a nP-and feels the doctor treats them better....

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Power2020,

Thank you for your reply. I think I really need to research the patient load here and see what is normal. I live in a small rural community. That is crazy to see that many people and still give great care. I'm sorry you are experiencing this. All your comments are definitely helping me form a better picture. Thank you!

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4 hours ago, Power2020 said:

I became an NP to help expand my knowledge to better help patients something I could not do to my highest potential as a RN. My expectations are different than the job and I agree with FNP and beyond....unfortunately working has been trying to see the most patients possible and this does not allow for proper care....

I am very sad about this ! expectation of seeing 24-26 primary care visits in a 8 hour shift is not fair to the patient care at all but it makes more profit..

I am bitter as well and I am not the type to become bitter...I feel bitter at this time :( Not trying to be negative but additionally consider if you are working with a physician you should follow their way of treating I will give you an example

If a patient comes in who usually follows the doctor but no room on his schedule. The patient comes to you and wants refill on sumatriptan- a medication that helps treating migraines. you review the chart- notice they are 60 y.o. w/hypertension...triptans increase blood pressure...and there isn't established safety of taking more than 4 tablets a month- but doctor was giving this patient 30 tablets/month w/refill < can't remember if that is the exact amount but obviously that is TOO MANY you tell the patient sorry can't do this and the patient gets upset with YOU because ur a nP-and feels the doctor treats them better....

Man I wish Triptans were the worst of my problems. Try that 60 year old on 90 Norco a month for *insert ailments of the day* and 60 Xanax to boot. While I've gotten good at convincing to deescalate, you can't just arbitrarily stop those does either. Many I just run a UDS, give a short term script, and encourage a follow up with their normal provider.

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7 hours ago, Power2020 said:

I became an NP to help expand my knowledge to better help patients something I could not do to my highest potential as a RN. My expectations are different than the job and I agree with FNP and beyond....unfortunately working has been trying to see the most patients possible and this does not allow for proper care....

I am very sad about this ! expectation of seeing 24-26 primary care visits in a 8 hour shift is not fair to the patient care at all but it makes more profit..

I am bitter as well and I am not the type to become bitter...I feel bitter at this time :( Not trying to be negative but additionally consider if you are working with a physician you should follow their way of treating I will give you an example

If a patient comes in who usually follows the doctor but no room on his schedule. The patient comes to you and wants refill on sumatriptan- a medication that helps treating migraines. you review the chart- notice they are 60 y.o. w/hypertension...triptans increase blood pressure...and there isn't established safety of taking more than 4 tablets a month- but doctor was giving this patient 30 tablets/month w/refill < can't remember if that is the exact amount but obviously that is TOO MANY you tell the patient sorry can't do this and the patient gets upset with YOU because ur a nP-and feels the doctor treats them better....

^^THIS! Power 2020, take heart! I've been there and as djmatte has stated, I've also experienced this with the narcotics. At my now last employer, I've had colleagues turn against me and have upset some higher ups because I refused to continue the insanity of inappropriate and potentially dangerous prescribing. I saw the writings on the wall for me and Left. But know you aren't alone. The expectations in primary care are insane, so for now, I'm leaving PC and going into speciality. I may be back as I do like many aspects of the job, but I'll be very picky which place I go back to. We are humans at the end of the day, not automated robotics that should follow the leads of colleagues or supervisors who don't always follow the rules, in addition to seeing a million patients a day and still leave with a smile on our faces?

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5 hours ago, ToFNPandBeyond said:

^^THIS! Power 2020, take heart! I've been there and as djmatte has stated, I've also experienced this with the narcotics. At my now last employer, I've had colleagues turn against me and have upset some higher ups because I refused to continue the insanity of inappropriate and potentially dangerous prescribing. I saw the writings on the wall for me and Left. But know you aren't alone. The expectations in primary care are insane, so for now, I'm leaving PC and going into speciality. I may be back as I do like many aspects of the job, but I'll be very picky which place I go back to. We are humans at the end of the day, not automated robotics that should follow the leads of colleagues or supervisors who don't always follow the rules, in addition to seeing a million patients a day and still leave with a smile on our faces?

I can't say my place is all bad. The providers looking to make changes out number tho ones who don't. And the owners of the practice who started doing this 35ish years ago are seeing much fewer patients now. Slowly but surely I build a list of patients who refuse to see me and I'm ok with that. So long as my maps score is manageable and appropriate I'm happy.

Primary care is a love hate relationship. I couldn't imagine going into specialty. I love the variety and the mix of patient visit types. I started my nursing career in pacu and found it hard to transition to far from that or the pain management Lane. FNP and primary care were my way into something with more variety at a higher level of knowledge which I would find hard to limit.

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Specializes in Nephrology, Cardiology, ER, ICU.
21 hours ago, climbingeverest said:

TraumaRUs,

Thanks, I love your answer. I'm trying to write my entrance essay now and I've been trying to avoid saying I want more money. But, it is true. I want to be able to take care of myself and I dont want to be in a clinic making ends meet until I retire. I do want to make a difference and be meaningful to my patients as well but I appreciate you saying that. What do you get to do as a CNS on a daily basis?

My role is the same as the NPs in our practice - we round on hemodialysis patients in outpt units. We bill under our own NPI numbers and are profitable for the practice

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