Work-life balance?

[Polly Peptide]

Between working as a bedside, hospital-based RN, and working as a nurse practitioner, which would you say offers you better work-life balance? And why?

If you chose NP, I would love to know more about your particular specialty. I tend to hear that primary care is tough for this.

At the end of the day, I KNOW that working as an RN or an NP should be about which job you want to do. However, there are a variety of things that factor into that equation.

Thank you!

[traumaRUs, MSN, APRN]

On 4/4/2019 at 8:12 PM, Power2020 said:

traumaRU what speciality are you in? u travel 100-200 miles a day? are you working a 8-5 or a flexible schedule

I’m in nephrology rounding in dialysis pts. I have a very flexible job and often leave home before 6am. However when I work till 7pm I start later. Some days are 12 hrs and some are only 4-6. Depends

[FullGlass, BSN, MSN, NP]

NPs can also work as 'travelers' or locums and can make a lot of money doing so. For individuals who want to take long trips and vacations, this can be a good option.

It is up to an NP to find a job that will accommodate their preferences. There are part-time NP positions.

I was offered an NP position at a community college with awesome benefits - 6 weeks of vacation to start and sick time on top of that, all could accrue, along with a great retirement plan. It was Mon - Fri (Fri was a half day) when school was in session, Mon - Thurs for summer session, and a 3 week winter break. It paid a bit less, but for someone who wanted a lot of time off, it would have been ideal. I didn't take it because I would have been the only NP and as a new grad, I just wasn't ready for that.

A lot of primary care NP jobs offer a 4 day week of 10 hours a day as an option. My clinic does.

A full patient load here is considered 18 patients a day, 19 in a real crunch. However, my average patient load is 14-16 patients per day. We have busy days and slow days. I am usually out the door at 5 to 5:30 pm. Occasionally I stay later to finish charting. Once in awhile I do a couple of hours work on a weekend. I also have a laptop, so I could leave at 5 pm and finish my charting at home.

We have several clinics, and it is understood that NPs and MDs occasionally go to other clinics if a provider there is sick/on vacation - maybe 3 to 4 times per year. We get mileage reimbursement and the commute time is figured into the work day. For example, if it is a one hour drive to the other clinic, then I start work at the clinic one hour later and finish one hour earlier, so the commute is not eating into my personal time. If it requires an overnight stay, we are put in a nice hotel/motel.

I can run small errands during my lunch break or admin time. If I need a couple hours off for a personal appointment, it is not a big deal.

One of my NP colleagues goes home every day to have lunch w/his family, since all of the NPs live on the same street which is only 5 minutes from the clinic.

[Vaibhav]

I have been working as a primary care nurse practitioner for 1 yr now and my clinic is good but charting is tremendous. I work m-f 8-530 and then take work home everyday because there is no way I can finish my charting 1 hr after work. It takes easily 3 to 4 hours to finish my charting and that I do seven days a week so, my work and life balance is not good at all. All NPs from my clinic take work home and charting that is all they do all 7 days. We take calls one entire week once in a month and work one half Saturday. I don't know if it's the software we use or it it across the board in primary care that charting has become our life? I am trying to find a job that will give me work life balance that I had when I was RN. I love my job as an NP but charting on weekends and then after work until I go to sleep has made my life miserable.

[djmatte, ADN, MSN, RN, NP]

2 hours ago, Vaibhav said:

I have been working as a primary care nurse practitioner for 1 yr now and my clinic is good but charting is tremendous. I work m-f 8-530 and then take work home everyday because there is no way I can finish my charting 1 hr after work. It takes easily 3 to 4 hours to finish my charting and that I do seven days a week so, my work and life balance is not good at all. All NPs from my clinic take work home and charting that is all they do all 7 days. We take calls one entire week once in a month and work one half Saturday. I don't know if it's the software we use or it it across the board in primary care that charting has become our life? I am trying to find a job that will give me work life balance that I had when I was RN. I love my job as an NP but charting on weekends and then after work until I go to sleep has made my life miserable.

What charting system? We are on epic and setting up my own smart phrases cuts back on my charting tremendously. In a year, I've made 86 that I can easily access in a manner that cuts back time. I've spent a good focus on tailoring my smart phrases for the most common things I see (especially the plan side) and organizing my notes to make things as efficient as I can. Everything from specific diets to the usual recommendations for acute sinusitis. I type in .mpsinusitis in my plan and everything I discussed and prescribed for that issue shows up.

Also patient loads do reflect how much you have to spend charting. My work has expectations of 18 to 22 a day. When I'm at goal, my charting slows. When I'm below, I typically take that time to catch up. I'm never more than two days outside of my visit to close a note. And rarely do it at home unless I feel there's a specific patient I feel needs some extra TLC.

[FullGlass, BSN, MSN, NP]

6 hours ago, Vaibhav said:

I have been working as a primary care nurse practitioner for 1 yr now and my clinic is good but charting is tremendous. I work m-f 8-530 and then take work home everyday because there is no way I can finish my charting 1 hr after work. It takes easily 3 to 4 hours to finish my charting and that I do seven days a week so, my work and life balance is not good at all. All NPs from my clinic take work home and charting that is all they do all 7 days. We take calls one entire week once in a month and work one half Saturday. I don't know if it's the software we use or it it across the board in primary care that charting has become our life? I am trying to find a job that will give me work life balance that I had when I was RN. I love my job as an NP but charting on weekends and then after work until I go to sleep has made my life miserable.

What is making you spend so much time charting? My clinic has a horrible EHR, yet after 1 year I am able to finish my charting by 5:30 pm 80% of the time. Some of our providers don't work during lunch and are out the door at 5 pm because they chart as they go. However, one of my colleagues takes and extra 2-3 hours every day after work to finish charting. It is possible to become more efficient at charting, even with a crappy EHR.

[Oldmahubbard]

Not to play the Psych NP here, but I have seen people who could never get efficient at charting because of anxiety or perfectionism.

No matter what they wrote, or dictated, they always felt it wasn't good or thorough enough.

I have seen people have to leave positions because of this. I have seen people lose out on major productivity bonuses. 80k a year.

My charting averages 90 minutes a day. I usually see about 20 people, and to be fair, most are not new patients, nor are they acute.

Food for thought.

[Vaibhav]

6 hours ago, djmatte said:

What charting system? We are on epic and setting up my own smart phrases cuts back on my charting tremendously. In a year, I've made 86 that I can easily access in a manner that cuts back time. I've spent a good focus on tailoring my smart phrases for the most common things I see (especially the plan side) and organizing my notes to make things as efficient as I can. Everything from specific diets to the usual recommendations for acute sinusitis. I type in .mpsinusitis in my plan and everything I discussed and prescribed for that issue shows up.

Also patient loads do reflect how much you have to spend charting. My work has expectations of 18 to 22 a day. When I'm at goal, my charting slows. When I'm below, I typically take that time to catch up. I'm never more than two days outside of my visit to close a note. And rarely do it at home unless I feel there's a specific patient I feel needs some extra TLC.

It is a allscript. I am not sure what version but I heard it was an old version. We don't have smart phrase option. We have to type diagnosis every time we see a patient. It is not just me who has this problem in my clinic. It is all APRNs and PA who takes work home and document. I see 15 to 18 pts per day and still not able to finish because 1st of all our software is very slow and it freezes all the time, kicks us out 3 to 4 times a day. My supervising physician who owns this clinic does not want to do anything because she does not document, somebody else does it for her. So she does not care. I wish we had an EHR that was user friendly.

[Vaibhav]

2 hours ago, FullGlass said:

What is making you spend so much time charting? My clinic has a horrible EHR, yet after 1 year I am able to finish my charting by 5:30 pm 80% of the time. Some of our providers don't work during lunch and are out the door at 5 pm because they chart as they go. However, one of my colleagues takes and extra 2-3 hours every day after work to finish charting. It is possible to become more efficient at charting, even with a crappy EHR.

We have back to back patients and I cannot keep that pt waiting until I finish my previous pt's chart. I have to type diagnosis every time and it takes time because when I type something and hit enter, it takes about 10 to 15 secs to populate whatever was entered. So every 10 to 15 seconds adds up and just not possible to finish it. I am able to finish other things such as HPI, ROS, Physical exam, but not the assessment and plan area that takes a lot of time. I use allscript. Let me know if you have any inputs on how to make doc faster.

[FullGlass, BSN, MSN, NP]

6 minutes ago, Vaibhav said:

It is a allscript. I am not sure what version but I heard it was an old version. We don't have smart phrase option. We have to type diagnosis every time we see a patient. It is not just me who has this problem in my clinic. It is all APRNs and PA who takes work home and document. I see 15 to 18 pts per day and still not able to finish because 1st of all our software is very slow and it freezes all the time, kicks us out 3 to 4 times a day. My supervising physician who owns this clinic does not want to do anything because she does not document, somebody else does it for her. So she does not care. I wish we had an EHR that was user friendly.

Our EHR does not have the smart phrase option, either. I was told to make my notes short and sweet, and I strive to do so. I can also type very fast. I try to chart as I go, usually work through lunch, and we do have 1.5 hours of admin time during our day as well. I live in a rural area, so our network and internet is slow.

You might want to do some brainstorming on how to make charting faster. I focus on a good HPI and documenting the PE. I consolidate the ROS into the HPI. The Medical Director says my notes are good.

[FullGlass, BSN, MSN, NP]

2 minutes ago, Vaibhav said:

We have back to back patients and I cannot keep that pt waiting until I finish my previous pt's chart. I have to type diagnosis every time and it takes time because when I type something and hit enter, it takes about 10 to 15 secs to populate whatever was entered. So every 10 to 15 seconds adds up and just not possible to finish it. I am able to finish other things such as HPI, ROS, Physical exam, but not the assessment and plan area that takes a lot of time. I use allscript. Let me know if you have any inputs on how to make doc faster.

For assessment, our system carries over dx codes from the bill, so I just go with that if it is simple, like strep throat. For situations with possible differentials, I just list the differential dx and a short blurb on why I picked one.

For the plan, our EHR carries over prescriptions and consults from the bill. I usually just leave it at that unless I have more detailed instructions for the patient. I've created some templates in MS Word and just cut and paste from there.

I also have to create a bill for each visit, selecting the dx code, procedure code if applicable, and select consults, imaging, and labs if applicable. I've taught my MA to enter certain labs for me with the correct codes and that saves me time.

[bbcewalters, NP]

2 hours ago, Vaibhav said:

It is a allscript. I am not sure what version but I heard it was an old version. We don't have smart phrase option. We have to type diagnosis every time we see a patient. It is not just me who has this problem in my clinic. It is all APRNs and PA who takes work home and document. I see 15 to 18 pts per day and still not able to finish because 1st of all our software is very slow and it freezes all the time, kicks us out 3 to 4 times a day. My supervising physician who owns this clinic does not want to do anything because she does not document, somebody else does it for her. So she does not care. I wish we had an EHR that was user friendly.

Is it possible to save templates in an word document and then Cut and Paste into Allscript? This isn't ideal but it may help some....Good luck that sounds like a tough situation.

Bobbi

[db2xs]

I have zero work-life balance right now. I had better work-life balance as an RN.