working alone as a new grad

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Specializes in ER/Trauma.

Hey all... just wanted to get some feedback on people's experience with working alone as a new grad NP. I recently turned down a job offer (for many reasons), but one was that they changed the schedule and I was expected to work alone straight out of the gate. I have also had a few interviews for urgent care clinics that also wanted me to work independently and I shied away from them.

I have been a nurse for 13 years and have almost 12 years of emergency nursing. I have also worked as a travel nurse for the last 5 years. I'm used to being thrown head first into situations and sorting it out as I go. I know what the appropriate plans of care are, but am still a newbie when it comes to procedures like suturing and formally reading XRs and billing and coding are still a mystery to me.

I know that, ultimately, it comes down to comfort level, but has anyone worked alone from day one without any issues, or would others advise against it? Did you feel supported by the physician if you did have questions, or did you rely on online resources to help with decision making?

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Specializes in Family Nurse Practitioner.

Perhaps psychiatry is different but in my experience employers expected me to be able to practice independently to the full scope of my license on day one as they were paying me a full wage.

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Specializes in Internal Medicine.

In my first position I was expected to work alone, but got to work for 3 months with the physician hiring me in the same clinic before I was put into another clinic on my own. I felt absolutely supported in my first position, and even if I was on my own, he was a phone call away and I would call him if there was something that stumped me and the answers weren't in black in white on resources like uptodate.

Most provider groups know a new grad NP will need some time to settle in, and if you're interviewing for a job and they know you're a new grad, I would articulate that. Doesn't have to be 100% hand holding, but having a resource nearby helps.

In the end though, if your job market is competitive and employers are wanting folks that aren't afraid to jump in from the get go, you might have to bite the bullet. So long as they don't mind being a resource to you even if they're not in house, it should be fine.

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Specializes in Internal Medicine.
Perhaps psychiatry is different but in my experience employers expected me to be able to practice independently to the full scope of my license on day one as they were paying me a full wage.

Totally think this is more unique to psych. I work in a hospital with an inpatient psych unit, and the NP's that work there all basically started after graduation without any sort of orientation or training. My best friend is a psych NP (and also originally an FNP) in central Texas, and it was the same for him. When I asked him how he got by, he told me "psych isn't quite as exacting a science as the rest of medicine, with huge pharmacy overlap between the different major disorders, and it involves a lot of longterm 'wait and see'". I definitely get where he is coming from when it feels like the entire bipolar of schizophrenic psych population is either on Lamictal or Abilify now.

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Specializes in Family Medicine, Medical Intensive Care.

I worked alongside with my collaborating physician for 4 months before I began practicing solo. It could've been longer, but we have a few providers on maternity leave at our other sites, so he has been helping those clinics out. Right before it was time for me to practice solo, we had a couple of meetings about my performance. He assured me that he is always available by text or phone call (he really is!) and that I was more than capable of handling a full schedule by myself. I still call and text him questions (especially situations that aren't black-and-white) but also use the resources available to me to make informed clinical decisions (e.g., UpToDate, pocket guides, textbooks, etc.). I try to keep a log of clinical situations that were difficult for me and seek out CEUs to help improve my knowledge base.

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Specializes in ER/Trauma.
I worked alongside with my collaborating physician for 4 months before I began practicing solo. It could've been longer, but we have a few providers on maternity leave at our other sites, so he has been helping those clinics out. Right before it was time for me to practice solo, we had a couple of meetings about my performance. He assured me that he is always available by text or phone call (he really is!) and that I was more than capable of handling a full schedule by myself. I still call and text him questions (especially situations that aren't black-and-white) but also use the resources available to me to make informed clinical decisions (e.g., UpToDate, pocket guides, textbooks, etc.). I try to keep a log of clinical situations that were difficult for me and seek out CEUs to help improve my knowledge base.

That seems like a great orientation period. But the sense I get from many of these jobs is that I would be solo from day one. One physician said that he needed weekend coverage the day after I finished my current travel assignment and would have to see if I was allowed to practice alone without my DEA in hand....

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When you say working solo, do you mean the only provider in the clinic? Or caring for patients in a clinic where there are other providers present?

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Specializes in Family Medicine, Medical Intensive Care.
That seems like a great orientation period. But the sense I get from many of these jobs is that I would be solo from day one. One physician said that he needed weekend coverage the day after I finished my current travel assignment and would have to see if I was allowed to practice alone without my DEA in hand....

Would someone be available by phone for questions? Any chart review to go over cases? UpToDate to look things up?

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Specializes in ER/Trauma.
When you say working solo, do you mean the only provider in the clinic? Or caring for patients in a clinic where there are other providers present?

Only provider in the clinic.

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Only provider in the clinic.

Gotcha. Yeah that'd be no bueno for me as a new grad. Just off the questions I've bounced off the providers I Shasta a clinic through week one, I'm certain that an off site collaborator world be tired of calls. Lol

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Specializes in Family Nurse Practitioner.
Gotcha. Yeah that'd be no bueno for me as a new grad. Just off the questions I've bounced off the providers I Shasta a clinic through week one, I'm certain that an off site collaborator world be tired of calls. Lol

Which is a shame and a direct result of our schools not preparing us to practice to the full scope of our licensure upon certification. Physicians are increasingly shocked and although it sounds nice I can not imagine many are willing to offer 1/3 of a year orientation as a previous poster described.

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Which is a shame and a direct result of our schools not preparing us to practice to the full scope of our licensure upon certification. Physicians are increasingly shocked and although it sounds nice I can not imagine many are willing to offer 1/3 of a year orientation as a previous poster described.

I don't know if I agree with that entirely. I think for any new practitioner be it in medicine or a PA, you should expect a degree of orientation and ramp up and not expect that person to be entirely on their own from day 1. For any program, understanding the small details of both how the clinic specifically runs to even the small prescribing preferences we garner take time to build. You don't really learn in school how *many doses*of flexril to give for that acute back pain that you know is part of the recommendations...only that it's prn and used to help out with the run of PT you are about to order. You get insight from other providers and learn for yourself what is an effective course. This is where a residency can be beneficial but as they are so sporifice, they are not generally a viable option. I don't think any clinic should be hiring a new grad to work by themselves without another provider present and not because of a lack of education, but a lack of applying knowledge to real world situations.

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