Tuesday, May 22, 2012

More Questions For A Nurse Practitioner

What was the 1st year of practice like, I would imagine that your employers just let you go out there and hit the ground running or was there some sort of orientation period?
My first year of practice was interesting to say the least! My very first job out of school was a catastrophe! I worked with a particular MD, who's wife was the office manager, that I got along with at the hospital very well. I thought that this would be a smooth transition because I have had a great working relationship with everyone else in the past. Piece of cake or so I thought. Well, I was seeing a full panel of patients from the start. Within a month, I was seeing 20 plus patients daily. The office CNA was a nightmare and kept going over to the doc's side of the office telling him that I was too slow and that I didn't know what I was doing. She questioned every test that I ordered in the office. It got to the point that I was contemplating taking her outside for an old fashioned showdown but I didn't want to lose my license so soon after I got it! I went to the doc and mentioned to him that she was countering everything I was doing and that I didn't appreciate it. Nothing was done. I continued to work but dreaded almost every day. One day, I wasn't feeling very well and asked the front desk to keep the schedule light so that I could work rather than go home. The wife (office manager) got upset because I didn't ask her first. I was under the impression that the doc was my boss, but I was obviously mistaken. I was let go on day 89 with no warning. He gave me a two week severance check and see ya! Needless to say, I was devastated as I had never been fired from a job ever!

So onto the next job..I started at another clinic that closed it's doors 30 days after I started. He had no intention of keeping it open so once again I was without a job. At this point, I was questioning whether or not I should be a NP!
There is light at the end of the tunnel! I started my current job and was the sole provider of a brand new office in a small town that is about a half hour from home and have never looked back! I was only seeing about 5-7 patients a day and then over the next two years it grew to a full practice load of 17-24 a day since.

Word to the wise! Know exactly what you are getting into before you start a job. Who is the real boss? How do you take care of conflict in the office? Know that you can be fired for any reason!

Do you have to take call? The nurses take call and triage them to the appropriate provider. I haven't been called that much over the last 5 years. I do insist that every Peds call come to me because sick children can be scary!

Are most MD's and DO's amenable to a constructive working relationship or is there push back? All of the  docs that I have worked with at my company are extremely integrated with the NPs and PAs. There is no class warfare and ever provider is listened to equally. No one is any better than the other so patients often can't tell who is a doc and who isn't. You can't pay money for that kind of working environment!

What would you say are the advantages (outside of the more flexible training) of being and NP over a MD or DO? The main advantage of being a NP or PA over a MD is flexibility,  especially if you are a Family provider. If I get bored, I can cross over into a specialty where a MD can't. Once you are a General MD, you can't just decide to work in Gastroenterology or Pediatrics. NPs and PAs are more mobile in that aspect which can be bad because for a doc if the NP just up and leaves for another office with little or no notice. A local NP has changed to five different offices in the last five years with some bad feelings from the docs. She is fast running out of options here.

Chime in with any comments!


  1. haha "Who is the real boss?" So true!

  2. Thank you so very much for this insightful article. As a final-year NP student, these are the questions that are generating in my mind.
    I'll be visiting you're blog often!
    11 months and counting!!!

  3. I agree that you should certainly know what you are getting into with your first job. I have been a nurse practitioner for three years and my first job was also a bad experience. I have found that many primary care and urgent care clinics are run very poorly. In my first job after graduation, I was left alone in the clinic with no supervising physician and as a new graduate I had a lot of questions but no one to ask. I was also promised quarterly bonuses which were never paid.

    I would recommend getting the e-mail addresses or phone numbers of NP's who already work in the clinic or have worked in the clinic you are hoping to work for. Contact them and ask them about their experiences and how well the clinic is run. Also, have someone with experience look over your employment contract, identify potential problems and ask to have those sections of the contract modified.

    There are good jobs out there, you may have to be patient to find them but it will be worth it!

  4. Hello to you!

    I'm the Internet Marketing Manger of Onward MD. I'd like to get in touch with you -- I have a couple propositions that might help you promote your blog and benefit us as well. Would you be willing to get in contact with me? If so, please contact me at jbouchard@onwardmd.com. Thanks so much!

    ~ Jacques Bouchard

  5. This post really made me laugh, you never know what you are getting yourself in to, until you are in it!

  6. Nice post.
    I think most of nurses are suffer through such conditions. Since I am a CNA from last 2 years, I also suffer from few critical experiences. Currently I have been studying for LPN exam. So your article is a nice experience for me about nursing job.
    Thank you

  7. I had a similar experience at my second job as a np, the nurses would question my judgement , make remarks behind my back. I left and Im hoping my next job will be better