Hi everyone, I recently graduated from FNP school in December and passed boards in February and I have no idea what I want to do. I have worked as a nurse for almost 7 years. 2.5 years on a surgical step down floor, 2.5 years in preop, 1 year doing outpatient pacu while I was in school. As a nurse I never found an area that I felt like was my place. There are lots of things that I find interesting but not one seemed to be the place I wanted to put down roots. I realized that I wanted to continue using my skills, but would prefer to not be in the hospital, this led me to NP school. However while in school I realized I don't want to do primary care so I have been thinking of doing a specialty of some sort. I have no idea where to start though. It's honestly very frustrating. I think a part of me had hoped by this age (29) that I would have a better idea of where I want to be, but so far I have only been able to discover what I don't like. I feel like I can't know if I want to do a certain job or not unless I actually spend time doing it, but so much time is lost looking for a job, learning it, investing in it, only to find out that you don't actually want to do it. At this point I'm wondering if I should just give up on finding something that I feel passionate about and invest in whatever will bring home the most money :/

First job. I was told I would be doing mainly post operative care for CABG, valve replacements, ablations, etc during the night shift and taking consults throughout the night. No call.

If you have don’t this, how was your experience? How did you prepare?

An interesting proposition/interest has been made by a physician at a local private ENT practice.

Scenario:

Pediatric Neurology NP at Academic Hospital (GA so independent practice limitations) who has additional specialization in Headache and Migraines and currently pursuing PMHNP specialty to compliment their current role as a provider.

Private ENT practice has sent a number of referrals to NP.

During a recent personal visit and conversation about "the NP's ideal situation would be operating a Headache and Migraine clinic", the physician then instructed for the NP to provide a perform with compensation, resource, and other needs. Essentially a business plan.

Has anyone else joined a private practice where they will be the only provider for a different specialty? If so, how did you establish compensation? The private practice obviously wants to make money, and could certainly provide value of all the logistics, sponsoring physician, etc. But the NP also wants some autonomy of schedule and ability to of financial reward for all revenue brought in.

Thoughts?

Note: This would unfortunately be about 2 years out as pension vesting would be a massive loss if not solidified, which was mentioned to the physician when brought up.

I’m working in a travel clinic, where we vaccinate for everything. I was alone one day without my receptionist, and came to think about, whether it’s legally correct to be alone in the clinic, if one of my patients goes into anaphylactic shock? My boss thinks it’s a stupid question, because the condition is rare… I can’t treat the patient with only 2 hands and I actually find it quite unprofessional practice. Am I overthinking this and being too uneasy?

I am a new grad starting my first job in an urology practice next month. Can anyone recommend some resources to help me prepare and refresh my memory before I start? I was planning on reading the uro and nephro chapters in my primary care textbook from school as a refresher. I’ve also been looking at the guidelines on the AUAs apps.

I listened to the Curbsiders podcast while I was in school and it was awesome so I would love a recommendation on a good urology podcast.

I have a few years of experience working as an RN on a surgical step down with urology and kidney transplant patients, so I have some basis for the work that they do but its been awhile! Just trying to not look totally clueless 😅

Future employer tells me they have a non compete clause that prevents their providers from taking staff/patients with them. Should i be worried? However they do not have “distance” restrictions when it comes to applying to a job within a close range.

What are you all making as new grads these days? I had an interview at a clinic today with a solo doctor and was quoted $90,000, which is less than I made as a staff RN in 2022 (8 years of experience in cardiology, half of that in cardiac surgery step down) and $30,000 less than I made as a travel nurse in 2023. I have more interviews lined up but I’m wondering if this is typical pay for a new grad NP these days (I’m in NJ for what it’s worth). If so, I have half a mind to stay an RN, since 3 12’s is a better work life balance for me as a new mom if the pay will be the same or worse as an NP.

Addendums

I have found recently on a few of my charts that another provider will add an addendum. For example I work in UC and will see a patient but a couple days later that patient may call back and request different antibiotic or have concern/question about something. Instead of charting a telephone encounter this provider will just unlock my chart and add an addendum with what they spoke to patient about.

Is this normal? It really bothers me and was going to mention it to my SP but wasn't sure if I was overreacting.

I’d like to ask if there are any NPs here who’ve done both medical and cosmetic dermatology, and if you like one over the other? I’m currently in the cosmetic derm space, and have an opportunity to transition to medical derm with the potential for a mix of cosmetic and medical derm (30-70) in the future. Thanks in advance for your insights!

PMHNP here, I've been practicing a year and a half, and have good days and bad days but I go home with extra work to do and feeling overwhelmed and crying about once a week. I am considering doing something else entirely, I love my patients but it is so emotionally draining and I feel so inadequate sometimes doing the best I can. It is affecting my relationships with family and friends, I don't have mental energy for anyone else.

I am considering working as a geriatric wound care travel nurse or doing physical (not psych) assessments for compensation and pension for VA. I guess I would like advice or opinions, from what I gather as long as I have training to do what I'm doing I am within my scope, and we all had physical assessment class in APRN school, plus I've been a nurse 30+ years. The wound care job trains you in wound care specialty first, and the Va place trains you in what they want for assessments as well.

I don't want to lose my skills and psych knowledge as I may want to go back to it someday in a different role.

Hello! I unfortunately allowed my Aanp certification expire. I need to submit a log of 100 CEs but I have no idea how old they can be? Is it from the last 2 year or more? Very confused on what they will accept. I’ll never let this damn cert expire again!

I recently accepted a 1099 position prn. I have never worked a 1099 job and especially not as an NP. My question is how do those of you that are paying yourselves in this scenario do it:

If I am scheduled for a 5 hour shift but only 2-3 patients are scheduled in that time frame, do I still send an invoice for 5 hour shift or only for the amount of time I spent on those patients?

Do I charge to the nearest half hour or 15 minutes that I work?

Just wondering how this works and how precise it should be since there is no guidance in my contract.

Thanks for the help!

What are peoples’ thought on 1099 jobs vs full employment? I’ve been at the same job (unicorn, pay has almost tripled since first hired in 2011 after graduating) for almost 13 years and I am now facing a move cross country and 99.9% likely a huge pay cut (NE to Washington state).

Any sense on how much % more I should be looking for in average hourly vs full employee as 1099 doesn’t include the non-cash benefits?

Ty in advance.

Edit: move is to required - parents are 78/80 and will be needing someone much closer going forward.

Hope every one is doing good. I will be moving soon and currently looking for a job in East TX maybe Dallas area but I can’t find a physician group that is 1099 everything I seem to find lately is W2. Hoping you all can help me out. Thanks in advance.

I found another NP job to finally leave my first (busy, overworked, underpaid) NP job!!!

The new employer wants me so start in 4 weeks. Credentialing is all within the organization and would be quick.

I gave notice to my current employer and instantly got retaliation, as expected when resigning.

I gave my current employer 4 weeks notice. My manager quoted the employee handbook that states you need to give 90 day notice. I don’t recall this information, but it’s possible it was in the handbook when I signed on.

My manager told me “4 weeks is extremely unprofessional and I would be burning bridges in healthcare where everyone knows everyone.” She then said if “I don’t give 90 days notice that there will be repercussions and that it is reportable to the state.” I don’t know if this is true or if it’s more of a scare.

I can’t even imagine asking the new employer to hold my position for 90 days. That’s insane.

Any recommendations on how to proceed?

Looked at indeed to see how the job market is for NPs. I’m sorry to say it’s looking like dog shit out there. NPs need to stop accepting these low ball shit for pay. Damn!!!

I currently work as a NP. I have been an NP for about a month. I switched roles at my current hospital from RN to NP and I cant work in both roles at that hospital. Love my job but it's been a bit of a pay cut.

Financially the cut is not feasible on a single income. I was thinking about going to work for another local hospital as RN. I previously worked at that hospital as a RN. Being an AGACNP there aren't like prn jobs that I can find.

Has anyone done this? Did you have challenges? I wouldn't do it forever just until I paid off any debt I have.

Edit to add: I am not asking for financial advise. Just the politics of working at 2 different hospitals in different scopes/roles.

I'm a poet and a didn't know it!

I am a primary care NP in a pediatric, outpatient, rural clinic. We have a patient that drives about 1 hour for monthly xolair injections for chronic spontaneous urticaria from their (out of network) allergist. The drive is cumbersome and the family is lower resourced. I have been asked to prescribe the xolair, managed by the specialist, to "protect the nurse's license" who are administering the med in our office. The patient would travel to the allergist twice a year (q6m) and I would prescribe monthly in between. I had a phone call with the allergist yesterday to discuss this kind of co-management. The patient (16y) initially refused to do home injections. She has been on this for a few years with good effect, and return of symptoms when stopped.

What are this sub's thoughts? Would you do this if it was you? What stipulations would you have if you were prescribing this?

TYIA!!

So this is my second nurses' week as a practicing NP. Last year my medical director gave us something to celebrate with and included me as a beneficiary. As a provider, I feel like I should do something for my nurses. How do other NPs celebrate nurses' week?

Next week is nurses week. My office has been short staffed and I have two exceptional nurses who have risen to the ocassion. Corporate is getting us all t-shirts and gave us a budget to order lunch. I function as the NP and office manager

I'd like to do something else for my nurses (outside of food, as I frequently will order in for them) but am stumped on what would be special. Any suggestions???

I am a year and a half into practice and it feels like it's harder, not easier. Is this a thing?

I work in a high volume outpatient specialty where I am the only NP. The people I work with are nice and I've made some friends there, but leadership within the practice is lacking and I do not have good support.

The person who is supposed to lead basically does as little as possible on that front - and unfortunately he is also my supervising MD. This is a person NOT INTERESTED in being in the thick of it, whether it be providing me guidance, giving direction to the team, or guiding the culture of the clinic. It leaves a vacuum for people who WANT to be in charge and that does not go very well.

I'm left to fend for myself and I've only gotten busier and busier.

I've managed to work out some changes in my template, which will reduce my overall patient load. It does not change anything else. Without support, I am completely overwhelmed most of the time, and I guess support isn't an option.

I feel like the MDs in my clinic all cope similarly with the practice style - by showing up, racing around to see patients, talking minimally to everyone else and trying to fly under the radar, then running to their office to chart quickly with the door shut, then out the door before anyone can ask any questions.

Is this typical?

I’m an FNP with 3years of experience, primary care and alittle Onc. As an RN I did work in a inpatient behavioral health ward for just under a year at a hospital.

Working in Primary care i feel like nearly 1/3 of my patients are dealing with psych issues and i’m either referring to psychs for medication mgmt because I’ve maxed out what I can do. anyway i’m thinking about doing a post masters but i would prefer online and 3 or 4 semesters. anyone take the post masters certificate route?

i know brick and mortar would probably be better but i completed FNP pretty much all online and i think i learned well enough in my own but also with clinicals. mainly because i didn’t work full time and just studied during clinicals. i’ve been saving for awhile so i plan to work part time and spend a lot of time self studying and reviewing anything that comes up during clinicals

any recs or tips?

I really had some hard questions which I hope they were part of the unscored part of the test. Walking out of the building, I didn't feel confident and I saw the email in my inbox but decided not to check until later. Hours later, I was delighted to see that I passed! I used SMNP, APEA, FNP Mastery, and Leik book 4th edition.

Question:

Do any of the big NP associations include anything like employment term review, contract review, access to employment attorney/specialist consult as a benefit?

Context:

I'm in an at-will employment state within an org that just abruptly introduced numerous significant employment parameter changes with dodgy rationale and zero flexibility. Considering seeking services of outside employment specialist to review legality.

Just got this email from AANP. Here's the website so you can read for yourself.

https://www.aanpcert.org/newsitem?id=146

So work has decided to part ways with the contracted MD SNFist and instead elevate two internal NPs (me included). Would round at 3 SNFs each, two half-days per week. Only visiting our health plan's members.

Few points to share (with questions/concerns below).

Current experience:

1. Neither of us have SNF NP experience, and to date our duties are completing in-home geriatric annual physicals, post-discharge evals, and follow-ups. Labs, diagnostics were deferred to PCP/specialists.
2. Work for Medicare advantage insurance plan, 40 hours/wk salaried. 3 years NP experience.
3. Both have had past inpatient RN experience- 10+ years combined.

New expanded role:

1. SNF NP role to be overseen by two internal MDs who also round at other SNFs.
2. Both MDs are committed to "handholding" one-to-one training for unspecified time until independent.
3. Rounding twice a week per SNF, and still expected to manage existing panel (approx 230+ patients) on non-SNF hours.
4. Unclear if expected to be on-call during non-SNF days/hours
5. Would still likely have home visit(s) the other half of day.
6. Compensating for SNF coverage. Terms undetermined.

Questions /concerns:

1. What's a reasonable workload given limited experience and current panel to manage already?
2. No plans to hire an additional NP/PA in near future. So sustainability of this new assignment is unclear. The internal MD expressed desire to advocate for new hire down the road.
3. What's reasonable compensation (considering that we are essentially replacing a doctor)?
4. Good resources/topics to brush up for this role?
5. Management is still working on defining the role/duties, so nothing set in stone yet.
6. No union representation, but have a supervisor who intends to advocate reasonable terms, and interested in our overall well-being.
7. Signs of exploitation/overwork to watch out for?

Thanks ahead for any and all feedback!

P.S. Just saw the recent post about nighttime nursing home coverage, but still felt like creating a new one)

Just curious what opportunities are out there. FT/PT/PRN.

I also wanted to know if anyone is working for a telehealth company with a multi-state license. How does that work? How do you get licensed? Credentialing? What about MD supervision? Prescribing? What about your med/mal?

Would greatly appreciate everyone's feedback.

Curious if any cardiac stress test NPs exist here. I’ve tried searching but keep bringing up results of “stressed” out NPs haha.

I imagine things are different everywhere. I’ll be talking with a hiring manager for a job posted for cardiac stress and wondering what some individuals days look like (and how they like it). From the way the description of the role reads, this is only pre/intra/post assessment of the patient during testing.

As always, appreciate the responses.

Having a hard time with figuring out what is fair for compensation per RVU. Right now I get a base + bonus after a certain threshold, past few years it’s averaged out to around $32/RVU. I end up doing well with having an established practice but every couple years I have to fight to get my base to the same level as new hires.

Is anyone familiar with any travel NP positions similar to the travel RN positions? Thanks!