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February 24, 2007
My NP Resignation
Beka - My NP resignation is in. I have never written a resignation letter before but circumstances demanded it this time. I’m not too sure if being an NP is what it is all cut out to be. My days at the medical practice had been growing longer and longer. I began waking up earlier each day and staying in the office longer than expected to fill that one last prescription, answer that last phone call and question from a family member and/or patient. Sleeping less and less became an issue because I had not been taught enough about vitamins and supplements, which was the mainstay for the practice.
During the day I was often booked with patients back-to-back, without any spare time to eat my lunch. I slowly began losing weight. Before long I was drinking protein high-calorie shakes but without a positive result -- my weight kept dropping. Despite my requests to have a 10-minute reprieve between patient histories and physicals, no one in the practice heard me. Maybe I wasn’t saying things clearly or loud enough?
Some patients would come in and ask to be seen by the "other NP." I began resenting the fact that, more often than not, I was being constantly compared to the "other NP." I would explain to patients my role and that I did things a bit differently. But again to no avail -- some patients would cancel their appointments when they heard I was scheduled. What was I to do? No one was listening. I frequently got the "Oh, well" reaction from other staff members.
During my scheduled days I would not be able to sleep the night before, due to worry. I prided myself on being well-prepared each day. Nights would be spent learning drug-vitamin-supplement interactions. Soon sleep deprivation became an issue. By December I had become the "Do It All" NP -- performing physicals and histories, obtaining veni-puncture samples, doing 12-lead EKGs, inserting IVs and mixing IV bags for chelating therapy in between patient visits. The last straw was when I wasn’t informed that I was covering the medical practice for "x" amount of days while the physician was headed down South.
It was a tough, uneasy decision to make: resignation. But, now looking back, it wasn’t so hard. In some ways I had been taken advantage of to a certain degree. No, I wasn’t the "other NP," nor was I going to ever be. I was simply going to be "Beka." Now, it is time to recheck those new job advertisements! Phew…
Other NP grads – tell me about your first job and how you fared. Are there any secrets to success?
February 24, 2007 in Beka | Permalink
Comments
Thanks for the intensely personal and frank account. Feeling like you failed is never easy to swallow, and talking about it is like regurgitating broken glass.
My similar experience was as a new Director of Nursing Services. I was brought in (relatively unqualified, I now know) with the caution upfront that I would have to reduce staffing 35%. I was idealistic, and was sure I could manage to do this, keep the facility running smoothly, and keep the respect and cooperation of the staff.
None of those things happened. We experienced every symptom of a staffing reduction: low morale, stress, blaming and finger-pointing, increased absenteeism, and eventually complaints from patients about the poor nursing service. It took 6 months to get things back on an even keel, and then I realized the administration was going to get rid of me at the end of my probation period, and blame any problems in a pending JCAHO site-visit on 'the new guy we got rid of'.
I returned to floor nursing after spending 4 months sulking on my back porch, a sadder but wiser RN. Now, when I consider a job, I look more deeply at the long-term implications of the change, from my end AND the end of the employer.
My thanks too for the suggestions about NP New Grads suggestions. I'm just getting ready to start grad school after a long hiatus away from the books, and I'm going to cut it out and paste it on the 'fridge so I can look at it periodically. You and your readers are some smart nurses!
Ray J, RN
Posted by: Ray Jones | Mar 29, 2007 12:41:58 AM
I have been a NP for 15 years, and I think I worked for the same Doc. My first experience was in the same alternative field, and I was treated similarly.
For the first time in 15 years I have a wonderful postition where I am respected and treated very fairly.
the fifteen yr wait....MY OWN FAULT. As a breed we can be quite co-dependent..,. Just don't.....You can not be everything, everywhere, all of the time. It is up to each one of us to clearly define our boundaries within the role that we take on right at the interview! Also please know that you are not starting your career in a normal or typical position. Alternative environments (and I worked in four of them) are structured very differently on almost every level.
ANd if you are a firm believer in the therapies in this field,they can be added into any environment safely, to a degree.
Remember that you are a nurse/practitioner. Not a resident, not a doctor.....You do not perform endless functions for endless hours. Pick your area, define your role, define your day.
Posted by: kris | Mar 5, 2007 12:28:36 PM
Don't give up on the NP profession after one experience. Sometimes when you are in school even when you are a great RN you don't even know what it is that you lack, until you get out there you aren't even aware of the depth of your lack of knowledge. It is essential to find a mentoring practice that values family but also to determine what you can bring to them as well. That can mean not the greatest hours to start with but you should negotiate that after you become more proficient that you will see as many patients in a shorter time frame, for example. I guess I must be the luckiest person on the planet because at my practice they were there all the time to ask questions, have them see something I was not sure about, and they provided me with constructive criticism. There are some things about being an np that are hard. Ordering tests or consults and having the results or letters go to your supervising doctor, for example. But I feel blessed to feel pride in what I do as a valuable member of my practice. Sometimes people just don't have the right fit the first job. Don't give up. It really is a great job and I do manage to have a nice family life and even walk at work sometimes at lunch. Good luck
Cindy
Posted by: Cindy | Mar 4, 2007 4:53:03 PM
Being an NP is the same as any other job in the medical field-you do have to set parameters early on so that you can survive in the field. I am a psych NP working in a community mental health center. Anyone working with primarily the indigent and Medicaid population will be busy. We all feel stress at work, but I feel fortunate because all the physicians and NPs work hard-everyone tows the line and does their share. We all help each other, communicate with each other and in the worst case scenario agree to disagree. Although there is a ton of stress in the job, it is mostly from administrative issues, fighting with insurance companies for meds/hospital stays, etc. So my advice as you look for a job is to find a fit that you are comfortable with and negotiate hours/call/pay duties as much as you can from the start. But also it is important to be part of a team and that is what makes for job satisfaction.
Posted by: Ted | Mar 3, 2007 8:09:49 PM
As a former ICU RN and Flight Nurse who became an NP splitting time between 2 jobs (2-3 days as NP, 2-3 days flying per week) I could relate to your story. I was in a thriving practice with great MDs and wonderful patients (Women's Health). But after 1 1/2 years of feeling schizophrenic (doing a pap smear one day and intubating someone at an accident scene the next), I finally decided to work only I job. I choose the one that provided less pay, worse hours and not so nice clientele....I kept flying! Something about critical care just gets into your bones and it is tough to get it out. Since that time I have helped out 2 of my hospital's service lines with fill-in NP practice. The one I enjoy the most is helping Trauma Services. This allows me to maintain some practice acuity. There is a different type of expectation for an NP, not necessarily more difficult by nature; but ones nature may find some expectations harder to take than others. I pray that you will find a good fit and one that doesn't require you to change your day and night rhythms all the time. NP or not....you are valuable and deserve to enjoy your work. thanks peg
Posted by: peg | Feb 28, 2007 11:28:31 PM
Beka,
Know that I'm not a nurse, but I'm have comment on latest entry on your NP resignation. ITA (I'm in totally agreement) with everybody. Especially, Erin.
Thank you.
Jessica
Posted by: Jessica A Bruno | Feb 28, 2007 6:33:56 PM
I can sympathize, I was feeling the same way with my fist job. I quit after 1 year exactly. I did not feel appreciated, I was ran by the administators and MA's in the office, the doctors kept themselves very separated from the NP's in the office and we were tossed in with the staff. I did not feel like a professional or repected. I was very happy to leave, I found a job with a FP doctor with 2 other NP's, we all run our own clinic although we are expected to see approx. 30 patients a day, I have put limits on my staff regarding physicials, sick visits and how many in an am and pm shift. Things have gotton better, I am very hopeful about the furture of NP and what we bring to a practice. Keep in there, I agree with the others in saying you need to find your area to excel.
Posted by: Terri | Feb 28, 2007 9:34:15 AM
Hi! I also resigned from a position recently...the physician really took advantage of me once I started. I have a lot of experience so some patients loved seeing me and I would spend a little extra time but then when the MD started taking more and more time off and leaving me to see the patients...the patients were cancelling and transferring. She just wasn't seing it as durint my time there I did see 40 NEW patients to the practice. She was too busy with violin, akido, travelling, writing, ballroom dancing,gun courses etc.
I truely believe she does not want to practice medicine except for when she wants to!
Posted by: J | Feb 28, 2007 7:50:11 AM
My first position as an NP was a first assist for a neurosurgeon. I knew I was there just to make money for the practice but it also provided (what I thought I needed) the experience for future employment.
What I eventually found was---I was not valued as a person--I was described as being essential and a value to the practice...this didnt stop them from laying me off when my doc was deployed to Iraq--over and over again.
I have found an area where I am respected, valued, and have an incredible future of practice and learning..as an NP on an ICU for a large teaching facility. I had to relocate but it was worth it!!
Pay attention NP's---our worth is finally reaching those that need to know---teaching facilities need us and it is incredible!! If you are ACNP the opportunities are unfolding as I type. Best of luck!!
Karen
Posted by: Karen | Feb 27, 2007 11:27:56 PM
As a recent NP grad, I would like to respond. I have been in my current position for about 3 months.... and I miss being a bedside nurse.
As a NP, I am providing care for HIV positive people in my area. I was absolutely not prepared for this position. I continue to feel overwhelmed, but at the same time, I do not hesitate to say no. I have been the one to dictate that I get 30 minutes for each patient, 45 minutes for a new patient and an hour scheduled for lunch. When negotiating my contract, I made it a point to include exactly how many hours I was responsible for seeing patients (6/day) and how many hours were my catch up time (2/day).
The medical system is trying to substitute NP's as less expensive medical providers.... and it is your responsibility to not let them treat you that way. If your job does not allow you to retain your nursing identity and give the level of patient care that people appreciate and value from nurses, then dont accept the job.
But dont give up on being a NP. You need to find a job that fits you better. When you were a nurse, you didnt start in OB and say, "hey this isnt for me" and leave nursing.... you would have changed to a different specialty. It sound like that is what you need to do now. When you find a good fit, you patients will benefit as well.
No job is worth losing sleep, losing weight and stressing about. We give enough of ourselves as nurses.... we shouldnt have to sacrifice our physical and mental well being.
One of the best things about being a nurse- if you dont like what you are doing... you can do something else and still help people!
Posted by: Erin | Feb 27, 2007 10:44:18 PM
I think you do have to set the tone from the beginning so that you don't wind up getting used and abused. I think the problem is the fact that the NPs don't get enough respect from the nurses, which is very unfortunate.
Posted by: Painson | Feb 27, 2007 4:29:08 PM
First, you will never be like the other NP. Nor do you want to be! You are now becoming the NP that you want to be. You will synthesize many lesson, techniques and styles and make them your own. If you could work in the ICU you can work at the clinic.
Also remember how to delegate. You are an NP now with a different set of priorities. The nurses should have been doing half of what you describe while you tended to your duties as an NP. You let them take advantage of you with the "oh well" attitude.
When you negotiatie your new position, be specific and get it in writting. There is a lot of information out there that can help you, but you have to find it and more importantly, USE IT!!
And bye the way, I am still becoming the NP that I will be.
Hang in there.
Posted by: Dave | Feb 27, 2007 4:06:12 PM
I am amazed you stayed so long! In a new position you will need to negotiate your parameters and practice rules at the outset.
Posted by: marcel | Feb 27, 2007 12:00:50 AM
