4 Cold, Hard Truths in Your First Nurse Practitioner Job

The excitement of graduating from your NP program and eager anticipation of starting your first nurse practitioner job (i.e. finally getting a paycheck!), probably have you feeling like you’re in a pretty good spot. And, you are. Congratulations on this step in your career are certainly in order. Personally, once I actually started my job, things took a turn for the worse. I found that starting my first NP job was an eye-opening reality check.

There was a significant disconnect between my life as a NP student where I was precepted in the clinical setting and my actual work as a nurse practitioner. This disconnect was unexpected and caused stress, anxiety and overall job dissatisfaction in my first year of practice. As I talk with other new grads, I find that many share sentiments similar to my own. Why this anxiety-provoking, stress-inducing, job-loathing among new nurse practitioners?

There are a few cold, hard truths about employment as a healthcare provider you may have been shielded from as a student in clinical rotations. Or, even if you were aware of these challenges, the realities of managing them on your own have yet to hit home. So, if you’re starting your first nurse practitioner job, be aware of this: You are no longer a student, you are an employee. Let’s look at how this plays out in practice.

1. Education Disparity

The cold, hard truth: You aren’t being paid to learn, you’re being paid to treat patients

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Many nurse practitioners approach their first job out of school as more of a learning experience. They expect an employer to understand that there’s a transitional period from when one graduates NP school to becoming proficient in practice. New grad NPs expect support from colleagues and mentorship from other experienced providers. Employers, however, expect that you’ll show up ready to work. After all, you aren’t being paid to learn, you’re being paid to treat patients.

Employers vary in their tolerance level, understanding and support of the new grad learning curve, but the bottomline is ultimately the same. You’ve been hired to treat patients and you will learn a lot doing so, but your role is not as an education charity project.

2. Standards for Success 

The cold, hard truth: If you’re not seeing enough patients to generate enough revenue to cover your salary, overhead, and generate a profit, you’re not providing value to your employer.

Nurse practitioners often graduate with an idealistic attitude. We spend years learning how to promote health, treat and prevent disease from a textbook-perfect standpoint and receive close attention from a preceptor when training in the clinical setting. The standard by which we’re measured is how much we learn – a personally and professionally fulfilling activity. Once we enter the employment setting, the standards for success change. Our success is measured by dollars and cents.

Patient outcomes are important. Patient satisfaction is important. Employers don’t deny these truths. But, when it comes down to it, you need to carry your own weight in practice. If you’re not seeing enough patients to generate enough revenue to cover your salary, overhead, and generate a profit, you’re not providing value to your employer. Metrics of success are created accordingly. Your employer will likely be more concerned with your ability to maintain high patient volumes, shorten patient visits and bill for services rendered than your ability to teach patients about a healthy lifestyle. 

3. Level of Support

The cold, hard truth: Your colleagues are not being paid to mentor you; they may even be disincentivized from helping you. 

Nurse practitioner school is overall a pretty collegial environment. Even if you thought your preceptorship was lacking, that individual did volunteer willingly for little or no pay to take the time to teach you. Your professors are invested in your success and your NP program has every interest in you passing the nurse practitioner certification exam with flying colors. The scene changes when you start your first nurse practitioner job.

In most practices, your colleagues are not being paid to mentor and train you. In fact, other providers in your practice are also measured by productivity metrics, so helping you out may even be a disincentive for the other providers in your practice. Taking the time to answer one of your questions means working more slowly. In practices that compensate based on productivity, helping you out may even negatively impact your coworker’s paycheck.

The good news? In most practices where I’ve worked, there have been a few kind souls who’ve helped me out. But, the response to my new-to-practice needs were not as overwhelmingly positive as I’d hoped.

4. Practice is More Than Patient Care 

The cold, hard truth: Clinical practice isn’t just about seeing patients, it’s also about navigating paperwork.

Ugh. Paperwork. While I was aware of the paperwork associated with patient care as a nurse practitioner student, I hadn’t yet felt the pain of being the one responsible for filtering through the stack of documents on a daily basis. From routine documentation to responding to patient requests and complying with the latest Medicare reporting guidelines, there’s a lot to contend with day-to-day as a nurse practitioner. Face time with patients may not even comprise the majority of your day. These often bureaucratic, or at least mundane, tasks become draining and frustrating, especially as a new graduate. When you’re a new nurse practitioner, patient care itself seems challenging and time consuming enough. Add on the extras that go along with the job and you may find yourself burnt out.

What have you struggled with in your first year as a nurse practitioner?


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