The caps are tossed in the air, there are no more discussion boards due, and you have submitted and closed out your Capstone or Project. Time to get to work! However, you quickly learn there is much to do and consider. The ink has barely dried on your degree and your head is in a tailspin looking at career opportunities, salary offers, malpractice insurance, and everything in between. Before you get yourself in a tizzy, check out some tips from other NPs to help you navigate your first year as a new Nurse Practitioner.

1. Don’t just take a job for the high salary.

Although it may be tempting with the student loans or financial implications that incur from graduate school, the highest paying job offer may not be the best option. Definitely know your worth and what you bring to the prospective company, but you should keep in mind that NPs often have other financial obligations that can quickly eat into that large salary. For example, credentialing can be a couple thousand dollars alone. Several of my colleagues have said that continuing education stipends are very important factors in the salary package. Some employers do not pay any continuing education money, while others pay several thousands.  As an NP, you are required to have CME for your credentialing body as well as for your nursing license. Also, think about the payor source for your service. “The Centers for Medicare & Medicaid Services (CMS) is the single largest payer for health care in the United States. Nearly 90 million Americans rely on health care benefits through Medicare, Medicaid, and the State Children’s Health Insurance Program (SCHIP).”  Unless your practice is private insurance only, chances are, your organization will need you to be credentialed through CMS. The cost for Credentialing through CMS is just over $500. The details on job offers are just as important as the bottom line salary. Consider the cost of health / malpractice insurance, retirement, and student loans if you have them.

2. Become active in your professional organizations.

There are state and national organizations for nearly every specialty of NP. It is important to get involved and be in the know. These organizations allow NPs to continue to grow professionally and stay current on changes in the profession. I make it a point to attend at least one nursing related conference every year if possible. The world of health care is rapidly evolving due to the COVID-19 pandemic, legislature regarding full practice authority, and marijuana legalization. You would be amazed at the many facets of diversity these organizations offer. Seek out Nurse/Nurse Practitioner organizations here. Network often and purposefully. I often reach out to NP colleagues if I run across an area in their wheel house. There is much accuracy to the statement “two heads are better than one.” I have met some very knowledgeable and diverse friends at local conferences that I have stayed connected with.

3. There is the Good with the Not so Good.

Every job has its pros and cons. When researching for a position, be sure to ask pertinent questions. So often in interviews for provider roles we ask the same generic questions: “What is my expected patient load in a day?” Or “Do I take call or cover weekends?” Perhaps, we should add to those questions, “Is this position based on Relative Value Units (RVUs) or salary?” RVU-based positions may be beneficial for high need specialty areas, like psychiatry or pediatrics as the compensation is based exclusively on productivity, with no regard to a guaranteed base salary. Large corporations tend to lean more toward salary based NP jobs that offer income stability but may cap earning potential. More about RVUs is located here. Also, be sure the company you are working for understands your scope of practice as an NP. I have had peers inform me that some organizations did not fully understand the scope of the NP. This is a conversation to have during the interview. It is also important to familiarize yourself with your state’s Board of Nursing guidelines for practice.

4. Time is valuable.

Administration time is a valuable commodity. Working as an NP is more than just patient visits. The NP has to follow up on phone or electronic medical record messages, laboratory, and imaging results. Administration duties that go beyond the exam room are common. When establishing a work schedule or even in the interview process, the NP should be sure to ask about this space which is more commonly referred to as “Admin time.” For example, say you saw 18 patients on Friday and ordered labs. On Monday, these results return and some require you to schedule follow up, or even referrals. If you are scheduled to be right back in the clinic to see 18 more patients, you may not have the chance to perform these duties. Admin time also helps if you have other projects like research or practice improvement in your responsibilities. Consider business/practice meetings and education in-services that are required for the NP to attend when thinking about admin time. Some practices have this time built into schedules while others expect clinicians to work it into their day. It is important to have a clear definition of how and if you want to incorporate admin time into your schedule before you start your role.

5. Work-life balance is more valuable than gold.

With all the duties and responsibilities of being a health care provider at any practice, remember to keep yourself healthy. If a schedule or workload interrupts the time you have with the people you care about most or for self care, then it is not healthy. Many organizations have begun incorporating mindful moments into the workplace as an avenue to prevent burnout. I once had a position where I worked 7am to 6pm Monday through Friday and worked on my laptop or on call until bedtime every night as well as most weekends. This job interrupted precious time with my family, time for myself, and I quickly resented it and resigned after just one year. Whatever that balance is for you, it is important that you maintain it and allow yourself to be at the most optimal state. We can better care for our patients when we are at a healthy state, which includes being rested, not stressed, and physically healthy. Commit to making yourself (your most important patient) a priority by preventing burnout. Here are a few tips located here.

With these tips, you can set yourself up for a happy career where you focus on taking care of people,  including yourself. Hopefully, the new and exciting profession you have just spent the last however many years working to enter is all that you dreamed it will be. There are so many aspects of being an NP that make it a satisfying and rewarding profession. Congratulations on becoming an NP! Now, go bring something to the profession to make it better because you are in it.

Marquita Fields, DNP, FNP-BC
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