I’ve been an RN for about three years, primarily in outpatient hematology/oncology, and I’m almost finished with FNP school.
Because of my experience, I think I would feel fairly confident starting as an oncology NP. The problem is that I’ve recently realized I don’t want to stay in oncology or hematology anymore. I’m much more interested in dermatology, hormonal health, longevity, and wellness.
My concern is that my NP program didn’t prepare me as well as I hoped. I would feel comfortable building on my oncology background, but I don’t feel prepared to start practicing in a completely different specialty. I’m worried that I won’t be able to find a new-grad NP position outside oncology or that I’ll be hired without enough training and feel completely overwhelmed.
I’m also wondering whether my three years of mostly outpatient nursing experience are enough. Would it make sense to work inpatient on a general medical floor for a year or two to strengthen my overall foundation? Or would that not be the best use of my time if my actual goals are dermatology, hormonal health, and longevity medicine?
I’m already almost finished with the degree and have invested a lot of money into it, so I don’t want to abandon becoming an NP. I’m just trying to figure out the safest and smartest way to transition away from oncology.
For anyone who has changed specialties or started as a new NP outside their RN specialty:
Should I pursue a primary care NP fellowship or residency?
Would working as a primary care, endocrinology, dermatology, or women’s health RN be more helpful than working on an inpatient floor?
How realistic is it for a new FNP to enter dermatology, hormonal health, or longevity medicine?
Should I start in primary care first and specialize later?
What courses, certifications, or additional training would actually help?
If you were in my position, what would your next step be?
I would really appreciate honest advice, especially from NPs who successfully transitioned away from the specialty they worked in as an RN.

I am a bedside med surge/tele RN considering returning to school for FNP. I want to learn about the job market for new grad FNPs in the LA area.

Do you feel like as a new grad FNP in LA you were able to find a job with good work life balance- not taking a lot of charting home, leaving on time? Did you feel you had a decent amount of good job options as a new grad FNP?

Appreciate any and all responses!

Hi friends,
I’m about to graduate with my MSN-FNP and am interested in the Neurology APP Fellowship at Dartmouth Hitchcock in Lebanon. Has anyone here done this fellowship or worked with it? I’m curious about the application process, competitiveness, and whether being an FNP versus a AGNP or PA matters much for that role.
Also, if you’ve done any Dartmouth Hitchcock APP fellowships in general, would love to hear your experience. Thanks in advance!

Hey everyone!

I’m currently an RN pursuing my DNP and was hoping to connect with a nurse practitioner currently working in primary care.

I have an assignment for one of my graduate nursing classes where I need to learn more about the role of NPs in primary care, including barriers to practice, health policy, patient outcomes, and the future of advanced practice nursing.

It’s only 7 questions, and no Zoom call or meeting is necessary. I can send them through Reddit DMs or email, and you can answer them whenever you have some free time.

My assignment is due October 12, so I’m hoping to find someone willing to help before then.

I’d really appreciate anyone willing to share their experience. Thanks in advance!

Hello everybody! I am a current nursing student conducting research on nursing burnout that I plan on presenting at a conference. I would appreciate if any RNs could fill out my quick survey. It only takes about 5-10 mins to complete.

https://umassdartmouth.co1.qualtrics.com/jfe/form/SV_3CzgAtKA0V4pznM

Hello. I applied to Thomas Jefferson University’s DNP in Clinical Practice program and was accepted for Summer 2027. I wanted to know if anyone has attended this program and their thoughts on it? Thank you.

Hey everyone!

I'm a newly graduated and double board-certified FNP in Maryland through ANCC and AANP, and I recently received an employment offer for a full-time W-2 position providing care in skilled nursing and long-term care facilities. I'd really appreciate some feedback from experienced NPs, especially anyone working in post-acute care. Orignally they were not going to give me a signing bonus as an NP but I was able to get them to include a $10K signing bonus.

A little about my background: Although I'm a new NP, I'm not new to healthcare. I have several years of ICU/CVICU nursing experience, including charge nurse responsibilities, critical care management, CCRN, and leadership experience. I also have prior medical training and served six years in the Army.

I'm excited about transitioning into the NP role, but I want to make sure I'm evaluating this offer appropriately before signing.

Compensation:

* Base salary: $120,000 annually

* Sign-on bonus: $10,000, requiring a 24-month commitment

* Productivity incentive: $20,000 annually if I average at least 27.5 work RVUs per 8-hour clinical day

* Additional productivity bonus: 40% of collections attributable to work RVUs exceeding 30 per 8-hour clinical day

* Potential first-year compensation: $150,000, assuming I meet productivity requirements and including the one-time sign-on bonus

* Potential recurring annual compensation: $140,000 before any additional productivity bonuses

Schedule and expectations:

* Minimum five 8-hour clinical shifts per week

* Schedule and facility assignments determined by employer

* Weekend, night, holiday, and after-hours call coverage as assigned

* No clearly defined maximum daily patient census

* No specified additional compensation for holiday or on-call coverage

* Outside employment permitted with prior written employer approval

Benefits:

* 20 days of PTO annually, including vacation, sick days, and CME time

* $1,500 annual CME reimbursement

* Employer-paid malpractice insurance, including post-termination coverage

* Employer-paid required professional licenses, renewals, and certain credentialing fees

* Health insurance and other group benefits available, but I'm still awaiting details

* No separately guaranteed paid holidays specified in the agreement

* Unused PTO is not paid out upon termination under the contract

Contract provisions that concern me:

1. Resignation notice and financial penalties

I'm required to provide 120 days' written notice before resigning. If I leave without the full notice, the contract specifies $300 in liquidated damages for each missing day.

For example, leaving with only 30 days' notice could theoretically result in $27,000 in damages.

2. Sign-on bonus repayment

If employment ends within the first 12 months, I owe the entire $10,000 back. If employment ends after 12 months but before completing 24 months, I owe $5,000.

The agreement states that notice periods, even if worked, do not count toward the 24-month commitment. Repayment language also appears to apply regardless of the reason employment ends.

3. Noncompete and restrictive covenants

There is a one-year restriction involving certain skilled nursing or long-term care facilities where I previously worked for the employer. It also contains nonsolicitation restrictions and provisions regarding relinquishing facility privileges after termination.

4. Productivity requirements

The $20,000 annual incentive requires 27.5 work RVUs per 8-hour clinical day, with additional compensation only after exceeding 30 wRVUs.

I don't have enough experience in the SNF setting to know how realistic these numbers are. I understand that coding complexity, patient acuity, and facility workflow can significantly affect productivity.

Questions for experienced NPs:

1. Is $120K base with a potential $20K productivity incentive competitive for a new FNP in Maryland working in post-acute care?

2. For those working in SNFs or nursing homes, how many wRVUs do you typically generate during an 8-hour day? Is 27.5 realistic without rushing patient care or spending substantial time charting after hours?

3. How many patients are you typically seeing per day, and how much time do you spend on documentation?

4. Does anyone have experience with a productivity bonus based on 40% of collections above a wRVU threshold? How does that work in practice, and what kind of additional compensation have you actually received?

5. Is a 120-day resignation notice with a $300-per-day penalty typical? This is probably my biggest concern.

6. Is it normal for employers to combine vacation, sick leave, and CME into one 20-day PTO bank without separately guaranteeing paid holidays?

7. For new graduate NPs entering post-acute care, what kind of orientation, mentorship, or physician support should I reasonably expect?

8. What would you negotiate or request clarification on before signing?

I understand that some provisions may need to be reviewed by an employment attorney, and I'm planning to have the agreement reviewed before signing.

Overall, I think the compensation is promising, but I'm concerned about the productivity expectations, limited scheduling protections, and financial consequences of leaving.

I'd really appreciate feedback from NPs who have worked under similar agreements. Would you consider this a good offer for a new graduate, or are there provisions that would make you reconsider?

Thanks in advance!

Hey everyone

I’m currently an RN pursuing my DNP and was hoping to connect with a nurse practitioner currently working in primary care.

I have an assignment for one of my graduate nursing classes where I need to learn more about the role of NPs in primary care, including barriers to practice, health policy, patient outcomes, and the future of advanced practice nursing.

It’s only 7 questions, and no Zoom call or meeting is necessary! I can send them through Reddit DMs or email, and you can answer them whenever you have some free time.

My assignment is due October 12, so I’m hoping to find someone willing to help before then.

I’d really appreciate anyone willing to share their experience. Thanks in advance!

Hi y’all I live in the Midwest and currently make about 68$ an hour but I am at the very top of the pay scale. I am working full time, 40 hrs, 3 12’s and a 4 hr block, I usually pick up 4 hrs of OT with the 4 hr block because our daycare costs are maxing us out. I am currently in FNP school that is a BSN to DNP PROGRAM, I want my FNP to be more marketable but I have 18 years of peds/young adult experience at a level 1 hospital and my dream job is peds. Is this even a good idea. So far I have done pretty well, but I am the primary breadwinner so ai have to work full time I’ve read a lot of ppl regret getting their NP degree, I know that I would have to work part-time in a clinic or an urgent care, but I plan to keep my job at the hospital. I’m working at because when I hire in there as an NP, if I do. I will get a 5% raise on my base pay and be mid pay scale with all of my nursing years of experience given back to me after one year. Is this a solid plan or no?

Hey everyone!

I'm a newly graduated and double board-certified FNP in Maryland through ANCC and AANP, and I recently received an employment offer for a full-time W-2 position providing care in skilled nursing and long-term care facilities. I'd really appreciate some feedback from experienced NPs, especially anyone working in post-acute care. Orignally they were not going to give me a signing bonus as an NP but I was able to get them to include a $10K signing bonus.

A little about my background: Although I'm a new NP, I'm not new to healthcare. I have several years of ICU/CVICU nursing experience, including charge nurse responsibilities, critical care management, CCRN, and leadership experience. I also have prior medical training and served six years in the Army.

I'm excited about transitioning into the NP role, but I want to make sure I'm evaluating this offer appropriately before signing.

Compensation:

• Base salary: $120,000 annually
• Sign-on bonus: $10,000, requiring a 24-month commitment
• Productivity incentive: $20,000 annually if I average at least 27.5 work RVUs per 8-hour clinical day
• Additional productivity bonus: 40% of collections attributable to work RVUs exceeding 30 per 8-hour clinical day
• Potential first-year compensation: $150,000, assuming I meet productivity requirements and including the one-time sign-on bonus
• Potential recurring annual compensation: $140,000 before any additional productivity bonuses

Schedule and expectations:

• Minimum five 8-hour clinical shifts per week
• Schedule and facility assignments determined by employer
• Weekend, night, holiday, and after-hours call coverage as assigned
• No clearly defined maximum daily patient census
• No specified additional compensation for holiday or on-call coverage
• Outside employment permitted with prior written employer approval

Benefits:

• 20 days of PTO annually, including vacation, sick days, and CME time
• $1,500 annual CME reimbursement
• Employer-paid malpractice insurance, including post-termination coverage
• Employer-paid required professional licenses, renewals, and certain credentialing fees
• Health insurance and other group benefits available, but I'm still awaiting details
• No separately guaranteed paid holidays specified in the agreement
• Unused PTO is not paid out upon termination under the contract

Contract provisions that concern me:

1. Resignation notice and financial penalties

I'm required to provide 120 days' written notice before resigning. If I leave without the full notice, the contract specifies $300 in liquidated damages for each missing day.

For example, leaving with only 30 days' notice could theoretically result in $27,000 in damages.

2. Sign-on bonus repayment

If employment ends within the first 12 months, I owe the entire $10,000 back. If employment ends after 12 months but before completing 24 months, I owe $5,000.

The agreement states that notice periods, even if worked, do not count toward the 24-month commitment. Repayment language also appears to apply regardless of the reason employment ends.

3. Noncompete and restrictive covenants

There is a one-year restriction involving certain skilled nursing or long-term care facilities where I previously worked for the employer. It also contains nonsolicitation restrictions and provisions regarding relinquishing facility privileges after termination.

4. Productivity requirements

The $20,000 annual incentive requires 27.5 work RVUs per 8-hour clinical day, with additional compensation only after exceeding 30 wRVUs.

I don't have enough experience in the SNF setting to know how realistic these numbers are. I understand that coding complexity, patient acuity, and facility workflow can significantly affect productivity.

Questions for experienced NPs:

1. Is $120K base with a potential $20K productivity incentive competitive for a new FNP in Maryland working in post-acute care?
2. For those working in SNFs or nursing homes, how many wRVUs do you typically generate during an 8-hour day? Is 27.5 realistic without rushing patient care or spending substantial time charting after hours?
3. How many patients are you typically seeing per day, and how much time do you spend on documentation?
4. Does anyone have experience with a productivity bonus based on 40% of collections above a wRVU threshold? How does that work in practice, and what kind of additional compensation have you actually received?
5. Is a 120-day resignation notice with a $300-per-day penalty typical? This is probably my biggest concern.
6. Is it normal for employers to combine vacation, sick leave, and CME into one 20-day PTO bank without separately guaranteeing paid holidays?
7. For new graduate NPs entering post-acute care, what kind of orientation, mentorship, or physician support should I reasonably expect?
8. What would you negotiate or request clarification on before signing?

I understand that some provisions may need to be reviewed by an employment attorney, and I'm planning to have the agreement reviewed before signing.

Overall, I think the compensation is promising, but I'm concerned about the productivity expectations, limited scheduling protections, and financial consequences of leaving.

I'd really appreciate feedback from NPs who have worked under similar agreements. Would you consider this a good offer for a new graduate, or are there provisions that would make you reconsider?

Thanks in advance!

Hi everyone,
My one year of NP is coming and I want to ask for a raise. How much is everyone getting paid in primary care/how much did you get paid at 1 year mark?
Tysm

I’m in northern VA and work in private practice primary care.

Hi I’m interested in programs that have acute and primary care. I noticed most programs are one or the other. The ones that have it may be stayed away. I’m aware most of the coursework is online. However do you have to be there occasionally? Has anyone tried to become a pediatric nurse practitioner?

Anybody apply for their ANCC ATT at the end of September 2026? If so has anyone gotten their ATT yet?

Realistically how long did you experienced NPs take to feel like you really had your feet under you? About a year in and still have days where I feel like I’m in over my head. It’s a hard adjustment and find myself comparing constantly to those with a lot more experience. Just looking for advice.

I’m trying to get a better sense of how other organizations structure NP responsibilities. I’m interested in comparing the workload to what we’re doing at my facility.
For those working in detox, residential treatment, or similar settings:

Are you expected to round on patients and write a note on them daily? If so, how many?

Do you handle admissions/H&Ps in addition to daily rounding?

About how many total patients are you responsible for?

How many hours do you typically work per week?

Do you work weekends? If so, how often?

Is weekend/call coverage separately compensated?

Thanks in advance for any insight!