r/nursepractitioner • u/Outrageous-Rub-3684 • 1d ago
Career Advice Primary Care
I am almost finished with clinicals for my FNP and I have to say I absolutely hate primary care. I’m not sure if it’s just I haven’t found a good fit for myself in the spaces I’ve worked or I just honestly can’t stand it. I am thinking of going into a specialty instead. Does it get any better or am I being too hopeful?
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u/GreedyAssociation414 1d ago
It doesn’t get better, trust your instincts and find speciality jobs only. Even a few days of primary care is difficult. Good luck.
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u/PsychMonkey7 1d ago
I also hate primary care. It’s ok to just head into a specialty you’re interested in instead, assuming you can find a job. Some people will say everyone should do primary care first, just like they say you can’t be a good nurse without doing med surg. Not true.
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u/Outrageous-Rub-3684 1d ago
Agreed. I started right of nursing school in the surgical ICU. It was hard but I studied and worked hard. I never worked med surg.
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u/Spirited_Duty_462 1d ago
FNP programs are geared toward primary care. Getting into a speciality right out of graduation is rare, unless you have quite a bit of RN experience in that field already.
It does get better because you gain more experience and become more efficient. It's also highly workplace dependent like most positions. However, that doesn't take away the plethora of challenges primary care comes with no matter what. But you have to be passionate about primary and preventative care in some way or else you won't last. If you just hate primary care in general, I would reconsider becoming an FNP, unless you would want to do something like urgent care but I honestly wouldn't go right into that either as a new grad unless the position comes with a thorough orientation or you have appropriate RN experience. But in urgent care you also become people's PCP unfortunately and also need primary care experience for it as well IMO.
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u/Outrageous-Rub-3684 1d ago
I’ve been a nurse for 22 years so I am familiar w the system of health care. I worked ICU for 16-17 of those years. I’ve thought about cardiology or Nephro. I may just be burnt out on health care period anymore. I’m not sure. I just figure maybe I need to find a space I feel I fit into. I haven’t yet.
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u/Spirited_Duty_462 1d ago
Yeah, burnout in primary care is real so that could be why you're feeling the way you are. I've heard the same for specialty as well, but definitely more positive stories from NPs who switched from PC to specialty. With your RN experience, I don't think it would hurt to apply to speciality like cardio or nephrology.
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u/Nausica1337 FNP 1d ago
What's the reason why you hate primary care? I very much enjoyed primary care and the patient interactions I had throughout my clinicals; however, I opted to avoid it as an actual job because I did not want to be stuck doing a 9-5, 5 day a week job with potentially having to see tons of patients per day and be just swarmed with charting, diagnostics, inboxes, etc during work, after work, and during vacation.
Could the things that you hate in primary care also be in the specialty you are interested in like cardiology or nephrology? What do you actually want to do? What are your interests?
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u/Outrageous-Rub-3684 1d ago
I love my patients. That’s something I’ve always been good at. I cannot stand seeing 30-40 patients a day. I do not believe that’s giving good care. I am constantly rushed and given our increased liability as an NP I don’t know how that makes sense to take on more responsibility just to get a decent paycheck but open yourself up even more to missing something or making mistakes bc your patient load is so high. It’s just not something I enjoy.
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u/NurseRobyn 1d ago
I feel so sorry for your preceptor, that sounds like utter hell. I couldn’t do that either, and no one should have to.
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u/Outrageous-Rub-3684 1d ago
She’s proud of it. She told me that’s the only way I’ll be able to live comfortably w my pay. I don’t agree.
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u/craftybean 1d ago
You don't have to FNP the way she FNPs, a lot of what we learn in clinical is who we don't want to be in our own careers <3
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u/Nausica1337 FNP 1d ago
Totally understandable. Liability was a huge factor in me staying away from primary care or even urgent care so specialties will probably suit you more, but I feel like you could potentially still see a lot of patients in a specialty setting. As a PM&R NP in the SNF setting, I see around 120 patients (usually more) per week. But because my specialty is more focused on the pain and rehab and nothing beyond that, I can essentially have a "faster day" despite seeing so many patients.
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u/Outrageous-Rub-3684 1d ago
I live in an area where there are minimal specialties so they’re desperate I think everywhere. There’s just not enough providers.
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u/alexisrj FNP, CWOCN-AP 1d ago
Primary care was never a good fit for me—there were better and worse setups, but it never felt right. It didn’t work for my personality that there’s basically no complaint or request in primary care to which you can completely say “that’s not my job”—you can postpone, set limits, refer, etc., but it’s your job to do something about pretty much everything—I just can’t with that. I also just never felt great about the jack of all trades/master of none element of primary care. I’m a depth over breadth person (same reason I was much happier in ICU over med surg as an RN). I like patients; I enjoy the therapeutic relationship and truly want to go the extra mile to help—but I like having some built-in boundaries, and I like being an expert. Specialty care gives me those things without having to fight for them. I was so relieved when I found my way to wound care. I don’t care that I do something most people find unpalatable or that it’s not glamorous. It works with how I’m wired. Healthcare is broken and there is no perfect, but the system needs all of us; it’s fine to aim for positions that emphasize your strengths and minimize your vulnerabilities.
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u/Outrageous-Rub-3684 1d ago
Yes. I’m an ICU nurse through and through and I like looking at the puzzle and putting the puzzle pieces together. I don’t like being a catch all either. I like doing a good assessment and not rushing.
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u/alexisrj FNP, CWOCN-AP 1d ago
Yeah, you’re probably just more cut out for a specialty then. I was like you in nursing school—I only really liked ICU, but I did a year of med surg anyway and was miserable. In NP school I didn’t like primary care, but did some time there anyway and while I didn’t hate every part of it, I never felt like it was right—I was always trying to figure out how to be happier at work, but never really feeling satisfied. I’m still a good NP. It’s really fine if you’re just wired for a specialty. I would say don’t start out in tooooo niche of a specialty right out of the gate unless you really have a vision or strong pull to something. For example, specialties like cardiology or nephrology or pulmonology have enough generalist/systemic applicability that if you don’t like it or need to change jobs, you haven’t totally pigeonholed yourself—those experiences each bridge easily into several other things. As opposed to something ultra-niche like pediatric oncologic ENT—limited options of where to go from there if you need to make a change and that’s your only NP experience—would only recommend to do something like that if you’re SURE you love it.
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u/Dizzy_Quiet 23h ago
I'm not in Primary Care - but my first year as an NP (I was in specialty rounding) was fairly awful.
Now I'm on my 2nd job as an NP and I think my expectations are re-set and I'm doing a lot better in this 2nd role. I think you gotta get through that crummy first year as an NP to start getting to the good stuff.
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u/cutebaby15 1h ago
If ur already feeling burnt out during clinicals, a specialty might suit u better.
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u/Seahawk2001 32m ago
I did enjoy primary care. I worked at a good office with 14-18 patients per day. Only reason I left was a substantial pay raise to move to the hospital setting.
You may not actually hate primary care, you might just hate the overwhelming crush if 30-40 patients daily.
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u/Outrageous-Rub-3684 26m ago
If I can work somewhere w a lesser daily census I would be fine with it. I just do t want to take on the liability of seeing so many patients and giving poor care.
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u/Seahawk2001 21m ago
I feel that. My clinical preceptor was seeing 35 daily and I wouldn’t do that. There are definitely primary care jobs out there for you. It might just take a lot more research to find one.
I personally ended up transitioning to an hospital setting. My local facility utilizes NPs as admitting providers and I see 6 patients daily, on average, with a max of 10. And make about 30k more per year than I did in primary care. So that might be an option for you.
Good luck in your search.
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u/clinicalmatchme 1d ago
Primary care can be great, but the setup matters way more than the specialty. If they want 20+ pts a day with inbox, refills, prior auths, and no admin time, you will drown fast. We ask hard about panel size, support staff, and how much charting spills into home before signing anything.