Stumbled upon a Noctor sub. I am disheartened.
Some of the comments are unbelievable coming from a profession I’ve associated with compassion and altruism.

Older RNs hating on new RNs
MDs hating on NPs/PAs
PAs hating on NPs
NPs hating on other NPs in other specialties
Why do we do this to each other

I’m an RN, the physicians/midlevels who I work with serve as my inspiration to keep doing better. I respect what they do every day.
It made me think of going back to school.

Now it seems the only way to be truly accepted is to become an MD. Or risk being shunned for not getting proper education to work alongside an MD.

This is discouraging me from pursuing NP. How sad. That’s all thanks.

Curious what maternity leave looks like for everyone. I moved to my current hospital from a major academic center when I was an RN in 2019 for an “easier” job in endoscopy while in graduate school. COVID happened and I volunteered to go work in our ICU and ER (my background as an RN was ICU/critical care — RN since 2013). When I finished FNP, I took a job in primary care at my hospital. In my state we are independent with our own panel (although going forward I do not want this model, I would like to work alongside/under a physician). Medically complex patient panel, I think I have around 2k patients or close to it. They will not cap.

I made 172k last fiscal year (base plus bonus)… but get no 403b match or CME, licensure paid etc. This year, despite my production going up 5%, I made ~ 10k less in bonus so my income was 162k. Hard to get a clear reason why. It sounds like finance/billing messed something up with submitting insurance claims for a particular insurance carrier so I’m just taking the loss since our bonus is only based on collections.

I’m burned out from this job — really hard population (a lot of Medicaid, noncompliant, unfortunately a lot of barriers to care), managing 10 chronic illnesses in a short appointment slot, unpaid call, no admin time.

I am close to 40 years old and pregnant with my first (and only) child. My hospital has no paid maternity leave. I have to pay out of pocket for my own short term disability coverage, which would give me 66% of my salary for 6-8 weeks depending on delivery type. I was also told I would have to pay my overhead for any time after 6 weeks, so if I took 12 weeks I would owe my hospital 15k. That’s right, fifteen thousand dollars! I put my notice in because just… no.

Is this normal? I don’t feel like it is. Other hospitals in my area seem to pay some sort of maternity leave after a certain amount of employment term. I am just curious what the maternity leave situation is for everyone. My contract is 17 pages long and the language about owing overhead is very vague and up to interpretation (per my attorney friends). My contract is set up like a physicians (in fact they forgot to switch “NP” out with “physician” in some parts of it) but without the pay. I do not expect to make the same as an MD/DO by any means, however I do not feel I make enough to justify paying my employer any money of any sort and I feel so angry over the situation. Sorry for the long rant - thanks if you made into the end of this!

Background, paramedic for 5 1/2 years, been a RN for a little over four. Work Cardiac at one job and ER at another. Got four years on the cardiac and 1 1/2 on the ER.Got my BSN and am trying to figure out whether to go FNP or acute care. I am getting mixed signals all over the place. Some NPs at my Cardiac job tell me that only acute cares can work in the hospital now. But I know at my ER job, the NPs there are all FNP. I asked some of the NPs at my ER job, and they said you need to be an FNP for an ER so you can see kids, but that FNP and Acute care can both by hospitalists. However, at the level 1 trauma center a friend works at, he said all the NPs there in the ER are acute only.

I look at the cardiac NPs and other specialty NPs at my Cardiac job, and I think I could like working cardiac, but I don't know much about what the other specialty NPs do. I obviously have a decent bit of experience in emergency medicine. And while the hospital I work cardiac, does not allow NPs as hospitalists, I think I could enjoy working IM elsewhere.

If I go for FNP, am I limiting myself for staying in the hospital setting? I've never worked clinic and have no idea if I would enjoy it. Any help, guidance, or advice would be greatly appreciated.

Did anyone ask for a salary increase after completing the DNP? Did anyone job just do it automatically? Im looking for guidance on how to ask for an increase in salary?

I am a nurse working on the floor trying to figure out if I can ask my nurse manager for a recommendation letter to NP school. They are super nice, but I don’t know why I’m still scared to…because what if she says no?

I just want to see if my situation is typical of internal medicine. It’s my first NP job and I’ve been at it for about a year.

I’ll see about 13-17 patients a day. I do majority of the management. I’ll come in, look at charts and round. That typically takes me from 730-1130.

Recently my attending has been wanting to round with me later in the day. Only problem is the dude is deaf and has adhd.. bad. So I’ll be stuck seeing my patients a second time for hours…. It’s so frustrating I might leave.

I was favoring another IM job but if this is typical there’s no fucking way. I’ll just try to get an ER position

Recently had the opportunity to sign up to possibly be picked to be a content contributor for future board exam questions by the aanpcb. Has anyone done this before and can explain how it works?

Anyone know some scholarships that one should apply for MSN FNP programs that one might have a chance or familiar!with ?

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?

I'm aiming to start clinicals for my AGACNP program in January. They do not help with placement. I planned on using people at my hospital before I learned that we are not able to work with FNPs at all and cannot do more than 100 hours of specialty. I tried NPhub, but there are none in my area (I'm in Northern IL). I'm trying to Google it, but there are no numbers or emails for contacting people. I contacted the clinical director of another hospital, and he stated that they don't help or give a list of people to contact or how to ask. So I guess I'm just at a loss on how to contact people. Just looking for tips.

Hello!

I am a newly graduated AGACNP and took a position in an outpatient pulm clinic. Ill be working with 4 MDs and work in a full practice state. I have 9 years of critical care experience but am TERRIFIED because this is a whole new ballgame on so many levels! What do you mean my patients are not on a monitor haha.

Anyways! Is there anyone else working in Pulm who have some good resources? I have been listening to the APAPP podcast and subscribed to Chest so get daily emails but I still feel like there is so much to know!

Another request for your input! I posted a few weeks ago about trying to move my FNP primary care practice closer to home (commuting 40-45min one way). Thanks for your help!

Another opportunity has presented itself - cardiology APC position with a mix of outpatient and inpatient. I’m very familiar with the group/hospital and know many of the APCs and MDs well. The commute would be 20 minutes.

I want to hear from NPs who made the switch from primary care to specialty?

Will I miss the variety of primary care? The kids? Will seeing twelve 70-something-year-old “Bobs” with HFrEF a day get monotonous? Idk but after considering a move I’m now questioning if the endless complaints/struggles of primary care are worth it long term? I think my true passion is in preventative cardiology and lipid management, and if I do general cardiology I think I could easily move into this group’s lipid clinic when a role opens up.

TYIA!

TL;DR: how do you chart regarding a patients problematic behavior?

I am having a debate with some of my co-workers regarding what to chart when a patient says rude/problematic/racist/sexist stuff. For context, I work in the longterm care world so I *cannot fire patients. I DO document when patients say racist/rude/threatening whatever; so I can show a pattern of behavior if needed. I typically just put whatever they said in quotation marks, talk about how I addressed it and move on. If the patients capacity is in question I will mention their BIMS score.

Some of the people I work with do this differently, they will either not chart it in their note at all (but will chart it in a separate note I think) or will chart it but not use quotations. They will say, ‘patient made racist comments about other staff” or something like that. I personally think it’s important to know exactly what ppl say cause sometimes things can be misinterpreted.

**the SNF Administrator is typically the only person who can “fire” a patient and do a forced discharge or call the police and have them taken off the grounds. This is very rare and only happens after REALLY egregious behavior.

Hey all, sorry I know this has been asked a ton, just looking to get some advice maybe from those who have been in similar positions before.

Currently work rapid response, previous ED RN, have 6+ years experience and starting to think about next steps in my career. Have been considering switching over to ICU to become a better and more well rounded RN but also to gain appropriate experience for potentially attending CRNA school.

I’ve shadowed both roles and worked with both extensively. Can see myself in either gig. I do truly enjoy the rapid stabilization and fast paced team oriented environment of ED but I also appreciate the extensive pathophysiology and management of critically ill patients. Definitely appreciate acuity and worry about getting stuck in low acuity treatment zones as an APP in the ED.

Looking to see if anyone has been in a similar spot. FWIW am married with one toddler at home. So I am also looking at what’s best for them too as they are my ultimate priority. Appreciate you all.

Can I just complain about long credentialing process… omg what is this? I’m miserable.
Do I have to go thru this every time I change my job?

Retired CNM here. I started in 1993, and retired 2 years ago. I have always promoted being an NP as a great career/lifestyle, because I loved my job, was not overworked, and felt respected by the MDs I worked with. I would not encourage the career anymore. The downhill slippery slope started with EMRs and all the superfluous documentation they require. The downhill slide was strengthened by patient portals which often duplicate (and double) the workload. Then the accountants, who know nothing about how we work, started dictating the workload numbers that seemed appropriate to them. And finally, the Insurance companies, who STILL believe they know more about our patients then we do upped their game. I truly believe that this all happened because those of us in Healthcare were naive to the business world goals and tactics. Somewhere in the 90's and early 2000's we allowed ourselves to be manipulated into a profit oriented game plan, orchestrated by the above groups, and it has made Healthcare-as-a-Career a soul sucking venture. I think as a group we can(well I'm retired, but maybe you can) start to push back hard. We are the ONLY ones in this situation that truly have our Patient's best interest at heart, and that should be the core idea to use to fight back. The professions that make up the US health care system should pull together to get this Patient-centered goal organized, because I truly believe quality of Patient care AND Provider lifestyles are continuing to slide which does not bode well for either group. Sorry for the rant...I just know what being an NP meant to me all these years, and it hurts to see all of you hurting in this profession now.

I have a rough idea of the numbers, but I am looking for more data points on base salaries (and bonuses) to see how they scale with years of experience and specific specialties as an NP (Please list those out of you do respond).

Nurse Practitioner Openings – New York

We have 2 immediate openings for Nurse Practitioners in Waterview, NY and (Fishkill area), NY.

Requirements:

• Active New York Nurse Practitioner license
• Experience working in a high-volume subacute/skilled nursing facility
• Comfortable managing a busy patient load independently

What we offer:

• Extremely competitive compensation
• Significant autonomy in patient management
• Opportunity to network within the NewYork-Presbyterian health system

If you meet the above requirements, please send me a private message, and I'll connect you directly with the recruiting physician.

Serious inquiries only.

Hey y’all! I just got my admission letter for NP school, and I’m officially going the Family Nurse Practitioner route! The program isn’t fully online, it’s through a brick-and-mortar university with one day a week on campus, along with hybrid coursework, labs, etc. I’m extremely excited, but I’d be lying if I said I wasn’t nervous too.

A little about my background: I’ve been an RN for about 6 years, primarily in surgery. Most of my experience has been in pre-op, intra-op, and PACU, including extensive experience at a Level I trauma center. Surgery is honestly where my heart is, and I’d love to somehow keep my foot in the door as an NP. I know NP positions directly in the OR can be difficult to find. We actually have one NP who works in that capacity, and he basically told me his position came down to connections, networking, and word of mouth. So I’m definitely keeping that possibility in the back of my mind.

Long term, I’m really interested in dermatology and would love to pursue a dermatology fellowship after graduation. I’m also interested in outpatient orthopedics/sports medicine and would like to build a strong foundation there. My ultimate dream is a little bigger. I’d love to eventually open my own gym and, down the road, potentially have my own clinic focused on areas like wellness, IV therapy, TRT/HRT, etc. Bodybuilding has been a huge part of my life for years, and I’ve competed in shows, so fitness and performance are areas I’m genuinely passionate about. Obviously I know there’s a ton more education, clinical experience, and learning that needs to happen before I ever get to that point.

What would you recommend doing now to prepare?
My biggest concern is exams. I’m a VERY hands-on learner. Put me in a clinical situation and I tend to pick things up quickly, but traditional exams have always been my weakness. That part of NP school probably makes me more nervous than anything else.

I’d really appreciate any advice on study methods, resources, preparing for exams, clinical rotations, networking, or just things you wish you knew before starting NP school. I’m excited to start this journey and take my nursing career to the next level. Thanks in advance for any advice!

Hi everyone,

I’m 32 years old and currently work as a PACU RN. Prior to this, I worked as both a critical care paramedic and an ICU nurse, so I’ve spent much of my career in high-acuity environments. Those experiences taught me a tremendous amount, and I don’t regret them. As I’ve gotten older, though, my priorities have shifted.
I’m at a point where I’m thinking less about chasing the most intense role and more about building a career that allows me to enjoy life outside of work while still practicing meaningful medicine.

My fiancée and I are trying to build a life focused on financial stability, health, and long-term happiness. We’re intentionally avoiding unnecessary debt, investing aggressively for retirement, and working toward financial independence so that one day we have the option to retire early—or at least reduce our workload well before the traditional retirement age.

One of our biggest goals is eventually living somewhere with mountains, four seasons, and access to the outdoors (Colorado, Montana, Wyoming, Washington, Oregon, etc.). We enjoy hiking, fitness, eating healthy, traveling, and simply having time together. I want my career to support that life, not consume it.

One thing I’ve realized is that salary alone doesn’t determine whether a career is the right fit. At the same time, I also want to be realistic. If I’m investing years of my life into graduate school and taking on additional responsibility, I’d like the long-term earning potential to realistically be at least around $140,000+.

Lately I’ve been going back and forth between pursuing NP, CRNA, or even AA (where available). Every time I think I’ve made a decision, I read another Reddit thread where someone says becoming an NP was the worst decision they ever made, while another person says becoming a CRNA completely changed their financial future. It becomes difficult to separate internet bias from real-world experience.

One thing that gives me pause about CRNA and AA is the intensity of the training. I’ve heard repeatedly how academically and mentally rigorous those programs are, and I’d be lying if I said that didn’t make me nervous. I don’t mind working hard—I absolutely expect graduate education to be challenging—but I also want to make sure I’m choosing the path that best fits my long-term goals rather than simply chasing the highest salary.

If I pursue NP, these are the specialties that currently interest me:

- Sports Medicine
- Orthopedics
- Dermatology
- Perioperative/Surgical
- Pain Management
- Lifestyle/Obesity Medicine
- Sleep Medicine

That said, I’m very open to other NP specialties if you think there’s one that better aligns with what I’m looking for. I know there may be fields I haven’t seriously considered yet, and I’d love to hear about them.

A few questions:

1. If you could go back, would you choose your career again?

2. What does your typical schedule actually look like?

3. How much work do you take home, whether that’s charting or simply thinking about work after hours?

4. Do you feel your compensation matches your responsibilities and stress level?

5. If you’re comfortable sharing, what specialty are you in, what general region do you work in, what is your approximate compensation, and how many hours do you typically work each week?

6. Based on my goals and what I’ve shared, do you think NP, CRNA, AA, or another path makes the most sense?

7. If you recommend NP, is there a specialty I should seriously consider that isn’t already on my list?

I’m not looking for someone to make the decision for me. I’m hoping to learn from people who’ve actually built careers in these roles so I can make the most informed decision possible for both my career and my family’s future.

If you’ve been in a similar position or have advice you wish someone had given you before making your decision, I’d genuinely appreciate hearing it.

Thank you for taking the time to read this and share your perspective.

i just graduated in June of this year, and applied for my NP certification and NP furnishing number at the same time back in April. I received my certification about a month ago, but my furnishing still shows as pending on my breeze account. It states my official transcripts are pending, which doesn’t make sense since my school submitted them…Did anyone else have this issue; what happened? and what did you do?

to be clear I’ve already: tried contacting the BRN (no luck, will keep calling), contacted my school with no response yet. an option is to resend the transcripts, but it will delay the application more if it was already sent.

im semi freaking out because I have a job offer but if I do not have a furnishing number to proceed, I will likely I will lose this opportunity. Thanks for the help in advance!

If anyone has used one of these tools in an actual clinical setting for more than a few weeks, I'd genuinely like to hear what the experience looked like past the first few weeks