Your very first job offer as a nurse practitioner is pretty much the most exciting moment of your entire life. Here you are, years upon years into studying and working your ass off to get to the finish line. . . ALL you want at that point is a job and some income. I never in a million years would have thought I’d turn down my first offer right out of school. But this is how it played out for me.
My very first job offer was at a clinic that made me feel uneasy and immediately put a bad taste in my mouth. My gut knew right away it wasn’t the right place for me, but my amateur NP brain and heart wanted it SO bad. I was still in the tail end of my last semester, a month away from graduation and months away from being licensed. I was STOKED to even be interviewing, let alone to be offered a generous salary right out of the gait.
It was a FQHC. Perfectly qualified to fulfill my commitment to the Nurse Corps. The clinic saw mostly Latino patients. . . right up my alley. And it was located about five minutes from where Matty and I wanted to move. It sounded so perfect on paper, but when I flew out to interview in person, there were red flags left and right. It took me over a week after getting the offer to make the final decision of “no”, and it came down to three underlying issues I had with it. . .
1. No Supervising Physician
In California, NP’s are required to have a supervising physician available at least by phone during every patient encounter. Not only could this site not promise me a supervising physician by phone, but they couldn’t give me a straight name when I asked who I’m assigned to. On top of that, the only physicians they DID have (working at other locations and only part-time) were an OBGYN and an internist. So any pediatric inquiry would be out of their scope of practice. It’d just be me and good ole UpToDate. This red flag waved “malpractice” all over my mind. I was immediately having visions of making executive medical decisions with zero practice experience under my belt and zero oversight. No one reviewing my charts for even the first month or two? No one to get a second opinion from on whether I’m making sound, evidence-based decisions? Not a good way to start my career. Maybe I’m crazy, but at the very least I’d like to follow the state law on this one!
2. I’d Be a Solo Provider
As if no supervising physician wasn’t nerve-racking enough, I’d also be the only provider at the clinic most days. No other NP’s or PA’s. Just a few medical assistants and me.
And actually. . . in all fairness, I didn’t panic as much on this factor alone. It wasn’t my ideal set-up for my first gig, but these are underserved, short-staffed clinics I was applying to. This is why the Nurse Corps needs me and I was willing to put on my big-girl pants for this site and be the only provider if that’s what they needed.
But not without ONE physician to collaborate with.
I even reached out to the Director of our program at Vanderbilt for advice on this. We set up a phone meeting and it put me at ease to know that her first job was a similar situation — She worked by herself five days a week at a rural, underserved clinic as a brand new NP grad. She said it was tough, but it was doable. HOWEVER, she said she had a collaborating physician she could call at any time for any questions or a second opinion. Her advice was to find out how much support I’ll have, and of course I was disappointed to realize I would have little to none.
3. No On-boarding Process
Ok, this could be no biggie. . . If I had coworkers and a collaborating physician there for me! What the hell! This was the bright red icing on the cake for me. In the initial moments of the interview, when I (of course) was considering taking the position, I demanded that there needed to be an on-boarding process for me. Especially if I’m working alone and with a population that predominantly speaks a foreign language to me. They assured me they’d arrange something and make sure there was “some sort” of on-boarding process. But this wasn’t enough to make up for the other short-comings.
What I did agree to
The job I DID take had a complete opposite offer (except with even better salary, whoop!). Without me even having to ask, they offered six weeks of on-boarding, introduced me — in person — to my designated collaborating physician, and reiterated, sensibly, that “the state of California requires this of all APRN’s”.
I turned down my first job offer, without any sort of back-up option or plan B. But I didn’t come this far in building my career to set myself up for disaster. And I would recommend this level of skepticism to any new grad! As my program director advised, “listen to your gut and you will know what’s right for you”. If it is right, you’ll feel it. And if it’s wrong, don’t ignore your intuition.
The location and name of the clinic in this post will be kept confidential to protect their integrity and privacy.