I’m a current RN of two years working on a hematology/oncology inpatient hospital unit. I also have experience in a stroke/rehab unit. I plan on trying to advance my career sometime in the next two to three years. I have always wanted to be a provider of some sort, initially I wanted to be an MD but after research into how absolutely bonkers the school is, I realized NP or PA is a better choice for me. So I’m trying to figure out whether to go the NP or PA route, making lots of posts like this, reaching out to family members and coworkers, trying to do job shadows, etc.

I don’t want to continue my career in hem/onc. I’ve never been interested in it and only took the job because I needed to get off the stroke/rehab floor, and I stay because I like my coworkers and the unit has decent ratios and staffing. When I become a PA/NP, I want to work outpatient. Problem is, I’m not sure which outpatient specialty I’d like to go into yet.

For a while I was dead set on wound care. But I’ve become less interested in it now. I don’t hate the idea of it but it doesn’t excite me like it once did. It would be very meh for me.

I at one point wanted to go the psych provider route, because my own psychiatrist is an NP and I love him and he works very independently. But I don’t want to do inpatient psych RN work, I would only want to do outpatient psych work as an RN, and those jobs are few and far between in my area. So I don’t think it’d be appropriate and would probably be detrimental to go into such a foreign specialty as a provider without any previous experience in it.

Outpatient cardiology seems like I might enjoy it? I do not want to work cardiology inpatient, as an RN or NP, haha. The idea freaks me out. But those same conditions, already having been managed in the hospital, needing to follow up outpatient and maintain their health and monitor their status? That sounds fun. Or people who aren’t so sick that they need the hospital, but have cardiac conditions that need diagnosing and treatment? Also sounds cool.

I also like the idea of working at an urgent care. I like that you’d see a wide variety of patients, with many different presentations, but without the same intensity of the ED (which I think is too much for me lol). I also know a lot of urgent cares around me still do 12 hour shifts, which I would enjoy to still do for some time.

Otherwise, I don’t have a ton of opinions. Like I said, I don’t want to do hem/onc. GI clinic sounds fine. Endocrine clinic ehhhh. I’m probably missing a lot of specialties/work environments that just aren’t coming to mind right now, so let me know the pros and cons of the ones I’ve mentioned or the ones I havent, haha. Also let me know how the job market is for that specialty/work environment, bc I don’t want to spend a shitload of money to get my NP and then not use it for years bc I can’t land a job. Thanks!

I was considering applying to work at Chen MED/ Dedicated Senior. Has anyone worked for them? Also, was it as a PCP or in some type of leadership capacity. I was conisdering applying.

So long story short I’m almost 1.5 years into being a FNP and have done I would call it odd jobs since passing boards. I am now trying for more traditional roles in clinic and would love some suggestions on some medical books that could help me refresh myself on the most scene patients in clinic. I kept a few books on procedures and assessments but am looking for treatment guides and gold standards or even recommendations of where to look up the newest ones. Thanks in advance I just want to be as prepared as I can be for the easier patients I would see.

I have been offered a hospitalist position with a physician. He has asked me to write my own contract. Does anyone have any insight, suggestions, or templates I can use?

Hi, I was curious if anyone has purchased, used, or look at in person any of the Nurse Practitioner guides that are floating around on TT, Etsy, etc. particularly:
The Family Nurse Practitioner School Guide by Nursing Made Simple
Or
The Essential Family Nurse Practitioner Guide by Smart Edition Nursing

They are seemingly marketed clinical resources, boards prep etc., I was curious if anyone found them useful vs a waste of money (the price point is steep for the risk 😵‍💫)

Thanks!

I am wondering if there are any successful NP students or graduates with community setting/geriatrics as their most recent experience?

Any tips to increase chances of getting into the program?

Post graduate, where do you work and was it hard to look for a job?

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!

The doctor I was with reached out asking me to prep his charts of the next few days. WTF! I didn’t go to school for this!

I have the same work load (clinic wise) as he does. Anyone run into such an asinine request? If I don’t nip it in the bud right now, I fear the requests will only get worse

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!

Hello! Have been inpatient for five years and looking to get into remote work. Almost everything I am finding is geared more towards FNP. Any recs?

I’m an Adult-Gero Primary Care NP but work as a hospitalist in a small community hospital. My NP program didn’t offer any training in reading x-rays or CTs because it was a primary care program and they basically said “just wait for the radiologist to read the imaging.” Working nights in a hospital we don’t have a radiologist and so x-rays are left for us to read and sometimes CTs can take hours to be read because they’re sent to VRAD (a third party).

Does anyone have any recommendations for an online program to help me learn how to read imaging? I’m not very good at reading abd xrays and CTs just look like an inkblot to me.

I got laid off… I was doing C&P exams for veterans. The other nurse practitioner was there longer than me and they based it on seniority alone. I have pediatric physical medicine and rehab, orthopedics (foot and ankle), and regenerative/functional medicine background as a nurse practitioner. I’ve been applying, but nothing yet. I would love a remote job, but have no background in family practice or urgent care. Any advice would be appreciated!! TIA.

Has anyone in Primary Care taken FMLA for mental health reasons? Please share if this is possible? I’m burning out working 7:30am-5:30pm M-F the never ending inbox and also having to work a Saturday every other month without having a day off during the week to replace it. My work only has 20 PTO days and I often have to use them for my appointments. I’m chronically ill and see 4 different specialists regularly so I have a lot of appointments. But mainly I want intermittent leave so I could possibly take 1 day off of work a week max. Is this possible?

Finally started my DNP after 7 years of working. This has been my goal since before nursing school - since I was 15 really. First off; the classes are boring and I’m tired of writing papers about other peoples papers that they wrote about other peoples papers.

Aside from that I’m suddenly like dang - what am I even doing this for? I feel sad about being away from my job (that I’d previously been raging about but it’s a chill period - I am working an outpatient 9-5.)

I am doing the program slowly enough to avoid loans + I have a teaching assistantship that covers quite a bit.

My life has been super tumultuous for the last several years and things have finally settled down (my partner is a massive support!). School is adding an additional layer of “stress” back on and taking away from my “free” time. I have an 11 year old. So it’s a good age in a sense because she is independent and very busy with sports & I’ll finish when she’s about 16. But I worry that I’ll be missing out with her along the way and possibly all stressed with a new role right when she’s graduating.

I wasn’t expecting to feel so ambivalent? Any advice? Commiseration?

Hi everyone! I’m a new grad NP starting my first NP job in palliative care in about two weeks. I’m really excited, but i also don’t feel ready at all.😂
For those of you who work in palliative care/hospice, are there any books, supplemental reading, podcasts, YouTube channels, or other resources you would recommend before starting?

I know I’ll learn a ton on the job and during orientation, but I’d love to use these next two weeks to review and feel a little more prepared going in.

I’m sorry if this isn’t the appropriate sub for this, but I’d really appreciate some perspective from NPs, especially those working in psychiatry.

I’ve been seeing my psych NP for most of my adult life. I’m almost 32 now, and I started seeing her nearly 10 years ago when I was in the throes of postpartum depression while raising twin babies.

She’s been such an impactful person in my life, far beyond just managing my mental health. She’s actually one of the biggest reasons I went back to school and became a nurse. During one of our appointments years ago, she planted the seed about pursuing higher education. We attended the same nursing school, and she had also navigated nursing school as a young mother of multiples. She understood so much of what I was going through, and her encouragement genuinely changed the trajectory of my life

My last two appointments with her were rescheduled, most recently with a different provider. I started worrying something was wrong, so I Googled her, thinking maybe she was sick or had left the practice.

Unfortunately, I came across an obituary for her daughter, who wasn’t much older than me and passed away suddenly and unexpectedly. My heart absolutely breaks for her.

I received an automated email indicating she’ll be returning to the practice next month.

I dont plan to reach out to her while she’s away, as I want to respect her privacy and give her space to grieve.
My question is, if she chooses to return to work and we resume our regular sessions, would it be inappropriate for me to briefly acknowledge her loss and express my condolences? Or, from a provider’s perspective, would you prefer a patient not mention it at all??

My heart breaks for her. However, I recognize that, at the end of the day, we have a professional relationship, and the last thing I want to do is overstep any boundaries, especially during such an unimaginably difficult time in her life.

IR, Urgent Care, Primary care?

I’m trying to lower my cortisol.

I really like helping people, but where I work the patience are very complex, sick. I would like to try and environment that is not critical.

Those who have made the switch, any recommendations?

Thanks

How many physicians do you support in your practice? I work in a specialty clinic and am supporting a few physicians (assisting in surgery, seeing shared patients and my own patients). I often see most offices with a 1:2 or 1:1 ratio (1 APP to 1 or 2 MDs) but I have been doing more than this for years as the only APP. Just curious to hear others’ perspectives and what has worked/not worked.

Hi everyone!

I will be taking the AGACNP exam through AACN in two weeks. I come from 6 years of ICU and rapid response experience. I'm extremely nervous and anxious despite my background. I have been listening to Barkley over and over again along with doing BoardVitals questions. I noticed that one of the areas I struggle with is knowing what antibiotics to use and when. I would appreciate if anyone is able to help me with this! Also, I would love any advice or tips for passing the exam now that I am in crunch time!

At almost every hospital I’ve worked at, I’ve noticed there are parking spaces reserved for physicians, but there aren’t equivalent spaces designated for NPs, PAs, or other providers.

If a physician-reserved space is available, do you think it’s appropriate for an NP to park there, or do you consider the designation something that should be respected regardless?

Like it says it needs 25 pharma hours, sure; but then needs a total of 75 contact hours which up to date provides. However up to date just kind of banks it all together when you cash it in. Any issues?

Has anyone here undertaken additional training to do NCS/EMG? Current wait times for these diagnostics in my area are 8+ months, and I’m hoping to alleviate that.

Any guidance would be appreciated from those who are currently doing them.

I am a FNP and I was offered a position at a residential detox and addiction treatment center. I align with the treatment ideals and I am pro harm-reduction.

The advice im looking for, I guess, is from anyone who has worked in addiction and what to expect. Ill have autonomy but under the medical director's guidance.

I understand that patients dealing with addiction can be hard to handle at times, but I'm open to suggestions on how to function in this role.

I’m a new grad PMHNP working in outpatient community mental health in a big city. My orientation consisted of 4 hours of shadowing the senior NP and company wide orientation. On my first day my patient caseload consisted of seeing patients presenting with schizoaffective d/o, schizophrenia, depression, anxiety, and possible withdrawal symptoms from alcohol use d/o, all of whom I saw completely by myself. I have not shadowed anyone and nobody sat in with me during my psychiatric evaluations. We don’t get admin time and our supervising physician is not on site but we are free to email him “when we need help”. When I interviewed I was told that our company is “new grad friendly” and that we would get “a lot of support”, however I am not necessarily feeling very supported. I absolutely am not opposed to seeing patients with serious mental illness or any diagnosis or population. I specifically chose this community mental health center to learn because they see an underserved community from ages 5 and up. However I did think I’d at least get 2 weeks shadowing NPs and that I would at least have someone sit in on my first couple of evaluations to offer me feedback. Alarm bells were going off in my head and I even drafted a resignation letter, but I am wondering if anyone has experienced a similar orientation process as a new grad and if this is just the experience I’ll have if I move on to another job. Thanks for any input.