This is a lengthy list that I initially prepared for my BSN students on what they need to know when seeking their first RN job.  The first half is tailored to them, but still may be helpful for the New Grad NP. The last half of the list is specific to NPs. These may seem like minor points but I can assure you, each one is important. Ironically, I had issues that involved nearly every single point on this list during the past year. (I apologize for the funky-formatting. This site has a mind of its own!)Questions to ask yourself…
  • What do I want to do? It’s ok to not know yet. 
  • Do I like/not like working with certain populations?  men vs. women, younger vs. older, do you speak another language (Spanish)
  • What do I NOT want to do? Pediatrics, Oncology, medical, surgicial.
        ◦       Medical floor- pts tend to be sicker, more chronic, more debilitated, liver failure (ETOH, DTs, confused, psychosocial issues), renal disease (diaylsis, AV shunts, lab values, renal diet, renal precautions with meds, fluid restrictions)
        ◦       Surgical- pts tend to be healthier, shorter LOS, predictable course of disease, (i.e. day #1, get OOB, foley comes out, PCA D/C’d; Day #2 tolerating full diet, Physical Therapy, etc à very specific treatments/goals), ALSO- have incisions, wounds, drains, foleys, PAIN (giving narcotics, pts can be demanding/cranky/lethargic).

Type of hospital or practice?
        ◦       Large, inner city- lots of staff, pay for parking, expensive cafeteria, tend to be higher crime areas, etc.
        ◦       Small, community hospital- smaller staff, get to know people more, free parking, less expensive (but may pay better)
       ◦       Magnet hospital- better reputation, more prestigious
        ◦       Teaching hospital- residents, interns, students
  • How far from home? Transportation- traveling requires reliable car, more time for commute, longer work hours, etc.
  • Nights vs days? Nights- pay more, able to learn at a slower pace. Days- pays less, see more people, in-sync with “the rest of the world”, busier/heavier
  • 12 hours shfts vs 8 hour shifts? Days are shorter with 8 hour shifts, but you work 5 days/ week if fulltime vs Longer days with 12 hour shifts but work 3 days a week or so

**ALWAYS do some RESEARCH before you interview/apply: google yourself, google hospital, google MDs, names of HR, nurse managers, look at overall reputation of hospital. Consider- Is there lots of turnover? Are they always hiring? For example. Yale is considered “woman friendly” and one of top hospitals.

During your visit:
*        Look at the condition of facilities: run down? not enough supplies? vs. brand new, state-of-the-art
*        Look at the staff:  Do they seem stressed out? Frazzled? Running around? vs Are they calm? Friendly? Able to take time to speak with you?
*        Sources of jobs: www.advancefornurses.com, nursing spectrum, allnurses.com, SimplyHired, Indeed.com, go to job fairs, open houses, word of mouth
BEFORE you accept the job: Questions
*        Length of Orientation: hours, days, location, preceptor
*        Evaluations/ Performance Reviews: 3, 6, 9 months and by whom?
*        Pay: hourly rate, bonuses, shift differentials, weekend differential, incentive pay, how do pay periods run – weekly, biweekly? Education days? Paid for  attending meetings, conferences on days off?
*        Job requirements: day/night rotations, float to other units, mandatory overtime, nurspt ratio, ancillary staff (no unit secretary on night shift, less PCAs), IV team or do nurses do them? Will you be you trained? Who does Phlebotomy- nurses or PCAs?
*        Benefits: holidays observed, vacation time, sick time, conferences, malpractice insurance, tuition reimbursement, PTO carried over year to year? Insurance- decent insurance? Start immediately or after 30 or 90 days? Dental? Vision? Short term disability? Long term disability? Pension plans?  Sunshine clubs?

Employment contract: Terms of Employment for NPs:
*        Orientation: length of orientation, location, preceptor, policy & procedure manuals, number of visits/day, time allotted for visits, time for learning EMR/ charting
*        Duration: “Evergreen Clause” (automatic renewal)
*        Compensation: hourly, salary, raises, bonuses, incentive pay
*        Benefits: medical insurance, malpractice insurance, holidays observed, PTO (sick, vacation, carry-over yearly), Conference days, CE reimbursement, Professional association dues, Licenses/renewals, Communication devices
*        Promotion of Company/NP visibility:  NP introductory letter, business cards, NP brochures, Advertising, signs
*        Performance Evaluation: Specific Examples i.e., review of 5% of charts for completeness, accuracy, accountability, compliance w/ laws. Input from co-workers, staff re: interoffice communication, flexibility, overall personality
*        Termination: 60- 90 days notice, In contract, state specific reasons for dissolution of contract (violation of law, breach by either party, performance of NP, Personal reasons)
*        Non-compete clause: 1-2 years, 10-50 miles
*        Job Description: responsibilities, evening and weekend coverage, refills, support staff, Staff expectations from NP (VS, triage, room stocking/maintenance)

Employer:
*        Practice history, philosophy, and reputation in the community
*        Past litigation, experience with previous NPs
*        Five-year plan for practice
*        NP Introduction: Introductory letter to patients, business cards, pamphlets
*        NP visibility, signs, brochures, advertising
*        NP access to profit/loss statements
*        Routine access to financial information, NP revenues generated

Patient Population:
*        Established client base, population targeted, assessment of population needs
*        Age parameters
*        ALWAYS ask: Most common diagnosis and treatment guidelines followed
*        Insurances: % T18, % T19, % MCO (which MCOs are practice contracted with, capitation/fee-for-service, NP billing)
*        Services offered: women’s health, emergencies, procedures performed
*        Expected patient volume, time allotted for visits

Office location:
*        Proximity to banks, retail shops, restaurants
*        Traffic, parking, access to building, free access to the office space, or is occupancy restricted to particular hours?
*        Safety issues, security personnel, outside lighting, crime issues
*        Condition of building, age of facilities, heat/plumbing issues, elevator issues
*        Office maintenance, cleaning crews
*        Availability of phones (# of lines), messaging, copy machines, fax machines, computers
*        Number/ size of exam rooms, staffing ratio for rooms, sinks available, condition of exam tables, stocking/re-stocking of rooms between patients
*        Equipment on-site- ECG machine, Pulse ox, O2 tanks, tympanogram, spirometry, vision/hearing testing
*        Condition/ age of current equipment, routine maintenance, cleaning/disinfection policy, cleaning of office, etc
*        Emergency equipment available
*        Availability of disposable equipment/ misc supplies (gloves, tape, gauze, office supplies, pt instruction sheets)

Office Schedule:
*        Hours of operation, weekend hours, after-hours coverage
*        Scheduling/ cut-off time for appointments, last appointment of the day, room in schedule for urgent visits/ walk-ins?
*        Room in schedule to return phone calls, reply to messages/emails, handling of refills, etc.
*        Policy for late/ no-show appointments
*        Office meal times, break times

Office atmosphere:
*        Professionalism of staff: Is there a handbook for personnel? Is the office understaffed /administrative deficiency? Do employees have clear job descriptions? Clear designations/duties?
*        Office dress code (hair, nails, jewelry), behavior code (smoking, personal calls, texting, music)
*        Areas for lunch, breaks, safekeeping of belongings and personal items
*        Noise level/space in waiting room, reception area, and exam rooms
*        Privacy/ ability to hear phone conversations, exams
*        Policy/attitude re: drug reps, sales people

Office staff:
*        Chain of command, senior staff, turnover rate, family members working together
*        Qualifications of bookkeeper, billing staff, % collections
*        Education level and credentials of support staff
*        Attitude toward NPs, experience with NPs
*        Delegation of tasks, triage, VS, Urine dipsticks, glucose, etc
*        Procedures for ordering tests/-getting results, informing patients, tracking
*        Staff meetings, input/suggestions
*        Handling of complaints, resolution of conflicts

Misc:
*        Telephone system/communication: individual voice mails? Policy on email exchanges with PHR and patients? How are incoming telephone calls handled?
*        Marketing/Practice Promotion: How are new patients recruited? Expected to do seminars/lectures? Healthcare fairs/screenings? Expected to recruit patients? Ask for referrals?
*        Patient satisfaction: Does office ask for patient feedback? Follow-up phone calls or mail questionnaires? Patient retention programs/incentives
*        Time Off: How to request time off, sick day policy – Who covers patients? When are you expected to cover other providers who are sick/ on vacation?
*        Hospitalized patients: Can you get admitting privileges? Process for getting patient admitted to hospital? Who follows patients in hospital and/or rehab?
*        Referrals/consultations: When and how to refer/consult? Does office refer to specific MDs? (Cardiologist, orthopedic MD, etc)
*        Abnormal test results: For example, 12 lead EKGs – if results are unclear, is there cardiologist who will review results?

 
 
I have not posted much on this site lately and I sincerely apologize for that! I landed my first job and spent 10 very busy months there. The time has come for me to move on. I decided to begin posting here again to share what I have learned as a new FNP. The first year out was like a roller coaster ride, lots of ups and downs, moments of excitement interspersed with moments of sheer terror and fear! Many more good days than bad days. I absolutely LOVE being a Nurse Practitioner and wouldn't trade it for the world. It is the best job in the world! If you are still in school, don't get discouraged! You are entering into a fantastic profession at a very interesting/ transitional time in healthcare. I promise you that you will LOVE it too!