Transcript: New Nurse Practitioner Job Tips with The Resume Rx

​Liz Rohr:

Well, hey there. I've got another bonus episode here for you. Another interview with Amanda from The Resume RX. And what we're talking about is red flags of interviewing, job search and contracts, which is just so many good gems in here. So if you're new here, I'm Liz Rohr from Real World NP and you're watching NP Practice Made Simple, the weekly videos to help save you time, frustration, and help you learn faster so you can take the best care of your patients.

So without further ado, I'm going to share my interview with her. So welcome again, Amanda. I'm so happy to have you here. Do you want to introduce yourself if anyone doesn't know who you are?

Amanda:

Sure. Sure. Hi everyone. My name's Amanda [inaudible 00:00:36]. I am a nurse practitioner and I have been for the past nine years or so, and I am the CEO of The Resume RX, which is a business where I help nurses and nurse practitioners specifically with career and resume strategy so that everyone can find their own fulfilling dream job.

Liz Rohr:

So Amanda is coming back today to talk about red flags of the job search process, interviewing and contracts, which I'm really excited to talk about. So we actually posted a question on Instagram for people to give some thoughts about it, but why don't we just jump right in? Do you want to start with job search red flags of job postings and what your thoughts are on that?

Amanda:

Yeah, for sure. So you definitely want to be on the lookout when you are getting a feel of what's out there in terms of job positions. When you're looking at postings, there are a couple things that can stand out as red flags. And so a first one, which is kind of funny is if they spell a nurse practitioner wrong, that's a big pet peeve of mine and I see it all the time. So if whoever's writing the job posting doesn't spell nurse practitioner correctly, I think that that's a little bit of a red flag.

Or if they use the acronyms differently, like if they say that they're looking for an LPN or sometimes people get LPN and NP confused.

Liz Rohr:

Yeah. I do see that.

Amanda:

Yeah. So that's kind of a red flag that they may not know exactly what you do or they may not be super familiar with the role. So that was one easy one. And then the other thing is sometimes I see jobs that are posted and they'll list a salary that's really high compared to that area or compared to that specialty or really high for a new grad salary.

And they'll say all over the posting, "New grads welcome. We train new grads. New grads, new grads." And while I love new grads finding jobs obviously and I love practices that are willing to mentor and kind of cultivate new grads, I don't find the reputable practices really advertising in such a flashy way.

So sometimes when I see that flashiness, whether it's a flashy salary or a flashy new grads plastered all over the job posting, I want to dig deeper and read through the fine print of this job posting to see if there's anything shady.

Like does it look like a place that could be treating pain patients with, I don't want to say pill mill because those aren't supposed to exist anymore, but places that are pain clinics that just write lots of prescriptions all day and are motivated by productivity or are they seeing a ton of work-related injuries and they want you to just kind of turn out lots of patients all day.

So those are kind of some trigger things that I've seen in job postings that I think should really kind of raise your flag so to speak to see if there's anything that's a little bit too good to be true.

Liz Rohr:

Absolutely. I totally see that. I think I definitely see that in terms of the new, all in caps, multiple exclamation points, new grads come on in. So being careful about that, just what does that actually mean? Absolutely. I'm trying to think if there's other red flags. Somebody posted on Instagram to me about saying there was a nurse position for, I was looking for a nurse practitioner, so yeah. The same things along the same lines of like LVN versus nurse practitioner and spelling it wrong or spelling it right. Things like that.

Yeah. So yeah, I think that's what we were talking about the main kind of red flags for job postings. I mean, I think that when it comes to postings too, we had talked about there's different ... And we're talking about the hidden job market.

And what we've talked about before about mainly people, new grads are looking at online job postings and I think we definitely see a lot of pain management and we see a lot of long-term acute care. And I think just being really careful about those are not necessarily all the jobs out there. Those are just in very high demand for a variety of reasons. But anyway, but we can move on to interviewing. There seems to be a little bit more in interviewing and contract. So what do you see as the red flags of interviewing?

Amanda:

Yeah, for sure. So I think that first of all, it's good if you haven't done a lot of interviews, it's good to know that there are questions that legally cannot be asked of you or that you have no obligation to answer. Which some people know, but maybe not everybody knows that. So I made a quick list that I'm going to read off, but you can't be asked in an interview or during the application process about your race, about your national origin, about your religion, your sex, your gender identity, your sexual orientation, whether or not you're pregnant or would like to be pregnant. That's a big one that I feel like can get a little bit touchy that maybe employers try to dance around. They might ask leading questions, asking you to tell them about yourself, but you don't have to-

Liz Rohr:

Like what? What would they say?

Amanda:

Well, tell me what you like to do outside of work or what brought you to the area or open-ended questions that you could fill with, "Oh, we moved here for my husband's job." That's fine to disclose, but you don't ever have to say your marital status. In terms of tell me about your availability. You can just say your availability, but you might be tempted to say, "Oh, well I have three kids.'

Liz Rohr:

3 kids at home.

Amanda:

And while I'm not saying that it's not okay to disclose that because sometimes in the right scenario, it's totally fine for you if you want to say that, but you don't ever have to because you don't want to give anyone necessarily the opportunity to judge you, or if they're looking for a particular person and those factors don't match that. So that's protected questions that they can't ask. They also can't ask about your age. [crosstalk 00:06:54] Yeah. For sure.

Liz Rohr:

[crosstalk 00:06:55] like what do you like to do outside of work? Every single interview I've been at, people ask me that.

Amanda:

I mean, even if you were 39 and a half weeks pregnant, in an interview, they couldn't ask you if you were pregnant. You might want to address that in that interview. But legally they can't ask you that. They also can't ask you about your citizenship. So that was asked, one of my Instagram followers asked me is it normal to ask for the city of your birth and your driver's license information on a job application. And that seems to be asking for your proof of citizenship, which I would say is not something that's normally asked.

Unless of course there's something that's required of the job. So if the job requires you to drive, they could ask for your proof of driver's license because that's a requirement for the position, but they couldn't necessarily ask you the city of your birth because that would imply your citizenship status.

Liz Rohr:

That's such a good point. Totally.

Amanda:

So it's tricky because in interviews, if you have an interview that's going well, chances are it's going to turn into this nice kind of conversational kind of dialogue, which is great, but just know that the amount that is shared is completely up to you as the applicant. The person interviewing you really can't and shouldn't lead you down a path to divulge more than what you are comfortable with.

Liz Rohr:

It's so true. And it's so funny because literally every single interview has asked me that. And one interview that I did, I actually consciously was trying not to talk about my daughter because I have a daughter, I have a toddler. And at the time, I just talked about her constantly. And so I tried really hard not to.

And it was very awkward when I accidentally mentioned a doctor's appointment I had to take her to or something like that. I don't know. I don't think that it was a thing. I don't think they were screening me for that, but yeah, it is really interesting how much information you can disclose or accidentally disclose if [inaudible 00:09:03]. I don't think it's necessarily a huge deal, but yeah. Are there other red flags you've kind of come across yourself?

Amanda:

Yeah, I'm not sure if this is a red flag necessarily. I'm not going to say that this is a don't proceed with this employer, but I don't like when employers ask medical quiz questions, like textbook questions, like test questions. I think it's totally fine when they ask for examples of situations and things that you encountered. Tell me about how you handled something where you didn't know the answer or conflicts that type of thing, leadership. But if they're going to ask you what's the dosing for this antibiotic for this disease-

Liz Rohr:

Do they really ask that? Have you been asked that before? That's awful.

Amanda:

I have not personally ever been asked a medical question aside from an interview for a remote position. So I interviewed and started with a company that did, it was tele-health essentially, and it was kind of concierge medicine. And there was a screening part of the interview. There was an exam where there was multiple choice questions that was kind of test questions to make sure that you knew how to appropriately triage emergencies, that type of thing.

But it wasn't in the face-to-face interview. I wasn't put on the spot, but I have heard of others in those scenarios. And I just have to roll my eyes because the best quality to have is that you know what you know and you know what you don't know and that's how I answer it. That's how I recommend answering that question.

If you're asked a question and you don't know the answer, which is very, very likely because they're probably trying to trip you up on something, you can just kind of, chuckle and say, "Oh, I'm way too nervous to know the answer to that right now, but I can tell you what I would do is I would consult this resource and this is how I look up things that I don't know. And I would ask my mentor or my supervisor or whatever," but yeah, it happens.

And when I hear about it just rubs me the wrong way because that's not the point of the interview because you can learn. Everyone can learn the book information and the guidelines and the memorizing. That's all stuff that anyone can learn. But in an interview, you're there to show kind of that stuff that you can't learn from a textbook that there's not an exam for.

And that's what a good employer should be looking for, should be getting a feel for how you work together and your level of compassion and empathy and problem solving and critical thinking and all that kind of higher level stuff that's so far beyond whether or not you know a textbook answer to a protocol question.

Liz Rohr:

Right, right. Oh, definitely. Yeah. So I mean, I don't think I've ever been quizzed in terms of antibiotic dosing or anything. I have had some clinical questions. I think the most common one that I've gotten across multiple sites has to do with what is an example of a difficult patient, which is kind of clinical and not really.

I can't remember if any other clinical, actual clinical judgment questions have come up, but yeah. That's a great point. I mean, if they are quizzing you on just kind of stuff you can look up, that's really kind of obnoxious.

Amanda:

Yeah.

Liz Rohr:

That's not very nice.

Amanda:

And I actually really love that question of tell me about a time when you had a difficult patient, because it gives you the opportunity to kind of explain your whole approach to how you go through that diagnostic process and that management process. And it gives you the chance to kind of think out loud and show them how you would approach caring for your mutual patients.

And I think that it can show a lot about you as a provider, especially as a new graduate when you are probably not as confident in the assessment and plan side of the soap note, you can at least kind of talk through what you know about the process and how you would approach things. And I think that can be really revealing to an employer about how you would be as an employee.

Liz Rohr:

Yeah. Absolutely. How to make a plan care, I have that whole video one if you haven't watched that one yet. Absolutely. Any other red flags that you've heard of from people working with people or just yourself or for interviews? I think one other thing that came up was being addressed as toots in an interview.

Amanda:

Yeah.

Liz Rohr:

Respectful language is really important. I think understanding, I don't know. One other thing I thought of was about one interview I went for when I was a brand new grad was working as a new nurse practitioner with a bunch of physicians who had never worked with a nurse practitioner before. And that's not necessarily a red flag, but they think that that deserves more caution in terms of the [inaudible 00:14:20] in that kind of scenario.

Because at least for me, I didn't have I felt like strong enough feet under me or legs under me to feel like I could navigate that and explain not only what my role is, but how much support I needed and really have that confidence to kind of not necessarily push back, but be really direct about hey, this is what I know as a nurse practitioner. It's different than being a physician and I need this amount of training and I need this schedule. I didn't necessarily have that knowledge right now back then.

So not necessarily a red flag, but something to think about.

Amanda:

Yeah, for sure. I see the thing that can happen if you're in situations like that can be great if you're the first nurse practitioner in a practice and you have the opportunity to define the role, that can be really great. The trap that can happen is you can become a glorified scribe, particularly in specialty practice, which happened to me in one scenario that I was eventually able to kind of navigate out of in that same practice.

But if a physician thinks that your role is to go in there and collect the history and do the assessment and do the hands-on stuff in advance, come up with the plan and then go in together and he or she gets to sign the chart and bill for the visit and call all the shots and call you-

Liz Rohr:

Ultimately make an ultimate decision. Yeah. Undermining kind of your ... Not everybody does that.

Amanda:

Yeah.

Liz Rohr:

That might sound really appealing to brand new grads. But the point is that you don't necessarily get control. And if you don't get to decide and you're doing all the hard work with supervision, but it's limiting your scope of your practice ultimately.

Amanda:

Yeah, for sure. That ideally is how I would like an orientation period to be for a new grad and a way to kind of feel out what the NP role will look like at a practice if it's not clear to you in an interview is to directly ask, "Can you tell me about how this practice has kind of used nurse practitioners in the past? Or can you tell me about typical workflow?" Or even better is getting the chance to shadow in the clinic. I think if you want the opportunity to shadow and for whatever reason, there's a hard that they don't want you to do that, then that would be a red flag.

Liz Rohr:

That's a red flag.

Amanda:

Yeah.

Liz Rohr:

Absolutely. I've always asked-

Amanda:

Yeah. Me too.

Liz Rohr:

Sorry go ahead.

Amanda:

No, I was just going to say, usually that comes as part of the offer. Like you wouldn't necessarily get that just because you're interviewing, but once you move past that first interview or if you're the only person interviewing or there's the implication of an offer, that's when that conversation is important to say. If you're not 100% sure about whether or not you want to take the position asking for even just two, four hours of fly on the wall shadowing can be really revealing.

Liz Rohr:

Absolutely. I'm so glad you recommend that too. I just started, I didn't do that the first time around when I got my first NP job, but when I got my second, I asked every single person and I shadowed for every single job and it was great. Because you get to see all the different people, the feel, the vibe, just the flow. And you can feel the energy when you get there. So is this a very happy workplace? Is this not a happy workplace? Do they all collaborate? It's very different when you're there in person.

Amanda:

For sure. Yes. Agreed. The other interview thought that I had was if they ask a lot of productivity questions. Like if right off the bat, they to know how many patients you can see in an hour.

Liz Rohr:

Especially in the first interview.

Amanda:

Yes. Especially first interview and especially as a new grad, because you're not going to know that. You may have a benchmark of what you saw per hour as a student, but that may not necessarily translate into your productivity as a provider. So any practice that seems kind of fixated on that should maybe that should maybe be a red flag and that would warrant either multiple interviews or a shadow experience for sure because I wouldn't want the expectation to be that you are a money-making machine from day one.

So that would be my concern with that. You don't want to be any practice's workhorse. You want to of course be a contributing member of the team and earn money for the practice. But you want to make sure that practice is supporting you. Yeah. No show ponies.

Liz Rohr:

I think the implication there for people who are not already working as nurse practitioners is that employers are ultimately concerned with your productivity of how many patients you see per hour, per day, because you are the revenue generating provider. Meaning that someone who works at the front desk doesn't bring in any money to the clinic. You are the revenue bringing in person.

And so the productivity numbers are super important when you look at financials in the course of the year, but at the same time, they need to know that implication is that they don't necessarily see a new grad as needing that love and care and support of a slower schedule and ramp up. They just want you to see 40 patients a day when you first walk in and whew, don't recommend that. I don't see 40 patients today. I see 20. And that's enough.

Amanda:

Yeah, I think the only place where it's even realistic to see that many patients is in urgent care.

Liz Rohr:

Yeah.

Amanda:

And even still not right out the gate, at least after several months, if not a year.

Liz Rohr:

Absolutely. Absolutely. So yeah. Let's move to contract red flags. Go for it. What thoughts do you have?

Amanda:

Let's see. So speaking of productivity, that's a good segue. I think if a contract offers productivity only pay, that's concerning. So there are a couple of different ways that your pay can be structured as an NP. You can either be kind of flat salary or you can be salary plus a productivity bonus structure, like a hybrid, or there are some contracts that pay you only based on the money that you bill or that you bring in.

So basically that would be your paycheck is related to the number and the complexity of patients that you see, which can sound really attractive. If you work harder, you make more money, but then what happens when there's a snow storm and all your patients cancel? Or if you want to go on vacation or if there is a global pandemic? There are all these kinds of situations that could happen that would completely wipe out your salary. So I like to see NPs taking a contract that has at least a reasonable, sustainable, livable base salary and then pay productivity pay on top of that.

Liz Rohr:

Absolutely. Absolutely. And I feel like that seems pretty standard, at least what I've seen in primary care. So hopefully, but yeah, that's a really good tip because I think it's so overwhelming for people to look at. First of all, when I was a brand new grad, I never signed a contract and then now I'm signing a contract and I don't even know what it does. So that's a really helpful tip. Any other red flags for contracts?

Amanda:

Yeah. I get a lot of questions about non-compete clauses and what that means and is it okay to sign one? And I don't think that the existence of a non-compete is a red flag in and of itself, but what you want to do is read the details of that. So a non-compete clause is when your contract states that after the contract is over, you can't work within a certain mile radius of the practice.

And sometimes they define the specialty. So they may say, "For two years after our contract ends, regardless of why it ends, you can't work for any other primary care facility within 15 miles of this metro area." That's just an example of what it could be. And so what you want to look at is the termination. So if they say for any reason, that means whether or not you quit, whether you're fired, whether you're furloughed, whether you're laid off, whether the clinic closes, those would all be reasons that they could enforce that non-compete clause. So at the very minimum, I would recommend getting that reduced to if you're terminated or if you resign.

And then you want to make sure that it's basically not wiping out all the places that you could potentially work in the area that you live. So you just want to look at that closely. There are a lot of nuanced details of that type of clause, but if that clause exists, you want to look at it and definitely feel permission to negotiate that.

Liz Rohr:

Yeah. Like get rid of it maybe.

Amanda:

Yeah I know. Yeah. Best case scenario is no thanks. I'm not going to sign that. I think that non-compete clauses are not very respectful. And I think that when you're entering this type of agreement, it should be a respectful agreement. And you're not anybody's nurse practitioner. You don't want anyone saying, "This is my nurse practitioner."

You're not the property of anyone. You're not anyone's show pony and along those same lines, it is respectful to decide what's not a good fit for you and move on professionally and it should be a two-way street. So I think that that type of language can potentially start things off on not such a great foot. So hopefully they'll be open to that conversation about either hopefully eliminating it completely. And if not making the terms very, very in your favor, I guess.

Liz Rohr:

Yeah. Yeah. And actually kind of going back to the pay and what you were saying about the different types of pay, productivity I feel like in my experience I've seen there being some sort of language about the expected productivity. Do you feel like that's pretty standard for nurse practitioners contracts? To say, "Oh, we expect eventually to see 25 to 30 patients a day," or whatever.

Amanda:

Yeah. I would love for new grads to have pretty explicit terms laid out. Like this will be the length of your orientation period and we will ramp you up gradually to an expectation of X. And then I really love and I really encourage for new grads building in some sort of time period where you have the opportunity to have an evaluation within that first three to six months.

I don't necessarily think there needs to be a contract renegotiation at that point. But having a sit down meeting so that you can take a look at what your productivity has been and where it aligns with what is expected of you or what they ideally want you to be at is smart. And it just kind of gives you the opportunity to sit down with the practice manager or the physician or NP who owns the practice and just make sure that everyone is happy with your work and that you're living up to expectations and where you can improve and all that.

Liz Rohr:

Absolutely, and this actually reminds me of Amanda had a free class the other night and hashtag not legal advice. I feel like we should put that on here because we are not lawyers and this is not legal advice, but just general thoughts about contracts.

Amanda:

Yes. Right. Yes. We're not lawyers. We don't play them on TV or YouTube.

Liz Rohr:

Oh, cool. Any other contract thoughts of red flags for people?

Amanda:

I would just really encourage people to make sure that things are clear. Like your hours. Your hours should be clear. Your responsibilities should be clear. Whether or not you're on call should be clear. And when that is and how often that is. If there's any call time at all, it needs to be very explicit, like one on-call weekend, every quarter or something. Whatever it is needs to be that specific because you don't want to end up having to take on a ridiculous amount of additional responsibility if someone else leaves the practice and this can happen a lot in smaller practices.

So making sure that that is just really clear, making sure that there's time off that's given to you and that it's not ... I've seen some contracts that say, "You won't have any official time off. You'll just work around your vacation and make up your hours elsewhere in the month." This happens a lot for shift work contracts. So emergency trauma service, that type of thing. And they'll say, "Okay, your contract requirement is 15 shifts per month." 15 12 hour shifts, which is essentially 42 hours a week.

And it kind of sounds like, oh, well, if I just want to take a week off, I'll just move my shifts around it. That sounds attractive, but that's terrible. If you want to go on a week vacation or if you want to go on a week and a half or two weeks vacation, you don't want to be working five 12 hour shifts before you go and when you come back. That's-

Liz Rohr:

[crosstalk 00:28:19] as soon as you come back.

Amanda:

That's terrible. You're going to resent your vacation. So don't do that.

Liz Rohr:

Don't do that. Definitely. Absolutely. Well, any other thoughts to share?

Amanda:

No, I think that that rounds it out.

Liz Rohr:

Awesome. Well, let them know if they're watching, they don't know already. You have your class right now and it actually closes tomorrow. Because this is going to go up tonight.

Amanda:

Yes. It closes Wednesday, April 29th at midnight. Dream Job Roadmap For New Nurse Practitioners. It's an online program that is essentially meant to take you from commencement to contract. So we're talking about job search, interview mastery, job negotiation, contract, all that good stuff. And I would love to have anyone who is interested. It's open until tomorrow night and it will likely reopen again in the summer to catch the next wave of new grads.

Liz Rohr:

Awesome. Awesome. Yeah. So if you like this conversation, you have more questions, Amanda clearly knows a lot of stuff, so can definitely help you out. And I'm really excited. I'm really excited for it. So thank you so much for being with us tonight.

Amanda:

Of course. My pleasure. Thanks for having me.

Liz Rohr:

We'll talk again soon.

Amanda:

Yeah thanks.

Liz Rohr:

So that's it. We'd love to hear from you. What are some questions that you have about interviewing or contracts or job searches? We'd love to be able to connect the dots there for you. And if you want to take this further, especially in the step-by-step making it super, super easy all the way from graduation into the first job and getting it sooner and interviewing with confidence and ease, definitely join Amanda for the Dream Job Roadmap For A New Nurse Practitioners.

She's worked really hard putting it together. It's super stellar. It's basically just everything you want to know. I'm inside of it as well. So I hope to see you there. Thank you so much for watching and I'll see you soon.