Transcript: What I Wish I Asked At My Job Interview As A Nurse Practitioner

Liz Rohr:

... and I've talked about this in some other episodes, but for new grads, there's no one standard recommendation, so you really just have to understand yourself, their typical schedule and your capacity.

Well, hey, there, it's Liz Rohr from Real World NP, and you are watching the Real World NP YouTube channel. We make weekly episodes to help save you time, frustration, and help you take the best care of your patients.

In this episode, I want to do another job-related overview video. I'm not really getting super into the specifics. Like I mentioned in the last episode, there are people who have literal entire companies dedicated to supporting all of the career moves for nurse practitioners, namely, one of them includes my friend Amanda Guarniere who has the company, The Résumé Rx. So I'll absolutely link to a bunch of resources that can be really helpful for you in terms of the detailed implementation of this.

But I really want to focus on some overview concepts of things to watch out for when it comes to your first job as a nurse practitioner, or even another second or third job. Maybe these are things that you didn't see in other clinic settings and might be nice for you to know. So I really want to talk about some of the things I wish I knew going into the job search process. Last episode I talked about job offers, specifically about the breakdown of things to look out for, the differences between administrative time and clinical time, salary considerations and number of patients you're seeing per day in addition to some other things. But in this episode, I really want to talk about what I wish I assessed of the clinic, and again, this is more of an overview and less of a how-to.

But when I got a job, basically what I did is I pulled up Google Maps and I typed in primary care offices, and I literally went through one by one. I made a little spreadsheet and I cold-called or reached out to them in some way or networked, looked at their job posting site. It was a bit of a hustle, but I do recommend taking a similar approach because a lot of jobs are currently available but they're not posted online yet. And likely you're actually going to get in the door before all of the... Once it's posted on the website and then all the applicants you're competing with in terms of first impressions, things like that. But, anyway, so I did that process. I got some interviews, and then I just was offered a contract and I took my job. Luckily it worked out really well with my contract, and it could have gone really badly, though.

So definitely check out that last episode to hear about some of those pieces, but things that I realized when I got my second NP job after leaving my first one. So a couple of things to keep in mind. I think first things first, talking about orientation I think is really important. When I was a new grad I sort of talked about that, but I didn't really get solid super answers about it, which ended up being okay. But there's a huge variety and not standardization of what the orientation process looks like depending on what clinic. So that's one thing that is so important to ask, and I continue to ask when I look for other jobs, because that's crucial. Am I going to see patients day one with no training or support? Or am I going to have two weeks or three months, or something like that?

I've talked about this in some other episodes, but for new grads, there's no one standard recommendation, so you really just have to understand yourself, their typical schedule, and your capacity. One thing is, I've seen people have two weeks of orientation. I've seen people have three months of orientation, six months, et cetera. The way that it typically works is no matter how long it is, you start by shadowing a provider and seeing patients off of their schedule and still doing a precepting type of thing where it's still your license, but it's not fully on you yet. And then you progress to your own schedule where you get a certain number of patients per hour, certain number of patients per day, and then there's some sort of schedule that goes up and up and up until you're at full capacity.

That's a really important thing that I would've liked to ask a little bit more about at the time of the hiring date. I sort of talked about orientation, but I was also a little bashful in this whole thing, which is why I do recommend checking out those career resources to help you go in really confidently, knowing what to talk about and how to talk about it and word-for-word scripts, things like that. But, yeah, I didn't really talk about that part. Other thing I didn't really realize, and I don't think I asked any questions about when I was a new grad, was about support staff. The staff who are... Well, all the staff really, but who are the providers? How much experience do they have? Is it a mix of physicians, physician associates, nurse practitioners, et cetera? And how long people have been there. Nice to know.

It's a little uncomfortable to talk about sometimes, again, which is why those scripts are so helpful. But having light conversations about understanding that and you can get a sense of people stick around for a while, is there a lot of turnover? Things like that. The next piece is about the other staff that are not providers and that can include all the people. I think one of the things is that it's hard to know when you're a new grad and you're going from being a student to a clinician yourself, is what crucial role those other staff members play because you just don't know. You're so focused on learning your job that, why would you think about that, or know about that? And so one of the things I did not ask, but you may want to consider asking and thinking about is, who are the people that work in this clinic?

I've talked a little bit about how primary care offices work, a couple of videos, so an episode I'll link to those down below. But with that in mind, there is a whole ecosystem of how this whole thing works. My personal experience, and I've seen this a lot in primary care, is that there's an office manager, there are people who are administrative staff that work at the front desk or they work in the call center, or there's a separate call center that does the client customer service type of stuff. You have medical assistants who work with rooming patients and collecting information and doing phone calls to patients, sending letters, obtaining vital signs, things like that. And then you might have a lab, you might have imaging technicians. You might have nurses, and you could also have other staff.

You could have community health workers, you could have a nutritionist, you could have a psych nurse practitioner. You could have a psych community health worker specifically. You could have a preventative care team that tracks all of the Paps and mammograms and colonoscopies and follows up with those patients and has a screening program. There are endless things that could be contained in a clinic and you don't know until you ask, and so it's helpful to go in leading, asking about specific things. But I think the most bare minimum crucial is to understand the day-to-day staff working with patients. Do you have a medical assistant? Does one medical assistant work with one staff member and you're paired up and you work together forever?

Not forever, but you know what I mean, ongoing, versus, is it whoever is there for the day, versus, do we have two providers to one medical assistant? Is that the standard? Is that just because we're short staffed right now? Et cetera. What are the things that the medical assistants do? Typically they can volunteer this when you're like, "Oh, tell me about the medical assistants. What role do they play? Are they matched up together? Do you just shift around?" And they can tell you more about that. But the other piece is about nursing staff, so if you are listening to this or watching this, Melissa, you saved my life my first year as a nurse practitioner. She was our team nurse and I had no idea how much I would need her help and how helpful she was.

So you may or may not have a nurse on staff, and so nurses can do things like have their own patient visits for hypertension follow-up, diabetes education, diabetes check-ins. They might have anticoagulation protocol visits where patients who are on warfarin, for example, they might have some written out protocol and sheet and dosing suggestions, and then you collaborate together with the provider. They may do vaccine appointments specifically for kids or even for adults or whatever. Another thing that typically they do is, I've seen all this a lot and I've experienced this myself, is that the providers are broken up into teams.

And so there's three providers per team on each side of the office maybe, and then there's one nurse that gets paired with that team, one nurse gets paired with that team and all of the incoming and outgoing communication through phone calls that go through the nurses will go through that specific team, which also relates back to the provider situation of what does team-based care look like? As an example, team-based care could be, on the days that I'm not in clinic on my administrative day, which I talked about in the last episode, these team members will cover my inbox, and so will watch out for any urgent labs, things like that. This is a little bit of a meandering episode, but hopefully this is helpful.

Another piece to think about in terms of support staff is the lab technicians and who staffs the lab technicians? Is it on-site? Is it part of your in-house staff? Is it one of the medical assistants that they all rotate through and staff the lab? And how do you manage critical results? Do you have a system? I did not have a system in my first job and that was very anxiety producing, that I have to just check, check, check, check, check, and only very specific ones got called in, versus my second NP job. They had a protocol for all the different lab results, all the different medium alarm ranges, and then absolutely high high red flag, call this right now kind of thing.

And they had a protocol for tapping in providers on site so that you weren't on the hook to constantly check your EHR on your administrative days when you were home to make sure that you didn't miss an urgent lab. So, yeah, I mean I think that those are some overarching foundational pieces to understand of how it works and what I wish I knew and thought about. There are so many places you can go with this and so many different nuances. Again, I will link to the more expert people in terms of the how-tos of guidance, but I'll also be thinking about if there are other things that I wish that I knew when I was a new grad. It can be pretty nuanced and a lot of things to think about, but hopefully that gives you some insight about what to ask for.

I guess one other parting piece on the note of, when I first started talking about in this episode was about the orientation process. It's helpful to know if somebody has hired a nurse practitioner before or not, or if you are the very first one. As a new grad, again, this is mentorship-type of opinion advice. You do what you're going to do, you do you, right? But I don't recommend that for new grads because it's hard to know what you need if you've never done it before, and if they don't know what nurse practitioners can do or what they need for support, especially in their first year of practice, that might not be the best job for you. I turned that down myself because I was like, "You know what? I'm not ready to educate what a nurse practitioner does, what we need, what has to happen, blah, blah, blah, blah, blah."

I could do that now pretty comfortably. I'd be like, "Oh, okay, here's how this works." I understand the differences between you and I, what I know, what you might know, what I need, et cetera. But, yeah, the only other piece I want to mention about the orientation process is I really strongly do, and I've said this in a couple of episodes, I do recommend advocating for mentorship for yourself. So what I did per the guidance of my colleague, Christina, who's amazing, was ask my supervisor to have an hour of time blocked off either every week or every other week and have time to meet with an experienced clinician to talk about all of my cases from the week that were still stuck in my mind.

Not every single one, but there absolutely were cases of labs I felt uncomfortable with, imaging I felt uncomfortable with, management of complicated cases that I just felt I couldn't sleep well until I got some further acknowledgement of like, "Was this the right thing? Is there anything else I need to do?" Things like that. And you might have to advocate for that for yourself, whether it's in the interviewing process or once you're already on the job. I had no idea until I was already on the job and I felt like I was drowning and I said, "Can I please have this, because I want to make sure that I don't quit this job immediately because I'm so overwhelmed."

So I do recommend that if you have that opportunity. But, again, please check out the resources for the how-to, but hopefully this is a helpful overview informational type of episode, and I'll see if there's other things that I can draw on about the job career-related stuff that might be a helpful overview for you.

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