The NP Career Brings Opportunity, But What are the Challenges?

When I blog, I'm overall upbeat about the NP profession because, well, I really do think it's the best!  As a nurse practitioner I earn an excellent income, have an extremely flexible schedule and a job where I am continually learning, challenged and encouraged to improve my practice.  But let's be honest.  Between sewing up lacerations on screaming children, monitoring combative alcoholics and dealing with the occasional case of C. diff, I do have bad days on the job.

Like any job, the nurse practitioner career presents challenges, even beyond those of the occasional "difficult patient".  What challenges might you face in a career as an NP?

Working With Multiple Supervising Physicians

I am assigned to a supervising physician for each shift I work.  When a chart needs to be signed or a case leaves me stumped, this is the physician I approach for chart reviews and with questions.  My emergency department employs nine physicians, each with varying styles of practice and attitudes toward medicine.  It can be very difficult to accommodate each physician's preferences.  For example, some physicians prefer oral steroids for asthmatic patients while others swear by the IV route.  In reality, there is probably little difference in how this affects the patient but you'd better be ready to justify your decision making or modify your preferred method of medication administration depending on your supervising physician that day. 

Although these are not significant differences in practice, it can be difficult to tailor my patient care based on the preferences of multiple supervising physicians.  On the positive side, this inconvenience allows me to observe multiple styles and methods of practice.  I have become a better provider by watching and learning from multiple physicians- with a few growing pains. 

Unconventional Work Schedule

My schedule flexibility working in the ER is unprecedented.  I have the unheard of ability to request ten, yes ten, days off each month (while I would love to use these days to take a European vacation every four weeks, my husband assures me we can't afford it).  I am thrilled with this scheduling luxury and don't think I could find it in any other career.  However, there is a downside to this flexibility.

In addition to day shifts, working in the ER requires night shifts, evening shifts, working weekends and holidays.  At this very moment, I am functioning on four hours of sleep and an abundance of caffeine.  Along with the occasional (or maybe frequent?) days of sleep deprivation, working holidays is tough.  It's difficult to throw on my scrubs and show up to work Thanksgiving Day while the rest of my family is downing turkey and wine followed by a nap on the couch.  The 4th of July is no fun when you are the one treating sparkler-related injuries rather than the one lighting lakeside fireworks.  My flexible schedule certainly comes with sacrifice.

On the Job Learning

Although I am a nurse practitioner, I am expected to know almost as much as a physician but with much less schooling.  This forces me to ask and endless number of questions to the physicians with whom I work.  I am constantly learning.  This offers both positive and negative aspects to my job.  On one hand, it ensures the my work day is never dull.  The challenge and excitement of learning makes my job intellectually stimulating and personally fulfilling.  On the other hand, some days you just want to show up and get your job done.  It can be frustrating not to have all the answers.

Conflicts of Interest

Medicine is a profession geared toward helping others.  It is also a business and these two qualities frequently conflict.  While I want to provide the best possible, most responsible care for my patients, red tape and pressure to create profit from hospital administration can interfere.  Laws and hospital system regulations occasionally prevent the best possible patient care creating a challenge for providers. 

Overall, my career as a nurse practitioner is rewarding.  Like all jobs, it does present difficulties of varying degrees.  Consider these challenges when looking for a job and find a position that seeks to minimize them.  Regardless of these inconveniences in NP practice, the positives of life as an NP far outweigh the negatives.

 

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Comments

Hi ERU,

Good question.  The physicians I work with respect my decision making so it's rare they disagree with my plan of care.  But, when a difference of opinion arises I think it helps to have the physician go see the patient as well and do their own physical exam.  This way, you both have seen the patient in person and have the same information.  If there is still a difference in opinion, I defer to the physician. 

Erin Tolbert

I am a NP in an ED. I share your exact feelings, thank you for this blog. I am wondering you you have any physicians that no matter what your clinical decision is they disagree with you? If so how have you dealt with that?

ERU

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