So You Want to Be a Nurse Practitioner

8/8/2019 So You Want to Be a Nurse Practitioner

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electronics. God has always had a sense of humor that way.

So off I went in search of a job. In the process I worked as a gravedigger and other fun

occupations. Actually, gravedigger was my first health care job. Although thats another story

also.

Ok, fast forward to Nurse Practitioner School. I found a local NP School that didnt require the

ridiculous GRE to get into the program. I applied and was accepted into the program on the first

round. I had been working in ERs and ICUs as a nurse for the past 11 years at the time I started

NP School. The first day of class was an eye opener. The Assistant Dean of the program talked

with us the entire first day. She knew her stuff because had we truly a clue about what we were

about to do we would have bolted from the room and chucked cookies in the hallway. The other

thing about the first day of the program was the intimidation factor provided by the other

students. Half the 15 people already had a Masters degree. All but one student had either a

Masters degree or two Bachelor degrees. These were not just smart people, they were very smart

people, as I would come to find out as I worked my way through the program.

Now, I found nothing about the NP program to be intellectually insurmountable. It did take

study, hard work, and lots and lots of hours on the computer sifting through the dregs of

electronic stacks to find the information I needed for the classes. In many of the classes I never

bought the book. Really you say? Yes, I never bought the book. I either had similar texts at home

already or found the information online, freshly printed or published, and just waiting for little

old NP student me, to dig it up. My wife is currently in the same NP program and keeps asking

me for the book I used for such and such a class. She gets frustrated when I tell her I never

bought the book for that class. That does not mean there arent classes for which you must

purchase a book, there are. Now, is that awkward enough? There are classes you will need to

purchase books for or you will have a very hard time passing the class. Is that better?

Ok you really want to be an NP. Take a deep breath and repeat the mantra;

I wont have a life for 2 to 3 years. I wont have a life for 2 to 3 years.


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Repeat that over and over about 10,000 times.

Tip #1. Dont piss off anyone.

Thats a real easy one and should be practiced on a daily basis. Why? The simple answer is that

nursing is a small, petty vindictive world ruled by Hitler-like women with Short-Woman

Syndrome. Youll have to meet me in person for specifics on certain people as I dont want to

get sued for saying unpleasant things about ghastly people.

Just trust me on this one. Nursing is a small world and if you are considering becoming an NP

you may need all the goodwill and help from every bad manager you have had to work for.

Another side to this is that many bad managers become managers of hospital departments that

hire NPs. If you piss off this person, even though they have no clue what we do, you will never

get an interview and you may miss out on a great opportunity.

As you get out into the NP world companies will want to talk to former employers to gauge your

demeanor under fire. They dont particularly care about your nursing skills because they dont

mean a rats-patootie to the medical world. They want to find out what kind of person you are.

Are you calm, quiet, understanding? Do you ask the doctor when you dont understand

something or do you first look it up in a text book?

Your first employer is looking for a good fit not just somebody who has the skills to diagnose

epistemological dualism with one ear plugged and both arms tied behind their back.

So- Rule #1- Dont piss off anyone, youll need them in the future.

Tip #2. You have to trust others to help you.

This is a real hard lesson for nurses to learn. You cant do everything yourself. The program I

went through had group projects that I hated with every breath I took. I now see the benefit of


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group projects. One person, doctor, NP, PA cant know it all and needs the benefit of and the

experience of others to assist in safe patient care. If you run into a provider who never consults

anybody else run. Run fast, run hard, but run. Everybody needs someone they can ask questions

of without repercussions.

The program I went through required us to develop and obtain our own clinical experiences. This

was the single most difficult thing for me to do in the entire program. I sweated blood over this.

The city I live in has three medical schools, two PA schools, two NP schools and a third NP

school on the way. It was beyond stressful for me to find appropriate clinical agencies and

preceptors.

Go back and read Tip #1. Employers are going to interview your clinical preceptors to see what

kind of person you are and how you practice. Make sure you get the best trained and respected

preceptors you can because your future employment depends not only on your skills, but those of

your preceptors. I worked as a Nurse Consultant for an HMO while going to NP school. I went to

over 100 offices and spoke to many, many NPs and doctors about acting as my preceptor. None

of the offices I went to would take me on as a student.

Frustrated, I wrote a three sentence one paragraph complaint about the lack of NPs willing to

precept students and posted it on the state NP listserv. I received over 900 angry e-mails in

return. Some were posted to the listserv but over 900 came to my inbox directly. I dont think

there are even 900 NPs in the state? I received one offer of help from an NP four hours away.

900 to 1, those are great odds. Many of the e-mails were so vial and vitriolic I deleted them

before I finished the first sentence. Feel the love yet?

I wish I had some magic formula for getting into an office and getting a good preceptor. I really

think its time for the state to step in and require the school to provide preceptors. The time and

stress I spent in trying to set up clinicals was way beyond unreasonable.

How did I finally get preceptors?


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1. I chased an NP down the hall of one of the hospitals in which I worked. It turned out he was a

fellow alumni who took pity on me. He had had the same problem finding preceptors. I had a

great experience in his specialty.

2. My fellow students gave me leads for preceptors, all of which I tracked down. Never let a lead

get away. My pediatric and OB/GYN preceptors were a direct result of my fellow students

arranging them for me. They said trust me, I can get you into this office or that office and they

did. I would not have graduated without their intervention. You have to help each other.

3. I spoke to and wrote to everybody I came into contact with about acting as a preceptor, or who

they knew who takes students. I have come to believe letters are a complete waste of time. Busy

NPs and doctors line their bird cages with student letters. You must get face to face or minimum

on the phone and speak directly with the potential preceptor. Its hard to say no to a face, but I

heard it over 100 times so be prepared for disappointment. One preceptor was gracious enough to

accept me as a student through an e-mail. I would not have completed the program without him.

4. Start very early looking for preceptors. Many offices have contracts with other colleges and

are set up to take students 1-2 years in advance. Its never too early to start setting things up.

5. Tell them you are going to be in the NP program and you are probably going to need a

preceptor in blah blah blah month of next year. Keep calling and reminding them about your

needs and that you are progressing and will start clinicals in such and such a month. This is

important because I did get into several offices where the NP accepted me, but the doctor had

arranged for a PA student to be with the NP. How nice huh! Ill say it again; the doctor arranged

for the NP to have a PA student without the NP knowing about it. It would have been nice for the

doctor to have the PA student since he arranged it dont you think.

Anyway I would get a call about 6:45 AM from the NP telling me not to come to clinical

because there was going to be a PA student that day. This happened to me throughout the

program and at several different offices. Every time the NP apologized about the PA student, but

really the doctor should have been the one to call me since he was the mules backside who


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caused the double booking.

Tip #3. Not everything is as it appears.

I now work in a family practice office. It took me 6 months of full time hunting to get my first

job. As it happens I work in an office wholly owned by a Hospital corporation. I did part of my

clinical time in a family practice office wholly owned by another Hospital corporation. These

hospital owned offices are more used to having students and are slightly easier to get into

because the staff is used to having students. One trick is knowing who to speak to and who to

call. Also, you have to go through the hospitals HIPAA, fire safety, back safety etc so give

yourself time to get all that stuff done. Six months in advance is cutting it close so dont wait

until the last minute.

Remember you are a guest while you are in clinical. You are also performing a job interview

while you are in clinical. Ill admit I was not as good at this as I should have been. I probably

would have had a job sooner after graduation had I spent more time in clinical. Ill get into more

specifics of clinical in another post.

Tip #4. Get all the paperwork for UPIN (Medicare number) AHCCCS (Medicaid for those of

you outside Arizona), DEA, prescribing and dispensing, NP certification, done ASAP when you

graduate.

Spend the extra money to have things processed faster if necessary. I didnt and had to wait 3

months just to get my state certificate. The school was the slow horse not the BON. Here in

Arizona it took less than one business day for the BON to process my application. Pretty good

for government workers. It took forever for the school to process my graduation paperwork- I

should have forked over the extra $50 to have it done in one week. Once its in the system you

cant decide to spend the $50 for faster processing, because they cant find your application

amongst the 100,000 or so other graduate applications.

Why does any of this matter. As a Nurse Practitioner you need your own UPIN for the billing


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company to bill for Medicare patients, otherwise its fraud unless the physician also sees the

patient. Since I work in a clinic owned by the hospital the physician has to see any Medicare

patients first, and establish a diagnosis. I always check what insurance the patient has to make

sure we are doing things legally. I worked had to get through school and dont want to be the

HHS whipping boy.

Get you DEA Number ASAP!

Having to run down the hall to have the physician sign a script because you dont have a DEA

number can bring your patient numbers way down. Remember, this is a business and you are the

cash generator for that business. You dont see patients, the company doesnt make money, and

you dont have a job. Spend the $210 and get a DEA number ASAP. Just as a side note the DEA

lost my paperwork twice and the state never sent verification to the DEA that I was a licensed

provider. I had to fax my diploma, prescribing and dispensing and NP certificate to the DEA and

let them work it through backwards. Is any body surprised by this?

AHCCCS (Medicaid)

You need to get an AHCCCS provider number ASAP so your employer can apply for provider

status with the various AHCCCS plans. Some will credential you others will tell you to bill

through the doctor. If you are planning to open your own office its an entirely different can of

worms. I suggest you read the archives of the CAZNAP listserv for a complete discussion of the

complexity of this issue. My AHCCCS provider number was processed in less than one week.

Again, I was surprised at the swiftness and first-rate job done by the state workers.

Because of budget problems (i.e., the AHCCCS plans are only making millions instead of

gazillions of dollars) some of the AHCCCS plans have decided not to pay retroactively for

services provided by NPs, PAs and doctors. This can make it difficult to get a job if the office

cant get paid for your service. It makes it double difficult for NPs because AHCCCS refuses to

credential NPs prior to them working for a physician or hospital. They will credential a doctor

anytime however. We, NPs, are being excluded by exception.

Next time: Tips on what to focus on during clinical.


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These are my thoughts and experiences and if you disagree with them, Phbttt. I really don't care!

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So You Want to Be a Nurse Practitioner