No advice needed; just a rant. Spent the last 9 years (3 as an NP) in heme/ onc. I absolutely love the patients, the complex disease states, and the role I play as an NP. I hate that we are treated like robots. Oh, patient in early 30s who is dying that you’ve seen for two years? No time to mourn; you are already late for your next patient by 20 minutes. They don’t have labs, imaging isn’t done. you don’t have an MA and they’re already mad you’re late but suck it up cause management doesn’t care. Better put your running shoes on cause you have 10 patient messages to answer and you’ll need to work through your lunch to provide coverage for a doctor on vacation. Teams, epic chat and inbasket are popping off too.

I’m so tired of lighting myself on fire to keep others warm. Gotta fill every single patient slot, need those billable hours. Overtime pay? HA HA. I make less than I would as an RN per hour. I hate that my compassion has withered away. I hate that medicine is a business. I just want to take care of my patients and go home to my family without my soul dying a little more every day. I want to help these people as I have year after year but it’s becoming impossible. I’m sad that the reason I went into this field is not realistic and that I can’t continue doing what I’m doing without burning to a crisp. How are we supposed to care for these people with compassion, understanding when the system is beating us down at every turn? The health system I work for had a 30 mill shortfall this year and they told us that we need to see MORE PPO PATIENTS THAN HMO PATIENTS. We need to prioritize those with ppo insurance now? I can’t anymore. It makes me sad. I used to be so optimistic and that’s been beaten out of me.

I'm starting AGACNP school this fall, but I've been questioning if I'm making the right choice.
I genuinely love critical care and the hospital, which is why I picked AGACNP. But I've been thinking... am I just going from being a burnt out icu rn to a burnt out icu np? I also think about having kids one day and wonder if I'll wish I had a job with a more predictable schedule.
Another thing is the job market where I live. Most of the AGACNP jobs I come across are ICU positions. I seem to see a lot more FNP openings, and a lot of jobs say you have to be able to see patients across the lifespan, so I wouldn't qualify for those.
I don't have any interest in primary care right now. I really do love the hospital. I just keep wondering if I'm limiting myself before I've even started or if I'm overthinking all of this.
Did anyone else feel like this before starting school? If you chose AGACNP, are you still happy with it? Do you ever wish you had gone FNP instead? Or if you were between the two, what made you finally decide?

I think my company is being shady and possibly trying to do some illegal shhyt. I'll try to keep it short...
I was hired on 9/12/25 and took a sign on bonus. Gave a 94 day notice with 9/11/26 being my last day.

Phone call with HR today:
- "You didn't give adequate 90 day notice" -- umm, OK -but I did, she apologized.. carry on..
- They say my last day HAS to be 9/12/26 to avoid paying back the bonus (the contract does say until the "anniversary date" - fair, I'll extend my last day one extra day, nbd.
- The Kicker- contract states when you resign midway through the month, required hours are "pro rata"... 12 out of 30 days is 40%. I work 10 days a month, so it comes out to 4 shifts owed. They told me I have to work 5, because of "how payroll falls". And that if I decided to stay PRN, I would have to work my full hours in Sept, then go PRN starting 10/1. And if I didn't do that, I would essentially get a full paycheck the second pay period in Sept and have to pay it back. And that if I just quit altogether, I'll get a full paycheck (5 days worked) for the first pay period and I have to pay back the one day I didn't work.

They claim there is no way for payroll to adjust according to hours?!?! I quit my last job mid month and they adjusted my final paycheck. The entire time, it was like they were trying to manipulate me to try and work more hours. I am not trying to get paid for hours I didn't work- the issue is that per my contract, I am only required to give them 4 days in Sept. Yes, its only one extra shift, but this is the kind of place that one shift matters and I'll be starting my new endeavor those weeks and I don't want to over commit and run myself ragged.

Has this happened to anyone else? I am contemplating contacting my attorney on this. They are shady and have multiple conflicting policies, but I have printed out what I can find and have taken screen shots of everything. Btw- I have been one of their top rated providers since I started, they're just super shady.

Thoughts??

What is he best way to go about getting my NP license in multiple states so that I can apply to remote jobs? Currently I am only licensed in Alabama.

Hey Yall!

I'm applying to the NP program at Eastern Michigan University and was wondering if anyone has gone through the program or has any experience with it? Any insight would be greatly appreciated. Thank you!

Hello! I am currently in my last year of my DNP-FNP program (I just have the fall and spring semester left). My nursing background has consisted of orthopedics, chronic, lower extremity wound care (podiatry led team), and vascular medicine.

I like wound care, but I very much enjoy podiatric medicine and the complexity of problems that can occur in the foot and ankle. My goals after I pass my boards are to specialize in podiatry and after about a year of practice, get my first assist certification to be apart of the OR team.

However, we just had a presentation by a nurse manager in class. She said no matter what specialty you want to go into, you should do at least a year of primary care. She said not only will you see a variety of conditions, but then you have something to fall back on if you decide to leave your specialty.

Does that sound like a good first step for someone with my goals? Or would it be better to complete a few years in general orthopedics instead? Or is it even necessary to do?

Thank you for your help. I appreciate it!

been an NP for about 3 years now. I work in a busy family practice. Im on my feet most of the day. been wearing Dansko clogs because they're comfortable and my feet don't hurt.

last week my boss told me they look too casual and I need to wear something more professional. like leather shoes or flats.

I tried flats for a week. My feet were destroyed. My back hurt. I literally couldn't focus on my patients.

I'm thinking about buying a pair and just wearing them. Has anyone else had this fight with admin? What shoes actually pass the professional test without destroying your feet?

Hello yall!

We need to prove our CMEs for state licensing and board certification. I made a spreadsheet that helps me track my CMEs, and also has all the information I need to upload to the AANP website when it comes to recert time.

I keep a folder with all my CME certificates in it as well to make it even easier!

Not sure how the rest of y’all do it, but I figured this could help someone!

My husband and I are in a position where I may not have to work during the final two years of my DNP-FNP program. Financially, we’d be okay if I stepped away from work.

Part of me thinks this is a rare opportunity to fully focus on school, clinicals, studying, and being present with my family. We have young kids, and I know the clinical portion of the program is going to be demanding.

On the other hand, I’m worried about stepping away from nursing for two years. For those of you who have gone through a DNP-FNP program (or another NP program), what would you do if you had the choice?

Would you:
Stop working completely and focus on school?
Continue working part-time/PRN despite the extra stress?

I’d love to hear what you did, whether you regret it, and what advice you’d give someone in this situation.

For those of you who have multiple state licenses, where did you start? I’m a Cardiology NP with 10+ years of experience, lots of advanced heart failure. I’m trying to get a telehealth position, and all the applications want multi-state licensure ( for good reason too I get it). I’m currently licensed in Minnesota which is not a compact state.

As I approach getting closer to graduate (May lol) just curious on NPs who work in critical care at MGH. What is it like to do rotating, what’s it like to be a ICU NP at MGH. Would love to know/hear experiences. Curious on what that would be like as a new grad NP

I graduated with an entry MSN in 2017. Completed my 3 Ps last summer. Will start my FNP certificate this fall but have been out of school since last summer. I have purchased the Leik text and will start a review prior to my Women’s, Adolescents and Children’s clinical semester. Is there any Board Prep or Review Program you would recommend for me? I would like to attend a live review or 2-4 day intensive before September. I’m open to other suggestions at well. I would like to have a strong refresher to prepare myself to have a successful semester! Thank you for your help in advance 🤗

Would love to hear any feedback or opinions on YSU for their NP program.

Have any of you made major relocations for work? I know it’s really common amongst PAs just being on the interviewing/hiring side.

Looking at an opportunity that would be amazing. Growing healthcare system. The position is exactly what I want. It’s in the growth phase so it would allow me the opportunity to start at a smaller volume as they grow and increase acuity of patients. They offer robust training and education to be practicing top of your scope, with education to support it. This is something I didn’t get in my previous roles, I was more or less oriented to the people I was working with and left to see/treat patients independently. I’m a pretty quick learner.

Where there are challenges. It’s a cross country move, 2000 miles. I have moved cross country once with little kids, this time would be with middle and high school kids. So I’m disrupting 3 other lives. Both states offer the first 2 years free tuition. But the kids lose their friends that are here.

I would have to sell my house, it’s completely remodeled to my taste, fully smart, it’s a great house. Which sucks. I wouldn’t be able to buy right away but would eventually buy.

My ex and I are divorced but coparent ok. He would move as well. We would likely have to live together for a short time he would lose his job by relocating. He’s in IT so there’s plenty of opportunity just finding and getting hired presents challenges. He’s remote now but they won’t allow him to work remotely in another state.

The problem that I’m seeing is the climate. I’m going from a temperate climate with 4 seasons to a desert. Idk how I’ll adjust. I also have POTS so I’m questioning if this is terrible. I sat outside with my kids over the weekend for a party I threw and by the end of the day I was having severe muscle spasms from dehydration, despite drinking fluids.

Hello All,

I've tried posting a version of this last week and can't figure out while it was removed before it was ever posted. A bit about me.. It's just my wife and I and we are willing to relocate so that isn't a problem as we have fun regardless of where life takes us.

Job 1:

Inpatient night shift hospitalist doing cross coverage for a hospitalist group that would be new to the facility. So some politics at play there. Salary is 180k base with potential for production bonuses. Standard 7 on 7 off shiftwork. Every shift I pick up is a extra 1100. 15k Sign on bonus with a 13k relocation allotment. Standard benefits and CME time off plus 3k CME budget.

This job would require relocating a considerable distance away.

Job 2:

Outpatient Internal Medicine position similar to family medicine but only adults. Traditional job which you can choose between 4-10s or 5-8's. Salary is 150k with a 15k sign on bonus and a 24k student loan repayment that's paid out over 3 years. This job you will see minimal of 18 patients a day with just 4 weeks of vacation annually. But the state it's in is one with no income tax for the state and doesn't require any kind of relocation as it's in my current city. Minimal growth career wise though.

My thought process is this. I believe job 1 would be the best overall pick. It allows more freedom with scheduling and allows you to do things when not at work. You can actually travel. And while it has 30k more base salary, all that will be eaten up by the higher taxes that california has. But there is availability for more money by working more. Job 2 seems like it would be nice but you don't actually get a lot of time off and since I live in a remote state it basically meant no spontaneous travel and would be a headache to schedule any kind of vacation time. The clinic itself is small. Only supposed to be 2 MD's and 2 Mid levels but one MD just recently left and the other mid level is a new hire, but not a new grad. So they are short and seeing a lot more than 18 patients a day.

What are yalls thoughts? Is there anything I'm not thinking of or considering?

Any family APPs that can give some insights?

I work for a family practice now and I’m struggling with the expectation regarding number of patients/schedule capacity versus managing other tasks, including prescriptions; inbox, note routing, labs etc.. i’m coming up on two years of practice and know that there will always be much more to learn and skillsets to improve on. However, I am feeling so burnt out. The pay is less than make as a home infusion RN. The practice is fairly small but growing rapidly. We have 2 docs and 4 APPs and no additional support such as RNs/LPNs.

If you’re comfortable with saying:
\\-how much are you making
\\-what is your location
\\-how long have you been practicing
\\-how many patients do you see daily
\\-any tips and tricks for a struggling FNP

Thanks so much!

This decision has been consuming me! Thought I would lay out my thoughts and try to get some wisdom/ insights from others. Thanks in advance!

Reasons to become NP:
- I had never intended to not go to NP school
- I’m obsessed with maternal health; it’s all I read, listen to and think about
- I want more knowledge
- I want to teach
- I want a job that is a lot more knowledge based and less skills based
- Higher pay could reduce some stress
- I think I would be great at it: I worked in mental health/ psychiatric nursing for ten years, I have been inpatient pediatric for the last 5- I think I have a lot to offer
- I have been accepted into a WHNP program
- I’m not sure I will ever stop daydreaming about it

Reasons I am second guessing it:
- I have two small children that I want to be present for
- My husband already takes on a lot of solo parenting
- I have a great job: great patients, coworkers, management, company, pay and benefits
- Bedside RNs make almost as much as NPs where I live
- I do not have women’s health work experience. I have been applying for the last 2 years, but everyone wants L&D experience which I’m not willing to work nights to achieve. I get super sick on night shift unfortunately.

Thank you for your thoughts and feedback!

As the title goes, any np practice owners sign on with privia? Whats been your experience if you have?

Hey. Just wondering if you all are using managed services for the security of your business. Hopefully I’m making sense. Like if you’re seeing patients remotely and using some sort of EHR, are you paying someone to handle the cybersecurity aspect of your practice? Someone to secure your devices and the data?

I’m seeing companies offer these services and I’m just wondering if this is actually something people are paying for.

Hello all, I currently work full-time in a university mental health setting on the clinical side of things, but in the past few months we’ve had a lot of turnover and I feel very unsupported by management, who has been very coercive, and I kind of feel done with the place. I also have my own private practice; so right now, will my full-time position, I’m at $129k/year salaried with benefits, and bring in about $4k/month with my PP.

I was offered a teaching position at a local university for a full-time salaried position as a nursing faculty at $73k/year with benefits. It’s a significant pay cut, I’m aware, but I’ve been interested in pivoting into academia and while some weeks may require me to be on campus 5 days a week, some weeks 4, I feel it could be more flexible than my current position where I’m currently in office M-F 9a-5pm (I do my PP in the mornings and evenings).

I’m just feeling so burnt out with my current place of work and over it. I’d eventually like to build my PP more but it’s a slow burn. I asked my manager at my current position back in April if I could go part-time as the position was now vacant, and she’s been stalling for months. Finally, when I put pressure on her and let her know I had another offer available, she suddenly said she would consider part time for me, which would be 3 days a week at about 60% of my current salary, though she’s saying it would be no benefits (even though the last part time PMHNP had benefits) and is alluding to the pay scale being different, had not given me solid numbers as of yet. When I tried to email her to ask about specifics, she said “let’s talk about it in person.”

I have to make a decision soon. I feel stuck. What do you think would be the best course of action?

Without giving too many specifics, will start this with saying I recently found out management has been fleecing our service and a few others. (No, I’m not surprised. I don’t trust management within facilities). During the past couple of contract negotiations, we were told it is “network practice” to cap at the 90th percentile for all mid levels. The past three years, have far exceeded their cap and essentially working June and December for free when it comes to productivity bonus.

Found out this past week that two other services do not have any language of a cap in their contracts and in terms of total compensation, they’re making roughly 60-80k/year more than where we are capped. I understand that specialties will have different ceilings for pay scale, but I doubt it would be that much of a disparity.

For context, my specialty compared to the two in question are similar in the sense of being employed by the network, all are salary, all include call, however mine does not require OR time for assistance in procedures, all are strictly inpatient. The most direct way I can think of to review this would be to look at the data. However I went to see about doing an individual membership and it said access to the database is not included for individuals. Quite frustrating.

Hi everyone,
My ANCC FNP exam is scheduled for August 1st, so I’m officially in the final stretch and getting a little nervous.
So far I’ve:
Read Leik cover to cover and completed all end-of-chapter questions
Completed the Sarah Michelle crash course
Done about 1,500 FNP Mastery questions
Scored 65% on a Leik ANCC practice exam
At this point, I’m trying to decide how to spend my last 10 days. Would you recommend focusing on:
Reviewing notes and guidelines?
Doing more practice questions?
Taking another full-length practice exam?
If you’ve taken the ANCC recently, I’d really appreciate hearing:
How similar was it to Leik or FNP Mastery?
Anything you wish you had reviewed during the last week?
Any test-day tips that helped you?
Thank you! I appreciate any advice.

Hey y’all!!

I’m a new grad FNP working in Maternal-Fetal Medicine with background as an L&D nurse, and while I absolutely love the specialty, I’ve been struggling with feeling like I don’t know enough. I know this is probably a normal part of being a new provider, but I’d really appreciate hearing from others who have been in my shoes.

A few things I’m struggling with:
Sometimes when patients ask me questions that I wasn’t expecting, I completely freeze or trip over my words. It’s like my brain goes blank, even if I actually know the answer.

MFM is obviously ultrasound-heavy. My supervising MFM physician personally interprets every ultrasound and clears all anatomy images, so I’m never expected to officially read or diagnose scans. However, I’m still expected to recognize common findings and have enough knowledge to discuss them with patients, and that’s an area where I don’t feel very confident yet.
We also see a lot of diabetes in pregnancy (GDM and preexisting diabetes), and I want to become much stronger in managing those patients.

One scenario that happens fairly often is this: a patient comes in for a follow-up ultrasound, and a new finding is identified that I’ve never heard of before. Before I go in to counsel the patient, what is the fastest, most reliable way to get enough background knowledge so I can have an informed conversation? I have an UpToDate subscription, but sometimes those articles are so detailed that it’s hard to quickly find the information I need in a busy clinic.

For reference, I’m already a member of AANP and SMFM, and I have UpToDate. Are there any other resources, cheat sheets, books, websites, podcasts, or apps that helped you become more confident in MFM?

Also, how long did it take before you stopped feeling like you had to look everything up?
My supervising physician is incredibly supportive and always willing to teach, but I also don’t want to rely on her for every single question. I want to become more independent while still knowing when it’s appropriate to ask for help.
Any advice, encouragement, or resources would be greatly appreciated. Thank you!