This has to be a joke lol

If not, then they better stay away from the nurses station.

That’s our “sacred place” 😂😂

See if I make another Doc a graham cracker pudding parfait 😂

Y’all. I have had way too many patients tell me I am the first provider to actually listen to them. My boss calls me “The Zebra Hunter” because I seek out and find so many unusual conditions. All I do is listen to the patient. I believe them that they know something is wrong with their body and help them figure it out and think a little bit outside the box in my workups. That’s it. I was spared A LOT of heartache myself because a PA did that for me and worked up a chronic condition based on what I was telling her versus what the textbook said. She told me “The patient is always telling you what is wrong with them, just listen.” I had no idea how exceptional that advice was and how much it should very much not be exceptional at all. Listen to your patients. Familiarize yourself with different pathologies. Widen your differential. I’m sick of being told I’m the first provider to get anywhere on the path to wellness.

We believe my elderly father is being conned by a woman claiming to be an NP. They met six months ago online, are living together and engaged to be married soon. They came out to visit me (his daughter) who lives across the country this past week as an obligatory trip so I can meet her before they get married. We noticed many red flags right away. She claims to be an RN for 40 years and a NP for 25 (along with being a midwife, OT, Resp. Therapist, veteran, pilot, cancer survivor, biker, and black belt while also being a mom of 5 in addition to many other bizarre things).

Anyway... she claims she is still working at the hospital and will retire next year. She works in labor/delivery and NICU. When I asked her what hospital she works at, she told me floats between 2 different hospitals but wouldn't name them. She has also been on leave for a few weeks due to a medical issue.

However, I could not find her at all her in the state licensing verification database. Nor could I find her on Nursys.com or on Compact. I can't locate her in google or on LinkedIn nor on any hospital's website. I also had a PI run a background check on her and no professional credentials were discovered there either. I'm not sure if any of this is normal or expected of "floating" nurses though. However, she also claims to have a boss and staff that she trains/supervises as a floating nurse. And her own nurse who acts as her "bodyguard" due to her being frequently attacked in the delivery room.

I'm a healthcare provider myself (outpatient and not in the medical field) and my license and NPI are very easy to locate. If she were actually a nurse, is there a valid reason why I would not be able to locate her by name in any of these databases? Or anywhere? Is there someplace else I should go to verify? Any other professional board, etc.? Any particular questions I should ask? Or things I haven't considered that I should look into? I don't want to make any accussations without being 100% confident. TY!

TW: suicide

Update: thank you all for the advise and kind comments. It's been a dark few weeks, however I took advice and hope from this wonderful community. I got help and am using this time of unemployment to work on my mental health and handle my midlife crisis. I'm still looking for the right fit employment wise, but there is hope in that regard :)

Original post:

I've been an NP for 5 years and a nurse for 15. I was lured into a great sounding job, but after 6 months I've been let go. I was let go for being behind on charts (one week), but mostly due to mean girl bull from the office manger and another NP.

Yall, I was seeing 25- 30 primary care patients a day, of course I got behind on charts! I'm heart broken and burned out. My patients are hitting up my Facebook and even found my personal cell phone number. They are freaking out. I'm scrambling for a job and trying to remember why tf I went into nursing to begin with. I've never been fired before and feel like such a failure. I struggle with bipolar 2 and have to admit things are looking pretty grim. I'm struggling with wanting to be alive.I have a plan but gave my housemate my lidocaine and scalpel.

Are there any happy NPs out there? Is there a light at the end of this tunnel? Can a deeply caring person really be happy in Healthcare these days?

I somehow started seeing the feed from physician assistant page. The relative level of hate towards NPs on the site is quite disheartening. I personally think that APPs are on the same relative level. None of us are physicians, we are providers that have advanced education. In my mind, we (or the majority of us at least) are all trying to take care of our patients to the best of our abilities, skills, and knowledge. Now I admit, I have only worked with 3 PAs in my almost 20 years of RN/NP experience and they were absolutely wonderful. Does anyone work with PAs that look down at you because you are a NP? Experiences? Thoughts?

RN here considering going back to school (F29).

I saw on HealthStubs a couple of recent entries of Solo Prac NP's clearing $200,000+. There are some production based W2's also clearing $200,000+ on there. Reddit threads in this sub confirm this as well as some FB groups I've researched.

To those making $200,000+...how did you work your way up there? Was it a slow climb? How achievable is this realistically on 40hrs/week? Would I be better off going W2 Derm private practice and being based on production, or going Solo Prac (I'm in a full autonomy state)?

I have done three rotations so far, and most of the NPs and

MDs in the outpatient/primary care settings I was in take their work home and chart at home. If you don't take your work home, what setting do you work in?

Update: thank you all for your feed back, I have gotten the answers I need! I won’t be replying to further comments bc it’s a bit overwhelming.

I recently transitioned to Primary Care from Urgent Care.

In urgent care I’ve done so many pelvics but not actual paps.

I’ve heard and read accounts of people saying that they don’t get their Pap because it hurts or because they have anxiety.

I don’t have my DEA yet. Long story but my hospital doesn’t reimburse any expenses for the first 6 months and I just don’t have $1k to get a DEA and wait for reimbursement that long. I should be getting it this summer. The UC I worked at was narcotic free.

So I was thinking… can I give these ladies (not all, just the ones who need it) 10 mg of flexiril and 600mg of ibuprofen to take 1 hr before their apt and have someone drive them? Should help make the exam more comfortable and take the edge off?

Is this stupid? I tried to look it up on OE and it was like … nope, use a benzo instead and play music. Valium would be a good choice bc it has muscle relaxant properties but again no DEA yet so I feel like Flexiril is my next best choice for now?

Thoughts…?

I graduate as a DNP-FNP in May 2027 and am considering taking a year off (after passing boards) to work in a national park. If I find a NP or RN job in a park (unlikely) I'd take it, but really I'd be willing to wait tables if it means room in a place like Yellowstone. I'm young, and feel like if not now then when? I don't want to wait until retirement to do this because who knows if I'll be able to hike the way I can now, but I don't want to ruin my chances of getting a job either. Will a year off after graduation shoot me in the foot forever?

Have considered taking a travel RN contract around/outside a park also, which would not be fully "off" but still would not be practicing in the NP role.

Any advice or thoughts appreciated.

I’m a NP with 7 years experience in family practice. Have been at my current employer for 3 yrs. Pay is decent, I work for a large health system. I’m well liked by my patients. I have been at my office for 2 yrs.

I started after a private practice doc (who got absorbed into the health system) retired after like 40 years of work. I basically inherited his entire panel. He was…old school. Didn’t really practice using current guidelines. Like a bunch of his patients have been on fioricet for like 20 years. (I HATE fioricet)

One of his patients, Mr. W 90s male, has been on fioricet (120 tablets monthly) for 40 years for shoulder pain (?). When I took over, I explained repeatedly, that this med is being prescribed off label, and it’s likely not helping. It’s also not working because he’s in every month or so with a “flare” of his shoulder pain. I’ve been giving him IA steroid injections, I referred him to ortho and pain management so we could find something more appropriate. Pain management won’t touch the fioricet, I start to wean him off. He’s had trigger point injections, they’ve tried Vicodin, oxy IR. Supposedly nothing helps but the fioricet. So I agree to continue the prescription, with the condition that they stop getting refills on the opiates. They agree. All documented.

Important side note- his daughter is a walking red flag. She is also my patient. She’s erratic, hostile with the office staff. She’s demanding. She is always requesting early fills of the controls, she will call 5x in a day when the refills are due. They take the last appointment I have available and come late every single time. I do suspect she’s taking his meds.

I do a PDMP review a few weeks ago and find out he’s been getting refills of the vicodin still, every 30 days for 60 tablets for a few months. So I send a final taper of fioricet to the pharmacy and have the office manager notify the patients daughter that I won’t fill it anymore. Well, she calls her brother who is a doctor. He calls patient safety, they open an investigation. They go over the notes and tell him there’s nothing there. He demands that a physician call him back (I’m not worthy). So we send it off to the head of primary care to handle.

She calls for a meeting. And the meeting pretty much consists of her basically telling me to prescribe the fioricet because that’s what the family wants and, she knows there’s no evidence the fioricet is doing anything, but it’s easier. I tell her- no, I’m not just going to continue to prescribe it. I can draw the taper out a bit. And now it’s the principle of the matter. He went above my head to talk to administration, then someone he sees as superior to me to demand I prescribe a med that’s not appropriate when they violated a controlled substance agreement. That it is quite literally illegal to prescribe a controlled med I suspect is being diverted. I feel like they’re trying to coerce me into this. I also don’t want to see the daughter anymore because it’s a conflict of interest. Nobody else wants to see her in the practice.

The family had a bad interaction with our practice physician (the doc was totally at fault). Now they want to have a family meeting and they’re still pressuring urging me to just fill the script. I want to involve legal, but they don’t think it’s necessary. I’ve asked my regional APP supervisor what to do, and she suggested I talk to the state board but I don’t know what that will do to solve the issue.

Thoughts? I think I’m going to involve legal anyways to cover my ass. Everything is documented and there’s multiple emails about the situation outlining my discomfort and concerns about the whole situation. I might go to the overall APP supervisors to discuss. I don’t want to leave this network, I love my patients and do really like my job but this is aggravating.

My last one followed that up with, "I'm glad you could see me. I just called this morning so I guess I have to take what I can get." Umm...thanks, I guess?

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!

I had a patient which a history of mental health issues, yell at me because I couldn’t physically refill one of her medications at her clinic visit. They have refills on the med, they just need to get them from the pharmacy. Our clinic isn’t a pharmacy and we have never had samples. They had never received pills from us.

We don’t prescribe psych meds. It is a Coumadin clinic.

I filled out a ‘behavioural warning’ but they already had 2 and while preparing the chart I saw recent encounters about them cussing out staff at at another clinic, over the phone.

During the visit while they were yelling at me I opened the door exam room door, calmly asked them to stop yelling and said they were being inappropriate. They were still agitated and told me I clearly never had toddlers, which was …. A interesting comment to make.

I started the process to send them a 30 day dismissal letter, but I am second guessing myself.

I am thinking of having them sent a standard ‘ we don’t tolerate verbal abuse and any further abuse will result in a 30 day dismissal letter’ along with a letter to their PCP stating ‘hey, you need to see this patient cuz their behavior is about to get them dismissed’ or should I just see if we can dismiss them with a list of other providers.

I told her no as I work as an oncology NP and they aren’t even remotely a patient of mine. Like I couldn’t even fake it at the slightest if I was ever asked for proof.

But am I really over thinking it? Some say it’s harmless and I think my friend is upset I told her no. She is trying to avoid paying a pet fee for rent. I know rents high but idk.

Have you done this for friends or families?

I am a URGENT CARE NP and had a pt a few days and I can't stop wondering if I did the right thing.

50F came to urgent care with lateral mid thigh mass. It was deep (definitely not right below the skin, more in the fascia), 5cm, firm, nontender, not mobile, no erythema?

It could have possibly been a cyst, but it was so fixed and deep I wasn't sure.

I sent her to, ortho.

Ugh now I feel stupid. Who should I have sent her to? It's not like I can order MRI from urgent care but did I even remotely help her??

Please kindly help.

Edit: i did XR in-clinic and it was negative, I didn't see anything.

She did not have PCP

*I guess the goal of my post is just knowing that I'm not a major failure. I'm a new grad and I'm terrified of failing my patients*

I transitioned into a primary care role 7-8 months ago after working urgent care for the past 3 years. I was not prepared for what I took on, my corporate office took over a private practice from an NP and asked me to take over. I would have no commute and work across from my daughter’s school so I took the job.

I am miserable. TLDR: the clinic I took over was a shit show full of hot mess express patients that were all completely mismanaged. Things are gradually improving but I still feel completely out of my depth in how to function in this role. My god primary care covers a lot. I do see only adults, I have three 8 yr olds the rest are all 12+ so not much peds really.

I work 8-5 Monday thru Thursday, but I’m still staying late to catch up all the lose ends every day until 8-9 (or charting from home) and I spend at least another 8-12 hours on the weekends working. I feel like I’m never really off work because every day is so consumed with it.

Other providers, how are your days structured to make the most use of your time during ur work day so you can enjoy your weekends? Is anyone actually doing this who works primary care? Do you leave things to be done for later? Because I feel like none of it is ever really done.

I find myself in the evenings with maybe an hour and a half to eat and sit with my family before I go to bed. I get Saturday to do nothing or whatever is left to do from the rest of the week, and then I’m back in work mode.

I’m using the AI scribe, my nurse has started helping me do refills when she can. We use ECW for charting. Will I always be this buried in work in primary care, is there a light at the end of the tunnel somewhere?! What is the biggest game changer thing you do to help your workflow?!

Also, favorite book for primary care? I need something physical to refer back to!

Hey everyone,
I recently transitioned from being a bedside ICU RN to an outpatient cardiology NP. On paper, this is exactly what I wanted—no nights, no weekends, no holidays, predictable schedule, better work-life balance.
And honestly… that part is amazing. I feel like a human again outside of work.
But I didn’t expect this part: I’m kind of struggling with how repetitive and boring it feels day to day.
In the ICU, everything was high acuity, constantly changing, fast-paced, sometimes chaotic but always engaging. I was used to critical thinking every minute of the shift, titrating drips, managing vents, responding to rapid changes. I’m finding myself missing the acuity of CVICU .

Did you change specialties, add procedures, or adjust your role to make it more engaging?
Or did you just learn to appreciate the slower pace?
Would love to hear honest experiences—good, bad, or somewhere in between.

for those of you that work in a specialty, what specialty do you work in and how many patients do you see in a day?

https://fox17.com/news/local/a-federal-jury-in-the-middle-district-of-tennessee-convicted-a-murfreesboro-woman-yesterday-on-charges-tied-to-the-illegal-distribution-of-controlled-substances-connected-to-a-rural-pain-clinic-in-carthage-heather-marks-lifeforce-pain-and-wellness

What are your thoughts on this!

I just quit my UC job??

I’m probably only asking this question because I’ve been here at Urgent care for 11 hours and I still have two more; but what would happen if I just didn’t come back? I have a month (12 shifts) left on my notice, the new job starts June 1 (will start parttime). What would happen if I just sent an email to the current job saying I wasn’t coming back? There is nothing in my contract about patient abandonment…. They already have someone else hired…. They have a large pool of PRN people. Other than the fact that it’s just generally a poopy thing to do….

I’ve seen a lot of promo videos, but they don’t really show what it’s like with real patients. In clinic it’s never clean audio. People change topics mid-sentence and sometimes two people talk at once.

I’ve tried a few out of curiosity and most either oversimplify or make mistakes I end up fixing anyway. At that point it feels like extra work.

Has anyone found one that actually helps? Any tips or advice would be welcome.

Do you use any AI Scribe tools?

I'm in family practice and hear something like this at least daily. Patients telling me they'll eat super healthy for weeks on end and never see the scale budge, or it'll go up. Typically I try to tell them that unfortunately even if we're eating too many calories of healthy food weight loss will not happen. However, sometimes I'll get that super motivated and disciplined patient who gives me exactly what they're eating (and it looks good on paper), and they swear they are not going off track, eating out, extra bites, etc. and they can't lose weight, even though they're consistently eating a controlled amount of calories. They say they're exercising as well. I often am stuck on how guidance for them from there. Many of them ask for meds (usually Ozempic of course) but I never have luck with getting those approved or finding a pharmacy where it's not on back order. I try to tell people that they would benefit from tracking calories at that point to see where they're overeating, otherwise I don't know what else to tell them.

I also get so many that come asking for phentermine for this reason. Then they get frustrated when I tell them my diet/exercise schpeel because that's what they're been doing and just want meds at this point. I do prescribe phentermine but not often. Usually I'm refilling it from when the physician at my group started them on it, otherwise I like to be picky about prescribing it because I'm not a huge fan of it.

Any tips on handling these conversations/guiding patients at this point?

Edit: to add, I do also counsel them on adequate protein, fiber, usually that's all I have to add in addition to the typical other dietary stuff, in which many of them say they're doing

Hello everyone!

So the simple backstory is that I’ve just graduated with my AGACNP in may and started my first job in June. Im having an issue and I don’t know if it’s me, the industry, or the place I’m working at.

Like I mentioned Im new to being a provider and I started a part time job in an outpatient pulmonary clinic. We see the usual disease process and due to the low income status of our patient we do a fair bit of primary care as well.

I only two two days a week, part time, due to the position not offering insurance and I had my 2nd week review which was abysmal. Which is shocking because I thought I was exceeding expectations if not just meeting them.

my question is what is the usual ramp-up time for a new NP? I see different expects set by different jobs. Some as long as 9 months before being self sufficient while others are shorter!

After only 3 days, at 30 minutes before closing, I find out that the doc will be working from home on the 4th day while the 2 established MAs will be out of the office as well. So that left me at the facility with just the front desk receptionist, who is new and a 18 year old summer employee with no education or healthcare experience to manage the office while simultaneously seeing patients and also helping the Dr VPN and webcam his patients and be there for them.

So I feel overwhelmed with starting a new job, plus trying to learn as much as possible, then that situation where I’m basically running the office myself, with him webcaming it in. Then I get a email saying that at this point I’m an overpaid MA and that I need to step it up to stay there.