In identifying what my specialty and professional setting I intend to work in as a nurse practitioner (NP), I have decided to focus on family medicine. I prefer to work in an office. I have chosen this specialty and this setting because I feel that it would offer the best opportunity to apply the best of both worlds of my training as a nurse and as a medical practitioner. As Sangster-Gormley, Martin-Misener, & Burge (2013) state, the nurse practitioner has from the nurse aspect of the position “the skills and training to look at the patient’s needs from more of a holistic, psycho-social as well as a physical aspect [NP]” and can therefore “manage more fully the whole impact of the patient’s illness or wellness and also deal with the family” (p. 6). This best-of-both-worlds opportunity is very attractive to me. Furthermore, being a NP offers me the combined opportunities to more actively engage in patient education. Whereas a traditional doctor would diagnose a patient and prescribe the appropriate medications, leaving patient education to the nurse, the NP is able to diagnose, prescribe, and offer patient education in a more meaningful way. Research has demonstrated that this multi-faceted ability on the part of NPs leads to better patient outcomes (Conlon, 2010).
In my position as a family medicine NP, I will likely have the following roles and responsibilities, according to the Campaign for Nursing’s Future (2014) website on “Family Nurse Practitioner”:
Diagnose illnesses
Prescribe medication and therapy
Conduct routine check-ups
Order patient lab tests
Assist in minor surgical procedures
Focus on disease prevention
The extent of my performance or involvement in these roles will depend on the laws and regulations of the state in which I ultimately choose to practice, of course. But these basic roles form the scope of my practice.
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I would prefer to join or start a private practice, rather than joining a retail-type medical clinic setting. I imagine that I would have patients scheduled throughout the day. The roles described in the last paragraph would be the kinds of activities I imagine I would be performing. I suspect most of my patients would be children and adults with normal health complaints such as sinus infections, respiratory infections, common childhood maladies (like chicken pox), and adults complaining of age-related or health-related issues (like high blood pressure). In cases more complex than these, my role would be to make arrangements for them to see the licensed doctor OR to develop a referral to a specialist like an otolaryngologist.
I’d prefer to work in an office setting. I’d rather have the opportunity to really get to know my patients and have good relationships with them, cultivate their trust and encourage them to seek medical attention in the right circumstances. It would also afford me the opportunity to better monitor chronic situations like diabetes or chronic sinusitis and better help those patients with management. It would afford a more intimate connection with my patients which I think is important to meaningful health care.
As far as compensation, I expect conventional insurance benefits – health and life. In terms of salary, the mean average salary of NPs was “$91,450 as of March 2013” (HCS World, 2013). Salary, of course, is usually commensurate with experience, so I don’t necessarily expect $90,000 out of the gate. I think I could reasonably expect between $70,000 and $80,000 in terms of salary – roughly $35-$40 an hour (HCS World, 2013). HCS World provided me with the benchmarks I have used for my expected range; HCS World utilized Bureau of Labor Statistics in developing their calculations. I recognize that the salary will be dependent upon a variety of factors including the size of the practice, the standard of living wherever the practice is, industry demand, and my years of experience.
In terms of what I am willing to negotiate and what I am not willing to negotiate, hours are negotiable. I am willing to work a rotating schedule of evenings, weekends, and holidays, if the office I end up working for offers evening, weekend, and holiday hours. I’m willing to negotiate on salary, within a given range of $65,000 – $85,000, given the factors mentioned in the previous paragraph that may influence salary. I am willing to negotiate on the doctor’s choice of which patients he or she may choose to see without letting me see them. I respect that some people may be uncomfortable with seeing a NP, or that they may have an established relationship with the doctor, which is valuable in helping improve and maintain wellness. It is more important to cultivate trusting relationships with patients which enable us to do what we need to do more effectively than getting involved in power-play.
Non-negotiable things are a bit trickier. I would not be willing to work for a boss whose religious beliefs meant that they avoided certain treatment options because they may conflict with the boss’ belief system. Needless to say, I would flee in a heartbeat if I discovered my boss practicing in unethical ways, and I would have no qualms about reporting said boss to the proper authorities. My job is not worth the violation of the medical oaths I’ve taken, nor the lives which might be put at risk by my boss’ actions. I would be reluctant to negotiate a salary below $65,000. I would unwilling to work for someone who treated their practice like a conveyor belt. I need to be able to treat people as whole beings, not just diseases, disorders, and illnesses. I appreciate efficiency, but that doesn’t mean I should have to sacrifice bonding with patients. How can they trust me if I don’t treat them like people? That would a problem for me.
- Campaign for Nursing’s Future. (2014). Family nurse practitioner. Johnson & Johnson Services,
Inc. Retrieved from http://www.discovernursing.com/ - Conlon, P. C. (2010). Diabetes outcomes in primary care: evaluation of the diabetes nurse
practitioner compared to the physician. Primary Health Care, 20(5), 26-31. - Sangster-Gormley, E., Martin-Misener, R., & Burge, F. (2013). A case study of nurse
practitioner role implementation in primary care: What happens when new roles are introduced?. BMC Nursing, 12(1), 1-12. doi:10.1186/1472-6955-12-1
