I am an FNP and have started a new position in an academic (read "with Residents") setting.  I'm working in GI surgery and am creating my own job and duties (it's a new position).  Has anybody else done this?  What are your duties?  How much "intern" work are you doing versus just assisting the interns with patient care?  I'm currently helping with putting daily orders in the computer (we only have 1 first year this month) and this takes probably 75% of my day.  We have one of the largest in-patient census' in the surgery department.  I know that I along with my 2 attendings are the one constant in caring for these patients as the residents change monthly or bi-monthly.

 

Thanks for any help you can give me. 

I too work in an academic hospital setting.  My collaborating surgeon is the Chief of Surgery, although I cover pts for 4 other general surgeons.  We have 5 residemts and 4 med students.  The chief resident runs the show, the third year covers thoracic surgery, the second year primarily is learning to operate, and the interns (2) cover the pts on the floor (orders, review of labs. . .)  I primarily manage the SICU pts as well as any "sick" preops or "complex" floor pts, consulting w/ the surgeon and/or cheif as necessary.  As I am a CRNFA I also spend time in the OR one or two days a week.  I 've been there just over a year and find the role although rewarding, a great deal of the time, terribly confusing!  I've found it difficult to figure where I fit in.  Sometimes I'm the intern, sometimes I'm the cheif, and sometimes I'm independent.  As I've been through several rotations of residents over the past year I find it best to tell them from the begining what I do according to me.  My collaborating surgeon(s)  I think views me as another resident but like you say a "constant" and he's very used to residents and deals primarily with the cheif.  I do an excellent job on a daily basis and my prescence has made a difference - at the end of the day I give report to the resident on call and/or cheif depending on how ill my pts are.  So you see it is not clear to me either, but because I have developed such a good working relationship with the nursing and ancillary staff and really like the institution I stay.  If you have any tips please forward.

Thanks Patti

Patty,

I actually got so frustrated that I have given notice and found another position back in private practice.  For the most part, I have been acting as an intern while the real intern went to the OR.  I have a great rapport with the nurses, social workers, and pharmacist.  What I found to be my biggest problem was the work day lengths.  I've put in anywhere from 9-12 hour days, 5 days/week.  I was actually informed after Christmas that this is what is expected of me.  Well, for me, that interfered with my family responsibilities and my daughter was suffering because we didn't get to spend any real time together before it was time to go to sleep.  I know that I do a great job on a daily basis, but, for me, the pay-off isn't worth it.  

 

Robin 

Good for you - If something came up, I would most likely consider it but things are going well enough at this point, that I'm not actively seeking another position.  The best thing agout our role is that we are in demand and we have many choices because of our flexibility!  Best of Luck.

Patti

I know this is late to add any input, but it seems to me that if you are inputting orders into the computer, that is a clerk or maybe an RN job, not that of a NP. It seems you're not getting the most out of your education.

LOL. As I re-read what I wrote, I hope that it doesn't sound accusingly towards you. I just don't think they are utilizing you well. You're in a unique position that you are creating a new position. I have done that once before and it is difficult. There is always some "fine tuning" to be done after you've done your pre-planning and started the job.

Best of luck.

Tom

Hello Robin,

I am a FNP working in an academic setting, inpatient Oncology unit. I have been here for a year now, and initially it was quite overwhelming trying to figure out where you belong, and defining your role and responsibilities. I enjoyed the opportunity at what I thought would be to create a new model nurse practitioner centered. I am on a team consisting of medical residents (rotating every month), and attendings rotating. I am at a point where I feel like a junior resident. I am the continuity for the patient, and the resource for the residents, but my work is monotonous and I am looking for a role that will expand beyond just rounding the patients in the morning and completing paperwork, as well as inputting orders during rounds. Being in a surgical setting you appear to at least have that component that could offer you some more challenges and opportunity to do more than just do rounds and physical assessments. It was a good year as a new grad to establish myself, and assimilate into my role as a nurse practitioner, but now I want more to my role and responsibility. I am looking to do more with outpatient and community with some research components. Good luck to you and I hope you can maximize your role and model.

I know this is a late reply as well.  I work in an academic setting as well with duties including office and a "free" clinic.  I enjoy the diversity and the students.  I have only been practicing since last October; however, I feel that I have grown in leaps and bounds.  I actually feel more comfortable in the in-patient setting due to this was mainly my RN background as well.  I know how to get things done in the hospital but am still learning the ropes of how to send patients to needed procedures etc in the outpatient rhelm.

I think in an academic setting like all roles, you need clearly identified expectations and role responsibilities prior to starting.  So I agree to someone who had written about the role needed pre-planning.  The students on service roatae through based on their schedules so does our physicians.  However, I see one of the stronger assets that I bring to our inpatient list is that I am the consistant member and can assist the physician or resident with what the plan was for the patient from the onset. 

I am sorry you grew frustrated with the situation and took other employeement.  I hope others continue to forge new roles for us as NP when given the opportunity.

Laurie

I found I was definitely being used as a junior resident.  I was part of a team of rotating residents and a pair of stable attendings.  Like you, I was the continuity for the patients, rounded early and completed "paperwork."  Ours was all on the computer as this facility is a mostly paperless one.  Unfortunately, the intern viewed me as "someone else he had to keep track of" and not as a resource at all.  After finding out that I was also expected to work intern hours, I sought, and found, employment elsewhere.  Academia is just not for me.  I love private practice.  My new place of employment is great.  I am building my own patient log so I see only new patients currently.  I have 1 hour per patient, so I'm seeing 6-7 per day right now.  My follow-ups, when they start, will be 20 minutes long.  My providers are caring and helpful.  At least one checks in with me every couple of hours to make sure I'm ok and not stressing about anything.  I have my own private office as well and can bring my child with me to work, if needed.  I can't beat that anywhere else.

Tom,

 

My hospital is "paperless" so everything is done on the computer and sent to the unit clerk who then takes it to an RN to be implemented, if it's an order.  Only progress notes were still being written.  H&P's as well as full discharge summaries were all done on the computer.

I am very happy in my new position, far away from academia.

 

Robin 

I am currently working in the Department of Surgery with residents and interns. I have previously worked with Internal Medicine residents/interns.  When I was working with Internal Medicine, I covered the residents/interns patients on their day off. I also helped with through-put trying to get the patients out of the hospital.  That may have meant helping with paperwork, following up with diagnostic tests, writing orders to facilitate the process.  It was very "loose" except for covering on days off. However, I was the continuity person, with the residents/interns changing rotation every month.

Now I do similar things with the general surgery residents, but I am in a Community Residency program, rather than a University program. This makes the number of people that I intervene with much smaller. At the beginning of the academic year I mostly write the post op notes on all the post op patients that are ready before I leave for the day (the rule of thumb is no post op note until about 3-6 hours after surgery). Later in the year, when I am sure that the residents have had the experience, I do consults, pre op notes, H&P's.  I also have a specific group of general surgery patients that I follow pre op, perioperative and post op.  The residents/interns usually come to me for guidance on what to do for this patient population. I am available to do some procedures, but I find that the interns/residents usually need to get their numbers, so this does not happen often.  Again, I am busier during days off/vacations or when the residents/interns are rotating off the general surgical team for a specialty rotation ( e.g. burns, trauma, transplant).

Hope this helps somewhat.

Jackie Sullivan