Tag : NP professional issues

Employment Contracts and Never Having to Say You Are Sorry

Count contracts among the top things you want to get right, or as close to right, as you can before you sign on the dotted line.
TIMING IS EVERYTHING
You should receive a copy of the employment contract either at the same time the offer is extended to you or shortly thereafter.  NEVER, EVER accept an offer until you have had time to fully review the contract.  In my experience, it is not so much that NPs and PAs regret the items they agreed to in their contracts as much as they lament what they neglected to include.

A typical contract is 1-2 pages and commonly uses boilerplate language.  It is sort of a one-size-fits-all form where the employer fills in the proposed pay rate, whether employment is full time or part time and a general description of benefits.  Many may also include a non-compete of some sort.

 
THE BALL IS IN YOUR COURT
Upon receipt and review of the contract you can either 1. accept it, 2. reject it, or 3. negotiate the terms.  Life is easy if you just sign it, which is what the employer is hoping.  And to be honest, quite a few of us feel just a little intimidated and so we close our eyes, hope for the best and comply.  Why? One reason is because we lack the training on employment contracts.  This is especially true for the new graduate NPor PA who has no prior experience in contracting and feels unsure about what is appropriate or how to respond.  It can also be a little intoxicating to receive that first job offer. I often compare it to a marriage proposal in which we are so flattered that we just say “yes” before thinking it fully through.
COUNTER OFFERS
Contracts needn’t be “standardized”. It’s your prerogative to negotiate and you can choose to include anything that is important to you.  In addition a wise NP or PA will clarify any points that they find to be murky or lead to possible confusion down the line.  So, rather than just signing as is use the option to add or delete information and send the edited the contract back.  That’s called negotiation.
*Note – etiquette dictates that you submit a counter offer only once. Employers have little appetite for a prolonged back and forth so you need to carefully think through your response.  In other words, you don’t want to find yourself in a situation where you are countering your counter.  Know your bottom line and leave it at that. 
WHAT TO INCLUDE
Wouldn’t it be nice if you had a handy checklist of items so you could more fully evaluate a proposed employment contract?  I want to share with you a reference that is the most comprehensive list for contract negotiation that I have come across.   It is identified as a “sample NP contract” but would work nicely for a PA as well. Click here 
The only thing I disagree with in this sample contract is the term length.  The sample utilizes a term of 5 years.  That’s an awful long time to commit to a new relationship!  I suggest a shorter term of 1-2 years.  Healthcare is changing rapidly and a shorter term gives you the chance to renegotiate sooner.
If you need more explanation on how healthcare changes can impact your employment please read my article “Contracts:Avoiding the Wrong Regrets”

 

I’m sorry, I couldn’t hear you over what your clothing was saying!

Initial impressions are strong and lasting.  It has been said that we will form our opinion of someone within the first 5 minutes of meeting them.  Of course, since we cannot truly begin to “know” another person in only 5 minutes it only stands to reason that our first opinion will be based mostly on what we can readily observe.   

Let’s apply this information to your next job interview.  An interviewer’s first, and most conscious, observation is going to be your attire and grooming.  Both of those factors create a very strong first impression. Unfortunately it is one of life’s little ironies that bad impressions will tend to make a bigger impact and last longer than do good impressions.   

 

This is why you need to get it right.  If you want to have a successful interview and get hired it is essential that you be remembered for what you had to say rather than for what you were wearing. 

Do not make these 3 mistakes: 

  1. 2001 is calling and wants their outfit back.  You really should update your interview wardrobe more often that you vote in a presidential election.  Yes, even the “classic” looks change over time.  Have you been holding on to an old suit because you think it will come back in style? Oh it will, but those sneaky designers will change it just enough that everything you saved will now look old rather than retro cool. 
  2. It’s never a good idea to look too trendy during your interview either.  Here is another tip – if you look in the mirror and think “oh, that’s really cute!” then don’t wear it.  Adults shouldn’t look “cute”. When you interview you want to appear to be professional not juvenile.  Stay away from loud colors, flashy shoes, plunging necklines and pretty much anything else that could do double duty on a Saturday night at your favorite nightclub.   
  3. Remember, it’s an interview and not a date.  Keep your jewelry simple, skip the perfume and tone down your makeup.  I recently interviewed a perfectly nicely dressed and otherwise very mature candidate, that is, except for the white sparkly eye shadow she was wearing.  I couldn’t stop looking at it!  What was she thinking? Well, I know what I was thinking – here is somebody with poor judgment

Stress is Contagious all Year Round

 

Have you heard about “secondhand stress”?  Turns out that stress may be transmitted from one person to another as easily as germs.  Dr. Amit Sood, who is an expert on stress at the Mayo Clinic, recently told the Star Tribune that “Stress travels in social networks,” and “It is highly, highly contagious.”

 

No surprise to any of us who have experienced stress in the workplace.  All it takes is one chronically anxious or irritable co-worker to start the wheels in motion and next thing you know the whole atmosphere at work has become toxic.  Early symptoms include decreased productivity, lack of morale and general mistrust.  Eventually, if not treated will result in chaos, back-stabbing and rapid staff turnover. 

 

No one wants to work in a toxic workplace.  The problem is that like many disorders, the condition is not always apparent to the casual observer.  And some organizations have become quite skilled in hiding their dysfunction. 

 

Since there is no known vaccine to prevent secondhand stress the best defense is primary prevention. In other words, you should avoid contact with the afflicted. 

If you are searching for a new Nurse Practitioner job,
the following suggestions will help you identify a potentially troubled workplace so that you do not fall victim to secondhand stress.     

Ask questions  

 

What happened to the person who was in the job before?  Why did they leave?  If your interviewer is hesitant or stumbles over their answer this could signal a problem.  Be especially alert for signs that the previous employee left suddenly or unexpectedly for reasons other than personal illness. 

 

Are there any other new staff?  If there seems to be an awful lot of new employees it could mean the organization or clinic has recently had a mass exodus.  If that is the case then you need to know why all those folks left.  

 

How long has the clinic manager been in their position? If there is new management, it could mean the organization is currently undergoing big changes and staff is still adjusting.  Some changes might be good ones, but change is still stressful.   

 

How long has the position been open?  Some jobs are open a long time for a perfectly good reason, but it could also mean no one wants the job. 

 

Do some cyber-snooping

Google the organization.  Many healthcare websites have ratings and allow comments.  Disgruntled patients can be a sign of an unhealthy environment.  Facebook and twitter might also give you a snapshot of what employees and patients are saying about the hospital or clinic.  Granted there will always be a one or two complainers but if you see a pattern then you should start to wonder what is going on. 

See for yourself

 

If you still have that nagging feeling that something doesn’t seem quite right you might consider asking for a “Shadow day”.  It’s easy for an employer to put on a good face or talk a good game during an interview.   Spending a half or whole day shadowing is a great way to get a feel for an organization.  Stress is hard to hide.  According to the article, the source of the stress can be compared to a vibrating tuning fork that causes everything close to it to vibrate as well.  Trust me, it won’t take you long to pick up on vibrations. 

Successful Job Searching after 60

Many of my posts are aimed at the New Graduate NP or PA but recently I had a question from a reader who was concerned about finding a new job after 60.

Dear Career Coach: I am wondering if you have any thoughts or advice about finding a job after age 60. I have been in practice for about 18 years. I am finding it rather scary to quit my job because I am worried about whether I will really be able to get another job. What do you think?

Dear Mature Job Seeker: Employers are looking for two main characteristics when they hire an employee. The first characteristic is your skills and expertise. After 18 years in practice I think we can safely say you should have no problem meeting that standard. But having experience isn’t enough, because the second thing most employers are looking for is employees who will stay with them for the long term. We all know that technically (and legally) an employer is not allowed to factor your age into their hiring decision, but I think we would both be kidding ourselves if we think that an employer is eager to hire someone who is within shouting distance of their retirement. The truth of the matter is that hiring a clinician is expensive and time consuming, and employers don’t want to have to go through the hiring process every couple of years – especially during tough economic times.

One option you may want to consider is doing a temporary or locum tenens assignment. You might find that short-term assignments are a nice fit with where you are in your career journey. This is the one setting where long-term commitments are not required or expected. Assignments can range anywhere from a few weeks to a year in length. When I was recruiting I filled many of my temp positions with “mature” clinicians who liked to work temp positions because they enjoyed the freedom and the variety. And did I mention the pay? Temp jobs usually pay very well. If you are willing to travel the opportunities are even greater.

Teaching is another idea you might want to entertain. Many colleges and universities employ folks in our profession in an “adjunct” type position to work with nursing or other healthcare students. They may have a need for teaching or assisting with specific courses or for supervising the students in their clinical rotations.

Above all, no matter what your age, I never advise that you quit your current job until you have a new job secured

Click here to read my original post and comments. 
Seems I stirred up a bit of controversy!

More reasons to hate on the term “mid-level” – as if there weren’t enough already…

As many of you know I do not particularly care for the term “mid-level” practitioner.  Just in case you aren’t familiar with my opinions on the subject you can read one of my posts from May 2012 in which I give numersous reasons to shun the term.  (if you agree please share!)

Now, as if there weren’t already enough reasons to dislike that label I have found yet another – and it is a doozy.

I came across a link to what is actually a very handy grid from which outlines the DEA authorization to prescribe controlled substances in each state. It is a state by state guide to which schedules we are allowed to prescribe.  This is actually quite a helpful resource if you are considering a move to another state or perhaps thinking of doing a NP or PA travel or locum tenens assignment.

The guide starts out with the official definition of a “mid-level” provider.

Pursuant to Title 21, Code of Federal Regulations, Section 1300.01(b28), the term mid-level practitioner means an individual practitioner, other than a physician, dentist, veterinarian, or podiatrist, who is licensed, registered, or otherwise permitted by the United States or the jurisdiction in which he/she practices, to dispense a controlled substance in the course of professional practice. Examples of mid-level practitioners include, but are not limited to, health care providers such as nurse practitioners, nurse midwives, nurse anesthetists, clinical nurse specialists and physician assistants who are authorized to dispense controlled substances by the state in which they practice.

OK, I don’t like this definition but I can live with it, at least for now.  But then I kept reading and I see that also included in this mid-level category is “animal shelters” and “euthanasia technicians”.  WTF?

This is still a helpful guide but it really is hard to look past this.  Who can we complain to?

You really must see it for yourself.  Click here.

Not sure? Shadowing might be the solution.

Have you received a job offer but you just aren’t sure if you are ready to accept?

You may have left the interview feeling a little rushed, and that your questions were not fully answered. This is not unusual.

Receiving an NP or PA job offer is a bit like receiving a marriage proposal. It’s very flattering to know that you are wanted. But sometimes you can find yourself so overwhelmed by the notion that someone truly desires you that you don’t consider whether or not the feeling is mutual.

Starting a new job is not unlike a marriage, it is big commitment and shouldn’t be left to one’s emotions, because once done, it’s not easy to undo. It’s one of life’s little ironies (or jokes) that getting out of a bad relationship can be much more complicated than entering into one.  (We will leave the topic of how to gracefully “divorce” a job for another blog!)

So for those of you entertaining an offer but still feeling unsure I recommend you consider a longer engagement. Before you think I have completely gone off the rails let me explain.

Ask for a “shadow” day. This has become more and more common in recent years. Requesting to spend a shift or two with one of their current providers, “shadowing” is a good way for both parties to get to know each other better.

As a clinician, you will get a clearer idea of not only the job duties and patient flow but also the personality of the practice. Remember, an interview lasts usually no more than an hour and everyone is on their best behavior. It’s a little harder to hide dysfunction for an entire day. If there is an undercurrent of tension or disorganization you are going to pick up on it.

So what’s in it for the employer? A good fit, that’s what employers get out of the shadow. Employers are just as eager to find an employee who fits in with their practice culture as you are to find a practice that fits you. A happy employee is a long term employee. As I have said many times before, clinicians rarely leave jobs where they are happy even if they can make better money elsewhere. Great pay and benefits aren’t enough for happiness.

Now that I think about it, that is the case for many marriages as well…

From a blog originally published on Advance for NPs and PAs

To err is human…but a second chance needs to be earned

Do you have a negative in your history? By negative I mean a dismissal, misconduct or a disciplinary action by your board. Personal negatives include criminal charges, DUI’s or a history of substance abuse.

All is not lost.

If you are a nurse practitioner or physician assistant and you have one of the above issues and you are struggling with how to frame a past transgression in your NP or PA resume I have some advice for you.

My latest column in Advance for NPs & PAs outlines some strategies for dealing with negatives in your professional background. I discuss when and how to bring up your past problems as well as what steps you must take to convince an employer to take a chance on you.

Click here to read my advice

Can’t we all just get along?

They say nursing “eats it’s own”. I had this recurring fantasy that when I became an NP that something would change, unfortunately this hasn’t been the case for me or many other Advanced Practice Nurses.

I have been receiving several letters lately from APRN’s all over the country expressing their frustration with their RN peers. They recount stories of the RN’s behaving like “tyrants” towards them. They accuse them of nitpicking, refusing to help and generally making the NP’s work life miserable. In some cases they tell me, RN’s are even assigned to supervise the NP’s. (This is a situation that seems wildly inappropriate at best, and downright dangerous at it’s worst.) The nurse practitioners attribute the RN’s behavior to “professional jealousy”.

Now I know there are 2 sides to every story and I am sure the nurses have their tale to tell as well. But unfortunately I too have observed and experienced some of this behavior firsthand. A few years ago I was working an assignment in which the RN’s refused to do vitals on my patients when they roomed them. Why? “Because you are a nurse” was the response. I shrugged it off because I personally liked these nurses but I must admit it really grated on me professionally.

This is a sad and disappointing side to our profession. When I teach new nursing students it’s one of the first things they ask me about in class. What does this say about us? In my years working as a recruiter I can tell you that it’s not money that leads many NP”s to search for a new job. Most Nurse Practitioners quit because they are unhappy and frustrated with their current work environment.

I’m throwing this one out to you for discussion. Do you have a story like this to tell? What have you done to resolve the problem? If you are a Physician Assistant does this happen to you as well or is this strictly a “nursing” problem? Leave me a comment.