Ep #25: Nurse Practitioner FAQ: Life as a New NP

Welcome to Becoming a Stress-Free Nurse Practitioner, a show for new NPs and students that want to pass their board exam the first time and make that transition from RN to NP as seamless as possible. I’m your host Sarah Michelle. Now, let’s dive into today’s episode.

Hey hey, friends. Recently we did a student episode where I answered a lot of frequently asked questions. Now, I’m going to flip the script a little bit and I’m going to answer some frequently asked questions by students after they have passed boards. So these are new nurse practitioner frequently asked questions.

Now, there will be some slight overlap here when we discuss getting your license. But the main focus of this episode will be life as a new nurse practitioner. This is just another one of those things that school doesn’t usually prepare us for. And so I really want to spend this dedicated time together getting you on the right footing after you pass your exam and enter into practice.

And so the first question here revolves around the basic steps that we need to take to be allowed to practice. If you listened to the student episode you can fast forward a minute or two. But if you haven’t, after you pass your board exam if you have not applied for your license that should truly be your very first step. You are not going to be able to practice without that license. That license is your ticket.

And in some states, the licensing process is pretty backed up right now. And so it may take months. The sooner that you can start the licensing process, the better off that you’re going to be. Your state is going to be the one who decides what all is included in that licensing process.

For example, here in Kentucky I had to have a background check, and I had to have fingerprinting done. I most definitely want to make the point here that any questions that you have about the licensing process please, please, please refer to your Board of Nursing.

Your Board of Nursing will have all of the answers for you. I see so many students out there trying to ask state specific questions on Facebook and that always makes me a little internally nervous. So please refer to your Board of Nursing for anything about licensing. But also anything about your scope of practice as a nurse practitioner as well.

So once we have our license, now we can start to have a conversation about NPI and DEA numbers. Your NPI number is your National Provider Identifier, which is just a really fancy way of saying it allows you to bill Medicare and Medicaid. DEA stands for Drug Enforcement Agency, and your DEA number is what will allow you to prescribe narcotics.

You can technically apply for these whenever you choose after you have your license. But here’s what I personally would encourage you to do, I would wait to apply for your NPI number until you’ve already found a job. The reason behind that is when you’re filling out the application, it’s going to ask for an address. If you put your home address in there until you get a job your home address becomes public information for whoever wants to look you up.

Typically, when you apply for an NPI number it takes less than 24 hours to actually be assigned that number. So there isn’t really a rush to get this done. And so there’s no need to put your home address out there on the interwebs for everyone to see.

I would also encourage you to likely wait for your DEA number as well. Your DEA number is close to $1,000 currently. And it’s typically something that can be easily negotiated into your employment contract. Currently, most people are getting their DEA numbers back in a couple of weeks.

So there’s really not a rush to get that done either. Because when you find that new nurse practitioner job there will likely be a month, if not two months of credentialing. So you’re going to have time to get these things done.

I think a lot of new nurse practitioners are so excited to finally have that license they want to do all the pieces they can possibly do and handle all the things they can control. But really, I think with NPI and DEA numbers you would just be better served if you waited until you had a job.

Now another huge new nurse practitioner question I get is how do I write my credentials. And so your credential should look like this, your highest degree first, your license, and then your certifications.

So for example, my credentials are MSN, APRN, FNP-BC, FNP-C. Now, the license piece can vary. And so some states don’t use APRN for example, instead they might use CNP. So just go by whatever is used in your state. FNP-BC is going to be for those ANCC test takers, and FNP-C is going to be for the AANP test takers.

And I know that you guys are super excited after passing, you want to put those new credentials everywhere. But truthfully, if you put all of those letters on your white coat your patient will have no idea what any of it means. And so I would personally suggest that you just keep it simple on your coat. I changed my coat to say MSN, APRN, that’s it.

But at the end of the day the choice is yours when it comes to what you put on your coat and what you sign with, as long as it aligns with whatever your state says as well. So that could also be almost a state specific question again. Which we are going to refer to who for that? Your Board of Nursing.

So then the absolute biggest question I see in my Facebook group currently, how do I find a job? And that is definitely a loaded question. Which is why I have an entire course now dedicated to not only finding a job, but also how to evaluate offers and really just set yourself up for success in that new job too.

However, the biggest piece of guidance here is to really spend some time networking and building up your connections. The majority of nurse practitioner jobs never make it to an online posting.  Hear that again, the majority of nurse practitioner jobs never make it to an online posting. Which means if you are not networking you are not going to know when that job opportunity becomes available.

So many of you out there believe that the job market is over saturated. But truthfully, new nurse practitioners just genuinely struggle with the skill of networking. And so networking can look a lot of different ways. It can look like making a social media post. It can look like reaching out to the types of clinics that you would hope to work for. And it can look like calling up old preceptors or clinics that you did clinical rotations at.

And that’s just the beginning of where you can start on your job search. But I heavily, heavily, heavily caution you guys that the longer that you believe for yourself that there are no jobs available, the longer it’s going to take the find that job. Just like with your board exam, mindset is a huge component of the job search process that you want to be ready for as well.

Now another great question I get is in regards to 1099 jobs. Prior to becoming a nurse practitioner most of us have just had typical W-2 employment as nurses. But a lot of part-time and as-needed nurse practitioner positions utilize 1099 instead.

So 1099, I’m not going to get too deep here, is simply just a tax election where you are considered to essentially be an independent contractor. This means you will not receive benefits and they are not going to remove taxes from your checks. But to compensate for this, many of these 1099 jobs are going to pay higher amounts for the work that’s being performed.

My biggest piece of guidance for pursuing a 1099 job is to please make sure that you are saving money for taxes at the end of the year, traditionally around 30%. And then depending on how much you’re making, you might need to be making some quarterly tax payments as well.

I think that’s where people run into the most issues with this type of employment, confusion over taxes. Therefore, the very best thing that you can do is get yourself an accountant to walk you through it for at least the first year. After that you could probably do it yourself. But you would hate to inadvertently make a tax mistake just from having a knowledge deficiency.

Also I want to discuss some resources to utilize in practice once you are a real deal nurse practitioner and you have secured that job. My personal favorites have always been Medscape and Epocrates.

With Epocrates I like the ease of access to look up first line medication within less than a minute on my phone. With Medscape I really like that to dig deep into patho or different disease conditions, whenever there’s a topic that I want to get more in depth information about.

The Sublax app, that is spelled S-U-B-L-A-X, is another great tool that we can use for X-rays. I also relied on the UPSTF app a lot when I was in nurse practitioner school to look up recommended screenings. But at this point I’ve looked at that app so much I almost have it memorized.

And if you’re listening to this episode right now, and you have an app that you absolutely adore, please stop by my new NP Facebook group, and share that with your other fellow nurse practitioners. The more resources that we have on board, the better we will all be. And that is because our resources allow us to combat down that imposter syndrome that inevitably pops up as a new nurse practitioner.

Another big question I get is whether it’s worth it to go back to school. So I want to start by saying there is no right or wrong answer here. I had only been a nurse for just under a year when I decided to pursue my first master’s degree, which was in nursing education. And some of the older nurses there looked at me like I was absolutely crazy.

So I really think it depends on if you can mentally handle your first year practice as a nurse practitioner on top of doing more schooling. I do think that the doctoral degree will eventually be the way of the future. But we’re still at a point where a master’s degree is sufficient. Until the day that we are required to get a DNP I think it just boils down to a personal choice.

My only hesitancy about going back to school, is when new nurse practitioners decide to pursue more school just because they can’t find a job. We know there are jobs out there, and maybe we just need a little bit of a tweaked strategy to be able to find those jobs. So I wouldn’t go back to school just because you can’t find a job. Let’s try to work on that piece first, before you jump into basically that big, huge commitment of going back.

And then the last question for those of you who are already practicing, I get asked all the time about how to combat imposter syndrome. Y’all in your first year of practice imposter syndrome can be so tough to overcome. That transition from being an expert RN to now being a novice nurse practitioner can feel really rattling and really unsettling.

I think one of the biggest keys to overcoming imposter syndrome is to simply have the awareness that that is what you are experiencing. Until you can label it and recognize it, it will be almost impossible to manage. And maybe this looks like some inner self doubt going on. Or maybe you’re asking yourself things like why would any of these patients today want to see me as their provider?

Imposter syndrome can make us be so negative to ourselves. And so when you start to feel this way, spend some time looking at why you are here in the first place. What makes you uniquely qualified for this position? It is never an accident to end up working as a nurse practitioner. And internally you have everything you need to succeed. The biggest thing is just building up confidence, which comes with both time and practice.

I think a lot of times when we’re new, we think we’re the only ones out there feeling this way. Which is exactly why I created that new NP Facebook group. Just knowing that you are not alone and there are others out there feeling imposter syndrome too, can really make all the difference in that first year of practice.

That was it guys, that was the last question. So I hope I cleared up some confusion for you no matter where you’re at in your new nurse practitioner journey. And of course, I’ll be talking to you guys next week.

As an extra bonus friends, if you’re looking for support no matter what phase of your nurse practitioner journey that you’re currently in, I have communities available for both students and new nurse practitioners. In these communities we work to uplift one another and grow this profession together every single day. Links to join will be included for you in the show notes.

Thanks for listening to Becoming a Stress-Free Nurse Practitioner. If you want more information about the different types of support we offer to students and new NPs, visit https://www.npreviews.com/resources. See you next week.