WORK/LIFE BALANCE FROM A MOM AND NURSE PRACTITIONER

Tips for searching for a job as a new nurse practitioner

9/29/16
I've been to quite a number of job interviews as a new nurse practitioner, and nailed several and bombed several. I have some take away points I hope new graduates out there may find helpful in finding and landing a job.

GETTING THE INTERVIEW

Get a CV together and make the information relevant to the job applied for. For example, I did some work in aesthetics per diem, which is hardly relevant to urgent care jobs or family practice jobs so I eliminated that experience for certain positions I applied for. Highlight any seminars, publications, and awards or training you have completed in addition to your required education. For example, I did a three day skills workshop for minor procedures and emergent care. Play up your duties at your previous positions, especially if you were involved in any quality improvement projects, employee training, or management positions.


SCHEDULING THE INTERVIEW

Some employers will want to do a pre-interview phone screening before an in-person interview, which I hate. In past when I have had these screenings I have felt ambushed and completely unprepared when I got the phone call . My advice is if you get a call wanting a pre-interview phone screening to reschedule it at a time when you are free of distractions, and make sure you prepare as you would for any interview, as often the questions are the same. I also hate when employers want to do an interview the same week or next day. I always try to get at least a weeks notice to prepare. This gives me time to update my CV, get my interview attire dry-cleaned, research the employer, practice interview questions, and find out how to navigate myself to the interview location.

WHAT TO WEAR
Keep it as simple, comfortable and as conservative as possible. Wear a suit (it doesn't have to be expensive, see examples below). I've often felt overdressed at some interviews, but it's definitely better to be on the overdressed side.



WHAT TO BRING
Again, be over-prepared. Bring three professional references (at least one who has supervised you), three copies of your CV, your RN and NP licenses. Many times I have not been asked for any of these items, but always have them. I like to carry all of these in a leather folder, such as the one below, to keep them flat and readily available. I also keep a notepad in the folder to jot down notes during the interview.



COMMON INTERVIEW QUESTIONS
If you are interviewing for a larger organization chances are you will be asked a standard set of the same questions as all candidates. The most common ones are:
*Describe your strengths and weaknesses.
*Describe a time you've had a conflict with a coworker and what was the outcome, or alternatively a conflict with a patient and how you changed the outcome.
*Why do you want to work for this organization?
*How have you implemented a change at your previous workplace?
*How would your former coworkers describe you?
*How many patients do you feel comfortable seeing in a day, or how many patients do you see per day at your current job?

The most important thing to prepare for these questions is to use specific examples. It's okay to embellish, but don't just say, "I'm a hard worker" Give specific accomplishments to back up your statements that are directly relevant to the position you are interviewing for. When describing your conflicts and weaknesses, make sure you use examples that have had good outcomes, not a time you nearly killed a patient, or were fired over a conflict.

If you are interviewing at a smaller practice, you may get a few of these questions, but the interview tends to be much more informal and just getting to know you better in terms of your skill set and personality.

QUESTIONS TO ASK THE POTENTIAL EMPLOYER


What is the expected patient load per day?
Some employers are very number driven, and expect 2.5-3 patients an hour in an ER/urgent care setting, and some want 20-25 patients seen a day in primary care.  Some employers may include a quota in your contract. These are challenging expectations to start off as a new graduate, so it's important to know if you are expected to hit these numbers straight off the bat.
What support staff do you have?
You will generally have a medical assistant in the outpatient setting, and a techs or RNs in the inpatient setting, however the duties can be greatly different in each setting. It's also important to know if you have access to diabetic educators, social workers, or case managers.
Some ER or other acute care settings will have scribes, whom are immensely helpful. As a new NP, the more support staff you have access to the better.

If you work in a state requiring a collaborative agreement, ask about your level of autonomy and if standardized procedures are in place. Some places of practice will require you to have your charts and orders cosigned by a physician.

State laws dictating NP authority vary greatly from state to state. Make sure the employer is in line with state requirements. As a new NP you do not want to start at a location without any supervision or person to refer to, however you do not want to start at a place where you are given no autonomy either, as this will not allow you to grow professionally.

Ask about training periods. Some jobs may expect you to jump in and start without any training. My first job offered a three month paid training period, where I was supervised and expected to be asking for help. This training period was profoundly helpful, and I had incredible mentors helping me.

FOLLOW UP AND ACCEPTING AN OFFER

It is completely acceptable to send a follow up email in this day and age. Make sure you always thank the potential employer for their time promptly after the interview.
A few things to consider when accepting an offer with a new NP position.
First and foremost, salary. Many employers will ask you at the interview what your salary expectations are, and DO NOT ANSWER THIS QUESTION DIRECTLY. I have been burned doing this, and it leaves you no room to negotiate. Many employers, especially public sector jobs and larger organizations have pay grade levels based on experiences, and thus will be no room for negotiation. Some employers, such as agencies that contract with hospitals, will pay a flat rate to all employees regardless of years of experience, and give bonuses for productivity. If you are interviewing at a smaller office or practice you do have room for negotiation, so the best answer if asked about salary requirements is say you expect a competitive rate that will take into consideration experience (if you have some), benefits (or lack there of) licensing, malpractice insurance, and CEU fees. If a position does not offer any benefits, as some do not, you can negotiate a higher rate to compensate for this. If you are a new nurse practitioner without any paid experience, don't be too picky about your starting salary. The most important thing is that you are getting a fair rate.
The second thing to consider when accepting an offer is, do I actually want this job? If you are only interested in a high salary or are unsure of your ability to perform to the required expectations of the job, think twice. As a new NP it is crucial to get experience in the field of your interest. I interviewed for jobs in aesthetics and pain management, both with lucrative salaries, but did not take these jobs as I knew I wanted to get experience in family practice. Although you may get a higher salary offer in a field outside of your interest, make sure this field interests you, and have the qualifications for the position. I also got calls to interview for  hospitalist positions, which I did not interview for because I felt in no way in my experience or training prepared me for these types of roles. If you are considering a position in a specialty, consider doing additional training, such as a residency. post-masters degree, or additional certification. Nurse practitioners are not required to do a residency, and thus being adequately prepared for a highly specialized role such as in oncology or cardiology may be challenging without adequate training. If you have previously worked as an RN in a specialized field however, this may have provided enough experience. I did interview and accept a position as NP in the ER, however I had previous experience as a RN in the ER. Had I not had this experience, I would have in no way felt prepared through my education alone for this position. AANP is now offering a certifications for FNPs specializing in ER. Another piece of advice I have to offer is if you are offered a position with an employer for which you have interned, or previously worked as a RN,  take the position. As a new nurse practitioner already being familiarized with a workplace setting will allow you to focus on the new role, rather than getting to know the charting system, new coworkers, and resources. Lastly, think about work-life balance. What is important to you in terms of hours and flexibility. When I was interviewing for my first job as a NP, I did not want a traditional 9-5 hours due to childcare issues, but I knew that meant working holiday, evening and weekend hours. Think about what your priorities are for a job, whether it be money, location, area of expertise, experience, or flexible schedule. Chances are you will have to make some compromises, so know what is most important to you, and what your long-term career goals are.

PAY ATTENTION TO RED FLAGS WITH POTENTIAL EMPLOYERS
As a new nurse practitioner you want to be in an environment that is supportive. If you sense that you will have a supervisor that is not approachable, will not have adequate training or support staff, think twice about accepting the position. If you sense disorganization, also think twice about accepting the position. At one interview for a new NP position I was kept in the waiting area for an hour after I had arrived promptly for the scheduled interview time. After an hour of waiting and reminding the front office staff I was waiting, I was directed to take a typing test. By this point, I realized this was not an employer I would care to work for, so I told them I was no longer interested and got up and left. At another interview, the person conducting the interview answered her cell phone and took a personal call during the interview. This seemed very disrespectful and disorganized to me.

BE PATIENT

Licensing and board certification can take several months. If you accept a job requiring credentialing, this can take up to six months. Some public sector jobs, and larger hospital organizations require a lengthy application process that can take several month to up to a year. Hang on to your current job if you are working, and don't get discouraged in the process.

Staying active during pregnancy

9/27/16

Being a full time working mother, it's hard to get exercise in, especially with the exhaustion of pregnancy. I've written in this previous post about my 55 pound weight gain during my last pregnancy, and this time in my second pregnancy I am determined to avoid such a drastic weight gain. Maintaining a healthy weight gain during pregnancy has the benefits of reducing the risk of stretch marks, varicose veins, hemorrhoids, and more importantly, gestational diabetes, hypertension, and a complicated delivery.  In addition, exercise can help you "train" for your delivery (my last labor was 22 hours long), and will also help reduce stress. During my last pregnancy, the only exercise I did was walking, and even that was restricted in my third trimester. So far I have had no complications with my current pregnancy that would keep me from exercising, so I am trying to incorporate a variety of activity into my busy schedule, which often means fitting exercise in whenever and wherever I can. After my first pregnancy I started using the Jillian Michaels workouts, and loved them, and have continued during this pregnancy with modifications. In the morning before my son wakes up I do her beginner shred, which is a 20 minute workout including cardio, strength, and abs. Since I became pregnant I use only 3 lb weights, and I don't do any of the exercises flat on my back. I also found the DVD series the pregnancy project to be a fantastic prenatal workout. There is a separate workout for each month of pregnancy. At first after doing the Jillian Michaels workouts, these seemed too easy for me, but they are surprisingly challenging. The workouts are longer than Jillianps, approximately 45 minutes, and focus more on strength and stretching, rather than cardio. Tracy Anderson, the instructor who is pregnant during these workouts, has you doing series after series of variations of donkey kicks. My gluts are burning after these workouts. Unfortunately I do not always have time in the mornings for a 45 minute workout, so I can only do these once about once a week.



I track my steps using a fitbit, and aim for at least 10,000 steps in a day, I do a mile or two walk with my son in the stroller. Whenever I have a free moment usually before work after I have dropped my son off at preschool or on the weekends I will go to a local park and hike the stairs with my dogs. When I don't have a full patient load at work, and when the temperature is not in the triple digits, I will take a walk on my lunch break at work.

I've also have incorporated some yoga into my exercise routine. I tried a drop in prenatal class at a local yoga studio, and loved it. It's also fun to be around of other pregnant women, so I don't feel as silly doing the poses with a belly. Yoga is not only relaxing, but helps maintain your flexibility during pregnancy. Unfortunately with my busy schedule it's not always easy to make time to go to a yoga studio.

I keep myself cool by putting a fan on when I'm exercising at home, and walking early in the day to avoid overheating, and drinking as much water as I possibly can. Of course check with your OB/GYN before starting any new exercise program if you are pregnant. If you were not active before pregnancy, it's best to take exercise very slow and light. Naturally, don't do any potentially dangerous activity, such as alpine skying or horse back-riding, although I don't know what pregnant woman would have the energy to do these activities in the first place. What ways do you stay active during pregnancy?

one year blog anniversary

9/19/16
It's been a year since my blog's genesis. I have always loved reading blogs of all sorts (see my last post), because I think it's such a great platform to express your own opinions.So much of social media is so abbreviated and trite, and blogging seems like a way to actually in-depth talk about interests and opinions. I started by only writing on my life outside of work. I had spent so many hours dedicated to studying and at the hospital without much life outside of that, this seemed like a fun way to talk about my life apart from work and school. I realized after several months that I did have a lot to say about my life as a nurse and a nurse practitioner too, and that I wanted to also incorporate that into the blog. Refining and promoting the blog has been a lot more work than I realized. It's no wonder why people blog as their full time job. I did a lot of work making it aesthetically pleasing and appealing to an audience, finding ways to capture new readers through social media outlets and connecting with other bloggers, trying to finding a focus, and creating fresh ideas to write about. I'm thrilled when I check the stats, that I have readers from literally all over the globe, from South Africa to Russia! I still have a lot of areas I want to improve on, and am constantly reading blogs on blogs and trying out new ideas and formats. I have grappled with my content and whether or not I should refine to one subject matter. Many of the successful blogs have a content-specific site, whether it be nursing, cooking, decorating, or parenting. I like having a variety of content and I like being able to write about all of the areas of my life. My most popular posts, however are those related to nursing and advance practice, so I plan to focus my blog more on these topics. The reason I don't want to refine my blog to one subject completely is that I am not a one dimensional person, I have a work and home life, and I care about politics,literature, as well as lifestyle topics. Often I think women are expected to stay in a box and be one dimensional. I struggle often with what to share, is a topic taboo, is this offensive, am I sharing too many details regarding my personal life, or to little? At first I didn't want to talk about politics or topics that would offend people, but now I like writing on these issues. I try to write on topics that may be controversial from several angles, and to go more in-depth than the often polarized views of race, gender, and politics found on most major media sites, which is not helpful in creating any dialogue at all. As far as details of my life that are unflattering or portray me in a negative light, well I'm not perfect and I like to write honestly about my life experiences. I also like to write about things that are fun, like cooking and gardening, and online shopping. As far as goals for the blog, I want to make it more polished and provide more clean pictures and editing. I don't have a crystal clear vision on where I want to go with my blog, but I know I want for it to continue to be interesting and fun to me, but also informative, interesting and fun to readers. If you have any feedback or topics you'd like to see more or less of please comment or message me. I'd love to hear from you!

Farwell to Summer Family Holiday

9/12/16
It's been more and more difficult to schedule a family vacation in with busy work schedules, financial restraints, and an extremely energetic two year old. This year I wanted to take a fun and manageable vacation with the family, and reserved a beach cottage for a couple days at the nearby Crystal Cove. This required a lengthy 7 month in advance reservation, but was well worth it. The cottages are historic and rustic, without a TV or wifi, but do have the amenities of showers a kitchen with a microwave, as well as a stellar view of the ocean. The cottages are in walking distance to the beach, and also to a little cafe and diner. I am especially grateful we were able to do this short getaway because with a second child on the way, I don't know if we will have another chance to have a family vacation as just the three of us. This vacation was so special not only because we had time as a family away from our day to day grind, but because our son is now talking and understanding the World around him so much more. As I watch these moments I know I can never get them back. One such moment was as we were watching the sunset on the beach after a homemade dinner around the fire, my son says "bye sun", and my heart melts. The trip was a quick farewell to summer, and just like that we were back to work, preschool, and the annoying everyday routines and stress. I'm looking forward to making new memories next year as our family grows to four, to take time to enjoy the simple pleasures and remember why we work so hard for what we have.











The pregnancy glow myth and my favorite skin care products

9/10/16
I am currently in my second trimester of my second pregnancy, and I have never struggled with breakouts this much in my life before.  As if dealing with the other symptoms that come along with pregnancy, mood swings, nausea, fatigue, and frequent urination wasn't enough, I have also had to deal with adult acne. The old wive's tale is pimples means you are having a girl, so we shall find out if this holds true. My skin has always been sensitive and prone to breakouts, and I have tried many products and routines to establish a clear complexion, however the hormones and stress this pregnancy have completely thrown my skin for a loop. In the first trimester I stopped using topical face wash with benzoyl peroxide, as it a pregnancy category C drug (animal studies show risk and human studies not available or neither animal nor human studies done), which may have contributed to my increase breakouts. In my second trimester, however, my skin was just getting worse, so I started using a small amount of clean and clear face wash with benzoyl peroxide once in the morning. I also started to use a dab of erythromycin, a prescription antibiotic gel on problem areas after using the face wash twice a day. Erythromycin topical gel is a pregnancy category B (either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk). Irregardless, only small percentage of topical medications are absorbed systemically especially when washed off quickly, so they pose very little risk to the developing fetus. I also switched to makeup that is noncomedogenic to avoid irritation to the skin. The NARS creamy concealer and tinted moisturizer are both light but provide adequate coverage throughout the day. I also use a daily sunscreen that is water-based in the morning, to prevent darkening of acne or other blemishes which can occur during pregnancy. There are limited studies on links to dairy and acne, but some have found a correlation, so I have been (unsuccessfully) trying to limit my dairy intake. Of course psychosocial stress can increase breakouts, as with other inflammatory conditions, so I'm trying to limit my stress (also somewhat unsuccessfully). I am neither a dermatologist nor OB/GYN, so this is not intended to be taken as medical advice, these are just some products I have found helpful. Always check with your OB/GYN first before trying a new skin product if you are pregnant, and always avoid rentin A products, isoretinins, or oral tetracycline antibiotics, as these are teratogenic (known to cause birth defects). If you have any tips or advice on controlling acne during pregnancy, please leave them below.
 

Summer Book Challenge Review #2: Marriage Can Be Murder

9/3/16
My husband picked out Marriage Can Be Murder (Dr. Benjamin Bones Mysteries Book 1)for me at a second hand store, and I at first thought it was weird and almost creepy choice. He defended himself, by stating that I love murder mysteries, so he thought I would enjoy it. I have to say it was refreshing reading a novel I knew nothing about. Apparently, the author was on the New York Times best seller's list, but this was the first I had heard of her. I expected this novel, judging from the somewhat cheesy title, to be like a Lifetime movie special, or like movie The Perfect Murder. The novel is actually nothing like what I thought. This is the first in a series about Dr. Benjamin Bones, a physician in England during the second World War. The novel opens with Dr. Benjamin Bones and his socialite wife Penny moving to Penny's countryside hometown, as Dr. Bones has been stationed their as part of his military duties as a physician. The couple are on the brink of divorce, after Dr. Bones has come to discover Penny's unfaithfulness. As they drive into the small town of Birdswing, they are involved in a vehicle collision, which severely injures Dr. Bones, and is fatal to Penny. While Ben recovers, a few members of the town convince him to see patients. As Ben befriends the townspeople and begins practicing medicine in the small town, he learns more of his late-wife's past, and begins to investigate his wife's seemingly not-so accidental death with the help of his new-found friends in the small community. This is an exciting novel full of supernatural, suspense, comedic relief, and intrigue.I highly recommend this one, if you like historical fiction or murder mysteries. I'm looking forward to some reading over the long weekend, so I hope I can get one more review in by the end of the summer.