Opportunities as Key Providers in Health Care Reform

Like pediatric nurse practitioners (PNPs), nurse practitioners (NPs) are healthcare providers in a variety of settings. Many studies have confirmed nurse practitioners deliver high quality, cost-effective care. The 2010 Future of Nursing: Leading Change, Advancing Health report by the Institute of Medicine (IOM) advocates for the use of NPs to the full extent of their scope of practice to eliminate barriers to healthcare access. With the recent restriction of physician-in-training work hours, NPs are strategically positioned to fill the gap and assume responsibility as health care providers for patients in teaching hospitals.

Identifying key issues related to the profession and understanding general business and healthcare policy trends positions you to be able to make informed career decisions. It’s essential to understand the role of the nurse practitioner, scope of practice, and market size and demand for the role. One consideration is the increasing need for NPs and PNPs with the entry of millions of patients into the healthcare system as a result of healthcare reform. As providers, it is important to understand that healthcare issues will impact your profession and practice opportunities. Being informed allows you to understand the potential challenges you will need to overcome or opportunities to pursue in your role as an NP or PNP.

In Gallup’s 2018 poll assessing ethics and honesty, nurses were again ranked the most-trusted profession in the United States. The public values the nursing profession and trusts them implicitly. Nurse practitioners are considered providers of safe, effective quality care. In collaboration with physicians and other providers, NPs work in teams to provide care to patients. As you continue your career as a PNP, we will offer you information regarding the job market and factors that influence your profession.

Where do you work?

Regardless of why you are looking for a job or a new position, you will want to thoroughly explore your options prior to beginning a search. Whether you are looking for a new job within your current hospital or clinic or considering relocation to another state, you have a variety of settings to consider for your next job opportunity. Pediatric nurse practitioners are utilized in primary care practices, community or children’s hospitals, schools, specialty clinics, academic institutions, Health Maintenance Organizations (HMOs), industry or as consultants in the legal and computer fields. Of course, the skills acquired as a PNP can also be applied to many other fields. Abilities to problem-solve, provide anticipatory guidance and teach are transferable to a variety of other types of positions.

Your PNP Career Path, Setting Your Goals

If you feel that you want to make a career change as a PNP, but you can’t afford to do it right now, strategically set short-term and long-term goals. Goals that are specific, measurable, action-oriented, resource conscientious and timely are more likely to turn your PNP vision into a reality.  In the short-term you may be able to focus on making yourself more marketable by learning a new language or skill, working on publications, volunteering, specializing in coding, changing units within your hospital to broaden your scope or taking on leadership responsibilities. By focusing on the short-term goals, you can position yourself to reach your long-term PNP goals which may involve a job change. Take advantage of periods of inactivity during your job search to work on your long-term plan.

Tip: Don’t let yourself become overwhelmed by the process. Breaking long-term goals into individual steps keeps you from getting overwhelmed and is proven to lead to better outcomes. Working toward a goal increases motivation and performance in your current PNP role. Location, interests, friends and colleagues, reputations, and salaries are all aspects you might consider when you start your search. Don’t be afraid to ask for help. There are many resources available to you that you may not have considered, such as:

• Local college counseling offices may be willing to provide advice and assistance.
• Local libraries and bookstores are great sources of career information and job searches.
• Your state employment center and the Office of Vocational Rehabilitation can also be helpful.
• The internet is loaded with career-related websites, some good places to start include:
  • • NAPNAP.org
    • NAPNAP’s Career Connection
    • NAPNAP’s Local Chapters

Look for employment trends that may influence job opportunities, such as geographic population shifts and industrial and occupational projections.

Continuing Education

Pursue professional development and increase your pediatric nurse practitioner (PNP) employment options through educational opportunities such as a doctorate, post-master’s degree or other credential.

Consider the following questions:

1. Do you want to go back to school or develop new skills while you’re working?
   If so, one of your PNP job search objectives could be to find an employer who supports education benefits. Working at a university hospital with tuition reimbursement benefits, locating near an academic institution and utilizing online options are all factors to consider.
2. Can you afford to attend a full-time education program?
   Financial assistance may be available through industry and government-sponsored programs, grants, scholarships, and loans. Talk to professionals at academic institutions who are well-versed in these issues, such as guidance counselors and academic advisers.

Use your current continuing education (CE) benefits, consider negotiating for CE in your current role or when searching for a new PNP opportunity. Utilize CE being offered as a point of negotiation.

The Right Job is Often Much Harder to Find than the Wrong Job

Searching for a job can be a full-time job in itself. Use this guide to help you break this task into manageable steps, learn how to find help, understand what your options are and how to evaluate opportunities. Take time to set your goals and evaluate your options while maintaining awareness of how your current situation might influence your pediatric nurse practitioner (PNP) job search. Find a position you believe you will find satisfying for 2-4 years barring any unforeseen circumstances. If you’re a new grad, think about what aspects of your job you enjoy or would enjoy. New jobs take time. The first year is usually spent learning how to do a job and developing partnerships with other providers; the second year you learn how to fine-tune your skills. Short-term positions might pay some bills, but they can be detrimental to your resume. Before you settle for an offer, consider:

• What are the providers’ and other staff’s perceptions of PNPs?
• Do they understand the role?
• How are the PNPs utilized?
• Will you be able to practice to your full scope?
• How are the PNPs evaluated?
• How is PNP productivity measured?  Are there specific metrics used?  What are they?
• What are the providers’ and other staff’s credentials?
• The right PNP job might be in a different city or involve a longer commute.
• You are more likely to be motivated when looking for the right job.
• By focusing on your interests, you will be more persuasive in convincing an employer to hire you. Let your passions show.
• Getting the right PNP job will motivate you to work harder to succeed.
• Short-term sacrifices often pay off in long-term satisfaction. Always follow through on commitments, phone calls and actions. Let others know they can count on you.
• Remember you only have one chance at a first impression. Every professional encounter is important, whether it be the initial contact or a job interview, a clinical rotation, a class or a volunteer opportunity. You never know where the next job opportunity may come from.

If you have a choice, it’s better to find a job when you are still employed. If you are unemployed, consider working in a locum tenens position (temporary replacement position) and make the most of the networking contacts you encounter in this position. Interim jobs may be stepping-stones to your ideal position. These are all good PNP job search strategies to consider. Don’t forget that NAPNAP and other association chapter meetings are great places to network.

How Do You Measure Pediatric Nurse Practitioner (PNP) Productivity?

As the roles and avenues for employment available to PNPs expand, and money for healthcare expenditures is at a premium, PNPs must be able to demonstrate their professional contributions and productivity. The work of a PNP is diverse and encompasses patient care, education, research and administration and documenting outcomes. Productivity can be challenging. Using recognized metrics to quantify one’s professional practice effectiveness is essential.

Within the role of patient care, provider metrics are easy to identify. The number of patients seen, diagnosis codes, patient satisfaction or the number of procedures translates PNP productivity into the type of measurements used for physician productivity. PNPs can continue to seek their own education as well as educate others. Metrics to evaluate the PNP’s education role can include tracking time spent obtaining continuing education hours annually, hours spent precepting or lecturing or time dedicated to teaching families. For new grads, a designated post-licensure clinical training program or fellowship should include time in the first year with preceptors, in didactics, the time designated for self-study and shadowing and training.

The role of the PNP as a researcher can be accounted for by receiving hours for reviewing journals, for implementation of evidence-based research, conducting journal clubs or participating in research and publishing. Additional metrics may be through certifications and licensure maintenance, quantifying billing paperwork productivity, mentoring activities or engagement in professional organizations.

By using a tool that is completed over time, PNPs can then accurately measure their professional contributions and productivity. With time, these tools become a powerful database and resource for conducting negotiations with employers, insurance and managed care companies as well as advancing PNPs professionally. As the role of a PNP in the delivery of health care continues to evolve, it must be documented to accurately and completely measure all the contributions to the health and welfare of the population served.

New Graduate Transition, What Now?

When you transition from a registered nurse to a pediatric nurse practitioner (PNP), your job transitions from a “job” to a “career.” That transition can be both exciting and uncertain. The transition has been described as carrying the bloody diaper to the provider to ask, “What do I do?” to being the provider. Many refer to it as learning to become the decision-maker. That new level of PNP knowledge and responsibility carries with it documented levels of stress and fear that are reasonable but requires support.

When you enter the last six months of your educational training to become a PNP, you might also consider starting your job search. Consider your PNP network, make a list of references, map out your geographic, practice setting and unit or clinic preferences and then start an electronic or paper file to track your plan and efforts. Create a calendar; include dates when you can work on your plan and times when you can interview either by phone or on-site. In addition, include two to four weeks of focused time after you graduate to study for your boards. Think about your ideal PNP start date as well.

Some things for a new graduate PNP to consider when evaluating a job offer:

• Orientation/onboarding process
• Preceptor(s)
• Mentor
• Other PNPs for support
• Physician involvement in orientation/transition
• Time allotted before being expected to carry a full patient load
• Supervisors’ understanding of your PNP role and expectations
• Staff’s understanding of the PNP role
• Support for the stress and challenges of transitioning into the new role
• Time set aside to review research and self-study
• Didactic training
• Opportunity to learn from shadowing and assisting
• Electronic Heath Record (EHR) training
• Process for establishing competencies
• Metrics used for evaluation and productivity
• Malpractice Insurance coverage

Hospital Setting:

• Advanced practice structure
• Designated process prior to working the night shift-with full responsibility for patients and less available support

Clinic setting:

• Patient load expectations in the first four months
• Experienced practitioner training of the PNP
• Night coverage, weekends, evenings, on-call responsibilities
• Admitting privileges