How are RN and Nurse Practitioner (NP) schedules similar? What are the biggest differences?
When it comes to maximizing your joy, fulfillment and overall life satisfaction, how you organize your day-to-day work schedule plays a big determining factor.
There are plenty of advantages and disadvantages to be aware of when it comes to nursing scheduling. Many nurses thinking about making the switch to nurse practitioner work want to know:
What are the key & common differences between how an NP is scheduled vs an RN?
In this “Best Of Nurse Becoming” episode, I’m covering:
- Everything you need to know when it comes to NP schedules… the good, the bad and even the ugly.
- The most common RN and NP scheduling types
- Pros and Cons of RN vs NP schedules
- How different specialties and settings can influence the type of schedule you have
- What to consider for your nursing schedule if you have a family
- The importance of setting boundaries and how it will impact your work life
- Why you should start thinking about this now, even if you are just applying to NP school.
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NP vs RN Schedules… The Good, The Bad And The Ugly
Common RN Schedules
Most RNs who are working in a hospital or subacute setting are working longer shifts, often around 12 hours, and for many RN’s it looks like three 12 hour shifts in one week, which equals a full time schedule. So it might be the type of situation where 36 hours/week is your full time schedule or in some instances, you could work three “12’s” and have about four hours of “float” time. This will depend on your pay period.
Now if your facility is one that is open 24 hours, such as a hospital or long term care center, it’s possible you might be on a rotating schedule, meaning that some shifts you work days, while others you’ll work evenings or nights. Or, you might be assigned to a “day”, “evening” or “night” shift primary schedule. This is really location specific and it depends on the facility. I’ve worked in places where nurses have been rotators, essentially, unless they were on permanent nights.
In any given pay period, they might be working, for example, from seven-to-seven, or five to five, but I’ve also worked in places where you were hired solely for a particular shift. In other instances, there are weekend contract positions which would be given to nurses who only work weekend shifts. In exchange for working only weekends, these roles may include a higher hourly rate of pay and or a lower number of hours needed to be deemed “full time” work status.
The Negatives of a Traditional 12 Hour Shift Schedule
First, these shifts are long, and recovery is often needed. If you’ve ever worked three twelves in a row – whether it’s days, evenings or nights – you probably understand the fact that it takes you a good entire day to recover from that intense stretch of work. And sometimes that day off after your three in a row can feel like a “lost day”.
I definitely felt like I “lost” days when my night shift would go until 7am, and then that same day was my “day off”, but I would be sleeping until 3pm! This flip flop in sleep and work schedule was difficult for me. It can be really taxing on your body to work this type of scheduling format.
Also, keep in mind there is typically a weekend and or holiday requirement. It’s rare to be in a setting that’s open 24 hours, like a hospital or long term care center, and not have to work some weekends or holidays. This can really affect your social and family time…
I’m thinking back now to a story from my childhood… My mom worked on the floor as a nurse until I was in high school; at that point she transitioned to an outpatient environment. I remember very clearly that every other Christmas growing up, she would be working. And my dad and I would get up early to attend the 6:15am Christmas service in the hospital chapel just to be able to celebrate together with my mom. The chapel smelled like antiseptic, rather than Frankincense, and my mom along with the other moms were dressed in their poinsettia or reindeer scrubs. And when the service finished, my mom would walk up the ramp to the elevator to the oncology floor, where she cared for patients (during what was quite possibly their last Christmas), while my dad and I would go to the family dinner celebrations.
If we were lucky, my mom would win the lottery to be able to go home early. She’d arrive just after we’d finished the ravioli. And you know, those holidays were defined by the absence of my mom. And I don’t say this to make anybody feel bad, or even make my mom feel bad because there certainly were so many pros of her having the schedule that she did, but the memory stuck with me. As a parent, I understand how difficult it is to be separated from your family on those few days a year that are really meaningful and where lots of memories are made.
The Positives of a Traditional 12 Hour Shift Schedule
I think the best part of having a three day, 12-hour shift schedule is, first and foremost, having multiple days off during the week!
You can go grocery shopping on a random Tuesday morning, you can get your haircut, you can go to doctor’s appointments – you can do all the things that you want to do without taking days off or without using your weekend time. This is especially helpful if you have kids or who are in school or a partner who works traditional business hours.
It’s nice to get a lot of these obligations done when you’re not cutting into any social time. And places seem to be less busy during these hours. The ability to schedule your shifts with built in stretches of time off without having to request vacation or PTO is a huge benefit, especially if you are someone who prioritizes travel, or you have friends or a partner who lives out of town. When you have three twelves, you can get your work done in a shorter part of the week as you can always ask to be unavailable on a long stretch of days without having to take time off. If you want to take a trip, you don’t need to take off time as you can potentially build in a week off somewhere just by how you stack your shifts!
Another benefit is the ability to adjust your hours within your role. So if you need to cut back your hours or want to go from part time to full time, this is likely to be accommodated without having to apply for a whole new job. I experienced this firsthand. I was fortunate when I was an NP to move from a rotator spot to a straight “night-shift” only position. People weren’t really begging for straight nights positions, because it’s not what a lot of people want. But this got me off this shift rotation. And I was able to have priority scheduling. So night shift people where I worked were able to essentially self schedule and 9/10 times, their requests were granted. This overall worked better for my family and I.
Even though I had to work nights, it was easier for me to have a routine. Rather than always wondering or finding out a month at a time, what days I’d be working, what hours I’d be working and having to kind of figure out on the fly or figure out with short notice what type of childcare we needed that month.
Another benefit of 12 hour shifts is that these shifts don’t bleed usually into the rest of your day. That means that your shift has a nice boundary to it. You can rest knowing if there’s something that is outstanding or something like a treatment hasn’t finished that needs to be followed up on, you can hand it off to the person who’s taking over for you.
Lastly, this type of schedule tends to have the minimal on-call or off shift requirements. No more fluctuating your schedule last minute!
What Types of Schedules You Can Expect as a Nurse Practitioner
If you’re not yet an NP, or you’re considering becoming an NP, I want you to pay attention here because I’m not sure a lot of people think about this before they make the decision to go down this path or before they decide which specialty to go down. This advice can vary and is mostly dependent on the type of setting you’re in. But these points are what I have seen most commonly.
First of all, there are definitely positions that have similar hours to what we just discussed – three 12-hour shifts. And for the most part, this is typically going to be for NPs who are working in the ER or inpatient settings. Typically, the types of NPs working in these arenas can be Adult NPs (like adult gerontology) or Family Nurse Practitioners working in the ER setting, or acute care NPs or specialty NPs who are working in the inpatient setting. (This is a bit of a generalization.)
If you know for sure that you need or want a three 12-hour, or rotating, or a nights type of schedule then I encourage you to consider ER or acute care. Just be sure to check into your Board of Nursing before you make any assumptions of which specialties can work where.
The most common schedule format for nurse practitioners is a traditional outpatient office schedule. So you can think of this as more of a Monday through Friday, 9-5 type of setting. In some instances and some practices, there may be extended hours during the week, or weekend hours. Some places also extend evening hours where one or two nights a week they’re open till 6pm or 7pm to accommodate their patients who work during the week. Some places do the same on weekends, or they reserve Saturdays for work and care hours. It is all highly dependent on the practice. Typically, you’ll have an expected work day consisting of your patient care hours, plus potentially some administrative or catch up time on either end of your day. For the most part, your “working time” is when patients can be seen, plus, perhaps a buffer on either side and time for lunch.
The Pros & Cons of The Traditional 9-5 Office Schedule
On the pro side, it can be nice to have a predictable schedule. Chances are, you’re going to know all your working days for the next year (and maybe even beyond). So with this, you can commit to things in advance without having to worry about the schedule. You’re likely to know in advance if they are open on holidays, too.
Another benefit is you’ll likely have weekends off. This could vary depending on the office because, like I said, some places have Saturday hours and thus could require Saturday rotation. Of course, there could potentially be some on-call requirements, but typically, most outpatient settings follow a holiday schedule. (So you won’t be wearing your poinsettia scrubs to the hospital chapel on Christmas morning, haha!)
Also, another big advantage is the routine. If you are someone who thrives on the routine of a fairly predictable day for yourself and your family, this can be an ideal schedule, as opposed to one when you’re getting a random schedule a month or six weeks at a time.
Now, on the disadvantage side… It can be really difficult to get anything done during the week other than work. You’re likely going to have to deal with taking up evening or weekend appointment times for personal visits, unless you’re taking time off. Nearly all trips or vacations will require you to use your PTO, which, as a side note is not a bad thing. I don’t want to discourage you from using or taking your PTO, I think we should all take all of our PTO every year to live happy, balanced lives. 😊
But that being said, you may not have enough PTO or you may be saving it for a trip, which means it may not be feasible for you to be taking that time frequently. For example, if you have a medical condition that requires you to have your own checkups every three months, this is something to consider.
Boundaries (And Lack Thereof) In This Type of Schedule
Another thing that I see a lot (and something we talk a lot about in the NP Society, which is my membership community for NPs and students), is the fact that you don’t necessarily have a defined end of your shift. Chances are if you’re working in this type of setting, you’re going to be a salaried employee, as opposed to an hourly employee. And what that means is that there’s an expectation that you get your work done at the end of the day. So if your schedule runs behind and you have charts to finish, you might be working extra and stay late to get them done. You’re not going to get overtime, you’re going to be paid your salary. But if you are running behind, or not getting your work done because of situations that may or may not be in your control, then it’ll be your responsibility to figure out when to get it done. The answer can’t be that you’re going to cancel your patients, right? So it’s up to you to figure out how to get your charting done.
I’m not going to lie, this is challenging. And this difficulty with the boundaried end of your day can be a really big source of dissatisfaction. There are certainly ways to deal with this. Sometimes it’s just an efficiency factor that becomes better with time. Other times, it’s making sure that your productivity expectations are actually reasonable, and that you’re being given the appropriate amount of time to finish your work.
I think it’s important to include this because this is what a lot of people struggle with, particularly when they’re transitioning from the nurse to NP role in this type of setting.
The other thing too is if you’re in a position that has a lot of responsibility, it can be difficult to feel like your work is EVER “done”. I feel like in the hospital setting, or in an RN position, you can pretty easily decide to leave work at work. But this can be a little bit more challenging when you’ve left work with things not finished, or you have situations or patients or complicated care plans that are in your head and carrying over day to day that you’re responsible for. This is why it’s really important to practice self care and having empowered boundaries.
Why I Stopped Checking My Work Email At Home
I’ll never forget when I decided to remove my work email from my phone after having my twins and returning to work. This was a BIG moment for me. I was never expected to check email from home, but I and so many people in my department did. And one day, I just decided that this was not sustainable for me and that I was going to stop. So I stopped. And once in between night shifts, I didn’t have much time for myself. I literally slept, woke up, took a shower, ate something and came back into work. And when I got to work, a coworker said to me, “Oh my gosh, did you see that email about x, y, z?” But I replied, “No, I just got here, I have been sleeping. I don’t check my work email on my phone.” And I had to say that a few times out loud not only to kind of let them know that I had set this boundary, but also to remind myself too! The more I was able to say, “I don’t check my work email from home”, the easier it became to feel less guilty and feel more confident in holding that boundary. It was a difficult boundary to set. But honestly, it was necessary for my self care, for my mental health, and my ability to be present with my kiddos at home.
Other Scheduling Styles for NPs To Be Aware Of
While the nine to five office schedule is most common, there are some other scheduling approaches that you may see out there in the NP world.
Most urgent care settings are open seven days per week, but not 24 hours, so many NP’s then do 12 hour shifts. So here you could potentially have the benefit of working three twelves without having to work overnights. Some specialties may have a hybrid schedule that involves both clinic time and rounding in the hospital. This would be common in an academic medical center where the physician or provider office building is attached to the hospital. If you’re an NP in long term care, this may involve going to different sites during the day. So on a weekly basis, you may be responsible for visiting a certain number of patients or a certain number of facilities. This may have some flexibility in terms of your shift length, too. That said, this could end up being a type of situation where you don’t necessarily have to be working from a certain time to a certain time, but you instead have to see all your patients at these facilities during the week.
Since patients at long term care facilities live there, they’re always there, which means you could potentially have some scheduling flexibility. It’s the type of situation where you can usually make up your own schedule as long as your work gets done.
As always, I have to give this disclaimer – this is very much location and employer specific. It is not an exhaustive list. There are many other scheduled types that I’m sure I haven’t mentioned. But I did want to give you the overview of these most common scenarios. So if you’re going from an RN to an NP schedule, you might want to consider this before you even start job searching. Depending on your preferences, and your situation, and your family needs, some of these considerations we’ve discussed may be non-negotiables for you. And I think that it’s good to think about and clearly recognize that before job hunting so that you can potentially cater your job search to roles and environments that would be conducive to your scheduling needs.
On the other hand, if you’re making a dramatic shift, for example, deciding to go from three 12’s to a nine to five, have a sit down with your calendar and your family as needed and decide where you might need some changes in either your support or your responsibility. For example, if you currently work weekends as an RN, and you’re moving to a traditional office setting as an NP, you may need some help planning family dinners or weeknight dinners during the week. Or if you have things that you usually get done during the week, decide when you will get them done with your new schedule.
All this to say, I encourage you to think outside the box. Your schedule can be a big piece of your overall life satisfaction, so don’t be afraid to sit down with your supervisor and try to negotiate a different option if it will improve your quality of life.
I’m rooting for you!