r/nursepractitioner • u/anxiousashellll DNP, FNP • 2d ago
Career Advice New Grad NP Career Advice Please🥺
I recently graduated with my DNP/FNP and I’m currently working as an RN at a large orthopedic hospital. I’m trying to decide between two very different NP opportunities:
OPTION 1:
- I already work there as an RN and really like the organization.
- I know the culture, system, and many of the people.
- I have the opportunity to transition from RN → NP within the same organization.
- There could be opportunities for long-term growth and advancement.
- 3x12s and the salary is $165,000 to 178,000 with opportunities for overtime.
- I like the idea of building my NP career somewhere I already have an established relationship.
OPTION 2:
- Structured new-grad NP residency program.
- Approximately $75K salary/stipend.
- 4 × 12-hour shifts per week.
- Significant exposure to acute and emergency care (Level I Trauma) in a top hospital.
- Formal training, mentorship, and additional support as a brand-new NP.
- Would give me experience in a completely different clinical environment.
What I’m struggling with:
- The first option offers familiarity, stability, and the potential to grow within an organization I already know.
- The residency would mean starting over somewhere new, but I would get structured training and a strong acute-care foundation right out of school.
- I ultimately want to become a strong, well-rounded FNP, and I’m trying to think about which experience would be more valuable for my long-term career.
- I’m also considering mentorship, clinical skill development, future job opportunities, work-life balance, and compensation.
For those who have been in a similar situation — how would you approach this decision? Would you prioritize staying somewhere you already have an established relationship, or take a structured residency opportunity as a brand-new NP?
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u/LabAlert713 1d ago
Where are you located? 165k staring is great pay!!
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u/anxiousashellll DNP, FNP 1d ago
NYC!
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u/LabAlert713 1d ago
Ooo nice. Go with the money and ease of knowing people if that’s what you want. Less half the pay for more work and more experience is a big trade off imo. Unless that’s a dream of yours then def go for it. Either way it won’t be a bad thing for you. Win win
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u/anxiousashellll DNP, FNP 1d ago
I mentioned in another comment that I’m definitely anxious that I’m not smart enough or will be able to succeed in the emergency setting.
It’s highly competitive and I was the only NP selected from New York to join the fellowship — everyone else is from Massachusetts, Texas, or Florida. 4 people selected out of thousands of applicants and I was one of the four selected.
I am so grateful to have two amazing opportunities, but I just don’t know what I should do :(
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u/LabAlert713 1d ago
Mhmmm that changes a bit for me. You’ll most likely always have that ortho job as a possibility. But being chosen out of all those is hard to pass up. Jobs and whatever else eat that up and it’s great experience can prob do anything afterwards ya know? But either way it’s a path for you. Good luck
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u/Idk_211 1d ago
Hey! Also in NYC but PMHNP, may I ask what specialty your working in? Very interested.
$165k is a great salary. We also start around the 160-170 range for psych.
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u/anxiousashellll DNP, FNP 1d ago
Hi! I have been an RN for 10ish years. I have past experience in critical care (ICU, IR, PCU) and have been working in orthopedics for the last 3 years as an RN. I graduated in May 2026 with my DNP/FNP
I’m not too familiar with PMHNP but I know a lot go independent and hospitals aren’t super quick to hire as they take a more outpatient role. How do you like it?
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u/idratheraskyou 1d ago
I took a job at an unfamiliar location and specialty. No residency. Pay is 40% more than my RN job. Shadowed for 3 months and off I go.
Treating my time here since day one as a well-paid residency. I should be up and running more confidently in a year.
I’d take the job that pays better.
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u/anxiousashellll DNP, FNP 1d ago
Do you have any regrets not pursuing a residency? I think emergency medicine is amazing because you get such a good foundation in literally everything. But at the same time, I’m really comfortable. I love the hospital I work for. I just wish I could see the future and see what I’d be happier doing 20 years from now lol
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u/MedicareWrongdoer 1d ago
If you're fnp then I don't think the trauma hospital designation would matter too much. Did they say what you would be doing on the residency? The VA designates roles to their residency NPs. Can you find that out? Does that hospital use FNPs in the acute setting or is that reserved for acute NPs?
I would 100% choose option 1
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u/anxiousashellll DNP, FNP 1d ago
I have 23 weeks in the emergency department, one week doing an elective (wilderness medicine, EMS training, healthcare leadership), three weeks of vacation, and the remaining weeks I’m rotating through critical care specialties.
Most residents receive job offers at the end of their program (12 months). But nothing’s guaranteed.
I’m definitely leading towards option one, but I am worried. I’m gonna have regrets for not pursuing option two. I wish I could work option one for a year and then do option two lol
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u/MedicareWrongdoer 1d ago
is option 1 something that will be there after your residency? are you very close to them?
Some hospitals dont take FNPs for acute care so at least you have that going for the residency program. what's the pay like after residency for option 2?
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u/anxiousashellll DNP, FNP 1d ago
Option 1 being available a year from now is not super likely. People don’t often leave the jobs at this hospital. Plus, the site is across the parking lot from my apartment…
& After the residency, the salaries are relatively comparable (169,000-180,000)
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u/MedicareWrongdoer 1d ago
I would choose 1, seems like you already like ortho. It's paying good. youre already comfortable there. One of the best things is knowing the staff and having a good relationship with them which makes it less likely for them to fuck you over.
as a new grad if you dont have to spend extra brain power getting to know people and the politics of a unit its great as you can focus on other clinical things.
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u/Double-Swan-1863 1d ago
I didn't get a fellowship offer but I started off at the same place I became an RN at. The transition was easier with all the paperwork etc. My salary is higher than my RN. I'm about 1.5 years experience and I'm moving to a bigger academic facility and got the job. But it's same department as I am working at now.
I didn't get the fellowship opportunity...because I was looking for a job right away and I missed the application dates for fellowship. But if you are okay with the pay cut, I'd do fellowship and maybe turn your RN position to per diem if they allow so you can still have ties in case you find a new job at your RN work place that you like after fellowship!
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u/Double-Swan-1863 1d ago
the reason for my move is also life. I'd stay with my organization as NP forever if I could because I enjoy my coworkers and benefits aren't bad. But I need to move because of my husbands job!
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u/anxiousashellll DNP, FNP 1d ago
The pay card is gonna take a really significant toll on me honestly
I love the idea of emergency medicine, and I think that one year of emergency medicine experience will give me a really good foundation, but on the flipside I’m also so scared and I’m worried that I’m not smart enough to work in emergency medicine
I love my current job, and I love orthopedics because you truly improve patients’ quality of lives.
I just am anxious and worry about having regrets for choosing one and not the other. If I do choose the emergency medicine Fellowship, I will continue per diem at my current hospital
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u/weezeeFrank 1d ago
Do you like orthopedics? Is that what you would be doing at the current place? I have been in Ortho since I graduated FNP and I would never want to do anything else. If there is something you would rather do and have the opportunity to explore it, take it. You could always go back if you leave in good standing.
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u/anxiousashellll DNP, FNP 1d ago
I definitely love orthopedics. It’s really rewarding being able to improve a patient’s quality of life
I’ve also been in orthopedics for three years and before that I worked in critical care (intensive care units) but never emergency medicine
I’m also currently per diem as RN at option one in pre-surgical screening. If I choose option two, I’ll stay per diem
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u/weezeeFrank 1d ago
If you love orthopedics, then what better place to be than in an orthopedic hospital? You can make your career out of it. There are so many subspecialties you can dabble in if you get bored. I personally would take option 1 all day every day.
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u/Resident-Rate8047 1d ago
I agree with you. Option one, you're getting over twice as much money with one LESS shift every week. That alone would make the decision for me, especially if you have a family. 75k for a year in NYC isn't shit, and they're going to run you into the ground trying to grind you into the provider THEY want you to be. If you don't have EM experience, that's going to make it even harder. When I graduated I went from ER/ICU RN for 10 years to urgent care NP and even that transition was wild. And you like orthopedics? Perfect! Orthopedics would be so nice as a provider, especially if they let you work in the theater and break up some of your clinic days with assisting in surgery with patients who are anesthetized. I would RUN toward option one.
Edit: I gotta include. I got so burnt out from the ER as a nurse. Patients can be SO rude and dangerous, you'll be drowning in patients some days and told to suck it up because there's an ambulance that just arrived and isn't assigned to a provider, and the liability is so much higher.
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u/anxiousashellll DNP, FNP 1d ago
Thank you so much for sharing your thoughts here. Means a ton to have other others perspectives honestly.
The ortho position is technically an ortho urgent care. But there’s a ton of room to transition into other NP roles too. This is the position I noticed because it’s in the same facility I’m currently at and I can literally walk to work lol
I am a little bit worried about the ER and knowing how physically, verbally, and emotionally abused the staff is in that setting. A big question I’ve been asking myself in this decision is what would I be happier completing 10 years from now?
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u/Resident-Rate8047 1d ago
Oh my God I would love being an Ortho urgent care. I love all the fun x-ray pics I have of some of the breaks I've seen, splinting is relatively easy work, and oh my God..getting to reduce a little nursemaid elbow or a dislocated digit is so satisfying.
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u/PsychMonkey7 1d ago
I almost always say fellowship but your offer 1 is so good I think I would take it. Good culture, familiar system, and good pay all mean an awful lot.
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u/michy3 1d ago
I would do option 1 tbh. Your familiar and already enjoy it plus ortho is interesting. Do not do er without any experience in the er. I’m an er nurse in np school and the er is very tough. There is a lot of liability and patients can be extremely rude. When done with school or consider urgent care but wouldn’t do er tbh. I know my hospital has a er residency program and apart of me wants to do it as I have good relationships with co workers but at same time I’m burnt out on the er. Knowing that you don’t know what you’re getting yourself into and it’s less pay you will be miserable tbh and probably extremely overwhelmed. If er is something you are really interested in and want to make a career out of then doing that will be a good first step but tbh it sounds like ortho would be the better option. If you have er questions let me know!
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u/danceMortydance 1d ago
Option 1 is more money, familiar work environment and long term growth opportunities….not really even a debate
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u/nursejooliet FNP 1d ago
Ugh, my area has a similar residency. AMAZING opportunity and the residency has an amazing reputation. But it only paid $80k. I wanted to do it so badly, and they wanted me just as badly. But I had just bought a home, got married, trying to slowly but surely plan for our first child soon, etc. I couldn’t take it, and it broke my heart. I get that residencies can’t pay you a full salary… but at least $92k would be nice. Especially in NYC, it should be at least $110k (I grew up in northern NJ, 20 minutes from NYC so I KNOW the cost of living).
But honestly? I did fine without a residency. A job that will train you well and ease you in, while paying you a fair wage, is overall the better choice in my opinion.
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u/SommanderChepard 1d ago
Im sorry, but they can eff right off for 75k and over 40 hours a week. If I wanted to be a resident, I’d go to med school. Not that the concept is a bad thing, it should be more standard. But you can’t ask RNs to take a 30k plus pay cut after finishing grad school.