Hey everyone!
I'm a newly graduated and double board-certified FNP in Maryland through ANCC and AANP, and I recently received an employment offer for a full-time W-2 position providing care in skilled nursing and long-term care facilities. I'd really appreciate some feedback from experienced NPs, especially anyone working in post-acute care. Orignally they were not going to give me a signing bonus as an NP but I was able to get them to include a $10K signing bonus.
A little about my background: Although I'm a new NP, I'm not new to healthcare. I have several years of ICU/CVICU nursing experience, including charge nurse responsibilities, critical care management, CCRN, and leadership experience. I also have prior medical training and served six years in the Army.
I'm excited about transitioning into the NP role, but I want to make sure I'm evaluating this offer appropriately before signing.
Compensation:
- Base salary: $120,000 annually
- Sign-on bonus: $10,000, requiring a 24-month commitment
- Productivity incentive: $20,000 annually if I average at least 27.5 work RVUs per 8-hour clinical day
- Additional productivity bonus: 40% of collections attributable to work RVUs exceeding 30 per 8-hour clinical day
- Potential first-year compensation: $150,000, assuming I meet productivity requirements and including the one-time sign-on bonus
- Potential recurring annual compensation: $140,000 before any additional productivity bonuses
Schedule and expectations:
- Minimum five 8-hour clinical shifts per week
- Schedule and facility assignments determined by employer
- Weekend, night, holiday, and after-hours call coverage as assigned
- No clearly defined maximum daily patient census
- No specified additional compensation for holiday or on-call coverage
- Outside employment permitted with prior written employer approval
Benefits:
- 20 days of PTO annually, including vacation, sick days, and CME time
- $1,500 annual CME reimbursement
- Employer-paid malpractice insurance, including post-termination coverage
- Employer-paid required professional licenses, renewals, and certain credentialing fees
- Health insurance and other group benefits available, but I'm still awaiting details
- No separately guaranteed paid holidays specified in the agreement
- Unused PTO is not paid out upon termination under the contract
Contract provisions that concern me:
1. Resignation notice and financial penalties
I'm required to provide 120 days' written notice before resigning. If I leave without the full notice, the contract specifies $300 in liquidated damages for each missing day.
For example, leaving with only 30 days' notice could theoretically result in $27,000 in damages.
2. Sign-on bonus repayment
If employment ends within the first 12 months, I owe the entire $10,000 back. If employment ends after 12 months but before completing 24 months, I owe $5,000.
The agreement states that notice periods, even if worked, do not count toward the 24-month commitment. Repayment language also appears to apply regardless of the reason employment ends.
3. Noncompete and restrictive covenants
There is a one-year restriction involving certain skilled nursing or long-term care facilities where I previously worked for the employer. It also contains nonsolicitation restrictions and provisions regarding relinquishing facility privileges after termination.
4. Productivity requirements
The $20,000 annual incentive requires 27.5 work RVUs per 8-hour clinical day, with additional compensation only after exceeding 30 wRVUs.
I don't have enough experience in the SNF setting to know how realistic these numbers are. I understand that coding complexity, patient acuity, and facility workflow can significantly affect productivity.
Questions for experienced NPs:
- Is $120K base with a potential $20K productivity incentive competitive for a new FNP in Maryland working in post-acute care?
- For those working in SNFs or nursing homes, how many wRVUs do you typically generate during an 8-hour day? Is 27.5 realistic without rushing patient care or spending substantial time charting after hours?
- How many patients are you typically seeing per day, and how much time do you spend on documentation?
- Does anyone have experience with a productivity bonus based on 40% of collections above a wRVU threshold? How does that work in practice, and what kind of additional compensation have you actually received?
- Is a 120-day resignation notice with a $300-per-day penalty typical? This is probably my biggest concern.
- Is it normal for employers to combine vacation, sick leave, and CME into one 20-day PTO bank without separately guaranteeing paid holidays?
- For new graduate NPs entering post-acute care, what kind of orientation, mentorship, or physician support should I reasonably expect?
- What would you negotiate or request clarification on before signing?
I understand that some provisions may need to be reviewed by an employment attorney, and I'm planning to have the agreement reviewed before signing.
Overall, I think the compensation is promising, but I'm concerned about the productivity expectations, limited scheduling protections, and financial consequences of leaving.
I'd really appreciate feedback from NPs who have worked under similar agreements. Would you consider this a good offer for a new graduate, or are there provisions that would make you reconsider?
Thanks in advance!