The Layoffs That Proved Our Workload Was Unsustainable
Last Updated: Mar 1, 2026
My first NP job was a residency. I had structured support, experienced mentors, and protected time for administrative work. That foundation gave me the space to learn, chart, and build confidence as a new NP.
My second NP job was a structural failure I could see unfolding in real time. And it taught me more about what new NPs actually need than any classroom ever could.
The Job That Looked Right on Paper
When I landed a position at a large primary care practice, I was confident I had done my due diligence. The interview process was thorough: multiple rounds with decision-makers. I asked about workload, administrative time, and support staff. I asked about the company’s financial health. They pointed to their opening of a new site as evidence of growth.
What they told me was true. It was far from the whole truth.
Two months after my start date, the company announced layoffs. They had to have known this was on the horizon during my hiring process. The original sites, including mine, were a sinking ship. The company was projecting an image of growth while the existing operations were hemorrhaging providers and revenue.
I would become the 16th medical provider to leave that organization in just 18 months. Many had resigned or retired before I ever set foot in the clinic. In the few months of my employment, at least nine colleagues announced their resignation.
The Revenue Problem Nobody Could See
Leadership understood one thing about the business: providers generate revenue. In the first round of layoffs, they protected clinical staff. Medical providers, nurses, and medical assistants were safe. The logic was simple: revenue-generating staff stays.
But that logic was fatally flawed. It failed to account for the unbillable workload that was silently destroying the organization.
The push to increase patient volume meant providers were delivering more care than they could document. Visit after visit went uncharted because there was no time to close the notes between patients. The unbilled encounters piled up. Revenue that should have been collected sat locked inside unsigned charts. Thousands of visit notes across the practice were incomplete, some from encounters more than six months prior. Each provider represented hundreds of thousands of dollars in unbilled services.
The clinic was losing money every day. Leadership could not see the root cause: the administrative burden on providers had made the work impossible to complete inside compensated hours.
The Invisible Work That Broke the System
The administrative burden extended far beyond charting. Communication between departments was siloed. Tasks that should have taken minutes got shuffled between teams for days. When unlicensed staff said a task was not their responsibility, it fell to the providers by default. We spent hours each day on administrative work that did not require our licenses and none of which was billable.
This is a pattern I have seen repeated across primary care: work that no one is paying you for expands until it consumes your schedule. The charting happens after hours. The inbox management happens on weekends. The coordination calls happen during lunch. The job spills past your compensated hours, and no one acknowledges the overage because the system was built to depend on it.
At this practice, the structural overload was not hidden. It was visible in every unsigned note and every exhausted provider. It was a job design problem, not a performance problem.
What Happened When Leadership Refused to Listen
In the meeting where layoffs were announced, providers were furious. Not for ourselves. For the support staff who were losing their jobs. We told leadership directly: we are the revenue-generating staff, we have a clear understanding of what is not working, and you need to listen to us.
They did not listen. They hired a consulting firm. The consultants interviewed every class of staff member separately and then told leadership what the providers had already been saying for free.
Under these conditions, colleagues quit due to overwork and inadequate support, which increased the burden on those who stayed. The layoffs removed more staff and destroyed morale. There was no plan to redistribute the work of laid-off employees. It fell on whoever was left. The cycle accelerated the very financial problems the leadership had been trying to fix.
The layoffs were framed as a necessary business decision. In reality, they were a failure of organizational design. Had leadership invested in clear delegation structures, cross-departmental communication, and protected administrative time for providers, the visit notes would have been completed. Revenue would have been collected. And my colleagues might not have quit.
A practice that fails to support its providers is a practice that will ultimately fail to support itself.
How to Spot a Flawed System Before It Fails You
This does not have to be your story. After my experience at that practice, I developed a method for vetting potential employers that goes beyond the interview.
Check employee reviews. Glassdoor and similar platforms reveal patterns. One negative review is noise. Five reviews describing the same workload problems, the same communication failures, the same lack of support: that is signal. Pay attention to reviews from providers specifically, not just administrative or front desk staff.
Check patient reviews. Google and Yelp reviews from patients tell the other side of the story. Complaints about long wait times, rushed visits, and unresponsive staff are not just customer service issues. They are symptoms of a system where providers are overloaded and support staff is stretched thin. When patients describe providers who seem distracted or offices that lose track of requests, you are reading the patient-facing consequences of an unsustainable workload.
Read both together. After I left that job, I was offered a position at another clinic with a $ 20k salary increase and substantial bonuses. A basic online search stopped me. The recruiters assured me there was ample time for administrative work and that dedicated admin blocks were unnecessary. Glassdoor reviews from providers described crushing workloads and overbooked schedules. Patient reviews complained of the same breakdowns: long waits, rushed visits, lost follow-ups.
The overbooked schedules and the patient complaints were two sides of the same coin: a systemic failure that meant hellish working conditions. The high salary was not an investment in its providers. It was the cost of replacing the ones who kept leaving.
I did not take that job.
For a deeper dive into what to look for during the interview itself, 5 Must-Ask Questions Every NP Should Ask Before Accepting a Job Offer walks you through the specific questions that reveal whether a practice is structured for sustainability or designed around overflow labor.
If this pattern feels familiar, I have built a framework for seeing it clearly. The free NP Workflow & Survival Guide walks you through the structural reality of why this work spills past your compensated hours and what a sustainable workflow actually looks like.
Continue the New Grad NP Career Series
This article is part of a series built to help new nurse practitioners navigate the transition from school to independent practice. Each article covers one distinct dimension of the career decisions ahead of you.
Article 1: Your First NP Job: More Than a Stepping Stone
Why the RN-to-NP transition is fundamentally different and what it costs you when your first job is the wrong one.
Article 2: The NP Negotiation Playbook: What to Ask For (Besides Salary)
The three non-salary essentials to negotiate before you accept any offer.
Article 3: Beyond the Patient Room: The Business Acumen Every New NP Needs
The revenue model, the profitability metric, and why understanding the business side protects your career.
Article 4: The Compensation Myth: Look Beyond the Starting Salary of Your First NP Job
Why your starting NP salary is not the number that matters and what to evaluate instead.
Related Reading
Stop Taking ‘Any NP Job’ to Gain Experience (It’s a Career Trap)
Job Hunting for PCPs: 8 Warning Signs You Can’t Ignore
Struggling to Find Your First NP Job? Read This Before You Give Up
Navigating the New NP Landscape: Is a Residency Right for You?
Frequently Asked Questions
How can I tell if an NP job has unsustainable workload before I accept?
Answer Capsule: Cross-reference employee reviews on Glassdoor with patient reviews on Google. Consistent complaints about rushed visits, long waits, and overworked providers from both sides indicate a structural workload problem, not isolated bad days.
Why do NP jobs with high salaries still have high turnover?
Answer Capsule: A high salary often signals that the employer cannot retain providers and is compensating with money instead of fixing the structural problems. The salary covers the cost of constant recruitment, not an investment in provider sustainability.
Is provider burnout really a system problem or a personal one?
Answer Capsule: When 16 providers leave the same organization in 18 months, the common variable is the system, not the individuals. Burnout caused by unbillable administrative burden, siloed communication, and unrealistic patient volume is a job design problem, not a character flaw.
What are the biggest red flags in NP job interviews?
Answer Capsule: Vague answers about administrative time, no structured onboarding plan, high provider turnover, and recruiters who dismiss the need for dedicated admin blocks. If the practice cannot explain how it protects provider time, it is likely depending on overflow labor to function.
Can I ask about provider turnover during an interview?
Answer Capsule: Yes. Ask how long current providers have been with the organization and what the turnover rate has been over the last two years. A practice with nothing to hide will answer directly. Evasion or defensiveness in response to a straightforward question is itself a data point.
Final Thought
Your first NP job sets the norms for your career. The workload you accept in year one becomes the baseline you measure everything against.
You do not need to learn this the way I did. You can vet employers before you sign. You can recognize structural failure before it costs you your confidence, your health, or months of unemployment while you wait to be credentialed somewhere else.
A practice that cannot support its providers will not support you. That is not a risk worth taking for any salary.
