Life as a new Nurse Practitioner has been busy and stressful to say the least. I’m excited to share today my experience thus far including what’s going well and what my biggest challenges have been.
I plan to post about once per month about my experience as a new graduate FNP in a community health center. As an NP student, I enjoyed hearing about other people’s experiences with the transition from student to NP. Hearing others’ experiences helped me understand what to expect and, now that I’m in the thick of it, know that I’m not alone in the challenges I’m experiencing.
Being a New Nurse Practitioner – My Experience Thus Far
The truth is I’m surprised how well things generally went during my first month. I anticipated the stress and challenge which has made the transition a little bit easier. It was almost as if I was bracing for impact. Several colleagues and my faculty warned me about the humbling experience of being a new graduate. I knew starting patient care as a new graduate Nurse Practitioner would be stressful. And it 100% is. But, I’m coping well and enjoying the process. It feels good to finally be doing the job that I’ve worked so hard and so long for!
Believe me, I still have a hard time understanding how I’m ever going to manage a full patient load. I’m currently seeing 1 patient per hour and will be increasing to 1.5 patients per hour very soon. I’m very lucky to work somewhere that provides a slow ramp up for new providers. In case you’re wondering, the ramp-up to a full-time patient care load typically happens over 4 months. This means that at 4 months the hope is that I will be seeing 3 patients per hour.
My situation is a little unique in that I’ve already been at this job for almost 3 months but just started independent patient care 1 month ago. Basically, the whole organization switched EHRs shortly after my starting which delayed my start of patient care.
What’s Going Well
Feeling very well supported by my medical director and other providers
I feel so incredibly lucky in this regard. My medical director and the assistant medical director have been welcoming and readily available for any questions. As a new provider, we have a lot of questions. Our questions range from little to big – everything from how to approach a new clinical scenario, how to order imaging and referrals, choosing the best medication when there are many options, and even about how to most appropriately chart something. I never feel silly asking a question. They are always available to me and have made it clear that I can always go to them with any question no matter how big or small.
My patients have voiced that they are happy that I am their Primary Care Provider (PCP)
It’s lovely hearing that patients feel a good connection with you as a PCP and want to continue to see you. I have had a few patients say that they’re going to refer their family members to me or, for kids, bring in the rest of the siblings to establish with me.
I really like the staff I work with
While I’m still getting to know everyone, so far I am enjoying working with my co-workers. In addition, everyone’s passion for taking care of our population is evident. Everyone has been so kind and welcoming which goes a long way when you’re new plus feeling nervous and stressed.
Seeing patients back for follow-up appointments
This is an experience we often miss out on as students. It’s been rewarding to see patients back in follow-up after we’ve ordered some lab tests or made a medication change. Seeing the outcome really helps connect the dots. This is why I went into primary care! I want to build long-term relationships with my patients and follow-up visits are a huge part of that.
What’s Been Challenging
Wondering – “Do I really know enough to be doing this job?”
Transitioning from school to the real-world is not without bumps. There are some patient scenarios that I feel comfortable with but many more that I do not. We aren’t expected to be experts right out of school but I’m finding it’s all too easy to have really high expectations of myself. My plan is to stay humble and admit when I don’t know something. I keep reminding myself that it’s okay to need to look up a lot of things and to ask a lot of questions. It’s 100% stressful to feel unsure about the diagnosis and plan though. My solution to cope with the anxiety this feeling brings is to remember that the only way to feel more confident is to keep moving forward and keep a learner’s mindset.
Learning a new EHR
As I mentioned, I learned a new EHR on the job and so did the whole organization. It was and still is a challenge figuring out how to do some of the more minor things. Normally when you’re a new provider, everyone around you is already experienced with the EHR. In my case as a new provider, I was lost and a little confused, but so was everyone else. This is already getting better/easier and will continue to do so.
Interpreting lab results
In school, I felt decently confident in my ability to interpret lab results. We practiced a lot throughout the program. I’ve found that now that I’m solely responsible for interpreting them and taking action, I’m definitely struggling. The lab results I’m seeing aren’t as straightforward as they were when presented in school or even when working with a preceptor. I’m trying to figure out the best resources to assist with lab interpretation.
Starting a job in a new city
Starting a job in a new city or an area where you haven’t worked in healthcare before can be challenging. There are new insurances to learn about. You have to get to know what resources are available in your area (housing assistance, rehab facilities, food banks, etc.). There’s also a whole new network of providers that you’ll be referring to. I took all of these things for granted when I lived in the Seattle area. I had worked as an RN in a community health center so I already had a good grasp of all of the different resources. Luckily, these things can be learned quickly and are easy questions for other, more experienced staff members.
Figuring out the process of working with a new medical assistant (MA)
As a student, I took for granted the already established relationship between my preceptor and her MA. There’s a learning curve when working with someone who you rely heavily on in order to do your daily job. I expected to have somewhat of a learning curve as I learned my MA’s style and while she learned my style and preferences. That being said, I didn’t expect that I would need to be so hands-on – teaching her how to do medication reconciliation, how to get a chief complaint, etc. On the bright side, this is one of those things that will continue to get better and easier with time.
My Goals For The Next Couple of Months
Increase the number of patients I’m seeing per hour, eventually getting to a full schedule
My goal is to increase to 1.5 patients per hour for probably the next 4 weeks. Increasing the number of patients I see means I need to get more efficient. This should be doable since I feel comfortable with the EHR and my MA now.
Find resources for lab interpretation
My task for the next couple of weeks is to find some solid resources for lab interpretation. Getting comfortable with lab interpretation is a long-term goal.
Learn how to shut off my brain when I leave work
This is something we can all relate to whether we are a new NP, and NP student, or an RN. It can be really hard to switch from work mode to home mode, especially when we’re new. I’m constantly thinking back on patient care situations worried I forgot something or I’ll wonder how a patient I was concerned about is doing. Or as another example, I’ve woken up in the middle of the night realizing I forgot to order a lab test or realizing I didn’t ask a question I should have.
Based on discussions with colleagues, this is a totally normal experience that will get better with time once we become more comfortable. For now, I’m trying to set some limits on myself. For example, I often want to look things up after work. While this is important, I cannot do this after 8 pm. After 8 pm I try to totally disconnect and relax. If I think of something after 8 pm or during the night, I’ll write it down to look at the next day.
Reflections on Being a New Nurse Practitioner
Being a new Nurse Practitioner has been busy and stressful to say the least. Based on what others have told me, I fully expect the next 1-2 years to be full of continued challenge and lots of growth. I know what I’m experiencing is normal. Your experience as an NP student or new NP is also likely normal. Sharing our honest experiences helps others not feel so alone. I’m looking forward to continuing to share my experiences, the good and the bad.
Comment below to share what about being a new Nurse Practitioner makes you the most nervous? What are your tips and tricks for separating work and home life?
Make sure to check out other recent posts: