Confessions of a Former New Grad Nurse Practitioner

These days, I think I may even take patients by surprise with my abilities in the emergency department. I look younger than my thirty (ugh) years, or so I am told. So, when I enter a patient's room to suture a laceration or drain an abscess, I get that "Wait! you're the one who's going to be doing this?!" look. Then, when the patient sees the results of a perfectly placed set of sutures it becomes apparent I've done the same job everyday for five plus years. It wasn't always this way. 

As a new nurse practitioner graduate I felt anything but competent. Anxiety and uncertainty plagued my work day. Here are a few things I did in my early years of practice that I recommend you avoid. 

I yelled at coworkers

When I started working in the emergency department I was stressed to the max. The high patient volume and increase in acuity compared to that I had experienced working in urgent care had me on edge. My coworkers took the brunt of my emotions. As a nurse practitioner you will often find yourself in a leadership position delegating to nurses and other staff. When you need something or have a request, ask nicely. Operating in a dictatorial manner won't make you any friends nor will it help you operate more efficiently. 

I was all about the Benjamin's

As a single gal with my first decently paying job (meaning more than $8/hour), I was thrilled each time my paycheck came in the mail. And, I wanted more, more, more. My first few nurse practitioner positions paid based on productivity. The more patients I saw and the more tests I ordered the higher my paycheck. So, each time a chart hit the "To Be Seen" rack, I hopped to my feet. Some days this wasn't a problem, but when the clinic or hospital was slow I should have deferred to workplace norm and shared the love, allowing each provider to see an equal number of patients so all could earn more evenly. I was not as discerning as I should have been in proving myself as a hard worker and ambitious earner.

I suffered from premature burnout

Along the lines of focusing too much on my pay, I picked up extra shifts like a crazy person. Excited about my new home purchase and wanting to be helpful and establish a solid reputation, I accepted extra work whenever a coworker asked. This left me utterly exhausted. At one point I even cried at work. In my boss' office. I don't recommend this route. Being a new grad nurse practitioner is difficult. You may find yourself struggling to keep up clinically making the average workday exhausting. Keeping your hours in check will help prevent burnout and keep you sharp so you can take advantage of learning opportunities that present themselves throughout the day. 

I executed my job search terribly

I was very fortunate to land a job in a desirable location within a week of graduating from my nurse practitioner program. But, I still botched the process. Although I was offered, and accepted, a position, I didn't do due diligence when it came to researching my prospective employer. I found myself in a clinic that compromised quality of care for cash and engaged in billing practices bordering on Medicaid fraud. Needless to say, I didn't stay in the job long, but I should have been more selective in selecting my first position

My clinical skills could have been described as "needs improvement" 

You might assume that having attended a well regarded nurse practitioner program that I stepped into my first position with sufficient clinical knowledge. False. I still had so much to learn. I asked my collaborating physician and NP coworkers questions about nearly every patient I treated. When I worked as the sole provider in the clinic on weekends, I frequently called my physician coworkers for assistance over the phone interrupting their precious Saturday afternoons. While I knew enough to ask questions rather than make clinical mistakes, I felt incompetent at times. I felt like more of a bother than an asset to the clinic given my inexperience. Be prepared to feel the same. 

I almost got sued

One day I treated a patient who seemed to have medical problems beyond the scope of practice of the urgent care clinic where I worked. Thankfully, I recognized the state of his condition, consulted my collaborating physician, and recommended that he seek treatment at the emergency department. He opted not to follow my advice ending up with a medical condition requiring a surgical fix. Once he recovered, he sought legal counsel and threatened to sue. Fortunately, I had done the right thing and documented our conversation so nothing came of the threat. But, it was a stressful reminder of the responsibility I have a a nurse practitioner. 

I made it!

Despite my initial misgivings in regards to my clinical skills and my occasional lack of professionalism, I learned to become a competent, confident nurse practitioner the hard way. While I still ask the occasional question of my superiors, I am prepared to diagnose and treat most patients presenting to the emergency department. I have become more laid back in my interactions with coworkers. Rather than snapping under stress, I use it to energize me. I've found a way to make time for both my work and personal life. Don't worry new grads-you'll be able to do the same! 

 

Do you have questions or concerns, or simply want to dish about life as a new grad NP? Post on the MyMidlevelU message board! MyMidlevelU is a place for NPs to connect and share. Get started by creating a MyMidlevelU account here.

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Comments

Thank you Erin this is a very helpful post!
What are some things a new grad NP can expect during their "orientation" to their new job and what advice or suggestions would you give as far as preparation?

- Rachel

Hi Rachel,

During orientation, you can definitely expect an introduction to whatever charting system you will be using. I would suggest taking a lot of notes to reference later as documentation in some EMR systems can take a while to master. I would also observe the workflow of the clinic/hospital while you orient. What kinds of jobs do the nurses do vs. medical assistants? What kinds of responsibilities do other providers delegate vs. take care of themselves? This will help you fit in with the work culture. 

Finally, as a new grad, identify any reference materials the clinic/hospital offers either online or in print so you can use them as needed. Good luck!

- Erin Tolbert

I just got my RN degree and I have a BS in chem and bio. I was wonderingto do my FNP online in 2.5 years part-time costing me about 60k. Do you think its worth it and will I be ready?

- Ben

Hi Ben,

You should be prepared for an FNP program with an RN degree and a background in biology. As far as being 'worth it', that is something you would need to decide personally. It depends on your interests, current financial situation and income etc. Looking at the average salary for FNPs in your area may help you decide. Also, there are many FNP programs online and at universities that cost far less than $60K. Perhaps you could look into some of these options?

- Erin Tolbert

Thank you for your fast reply. I was thinking of simmons college and Chamberlain, both online. Simmons is tge fastest since it will give me only MSN by passing BSN, costing 60k. I live in Philadelphia, Nd those are the inly options I found, other than going back for BSN then applying for MSN. Any help is appreciated.

- Ben

Hi Ben,

You could also look into these RN-MSN programs online that have a nurse practitioner focus. Some may be more cost effective. 

- Erin Tolbert

I was wondering if you had any more information on your site about malpractice and being sued. I've only been working for 3 months as a NP and made an error that could potentially come back to haunt me. The patient is fine right now but I feel terrible and am questioning my ability to be a NP. Of course, its a learning moment but...the guilt. Do NPs still practice with malpractice on their records, how common is it?? My boss is very understanding, explain she too has made an error, and is telling me to relax (she doesn't even know how nervous I actually am). Just totally bummed with myself and feeling overwhelmed. Any insight would be helpful.

- MM

Hi MM, 

That is a stressful situation! I don't have information up on the site about being sued...let me work on getting some content related to this. That being said, I do talk with a lot of attorneys who work with nurse practitioners. The best thing you can do is to get an attorney involved early. Don't sign anything, talk to anyone etc. without getting legal counsel first. This prevents a potential mistake in handling the situation on your part and leads ultimately to a better outcome. 

- Erin Tolbert

Hi Erin, do you intubate patients in the ER?

- Jon

Hi Jon, 

I do not. The way our emergency department is structured, MDs are the only providers who intubate. In some other emergency departments, particularly in settings like critical access hospitals, NPs and PAs do intubate patients. 

- Erin Tolbert

I'm about to graduate soon but I am truly worried that I don't know what i'm doing! I attended on online NP school where they didn't have a group of qualified preceptors. Because of that I had problems finding them and resorted to going to anyone who would be willing to sign off on it. Unfortunately, some of the preceptors that I had weren't all too interested in precepting me! I'm regretting my decision for trying to finish my program as soon as possible at the expense of my education! I don't think i'm ready to treat patients yet and I am worried that I will annoy my colleagues too much!

- Jason

This is exactly me right now! I feel incompetent, a bother to the other providers, and I pick up shifts like a crazy person. I do ask questions even if I think they are stupid bc I don't want to miss anything!
I am currently trying not to feel guilty about this full weekend off with so many open shifts! This was reassuring to read. I know it gets better, that day can't come fast enough! Thanks for sharing!

- Jodie

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