How I Bridged the Knowledge Gap Between My NP Program and Practice

Hands down, the most difficult part of my nurse practitioner career to date has been on the job learning.  Shockingly, it has even been worse than changing adult diapers on the neuro unit during my RN program.  Bridging the gap between what I learned in school and the knowledge and skills necessary to practice has not been easy.  This was most difficult in my first year as a NP and gets easier with time, but I have to wonder is there a better way to kick off a career as a nurse practitioner?

My first few months of practice, I literally sat in my car upon arriving at the clinic willing my feet to take the few steps through the front door to begin work each day.  Not even my spirited supervising physician who drove a Harley and lived with eleven Chihuahua's could ease my anxiety (true story).  The stress of being a new NP was overwhelming.  Each new work day presented an exhausting list of challenges, mainly the pressure to perform in a busy, performance-based practice despite my new grad status and associated lack of knowledge.  

I would moan and curse under my breath, filled with dread when I noticed an office visit requiring a procedure on my schedule.  I have seen an abscess drained but never performed the procedure myself I would think.  Not only did I have to gather the courage to learn on a real, live patient but I have to take another nurse practitioner or physician (usually the one with all the Chihuahua's) away from their busy day to help train me.  

Once I thought this learning process was complete, that I had mastered the life of a family nurse practitioner and the art of working in a walk-in clinic, that I no longer deserved newbie status, I decided to pursue my dream of becoming an emergency department nurse practitioner.  You can imagine my joy upon hearing the words "You're hired".  However, my first day of orientation was immediately followed by the apprehension of beginning the on the job learning process all over again.  Only this time it was worse.  I don't think I even deserved newbie status.  I was more at the "even the ED techs know more than this girl" level.

The emergency department is a busy place.  Speed, efficiency and accuracy are key.  These valued qualities were exactly what I lacked as a relatively new nurse practitioner beginning practice in a new specialty.  I had to psych myself up for work each day mentally preparing for what would likely be the most stressful day of my life to date.  I know, I sound dramatic, but that's how I felt.  And, drama queen aside, these really were some stress inducing days.  Fortunately, just like my prior position in the walk-in clinic, I persevered tackling the learning process step by step.

Despite the unyielding demands of my first years as a nurse practitioner, I am proud I challenged myself to pursue a new specialty rather than stick with one less satisfying.  As a new nurse practitioner, you may find yourself stretched thin and stressed out in your first job.  Don't fret.  Here are a few tips in conquering the on the job learning process and surviving your first year of practice:

  1. Work Hard.  You may not have a wealth of clinical knowledge to offer but if you make up for this with a superior work ethic your effort will not go unnoticed by your employer.  By working hard you demonstrates to your employer that you are worth the time and effort to train.  As you continue to learn, you will become an invaluable employee worthy of the investments your employer has made in your future. 
  2. Be Tenacious.  It can be tempting as a new nurse practitioner to take the easy way out.  You may be able to get by without picking up charts for patients with problems you are uncertain how to treat or procedures you are uncomfortable performing.  Rather than avoid these anxiety provoking situations, relish them as fundamental learning experiences.  Grab another provider and seek help in learning something new.
  3. Choose Your Employer Wisely.  Not all employers are understanding of the learning process nurse practitioners undergo their first years on the job.  Be upfront and honest in your interviews asking if employers plan to foster your development into a more confident and competent NP.  Of course, highlight your eagerness to learn and strong work ethic emphasizing how these can speed the learning process.  Find a workplace where you will enjoy constant support from other nurse practitioners, physicians or physician assistants.  This is the safest, most effective way to learn.
  4. Ask Questions.  It can be intimidating to stake out another provider taking time away from their busy schedule to ask a question regarding care for your own patients.  It is even more intimidating to repeat this ten times throughout the day every day of the week.  Eventually your coworkers will run when they see you coming.  Don't be deterred.  The best way to learn is through asking questions.  It is much better to face the prospect of annoying another nurse practitioner than to compromise the safety of your patients.  When in doubt, always ask.
  5. Have Realistic Expectations.  The nurse practitioner learning process isn't easy for anyone.  If a someone tells you otherwise, they are lying.  As a nurse practitioner, you must balance the demands of patients and employers, work within an ever increasingly complex medical system all while learning new skills.  It's a tough job.  Rewarding, but tough.  You can't possibly learn everything you need to know in your nurse practitioner program so expect some bumps along the way as you enter your new profession.  It gets better, I promise. 

I wish I could say there is a secret to breezing through those tenuous first years of practice as a nurse practitioner.  There's not.  Stick with the learning process even after your nurse practitioner program is complete.  You will make it through the difficult first days of your career, one day waking up to realize you have come through on the other side. 

 

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Comments

Today was my first day and I needed that encouragement. Thank you!

Oc

Just started as a new grad in a pediatric office. I've been feeling the stress but am lucky I have a very supportive work environment. Needed this article for sure!

Dotti

Thank you for this article. I am finishing my NP program and am very apprehensive about entering into this new roll. These encouraging thoughts are well appreciated

-anonymous

Exceptional story and truly optimistic. These words of encouragement are well appreciated as I matriculate through my first year as a primary care NP.

Anonymous

Thank you so much for writing this article. It is truly an inspiration. Keep up the awesome work and best of luck with your career =D

Melissa

Thanks for such a wonderful article! I have been a PNP for half a year now and recommend that one gets the educational component in writing! I was told that my MD will teach along the way - after several months of asking for tips and protocols, I was told that I would have to learn it on my own through books and articles - and this is a teaching hospital. I love my patients, but wish I had some back up now and then to run things by w/o severe criticism for any question....and forget about the collaborate agreement ...it was produced and never used!

Anonymous

I have been working as an FNP for two years now and it is always stressful to begin something new. Know yourself and your limits because this knowledge will help you to find the right fit for your area of practice and interpersonal relationships with those that will be training you to be proficient. Personally, working in a fast paced or emergency environment was probably my last choice. I started in home care as a PCP training with a doctor and doing health assessments independently. It was a great way to ease into the roles and I have definitely learned a lot. I am still doing home care, but have started a new career in asthma, allergy and immunology as this was my long term goal all along. I am very knowledgeable in asthma but started at square one with allergy and immunology. I have a great teacher and a supportive office and wouldn't have it any other way. This is a dream come true in terms of long term aspirations and is very rewarding to know that years of hard work and sacrifice yield results. Best of luck to you all!

Natalie Arias

Thank you so much for taking the time to write about your experience to encourage us new NP's. You tips above very helpful. I 'M graduating in May and have been going for FNP jobs interviews times and again I ask myself can I do this?? deep inside I know I can but the fear is real...

Sara

Almost half way through the FNP program...great, valuable insight - thanks!

Shelley

I will soon be in the position of a new nurse practitioner role. I greatly appreciate your insights and the time you have taken outlining your experience and some helpful suggestions. Thank you!

Jess Anderson

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