Today I realized that sometime within the next few weeks (I can’t recall my exact graduation date) marks the end of my first five years working as a nurse practitioner. This means a few things: a. I should be allowed to make a cake, cupcakes or some otherwise delicious commemorative treat b. I’m rapidly aging c. it’s a perfect time to reflect on my NP life. I wish I could share my freshly baked and frosted celebratory sweets with all of you, but for practical reasons you’re stuck with only my reflections.
To give some background on my early career takeaways, I’ll give you a quick summary of my journey so far as a nurse practitioner. In 2008, I graduated from my family nurse practitioner program at Vanderbilt University and with persistence as well as exploiting a few legal loopholes found a job at a family practice/ walk-in clinic within a week of my graduation. While I learned a lot on my first job, the clinic was poorly managed and all about billing. I realized that medicine is a business, but I felt the billing practices at this clinic compromised my integrity and I chose to leave after a year.
Next, I went to work at an urgent care clinic near my home. The physicians at the clinic were eager to help me learn and fostered my development into a more competent clinician. I became proficient at recognizing patients that required advanced treatment and diagnosing those we could treat within the urgent care scope of practice. I honed my procedural skills under the watchful but patient eyes of my supervising physicians. Eventually, after about 18 months, I reached a point where I craved a new challenge. I could manage the urgent care clinic with ease and was ready to move on to something bigger. So, I decided to pursue my dream of working in emergency medicine.
Through a connection I landed a job working as a nurse practitioner in a local emergency department where I am still employed today, nearly 3 years later. I love the fast-pace and the daily challenges of working in the ER and haven’t looked back since. The first five years of my NP career has had it’s share of ups and downs. Here are some thoughts as I look back on my early years as a nurse practitioner.
What I Did Right in My First Years as an NP
1. Create New Challenges- It’s easy to get comfortable in a job or settling for picking up charts of only lower acute patients. No one wants to be the one asking questions or putting a lack or experience on display. There are a lot of growing pains that go along with being an inexperienced nurse practitioner. I’m glad I took them on and suffered through them rather than settling for an easier job. I feel that few years of taking risks, asking countless questions and accepting career related challenges helped me become much more confident and competent in my job.
2. Continue Learning on the Job- This goes along with challenging yourself within the job you have chosen. Don’t be afraid to ask questions. When you encounter a clinical situation with which you are unfamiliar, do some research about the topic on your own. Take a job that may be more difficult so you can further your learning. You can always learn more in medicine. Never stop.
3. Keep in Touch with NP Program Classmates- Even if they aren’t your best friends, keeping in touch with your NP program classmates or making other friends within the profession is key. These individuals serve as connections when looking for a new job and a sounding board throughout more trying times in your career. It’s fun and reassuring to have a few people in your life who understand your work. Whether you need to dish about a bad day in the clinic or share a rare clinical encounter that few others would understand, having friends or even simply acquaintances in the same career is a must.
What I Did Wrong in My First Years as an NP
1. Not Getting Involved in an NP Organization- Epic fail here. Becoming and active part of an NP organization makes my New Year’s resolution list every year but I never follow through. I have attended a few local NP meetings and maintain my AANP membership but I’m a passive participant. I wish I would have become a more active member of the local and national nurse practitioner community.
2. Not Considering Non-Clinical Factors in Finding a Job- As a new nurse practitioner, I was happy to find a job, any job. My desperation kept me from asking hard questions, negotiating my contract and considering the culture of the clinic in making my job placement decisions. While I ultimately found a job that I love with a supportive culture, I learned the hard way. Don’t settle for working in a negative environment.
3. Not Continuing My Learning at Home- While I feel that I have done a good job of overcoming my clinical inexperience, there’s still a lot I don’t know and many areas where I could become more proficient. There’s only so much time for learning on the job. I wish that during my first years on the job rather than collapsing onto my couch in the evening with the TV remote and a slice of pizza that I had spent even just 30 minutes a day filling gaps in my clinical knowledge.
My first five years as a nurse practitioner have been great. So great in fact that I began the MidlevelU blog. I think the next five years will be even better. The hospital where I work is becoming a level II trauma center which should bring even more action to the ER. I’m excited about the opportunity to learn from trauma surgeons and embrace the new challenges this will bring. I can’t wait to grow the MidlevelU community and share my experiences with you. And, I hope to spend the next few years tackling the misses from my earlier NP career.
Here’s to another 5 years of the NP life!