Does it Get Better as a Nurse Practitioner?
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Show notes:
Let’s be real: the first few years of practice as an NP can be TOUGH. Not only do you have this vast amount of new clinical knowledge to put into practice, but you’re also learning the ins and outs of how a clinic runs (for better or worse), and adjusting to being the place where the buck stops. Is it really surprising that you are wondering if it gets better?
It’s a kind of taboo topic, even though it’s a common question that most NPs ask (if only to themselves). It’s also time to put a spotlight on it, to normalize it, and to realize that most of us have asked that question - and managed to make it through to the other side.
Does it actually get better as a Nurse Practitioner?
This week, let’s talk about how it gets better as a new NP:
✅ How long does it take to get better?
✅ The role transition from RN to NP
✅ How the complexity of the US healthcare system impacts transition to practice
✅ Examples of what it looks like when it DOES get better
Know that you’re not alone, and you’re doing better than you think. And at some point, the day will come that it will get better – either naturally or because you made the adjustments so that it is better for YOU.
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WEBVTT
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Hey there, welcome to the Real World NP podcast.
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I'm Liz Rohr, family nurse practitioner, educator, and founder of Real World NP, an educational
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company for nurse practitioners in primary care.
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I'm on a mission to equip and guide new nurse practitioners so that they can feel
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confident, capable, and take the best care of their patients.
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If you're looking for clinical pearls and practice tips without the fluff, you're in
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the right place.
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Make sure you subscribe and leave a review so you won't miss an episode.
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Plus, you'll find links to all the episodes with extra goodies over at realworldnp.com
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slash podcast.
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Well, hey there.
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So in this episode, I want to talk about a question that one of the new nurse practitioners
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that I was mentoring had asked me.
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So just for context, so I had the absolute pleasure of having a small group cohort
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of mentorship.
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So a number of new grad nurse practitioners on Zoom calls with myself and another experienced
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nurse practitioner.
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Her name is Brianna and she's amazing.
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Hopefully you'll meet her someday on the channel or maybe behind the scenes once
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you're once you're part of one of our products or services.
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But Brianna is amazing.
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But anyway, we were talking in the small group and so we had build rapport over the weeks
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that we had worked together and we were kind of just doing our wrap up call.
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And Brianna and I, this nurse practitioner mentor, we were talking with the group
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and we're kind of like, you know what, you all are doing such a good job and you're
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doing better than you can appreciate, than you can see.
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And this really does get better.
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And then one of the mentees was like challenging me a little bit in kind of
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a joking way of like, but does it actually get better?
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Does it actually get better?
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And I want to talk about this question on this episode and what we talked about.
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So I think just for context, I've said this in a couple of different episodes, maybe
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in a different couple of different ways, but just to put it really plainly in an
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episode, if you haven't heard me talk about it before, likely if you are a new
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grad, you are experiencing this, right?
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The role transition is really challenging.
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The first year to three years is rough.
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And I think that it's a pretty common experience for other nurse practitioners
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that I've talked with, that I know, that I work with.
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Once they hit that three year of experience mark, it's like something
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really shifted overnight.
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But until you get there, there's a lot to take on, right?
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So not only are you learning all of this clinical medicine that we all
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continue to learn every single day for our entire careers, right?
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No one is ever going to, quote unquote, arrive with all the medical
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knowledge, right?
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So that's one of the pieces of being a new grad.
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The other thing is that you're trusting your clinical decision-making
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process for the first time on your own.
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And that's like a whole thing.
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Like that's a thing that you can learn about, but you have to practice.
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The other piece of it is that you're learning things like how clinics work
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and you're learning time management, how to talk to patients, how to
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supervise your staff, how to be a leader in this leadership role that like
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you kind of weren't prepared for, you were kind of just like put into
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and then all eyes are on you and you're giving the final answers at the end
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of the line.
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The reality is, is that it's never, you're never practicing like alone,
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alone, right?
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There's, it's not the only clinician that exists in the entire world,
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right?
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But it does really feel that heavy responsibility of like all eyes are on
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you, of like, what do I do here?
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Right?
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So that's just the context, right?
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And if you're in this clinical experience already, if you're in those
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first couple of years, you're probably like, duh, of course I'm
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experiencing that, right?
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But I just want to normalize that all of those things that are new, like
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once you hit that, you know, year mark, two year mark, three year
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mark, that all gets better, right?
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You're not learning how to conduct visits.
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You're not learning how to take a history.
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There's so much muscle memory of like all of your processes.
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There's all of the clinical knowledge that when you were a new
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grad, you have to look at this up for the first time.
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And then once you get to that two year mark, three year mark, you're
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like, oh, I've seen that a whole bunch of times.
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I don't even need to read about that.
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Maybe I'll pull up an up-to-date article and I'll like read about
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what updates there have been in the last year, because I haven't seen
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it in a year, this random chief complaint, right?
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So, so yeah.
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So, so I, the first part of our kind of answer was that, um, and, and
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things to add to on this episode is that like, that there are so many
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components of the first year of becoming a nurse practitioner and first
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two years and even up to three years, right, or even beyond, right?
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But I feel like for so many clinicians, three years, it's like, wow, there's
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something that really changed, like almost overnight where you're like,
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oh, wow, I can just show up to clinic, see some patients, give me, give me
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an 83 year old patient with 20 comorbidities, I haven't looked
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at their chart, let's go, right?
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That's how I'm feeling, right?
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That's how I started to feel when I was at three years in.
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And for context, the mentees that I was working with who are nurse
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practitioners in their first year are like, wow, I just like, I
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look up all my charts the night before I'm doing so much pre-charting.
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I'm coming early.
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I'm staying late.
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I'm writing these novel notes, right?
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All that stuff gets so much easier.
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Right.
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And so you get to this place of especially that three year mark where
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you can just show up and do your job.
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It's still stressful, right?
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Like, I don't feel like I've ever quote unquote, arrived to this
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place of like, I'm never stressed out.
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Like there's, there's like, but it's healthy stress, right?
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Because we have a job that is high responsibility.
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We're taking care of patients lives, but it also gets to be fun.
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And I think that for me and my experience and also the nurse
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practitioners I've worked with over the years, those first couple
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years, it's, it's a little bit challenging for it to be like as
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fun as it could be, because there's so much to learn.
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It's just a huge role transition.
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So, um, there are fun parts along the way, but it gets to be more
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fun as you go along and you're like, okay, this is old hat.
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This is like stuff.
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I already know I'm really good at this.
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Right.
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Um, whereas like when you're a brand new grad, especially if
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you've worked as a nurse before, or if this is your second career,
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you're really good at whatever the thing is that you used to do.
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And then you're coming into this job or you're brand new and you're
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like, I'm just terrible.
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I don't know what I'm doing.
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I'm going to fool everybody.
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They're going to find out that I don't actually know anything.
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Right.
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And so that's, that's the beauty of it.
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When you get to that, like two to three year mark, I'm just
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going to say three years because it took me a while, um, but
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it could take even longer.
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It's not like a hard and fast thing.
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But yeah.
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So, so all of that stuff gets easier and you don't even have
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to think about it anymore.
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I do want to normalize though, that healthcare is not all stars,
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unicorns and rambos as much as I would like it to be.
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I think that there is a challenge in healthcare, the way that it
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functions in the U S especially.
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I haven't practiced internationally, but in the U S we have a lot of
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challenges as it comes to funding and insurance and the way that healthcare
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clinics are run and the system works.
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That, um, the hardest part, the thing that we were talking about, and
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I'll just speak for myself here.
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I feel like the hardest part at this point with all the experience that
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I have is, um, there are those components, right?
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There are things that we all find that we love to do and that we're
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better at, and we're not as good at.
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And then we, what I find that I do and that the other clinicians that
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I've worked with do is we really just try to highlight the things that
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we're best at and then mitigate the things that we're not as good at
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or that we don't love.
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For example, I hate paperwork.
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I do not like writing notes.
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I hate writing notes.
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I love lab interpretation, but I don't love the kind of like
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tedious part of that work.
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Like my real strength and my skillset is connecting with patients,
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medical diagnosis, teaching, mentorship, right?
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And so for me, I got to this place of realizing that, you know what?
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I always knew, I always, always knew that I wanted to be in primary care
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and I wanted to work as a clinician, but I also always knew that it was
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going to be clinician, clinical work and something else.
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And so I went through my personal journey of like, do I want to do
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public health, do I want to run a business, do I want to side hustle?
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Do I want to go into teaching?
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And I chose teaching and business.
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That's what my choice was.
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And that that's why I run this company.
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That's why I do what I do.
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And it's able to support me, um, in my life goals and in my
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personal life and my family and all that stuff to do both jobs.
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So other ways that one of the other things that we talked about in the
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context of this conversation is that, you know what, some people want to
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do primary care full-time and that is their thing and they're going
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to do that forever until they retire.
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There are other people who don't want to do that.
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They know that they don't want to do that or they're realizing,
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you know what, um, it's really a lot for me to have all of these
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notes, all this paperwork, et cetera.
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And either they figure out, you know what, maybe it's the clinic.
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Maybe it's this particular job that's not working for me.
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Maybe it's another type of work that I want to do, whether it's a lifestyle
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choice or, um, like driven by your lifestyle choices, like I really
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don't want to take any paperwork home.
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I don't want to be doing the type of paperwork that you get in primary care.
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So I'm going to go do urgent care instead.
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Not that urgent care is all hearts and rainbows either, but we just
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kind of like make these decisions of where, what we want our lives to
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look like and what we want our careers to look like once we get to that place.
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Um, and as another example, there's like, there's, the options are
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like, like really like limitless.
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It's really unfortunate that, that our healthcare system is not.
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I don't, this is opinion, right?
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Obviously this whole thing is opinion.
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But my opinion is that like, it's really unfortunate that our
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healthcare system is not, and our education system is not set up such
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that you can go to grad school, have all these loans, work in your job,
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repay those loans, right?
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Like that's a huge stressor for a lot of people.
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And, um, like there are still opportunities that we can do instead
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of in addition to right with, with all that context in mind.
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Like, I think some people get really upset when I talk about how a lot of
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people are not full-time in primary care, because they're feeling some
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type of way about the fact that they have student loans and it's like,
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well, I have loans to pay, but also we get to choose what we want to do.
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Right?
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So, um, just for other examples of things that we talked about in
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terms of like, does it get better?
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So I guess first point is yes, it does get better because you learn all of
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these things in the first three years and it just takes a while and it's
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just time and practice and like a lived experience to get those skills.
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But once you get to that place, then you have to figure out what is your
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thing, like, what do you love to do?
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Is it talking with patients, patients?
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Is it teaching?
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Is it, um, who knows, right?
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You get to decide for yourself.
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And then at that point, you can evaluate at any point, honestly,
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you don't have to wait three years.
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But like, that's how, that's the place that where it's like, once you get past
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that initial learning, if you're still having a hard time of it's not really
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getting better, then you have to decide for yourself, like, what are
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the things you can do with your career and your life so that you
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will feel fulfilled, right?
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And then the other piece of that, um, I guess just a couple of
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examples of what other people have done.
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So in my primary care clinic, most of the providers do three quarters
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time, because that is enough for them.
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Uh, and that's what they need financially and it supports their lifestyle
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and their family and all of that.
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And so I found a lot of people in primary care will do half time or
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three quarters time instead of full full time, they talk about sessions,
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like four hour blocks of time and how many sessions per week.
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Right.
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And so again, that might bring up some feels for you about like,
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that's not fair that we're set up into this system where we can't
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really sustain this full-time career and pay back our loans, et cetera.
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I'm not saying that at all.
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I'm just saying some people find that's true for themselves.
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And so the other thing that some people do is like,
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that's just all they work.
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Some people have grant funded, um, other stuff.
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And I talked about this, I think in another primary care
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video or episode rather, um, where like they applied for grants
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to work on a special project in their clinic.
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So they work on HIV care, maternal health, um, things like that.
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They get some sort of grant funding and that allows them
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to work on that project for four hours a week instead of seeing
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patients for that four hours a week.
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And so they still work full-time, but they're just doing other things.
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So, um, and then the other piece of it is, is, you know,
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maybe you do love full-time, you want to work in primary care forever.
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We just have to feel, figure out what are the things, no one can
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be perfect all of the time and what are the things that you want to
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focus on and what are the things you don't want to focus on.
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Right.
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And I talked about, I don't love writing notes.
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I don't not write my notes.
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Like I'd be still legally have to write notes, but I figured out
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system where I can hack it such that it is the least painful possible.
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And I can talk with my patients more.
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I can mentor more.
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I can precept students more.
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Right.
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Um, and those are the things that helped me figure out what
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I want to do with my life.
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Right.
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So, um, so yeah, so there's just, that's just like a starting
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place though, cause that's not covering all the potential options
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of like what it could be like, right.
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In terms of the getting better.
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But I do just want to normalize that those first couple of
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years are really tough.
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And once you get over that, like you're not going to do that
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stuff forever.
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You're not going to have to look up your patients the night before
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and pre-chart and all this stuff and like look up labs for hours
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and hours on end, you're not going to have to do that forever.
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Like that, that is a very strong initial part of the role transition.
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And then once you get to that place, you get to decide,
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what is it that's bothering you?
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What is it?
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That's not the issue.
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And for, for myself and for the other colleagues that I have,
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it's not the job.
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It's not the, you know, working with patients.
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Like that's the favorite part.
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It's just some of the ways that healthcare is set up writing
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notes, like that, that kind of stuff.
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So, um, so that's the place to take it from there.
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Once you get to that place of like, how do we optimize your,
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your, your living experience, right?
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Your, your career and your lifestyle and what questions can you ask?
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What are the things that are people around you doing?
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Um, stuff like that.
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So hopefully this episode was helpful.
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If you have not grabbed the copy of the ultimate resource guide
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for the new NP already head over to realworldnp.com slash guide.
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You'll also get these episodes and stranger inbox every week with
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notes from the patient's stories and bonuses.
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I truly don't share anywhere else.
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Thank you so very much for watching.
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Hang in there and I'll see you soon.
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That's our episode for today.
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Thank you so much for listening.
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Make sure you subscribe, leave a review and tell all your NP
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friends so together we can help as many nurse practitioners as
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possible, give the best care to their patients.
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If you haven't gotten your copy of the ultimate resource guide
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00:14:51.930 --> 00:14:56.590
for the new NP head over to realworldnp.com slash guide.
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00:14:57.030 --> 00:15:00.230
You'll get these episodes sent straight to your inbox every week
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with notes from me, patient stories and extra bonuses.
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I really just don't share anywhere else.
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Thank you so much again for listening.
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Take care and talk soon.
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