New Nurse Practitioner: When You Don't Know the Answers

On the job learningNP Students

Aug 18

Written By Liz Rohr

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Show notes:

Sitting in the room, face-to-face with your patient, and they ask you point-blank: So what's wrong with me?

As a new grad I would dread this scenario— I'd freeze up, stutter, stumble and turn bright red (although it's hard for me not to do that). I never felt like I knew enough.

There's a better way around this.

And really, it's SO okay that you don't know all the answers.

In this video, I'll tell you:

The MANY reasons why this is actually okay (and why we should probably even celebrate it), and
The simple strategies I use to handle it.

Here's that meme I was talking about:

Thanks so much for watching. Hang in there, and see you soon.

If you liked this post, also check out:

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Hey there. Welcome to the Real World NP podcast. I'm Liz Rohr, family nurse practitioner, educator
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and founder of Real World NP, an educational company for nurse practitioners in primary
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care. I'm on a mission to equip and guide new nurse practitioners so that they can
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feel confident, capable and take the best care of their patients. If you're looking
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for clinical pearls and practice tips without the fluff, you're in the right place. Make
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sure you subscribe and leave a review so you won't miss an episode. Plus, you'll find
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links to all the episodes with extra goodies over at realworldnp.com slash podcast.
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So today I want to talk to you about the top three survival tips for the first year
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as a nurse practitioner. I want to set some context though. When you were a student,
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you went from your preceptor to go see a patient. You'd come back in to see your preceptor,
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discuss the case and get an okay that you did it right or a correction if it's not quite
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on the right track. However, when you're a new nurse practitioner, you're on your own for the
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very first time. There's literally thousands of decisions to make per day. And when you're new,
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all of those decisions are actually questions. So the top three tips that I have if we're doing
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a countdown, starting with number three, number three is going to be your resources.
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So when you have questions and you don't have anybody around like, is this actually otitis
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media? Should I treat with antibiotics? Or does this rash need prednisone? Or is it okay
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to use topicals? I'm not quite sure, right? Your resources are going to be the things that
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turn to back you up. You need to feel really good about them and you need to be able to
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trust them that they're really solid. If you don't have that, you're going to end up doing
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some doctor Googling, which isn't necessarily a terrible thing because it may have led you
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here today, but it's going to take a lot more of your time to research, to find valid
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resources in the moment. And it's just not that efficient, especially if you're trying to
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fast. If you don't have resources that you feel great about, I've made an ultimate resource guide
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for the new NP. It's free. It's in the show notes of this episode. If you want to give it
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a download, if you haven't already, it's my favorite resources that I use every day. So
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hopefully it's really helpful for you. One of the things that I found for myself as a new grad
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and that I see all the time with new grads that I work with and that I talk to on the
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internet is that there's this phenomenon of wanting to know all of the things all the time.
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And so it's almost like oversaturation of resources to the point of overwhelm. So that's
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why I've really honed these down into the most impactful and helpful ones. Of course,
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there are tons and tons of options, but those are my particular favorites. So I've done that
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work for you if you'd like that support. So that's number three is resources. Number two
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is time. So what do I actually mean by that? Right? We have all, we all have 24 hours in a day,
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but backing up for a second, when I became a new nurse practitioner, I saw one patient per hour
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and that was gradually increased over the course of weeks to months up to a full year. I was
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very lucky to have a full year of getting to full schedule. It really varies from new grad
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there isn't really one set orientation recommendation, but that's typically how
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that goes. So what's important about time is that we need to check in and see,
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is this enough time for me? Am I completely overwhelmed? Am I seeing too many patients
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too fast without enough support? Right? Are you completely drowning? Do you feel like you're
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coming in an hour early, staying two hours late? You're still working in the evenings
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on the weekends. You never have time off. You don't do anything but work. Right? Like that
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right there is probably a clue to you that it's a bit too much. There's definitely a learning curve
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and you'll see some of that. If it feels like you're really drowning, I'd recommend talking
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with your supervisor and having a meeting with them. Basically what you can do is just say,
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you know, Hey, you know, this is how I'm feeling. What can we do about this? Right?
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They can talk with you about maybe you're seeing too many patients per day to start. Maybe it's
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too fast of an orientation. Maybe you're seeing really medically complex patients and they can
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mitigate that by having you see some more straightforward, simple complaints like urgent
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care visits with a UTI or uncomplicated URIs, things like that. The thing to keep in mind,
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though, is that the thing that I see for so many new grads is that they don't know what's
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normal and they don't know what to expect. And they are so, and again, speaking from personal
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experience, they're so eager to prove to themselves and to their colleagues that they
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know what they're doing and that they can do this. And so a lot of the times they're
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reluctant to say anything and they feel like they're lucky to have this job and they don't
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want to complain. And that's super, super valid. I think one thing that I'd like to
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encourage you to do, whether you're a nurse practitioner student or you're a new grad,
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is checking in with other colleagues at your current practice or NP students that you went
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to school with. Because it's so hard to know if we're overwhelmed because we're new or we're
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overwhelmed because there's too much on our plate and it's really hard to advocate for
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ourselves if we don't know. So I do recommend checking in with either colleagues or friends
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and having that conversation and honoring your boundaries there because it's so important
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to take good care of ourselves from the beginning so that we can have a long career
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as a nurse practitioner. Number three is resources. Number two is time. And number one
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is having a mentor. If you don't feel like you have this at your current clinic,
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stick with me for a second. What I mean by a mentor is somebody that has more experience,
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whether it's a nurse practitioner or a physician or a PA actually, don't want to leave them out,
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that you can talk to with questions. So most of the time for new nurse practitioners,
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those thousands of decisions and questions per day end up being that you're asking these
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little questions, bits and pieces in between patients throughout the day when someone's
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available, which is perfectly normal and helpful, right? But it's also, I found myself
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not wanting to bother people and feeling like such a burden. And so having a mentor for me was
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so helpful. Basically what I mean by that, it's somebody that you can meet with once per week,
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hopefully for an hour, if not half an hour, but just somebody who's more experienced,
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like a set part of your week. For me, it was every Friday at lunchtime from 12 to one,
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I would meet with a more experienced clinician and we would go through all of the cases that were
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keeping me up at night that I was really stressed about all these little nagging
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questions that I really didn't want to bother people with, but I really felt uncomfortable
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not knowing what to do. And the reason I'm saying this is because I actually had to ask
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for this for myself. This was not arranged for me when I was a new grad. And so the reason
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I asked for this is because another experienced clinician recommended that I ask for this for
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myself. And a very like matter of fact, like, you know what, you're a new grad, you need this.
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This is a reasonable request. So basically I'm trying to pass on the wisdom that I receive
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to you so that you have the confidence to ask, Hey, you know what? It would really help
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me to sit down and discuss cases that are keeping me up at night that I'm really stressed about.
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Is it possible for me to meet with somebody for once a week for an hour to talk about all of
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those things? And I can't remember actually how long I did that for. It was either six months
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or maybe even nine months, but it was really, really helpful. And it was just a very plain
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matter of fact conversation that I had with my supervisor and she was very accommodating for
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Not everybody is going to be as open to that, but it's definitely worth asking because it's so,
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I can't stress this enough. I have some strong feelings about this because I see over and over
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again, new nurse practitioners taking jobs where they feel like they're very lucky to have it,
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but then they're not given the adequate support that they need in the job. And then they get
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burnt out. And I can't stress to you enough how important it is to get the support and
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self-care that we need from the beginning so that we can stay in this career for the long
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haul. And it also benefits the clinic for them to retain you over time than it is for
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you to get burnt out and leave after one year. So it's definitely worth a conversation.
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Having that solid hour to sit down, focus and go through all of those little bits and pieces
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of cases that were bothering me was just so life-changing for me. And it really boosted my
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confidence. If you have a supervisor who's open to this, I would definitely approach them,
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see if it's a possibility, whether it's with them, another nurse practitioner, a physician,
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a PA, a DO, et cetera. A nurse practitioner would be especially helpful because they
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understand the role transition in a very specific way. If you feel like you don't have
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this, there are a few resources, even if you've had that conversation and it's not going to
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work out for you, there's a few resources that I've found for mentorship. If you don't
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have that option and even advocating for it hasn't helped you. They're actually inside
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the Ultimate Resource Guide below this episode. So definitely be sure to give it a download.
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It's also at realworldnp.com slash guide. You'll also get these episodes sent straight
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to your inbox every week with notes from me, patient stories and bonuses I really don't share
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anywhere else. So definitely be sure to hop on that email list and you will get all of those
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resources. But yeah, those are my top three tips. So number three countdown is resources.
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Number two is time. And number one is definitely, definitely mentorship.
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Thank you so much for listening and I'll talk to you soon.
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That's our episode for today. Thank you so much for listening. Make sure you subscribe,
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leave a review and tell all your NP friends so together we can help as many
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nurse practitioners as possible, give the best care to their patients.
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If you haven't gotten your copy of the Ultimate Resource Guide for the new NP,
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head over to realworldnp.com slash guide. You'll get these episodes sent straight to
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your inbox every week with notes from me, patient stories and extra bonuses I really
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just don't share anywhere else. Thank you so much again for listening. Take care and talk soon.

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Liz Rohr