New Nurse Practitioner Transition | You're Not Alone
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New Nurse Practitioner Transition
This has been on my heart this week - between working 1 on 1 with mentees and seeing the landscape online of new grad nurse practitioners, I see this ALL the time.
Feeling like you're the only one feeling this way.
Feeling behind, not knowing enough, and then beating yourself up for it.
If this sounds like you, take a listen-- sometimes just naming and acknowledging what's ACTUALLY going on makes a difference in how you're feeling about it.
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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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So I don't know if you need to hear this, but I feel like this has been on my heart
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and I feel like somebody needs to hear it.
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And maybe that's you.
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So I've been in practice since 2015 for about five years now.
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And the entire time, basically the entire time since I started, since about six months
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in, I've precepted nurse practitioners without a break because I love it.
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And then also when I was in school, I mentored earlier on students.
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I just can't help myself, but I've had a lot of experience mentoring and working
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with newer nurse practitioners and nurse practitioner students.
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And I see a lot of commonalities and this feeling of like they feel really alone.
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And so I just wanted to kind of speak to that experience of the transition to
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practice. But yeah, basically, I didn't really feel like I was, I knew what I was
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doing or I really loved being a nurse practitioner until about three years in.
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And I hesitate to share that because I feel like it might be discouraging, but
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I feel like it's also very honest.
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And there's a spectrum, right?
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And so there were always aspects of my job that I enjoyed along the way, but I
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didn't really feel like I can walk into work.
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I am happy to be here.
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I'm excited. I'm not super nervous.
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Like I'm always a little bit nervous, right?
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But just like walking in, feeling like I know what I'm doing, feeling
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confident, like all that kind of stuff, it took a little bit of time.
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So I just wanted to like name and like acknowledge this.
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Like what makes this transition so hard?
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So there's a lot of reasons, but one of the things I particularly see is that
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nurse practitioner students and nurse practitioners, after they get into
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practice, is they are very heart-centered, excited, like focused on
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impact and being the best nurse practitioner they can be.
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Like really, really like just like super high goals.
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And I have those too.
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And I think also I've met with that is this is so much excellence and so
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much achieving and so much quality, but at the same time, like those things
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together are so beautiful and we need more of that in the world.
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I think we also have like a darker side of it, though, that I think that
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makes people feel like they're really alone in this transition.
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There's this kind of like general psyche.
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And again, like this is not just the people that I work with, like in
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person, but I'm also very I have my, my spidey sense out in the world in
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terms of the internet and all that kind of stuff.
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Like I just see these themes over and over again of this like general
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feeling of like rushing and stress and anxiety and like, not enoughness.
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Like, I don't know enough.
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I'm not doing enough.
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I'm not doing it fast enough.
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There's all these like things that I need to have done yesterday.
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And I just wanted to share like, number one, you're not alone in that.
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And then I also wanted to share it, like what is so hard about this
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transition and like, hopefully encourage you to acknowledge yourself and
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give yourself a little bit of slack.
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So like, for example, like if somebody comes in, like you're
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working in the clinic, right.
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And somebody comes in with a chief complaint of abdominal pain, like as
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a nurse practitioner, new or newer nurse practitioner, your first thought
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is like, okay, so like, I have to investigate the chief complaint of
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abdominal pain, which is a kind of like a stressful, scary diagnosis,
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right, or chief complaint.
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You're thinking about the differentials.
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You're thinking about knowing all of those diagnoses, right?
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What that means, what that looks like, the physical exam, the
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history questions, making those decisions about the plan of care,
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the interventions, how to interpret those tests that you might order,
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what interventions to choose based on which diagnosis, like that right
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there is a ton of brain power.
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And then you're doing it in the context of like a real life person
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in front of you, right, who is coming with a chief complaint of
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abdominal pain, but may also have some other concerns, right.
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And each of those concerns that they have warrants that same process
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of differential diagnosis, history, taking all of that stuff, right.
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And then you also like are trying to navigate this communication with
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the patient of like helping them feel heard and cared for, while at
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the same time, acknowledging their concerns and like staying in your
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lane of like how I can best help you today.
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And at the same time, you have those other layers of like time management,
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like you're trying to do this all in about 15 to 20 minutes, getting it all
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done nicely, you know, wrapped up with a bow, documenting appropriately
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your history, your physical exam, signing off your note, and then you're
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just making your own decisions, right.
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And that in and of itself is a huge, huge role transition of like being
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the end of the line, right, where you, you're not always the end of the line.
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Like you, you ideally should have some sort of support, other colleagues,
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other supervisors, like a supervisor that you can go to, which I could
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go on and on about, but I'll, I'll save that.
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But you're not necessarily always the end of the line.
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Like in this moment you are, but in the scope of everything, like there
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are other, there are other resources, there are other people, there are
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specialist, things like that.
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And then like in the context, like this is just one patient visit.
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And then you go out of the room and there are more patients waiting the
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front desk is coming to talk to you, to make a decision about something that
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you're like, I have no idea what to make that decision about, and like your
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labs and the med refill, like there's a lot, right.
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And I'm not saying this to kind of stress you out, but I just want you
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to acknowledge that like, as an experienced clinician, most of those
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things for me are like well-worn pathways now, like I'm comfortable
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getting a history, I'm comfortable directing the visit and communicating.
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And I've also seen diagnoses before and I've done the differential
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workup, even when there's unusual presentations, like I've done, most of
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the brain power is on the new stuff.
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And it's not on the like foundations of your practice, right, of documenting
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and signing your note and all that stuff, you know?
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So there's a lot.
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And so I just wanted to, like, I hope that you can acknowledge
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that like each of those things is something new to learn.
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Another part of it is that like every day is new, every patient is
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new.
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And like, I hear this from the mentees that I work with too,
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of this is like kind of brain exhaustion of like, I just want things
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to be like something to be easy, you know, I just want something to be
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normal.
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And that is just like a process over time.
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And it does get better and better, but like it takes a while.
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It takes a long time for those to kind of be like well-worn pathways
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in your brain, such that you can kind of like, those are easy.
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Those are the easy parts, right?
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And then you can just focus on the hard stuff, which is the
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differential diagnosis, the management, like all of that stuff, right?
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So, like, I just, like, I just want to pause and like, hopefully you
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can, I want to acknowledge you for being on this path.
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And I'm going to try not to get emotional.
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It's really hard not to, because I acknowledge how difficult this is
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from my own experience and from what I see in other nurse
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practitioners.
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But like, I just want to acknowledge you for like putting your
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beautiful heart in the world and like undergoing this transition to
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practice.
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And it's not easy.
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And I hope that you can give yourself that same acknowledgement of
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recognizing how much you are actually learning on an every day,
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moment to moment, minute to minute, like day to day process, right?
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And then like one other thing I wanted to highlight is that like in
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terms of like the transition to practice of like how people kind of
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like feel like they don't necessarily see how much they're
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doing and which contributes to that feeling of like, oh, I don't
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know if I'm not doing enough and like not necessarily knowing what
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they're getting themselves into kind of thing.
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It's like a little bit of a theme of like what I want to be
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focusing on in this video, but there's a lot of, especially with
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the transition to practice is like nurse practitioner students are
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taking textbook patients and textbook chief complaints and diagnoses,
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like even the simulated patients, like in the real world in your
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clinical rotations, you'll see this, right?
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But like in the school based world, it's beautiful and it's so
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fun differential diagnosis and diagnosis in general is super
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interesting and fun and like you're a detective and you're putting
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all the pieces together and it's so lovely when they all fit together,
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you get your checkboxes, it's tied with the bow, you know exactly
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what to do, what to order, how to interpret it, the treatment,
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they all get better, right?
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That's beautiful.
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That does happen in the real world sometimes and it's super cool,
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but at the same time in the real world, patients come with chief
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complaints of all kinds and some of them unusual.
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Some of them are difficult, right?
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Their abdominal pain that's really vague and it's not really fitting
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into a category and it's like unclear and then you know, and then
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there's also this like experiential knowledge that I have now that
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it's hard when you're a new or new practitioner of like some things
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go away on their own and some things are not explainable and like
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I've acknowledged that reality from just from experience, right?
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And experiential knowledge of somebody coming with a chief complaint
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that they're really, really concerned about and I go through
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all the history questions, the physical exam, the investigation,
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all that stuff, and then they come back in for a visit like two weeks
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later, a month later and like, oh, that went away.
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That was just like a day, you know, or they'd had it for three
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months and then it just went away, right?
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And so that I never know, I never don't work up and investigate
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someone's chief complaint, but I also have this like knowledge of
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like, you know, like the pressure comes off a little bit, especially
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with like the more vague diagnoses that are the vague chief
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complaints that are not matching up, that don't have any red flags.
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You know, I have a little bit more ease with that.
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I mean, that's to say, like, also there are chief complaints
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that we cannot investigate.
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Like there aren't, there are distinct answers for, despite
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our best efforts and investigation.
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And those patients are still suffering, which is really unfortunate.
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That is one of like the biggest kind of like heart challenges
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that I have in terms of like, desiring to care for
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patients in clinical practice.
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But we, we know, I think by the evidence that the more
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unusual presentations, the more zebra diagnoses can take some time
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to uncover in multiple specialists in the same, like multiple
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specialists within one specialty field, sometimes, you know, like
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a patient in, in the lab course recently, someone was presenting
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a case of abnormal labs of somebody that took nine specialists
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to figure out what was going on with them.
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And they ended up having something like a zebra
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diagnosis, right, which we talked about.
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So, so yeah, so things like that happen.
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Um, but yeah, I guess my main point here is like, I just, I hope that you
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number one can acknowledge number one, that you're not alone.
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And number two, that this is very hard and all of the ways that I can see how
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it's hard that you might not be seeing because you are maybe
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discrediting how much work that is, how much brain power that's taking,
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because you're very focused on the, the generating the differentials
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and learning more medicine.
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Um, maybe you're not, maybe you are acknowledging how hard it is,
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but, um, with that said, I still hope that you can acknowledge yourself,
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that you can take really good care of yourself, give yourself more slack,
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try to get rid of those thoughts of like the not good enough and not
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knowing enough, because this is a marathon.
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It's not a sprint.
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Um, and it's, and it's a, it's a huge personal development transition.
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Like it is, it is mind blowing how challenging this is.
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So, um, so yeah, just keeping all of that in mind.
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I hope you're taking really good care of yourself, giving
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yourself slack, getting support, asking for support when you need it.
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Did you like this video?
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If so hit like and subscribe and share with your NP friends.
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So together we can reach as many nurse practitioners as possible to
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help make their first years a little bit easier.
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And if you haven't grabbed it already, head over to realworldnp.com
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slash guide, um, for the ultimate resource guide for the new NP,
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which I put together of my own kind of favorite resources, the best
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tried and true over practice over time.
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I really just don't share in morale.
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That's our episode for today.
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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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