What Is Your Philosophy Of Practice As A Nurse Practitioner?
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Show notes:
If you feel like you’re drowning in role transition, you are 1000% not alone.
In fact that exact phrase, “I feel like I’m drowning” is one I’ve heard over and over and OVER again (and felt myself.)
So, whether you're a new grad feeling the overwhelming pressure of transitioning to practice or an experienced practitioner transitioning between specialties…
Today's video is for you.
I dive into:
How your individual style shapes your approach to patient care.
The evolving nature of practice from must-know essentials to more nuanced decision-making.
What to consider when you’re looking for the one "right" answer
Spoiler alert: there's no one-size-fits-all in medicine, and the journey to finding your philosophy of practice is as unique as you are!
The truth is that the transition to practice and role transition are hard AF and it is COMPLETELY normal to feel nervous, under-prepared, and overwhelmed.
You’ve got this.
Resources mentioned in this episode:
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 for clinical
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pearls and practice tips without the fluff, you're in the right place. Make sure you subscribe and
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leave a review so you won't miss an episode. Plus you'll find links to all the episodes with
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extra goodies over at realworldnp.com slash podcast. Hey, so in this episode, I want to
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talk about something called philosophies of practice. I feel like other people say this,
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I don't think I came up with this idea, but it's something that I talk about a lot with my new
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grads when I'm either mentoring them or just in conversation with them. And I feel like the
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purpose of this episode, as well as that pillars of NP practice episode, which I can link
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to down below, my main purpose with both of these is kind of, it's almost like lifting
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the curtain of the mystery for NP students, but also like an orientation piece for new
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nurse practitioners to kind of like help ground you because if you're a new grad or even if
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you're changing from one type of specialty to another, oh my gosh, it's just, it can feel
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really, really hard. But this episode is a little bit more pertinent to, I guess you
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would still be figuring it out if you were transitioning from another practice after having
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some experience. But yeah, I think a lot of new grads talk about the role transition being
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like they're drowning. I absolutely felt that way as a new grad, but like it's just amazing to
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see the same language being used by nurse practitioners across the country. Like it's
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wild. So that's like, that's like a really like unfortunately normal experience of just
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feeling like you're drinking from a fire hose or you're drowning, like all this stuff.
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So yeah, so these episodes are really meant to help ground you and like what is going on
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here? And like what am I trying to navigate here just to help you kind of get your bearings,
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I guess. So in this episode, I want to talk about philosophies of practice and I love memes,
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but I am terrible at making them. I really am envious of the people who are really good at
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making them and are hilarious and I really appreciate that. So shout out to me if you
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are a meme creator and you know what I'm talking about and you want to work on some
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memes for this, I would, I love you for that. That would be amazing. Let me just paint the
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picture, I guess. So I guess when I talk about philosophy of practice, I'm talking about how
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like our style, like what feels good for us, right? Because medicine is medicine is medicine,
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right? And there's algorithms and there's guidelines and there's all this stuff
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and there's a lot of gray area and a lot of choices that we need to make,
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right? And I think that's one of the pieces of when you're a new grad that you just have to
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get used to just making a decision and trusting yourself. And yeah, so when we talk
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about philosophy as a practice, it's really like, what is your style that you bring to
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practicing medicine? So when I have new grads, so I don't do one-on-one mentorship anymore.
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We do have a mentor named Briana who does one-on-one mentorship, but when I had clients
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before, this would come up over and over and over again. And so I think when we learn
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medicine in that like textbook school exams type of way, it's kind of like easy to
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a patient that is like a textbook patient that has a clear answer, clear pathway forward,
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et cetera, right? The real world does not like that as you've probably seen or you will see.
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And then I think there's this like huge massive discomfort that people have when they
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leave school feeling like, oh gosh, I wish I knew more. I don't know if I know enough.
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I don't know if I don't feel prepared to take on this role. Like I feel like an imposter,
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like all of this stuff. And then that feeling of drowning, like it's just a lot.
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And again, I'm like not saying this to scare you. I just really want to, if you're a
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student, but like you should really want to normalize and validate if you're feeling this
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way yourself. Totally, unfortunately, totally normal. I wish it wasn't that way, but yeah.
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So a lot of the clients that I see, the newer nurse practitioners. So when they come to me,
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a lot of them are like, here's this clinical case. I have this patient who has hirsutism.
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I feel like I get that example a lot. I just, I think of a very specific client
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that I had a couple of years ago and we talked about this case, but it's this female
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patient in her sixties who had hirsutism and she was kind of jumping right into like,
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so I was looking at the treatment options of this or this, right? Well, first of all,
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we did a little pause. We did a step back of like, okay, so well, what are your
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differentials before you jump into treatment? Like, let's just make sure we're not missing
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anything more serious or more tests that need to be done, et cetera, et cetera.
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So we had that conversation. And then when we started talking about the management options
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and like the workup plan, workup that had been done, what are the treatment option plans?
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What are the next steps forward? I'm just giving this as one example, but I see this
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all the time. It's like, no, no, no, what's the right answer? Like what? Tell me,
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tell me the right one. Here are these two options. You can do a topical thing or you can do a pill.
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Which one can I do? Actually, I don't think that patient was in her sixties, but anyway,
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I don't remember the details of the situation, but basically there were two treatment options
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and I was like, well, you get to choose. This new grad was like so frustrated.
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And I remember being the same way when I was a new grad. And that's what I mean by
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philosophy of practice, right? So when somebody, when they come in and they have this problem,
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you have some choices to make and then you just get to decide what is your philosophy about that.
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Right. Are you likely if you're a new grad, you're probably going to be a little bit more of a
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stickler about everything because you're just so nervous. But over time you can kind of
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decide, Hey, are we going to wait and see if these symptoms get better? And then watch out
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for the alarm signs. Are we going to treat them right away? Are we going to do lab tests
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right away? When are we going to repeat the lab tests? What are those choices? How kind of
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exact or free flowing are you? If you've been around for a little while, you've probably noticed
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that I'm pretty relaxed. I'm very committed to evidence-based medicine. And I also appreciate
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because I have many years of experience working in a federally qualified health center or multiple
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FQHCs that the real world is a tricky place sometimes. And we sometimes have to do choices,
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make choices like harm reduction, for example, versus like, oh, this is the gold standard of
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treatment, but you know what? At least you're doing this thing, which is reducing your harm.
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So anyway, more concrete example I want to share with you is like, for example, a lot of new grads
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say they have like a lab result, right? So let's take high white blood cell count, for example.
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So I actually have an episode on this. It's a oldie, but a goodie on the YouTube channel.
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I believe it's on the podcast as well, but I give a case study example of elevated white
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blood cell count. And so if you're in clinic, you're practicing in clinic and you see this
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high white blood cell count of like 15, you know, the normal range is about four to 12.
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I'm talking about U.S. units, you know, between four and 11, four and 12. And this one's like 15,
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maybe 17. And you're just like, oh my gosh, I'm going to do all these labs. I'm going to
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set them to hematology right away. That might be the person that you ask, you're like, oh,
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I'm so nervous. Should I do this? And then you ask one person, they're like, oh,
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absolutely. And you might want to do X, Y, and Z tests too, right? You might want to,
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oh my gosh, I'm losing the test on the top of my head. It's not a test that I would
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choose. So I'm not even going to mention it, but there's another test that sometimes
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people go down the route of high white blood cell count. I'm not getting into details of a
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situation. So go look at that case study if you want to look at it. I think I mentioned
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that test in there. And then you can kind of like walk down the hall, as a lot of skeptical
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new nurse practitioners do, hint, ask me how I know. And then I went all the way down the
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one may go down the hall and ask another person. And they're like, oh, no, no,
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that's fine. Just watch it. Just tell them to come back in three to six months. Right.
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And so those are very, very, very different approaches to medicine. And so that's kind
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of what I'm talking about by philosophies of practice. And the reason I brought up means is
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it just seems like no matter what clinic I go to, I find some sort of variation of like,
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if I vibe with that person's philosophy or not, like, are they too much of a stickler for me?
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Are they too lax for me? Are we on the same page about stuff? Like that kind of thing.
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And then the other piece of that, when it comes to philosophy of practice,
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again, I wish I had like pictures of this user. I spent a lot of time thinking about
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this, but when I think about that role transition to practice, when we first start
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as a new grad, it's kind of like, so if you're watching on YouTube, you can see this,
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but if you're listening on the podcast, you can't. So I'll try to describe it. But basically
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it's a series of concentric circles. So there's a circle in the middle and that's like the must
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do. Right. When we graduate from school, these are the things that we must know,
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that we must not miss so we don't harm anybody and we provide safe care. Right.
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Here's the must dos. Right. Somebody is having a febrile seizure. That's not a good
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example. But anyway, if there's some sort of urgent situation at hand, okay, we need
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to recognize and know that they're going to the ER. We're going to send them to the ER.
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We're going to put them on an ambulance if that's appropriate. XYZ. Right. And then the
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next concentric circle is like, you know, as we grow in our practice, right, there's,
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there's like the kind of like other standards of care. Right. And it's sort of things like,
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you know, like if you really enjoy doing physicals and talking about health education
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and kind of like that bread and butter of primary care, like that, this is like the
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core stuff that we're talking about, like seeing all the time, but it's nothing that has
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like a quote unquote fancy diagnosis or fancy labs, which is one of the things I refer to as,
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I feel like other people say that too, but it's like, oh, okay. If they have like complicated
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cirrhosis or heart failure with carnal renal syndrome, like, oh, no, thank you. Like,
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no, no, no. That's not who I'm talking about. Right. That's that next concentric circle of
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like, you know what, I'm going to let somebody else handle that, whether it's somebody in my
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clinic or I'm going to refer them, you know, whenever that diagnosis comes up, something like
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that. And then you have another concentric circle, which is like, again, if I take those
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examples of those really complicated patients, some people really thrive there and they really
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enjoy those particular patients and they might not enjoy doing the kind of like bread and butter
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of primary care with health education and doing physicals and doing PAPs and things like that.
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And just to clarify that concentric circle, I never recommend new grads jumping into that
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for this scope of practice. And this is again, maintaining our scope of practice,
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but just pushing it to our limits of what is safe and legal in our states. But yeah,
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so those are kind of the things to think about as you're going through practice. Like
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there are choices that you're going to have to make. You're just going to have to decide of
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you know what, I'm going to try this one out and we'll see how this goes. This is an option and
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this is an option. I'm going to go with option A, see how I feel about it. Maybe next time I'm
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going to choose B because I didn't like how that went or it doesn't feel great to me,
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et cetera, et cetera. And then that other piece is like, how tightly managed do I want
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someone to be in terms of testing and referrals and seeing them? How soon do
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I want to refer them versus keep them in the clinic? And then I'm going to do the workup,
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the primary workup specialists would do, and then I'll send them out.
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How fancy do I want to get with those labs? How confident do I feel about interpreting
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the results, et cetera? That's really more like as you grow in your practice over time,
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please don't do that as a new grad. I do not recommend that. But yeah, so basically this is
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bit of a longer episode, but what I'm talking about here is I just want you to be aware of
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and grounded by, and that can be really jarring to be like, oh, I have to make this
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decision. I'm like, me? Like really? I have to, but knowing that something that you are
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only going to discover through practice over time and through talking with other clinicians
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and you're like, yeah, I, I'm down for that, right? Like I had this clinician that I,
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this physician that I work with at my last job and he, where I were just, I just felt like
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he's in a pod, but like he just knew more than I did. And I was like, can I just download your
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brain? Like I've been in practice for seven years, but I still want to know all the things
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you know, right? But the way that we would nerd out on patient cases, like we just really
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vibed, right? And I think that's something that we'll just figure out with time.
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And there are different choices when you're first a new grad and you're like, oh, there
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has to be one right answer. And the reality is that there are many ways to practice medicine
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excellently and safely. You're going to figure that out as you go. Hopefully that's a grounding
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concept for you to think through to kind of like build your confidence there of like,
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you know, as long as we're choosing the safest option at the end of the day,
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there are many, many choices to be had. That's our episode for today. Thank you so
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much for listening. Make sure you subscribe, leave a review and tell all your NP friends
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so together we can help as many nurse practitioners as possible, give the best care
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their patients. 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 your
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inbox every week with notes from me, patient stories and extra bonuses I really just don't
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share anywhere else. Thank you so much again for listening. Take care and talk soon.
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