Transcript: Does it Get Better as a Nurse Practitioner?

Liz Rohr:
Well hey there, it's Liz Rohr from Real World NP and you are watching the Real World NP YouTube channel. We make weekly episodes to help save you time, frustration and help you take the best care of your patients.

So in this episode, I want to talk about a question that one of the new nurse practitioners that I was mentoring had asked me.

So just for context, so I had the absolute pleasure of having a small group cohort of mentorship. So a number of new grad nurse practitioners on Zoom calls with myself and another experienced nurse practitioner. Her name is Brianna and she's amazing. Hopefully, you'll meet her someday on the channel or maybe behind the scenes once you're part of one of our products or services, but Brianna's amazing.

But anyway, we were talking in the small group and so we had built rapport over the weeks that we had worked together and we were kind of just doing our wrap-up call. Brianna and I, this nurse practitioner mentor, we were talking with the group and we were kind of like, you know what? Y'all are doing such a good job and you're doing better than you can appreciate, than you can see and this really does get better. Then one of the mentees was challenging me a little bit in kind of a joking way of does it actually get better?

I want to talk about this question on this episode and what we talked about.

So I think just for context, I've said this in a couple of different episodes, maybe in a different couple of different ways, but just to put it really plainly in an episode if you haven't heard me talk about it before, likely if you are a new grad, you are experiencing this. The role transition is really challenging. The first year to three years is rough and I think that it's a pretty common experience for other nurse practitioners that I've talked with, that I know, that I work with. Once they hit that three year of experience mark, it's like something really shifted overnight, but until you get there, there's a lot to take on.

So not only are you learning all of this clinical medicine that we all continue to learn every single day for our entire careers. No one is ever going to "arrive" with all the medical knowledge. So that's one of the pieces of being a new grad. The other thing is that you're trusting your clinical decision-making process for the first time on your own and that's a whole thing. That's a thing that you can learn about, but you have to practice.

The other piece of it is that you're learning things like how clinics work and you're learning time management, how to talk to patients, how to supervise your staff, how to be a leader in this leadership role that you kind of weren't prepared for. You were kind of just put into and then all eyes are on you and you're giving the final answers at the end of the line.

The reality is that you're never practicing alone alone. You're not the only clinician that exists in the entire world but it does really feel that heavy responsibility of all eyes are on you of what do I do here? Right. So that's just the context. If you're in this clinical experience already, if you're in those first couple of years, you're probably like duh, of course I'm experiencing that. But I just want to normalize that all of those things that are new, once you hit that year mark, two year mark, three year mark, that all gets better.

You're not learning how to conduct visits. You're not learning how to take a history. There's so much muscle memory of all of your processes. There's all of the clinical knowledge that when you were a new grad, you have to look at this up for the first time. Then once you get to that two year mark, three year mark, you're like, oh, I've seen that a whole bunch of times. I don't even need to read about that. Maybe I'll pull up an up to date article and I'll read about what updates there have been in the last year. 'Cause I haven't seen it in a year, this random chief complaint.

So the first part of our kind of answer was that... Things to add to on this episode is that there are so many components of the first year of becoming a nurse practitioner and first two years, and even up to three years. Or even beyond. But I feel like for so many clinicians, three years is wow, there's something that really changed almost overnight where you're like, oh wow. I can just show up to clinic, see some patients. Give me an 83 year old patient with 20 comorbidities. I haven't looked at their chart. Let's go. That's how I'm feeling. That's how I started to feel when I was at three years in and for context, the mentees that I was working with who are nurse practitioners in their first year are like, wow. I look up all my charts the night before. I'm doing so much pre charting, I'm coming early, I'm staying late. I'm writing these novel notes.

All that stuff gets so much easier. So you get to this place of, especially that three year mark where you can just show up and do your job. It's still stressful. I don't feel like I've ever "arrived" to this place of I'm never stressed out. But it's healthy stress because we have a job that is high responsibility. We're taking care of patients' lives, but it also gets to be fun. I think that for me and my experience, and also the nurse practitioners I've worked with over the years, those first couple years, it's a little bit challenging for it to be as fun as it could be, because there's so much to learn. It's just a huge role transition.
 

So there are fun parts along the way, but it gets to be more fun as you go along and you're like, oh, okay. This is old hat. This is stuff I already know. I'm really good at this. Whereas when you're a brand new grad, especially if you've worked as a nurse before, or if this is your second career, you were really good at whatever the thing is that you used to do. Then you're coming into this job where you're brand new and you're like, I'm just terrible. I don't know what I'm doing. I'm going to fool everybody. They're going to find out that I don't actually know anything.

So that's the beauty of it. When you get to that two to three year mark, I'm just going to say three years because it took me a while, but it could take even longer. It's not a hard and fast thing, but yeah. So all of that stuff gets easier and you don't even have to think about it anymore. I do want to normalize though that healthcare is not all stars, unicorns and rainbows, as much as I would like it to be. I think that there is a challenge in healthcare the way that it functions in the US, especially. I haven't practiced internationally, but in the US, we have a lot of challenges as it comes to funding, and insurance and the way that healthcare clinics are run and the system works that the hardest part, the thing that we were talking about, and I'll just speak for myself here. I feel like the hardest part at this point with all the experience that I have are those components.

There are things that we all find that we love to do and that we're better at, and we're not as good at. Then what I find that I do and that the other clinicians that I've worked with do is we really just try to highlight the things that we're best at and then mitigate the things that we're not as good at or that we don't love. For example, I hate paperwork. I do not like writing notes. I hate writing notes. I love lab interpretation, but I don't love the kind of tedious part of that work. My real strength and my skillset is connecting with patients, medical diagnosis, teaching, mentorship.

So for me, I got to this place of realizing that, you know what? I always knew, I always always knew that I wanted to be in primary care and I wanted to work as a clinician, but I also always knew that it was going to be clinician clinical work and something else. So I went through my personal journey of do I want to do public health? Do I want to run a business? Do I want a side hustle? Do I want to go into teaching? I chose teaching and business. That's what my choice was and that's why I run this company. That's why I do what I do and it's able to support me in my life goals, and in my personal life, and my family and all that stuff to do both jobs.

So one of the other things that we talked about in the context of this conversation is that, you know what? Some people want to do primary care full time and that is their thing and they're going to do that forever until they retire. There are other people who don't want to do that. They know that they don't want to do that, or they're realizing, you know what? It's really a lot for me to have all of these notes, all this paperwork, et cetera. Either they figure out maybe it's the clinic. Maybe it's this particular job that's not working for me. Maybe it's another type of work that I want to do, whether it's a lifestyle choice or driven by your lifestyle choices. I really don't want to take any paperwork home. I don't want to be doing the type of paperwork that you get in primary care. So I'm going to go do urgent care instead.

Not that urgent care is all hearts and rainbows either, but we just kind of make these decisions of what we want our lives to look like and what we want our careers to look like once we get to that place. As another example, the options are really limitless. It's really unfortunate that our healthcare system is not... This is opinion, right? Obviously this whole thing's opinion, but my opinion is that it's really unfortunate that our healthcare system and our education system is not set up such that you can go to grad school, have all these loans, work in your job, repay those loans. That's a huge stressor for a lot of people. There are still opportunities that we can do instead of, in addition to with all that context in mind.

I think some people get really upset when I talk about how a lot of people are not full time in primary care, because they're feeling some type of way about the fact that they have student loans and it's like, well, I have loans to pay. But also we get to choose what we want to do. So just for other examples of things that we talked about in terms of does it get better? So I guess first point is, yes, it does get better because you learn all of these things in the first three years. It just takes a while and it's just time, and practice, and a lived experience to get those skills. But once you get to that place, then you have to figure out what is your thing? What do you love to do? Is it talking with patients? Is it teaching? Is it who knows? You get to decide for yourself and then at that point you can evaluate at any point, honestly, you don't have to wait three years.

That's the place where it's once you get past that initial learning, if you're still having a hard time of it's not really getting better, then you have to decide for yourself, what are the things you can do with your career and your life so that you will feel fulfilled. Then the other piece of that, I guess just a couple of examples of what other people have done. So in my primary care clinic, most of the providers do three quarters time because that is enough for them and that's what they need financially. It supports their lifestyle and their family and all of that. So I found a lot of people in primary care will do halftime or three quarters time instead of full, full time. They talk about sessions, four hour blocks of time and how many sessions per week.

So again, that might bring up some feels for you about that's not fair that we're set up into this system where we can't really sustain this full-time career and pay back our loans, et cetera. I'm not saying that at all. I'm just saying some people find that's true for themselves. So the other thing that some people do is that's just all they work. Some people have grant funded other stuff. I talked about this, I think in another primary care video or episode, rather where they applied for grants to work on a special project in their clinic. So they work on HIV care, maternal health, things like that. They get some sort of grant funding and that allows them to work on that project for four hours a week, instead of seeing patients for that four hours a week. So they still work full time, but they're just doing other things.

Then the other piece of it is maybe you do love full time. You want to work in primary care forever. We just have to figure out what are the things... No one can be perfect all of the time and what are the things that you want to focus on and what are the things you don't want to focus on? I talked about I don't love writing notes. I don't not write my notes. We still legally have to write notes, but I figured out a system where I can hack it, such that it is the least painful possible and I can talk with my patients more. I can mentor more. I can precept students more. Those are the things that help me figure out what I want to do with my life.

So that's just a starting place though 'cause that's not covering all the potential options of what it could be like in terms of the getting better. But I do just want to normalize that those first couple of years are really tough and once you get over... You're not going to do that stuff forever. You're not going to have to look up your patients the night before and pre chart and all this stuff., and look up labs for hours and hours on end. You're not going to have to do that forever. That is a very strong, initial part of the role transition and then once you get to that place, you get to decide, what is it that's bothering you? What is it that's not the issue?

For myself and for the other colleagues that I have, it's not the job. It's not the working with patients. That's the favorite part. It's just some of the ways that healthcare is set up writing notes, that kind of stuff. So that's the place to take it from there. Once you get to that place of how do we optimize your living experience? Your career, and your lifestyle, and what questions can you ask? What are the things that are people around you doing, stuff like that.

So hopefully this episode was helpful.

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