Transcript: New Nurse Practitioner Q & A | How to know when to change jobs

​Liz Rohr:
Well, hey there, I'm Liz Rohr and you're watching NP Practice Made Simple, the weekly videos to help save you time, frustration, and help you learn faster so you can take the best care of your patients. So I'm doing something a little bit different today. I'm doing a Q&A from the community. I have a question here that I had an email about, and I really want to be able to share answers to your questions within a larger community, because if you have a question, it's very, very likely that other nurse practitioners have the same question. So this question is from Beth from Oklahoma City. And what her question was is about, "I wonder..." How to know if you're on the right path? And so for her, just to sum up her question, what she was asking is, she's getting the same feelings like she got when she was a nurse of, "What did I get myself into?" What is your path in the first year and how do you know when it's time to change jobs?

Because I shared recently on a video that I changed jobs, and she wants to know, when is the time to know that? And in her current practice, she really is grateful for everything that she learned, but she feels like she's so busy charting and putting out fires that she's not really learning the basics. And she also feels like she's more of an assistant to a medical provider, more so than her own clinician, kind of following up with questions and tasks instead of doing her own cut up panel work. And family is really important to her and she's not happy charting all the time and feeling really stressed and working late. So Beth, thank you so much for this question and my heart goes out to you, and I'm sorry it's taken me so long to respond to you, but I just wanted to say that this is an incredibly common experience.

I literally could have written this myself, with a few changes, but I think that this is a very common experience from what I hear from new nurse practitioners in that they feel questioning, what did they get them themselves into? Is this the right path? Did they make a mistake? Should they go back to their old job where they knew what they were doing? It's crazy how common this experience is. I do a ton of talking to new nurse practitioners and I am observing the landscape in many different platforms and I really hear it all the same. And even just working myself and working one-on-one with other new nurse practitioners in person, it's very common to, at the very beginning, I think it's just part of that transition of just feeling completely overwhelmed.

For me, for example, what I would do is I would see a patient, I'd have to look something up for every single one of them. I'd go out of the room, look something up very quickly on UpToDate, ask my colleagues because I didn't believe in my own confidence, my own abilities, my own knowledge, just to get verification until I got a little bit of pushback from one of my mentors who was like, "You know what? You can do this, make a decision and move forward." And so that's how my daily life looked like. And I also just felt like I was constantly working. I came in early, I stayed late, like an hour on each side, and I also worked on the weekends. And for a really long time, I worked like that. I mean, I think I probably worked like that for the first full year, if not later. I think it took me about a year and a half to two years to really feel like I got things under better control.

I didn't have a child at the time. I have a toddler now, and that was workable for me in my life. I don't know what it would be like now, having my daughter, if it would be the same, but I think that's a very common experience for people and a lot of reasons why new nurse practitioners get really frustrated. And I think that for me personally, the path forward, I think I kind of accepted that as part of my journey and I was okay with it. I don't love that that's really common. I think that really wears on new nurse practitioners in their first years. And I wish it wasn't that way, which is part of the reason why I have this website to hopefully make that easier, that transition. But it's really common.

In terms of me and my own path and how I decided to go forward, one thing, part of your question was feeling like you are someone's assistant and you're not really your own clinician. And I feel like it really depends on the state and the type of practice that you work in, but for me, in the setting that I work in Massachusetts, community health centers, typically, the ones that I've interviewed at, at least, have a very independent practice model where they have their own panel of patients, they do their own work, they have their own patients, and they're only covering for other providers, whether NP or MD if they're out. Whereas in some other practices in the same state, potentially hospital-based or something else like that, they have very different roles. One of my colleagues that I used to work with in a primary care PCP type of setting... I'm still a PCP, but for her, she is in a specialist practice at a major hospital and she sees patients off of the MD's panel.

And so they see the MD and then every other visit, they alternate with the nurse practitioner and they have to do more of those task-related things that... Each has its own side, right? I prefer PCP because that just fits better for my personality and what I enjoy about my job. However, it would be really nice in some ways to not have the onus of the responsibility on me when it's not my panel, if that makes sense. And there's more to say about that in terms of pluses and minuses. But yeah, I mean, I think the unfortunate part of what I've seen for people is that if that transition of taking that long of a time to get used to the amount of workload, I think the reason why it takes so long to get used to it is that you have to stop and think really hard and do a lot of reading and research for every single decision that you make when you're brand new in the first year to two years.

Whereas now, I've looked all this stuff up a million times. And so I can make decisions a lot faster, I finish my notes faster, I know exactly to ask in my visit based on the notes and the differential diagnoses that I've seen before. And so it's a breeze now and I barely take things home. I mean, I do have to come in early and stay a little bit late so I don't actually chart at home, and that's a little bit inescapable in primary care. But I think the other thing to think about is, are you seeing too many patients? Are getting paid for administrative time? Or if you have all of those things that you want, is this a good fit for you in terms of working full-time and is it an option to decrease your time? Because I think that the other things that I've seen for people is if they can't handle that or they don't like that, they typically cut down. But I do have to say, if there's any reassurance going forward, it does get better and better.

I think one thing that I would encourage you, in terms of making that decision of what's the right path for you, is to really... I think that sometimes, especially as ambitious, smart, really driven people that we are as nurse practitioners, I think it's very easy to override our own needs, especially as caregivers too. And I think what's really important is if you can kind of slow down. What I personally do is try really hard to just tune into my own intuition and my own body and think about what I want and how it makes me feel physically. Do I feel contracted when I think about this particular job? Versus, am I very excited about the prospect of doing X, Y, or Z?

And in terms of my personal transition between two jobs, I think it was a variety of lifestyle factors. And my commute was really long, the population was really heavy in terms of a lot of high burden of mental illness, and I just felt like it was time for a change. And for me physically, I just felt like I wasn't lit up as much as I had been before. Kind of going back to that feeling of what lights you up and thinking about physically how that feels. So hopefully that's helpful. I mean, one reassurance that it does get better, and that's a really common experience of taking a lot of work home and feeling like you're constantly working or constantly thinking about work. And then the other side of it is like, is this practice the best fit for you? Do you want more independence? Do you want your own panel? Do you want to not be in primary care? Do you want to see less patients during the day? Things like that.

So if you haven't grabbed the Ultimate Resource Guide for the New NP, definitely head over to realworldnp.com/guide. I put together all my resources that are my favorite ones, and you'll also get these videos sent straight to your inbox every week and bonus content that I don't share anywhere else. Thank you so much for watching. Let me know if you have any questions and I'll see you soon.