Transcript: New Nurse Practitioners Pillars of Primary Care

So, as you can imagine, I spend a whole lot of time thinking about the transition to practice from Grad school into the real world and why it's so hard and like why it's so terrible and what we can do better about it as a profession, what I can contribute with this company can contribute where are we going as a profession in terms of like, movement forward. And one of the pieces I've thought a lot about and one of the things I try to do with the company of Real World NP is address like three main pillars of that transition to practice.

And this is just something I came up with. It's not like set in stone, but these are the observations that I've had for myself and over the years and with the people I've worked with.

But really like I think I think the issue is is that when we graduate, first of all, terrifying. Nobody feels ready. And yeah, it's just like, how am I supposed to do this? I'm an imposter, all that stuff, right? And a lot of people feel like, I'm not prepared. I wish that I knew more things. And they're really worried about the clinical topics. They're really worried about the clinical knowledge and knowing the answers and making decisions, which is all like a valid real hundred percent. That is a huge part of the transition.

I wanted to talk about the other pieces.

So the first transition of practice is about clinical knowledge, right? So we graduate with the skills and tools and baseline knowledge to be able to continue to learn as we see patients, as we practice in real life, right? Because like even if even if we've studied for thousands and thousands of hours, right, the people that you see in real life are not to expect people, and there's a lot of gray area, and there's a lot of uncertainty, And there's a lot of lack of answers even though you wish you had an answer like people just come in a couple of weeks later and you're like, oh, no, just went away. No, it's a big deal.

The thing that you saw them for like a couple of weeks ago, and it was you know something they were really stressed out about you know, and you were really stressed out about helping them with specialist referrals and all these tests and all the stuff, and then they just they don't have symptoms anymore, right? Which is really great for them and it kind of is really like such a mind game roller coaster for nurse practitioners, especially new ones.

So yes, so absolutely clinical talk, clinical knowledge, building your clinical knowledge, like that is a huge part of this transition of practice and that's why it's so hard.

I think the two other pieces though, the second kind of pillar of this transition of practice is navigating the healthcare system.

Like that's the best name that I've come up with this kind of category, because there's this whole other element that we are really aware of, at least I wasn't aware of and it sounds like a lot of other people aren't aware of either is that when you get into the real world you have to deal with things like not only are you like diagnosing and managing illnesses and diseases and things like that and helping patients you're also trying to figure out like how health care works right?

How do you do billing and coding, where do you order your medical equipment from, what kind of paperwork do you have to do for these diabetics shoes, like, how do you order visiting nursing services for somebody you know, how do you like yeah depending on which insurance that the person has like where you get your medical equipment from right there's just like so many different pieces.

In addition, there's also I've done a couple of episodes on this on the YouTube channel and the podcast where I talk about the challenges of navigating primary care. So one of the challenges is that I was like totally not aware of because I was so, again, I was so focused on the clinical knowledge building, right? And I kind of just started a job and I was like, I'm just going to do my thing and it's like, oh, no, you exist in this ecosystem of how healthcare works, right? And so I talk about the challenges of primary care. There's a whole playlist on YouTube if you want to look at that. But when I'm talking about it, like, basically the business of primary care, the business of healthcare, and understanding things from that lens is really going to really, like, when I learned that, It really helped me understand where my boss was coming from, how to communicate with them better, how to get what I needed better. And then like once you understand the business of healthcare, then you can start to troubleshoot.

Okay, so like the scheduling thing is happening all the time. I'm like, you know, running out of time for patients or I'm getting them like double triple booked or I just crazy stuff like that, right? Like that's like a huge challenge that I think is really sneaky, which is one of the reasons why I'm making this episode because I think so often we're focused on clinical knowledge and then there's these other two pieces and so again navigating the healthcare system like the real world of like how this all stuff like bits together.

Yeah and then you have things like procedures like where do you get equipment? How do you order needles for injectable medications, right? Like how do you send it to the pharmacy, oh my gosh, there are so many pieces, right?

And then the third pillar is what I kind of call like either people use the word role transition, so I've kind of named it like role transition and stepping into leadership, which like sounds like, oh my gosh like, no thank you. I have way too much on my plate to think about any sort of like personal growth development into leadership and blah, blah, blah, right?

At least that's that's like my own like new grad head in my mind brushing me off right now. But the reason I'm saying that is because unfortunately, this is like a not optional piece. Like that's the kicker of it is that it's like not some like, you know, idealistic thing in the future where you're like, oh, I'm going to develop my leadership skills. It's like, no, no, no, no. You are already a leader. Even though you don't really want to be as, really, as a new grad, right?

And so, like, I just remember when I came in, and I was at my clinic and I was a new grad and everybody, like, our admin staff at the front desk, the lab, the nurse, like everybody, like, all of these associated clinic members came to my office to talk to me about this patient's situation. And it's like, oh, oh, I'm the designer, right? And then the other piece of that is that you have to, again, those situations where it's like, you're at the end of the line. I mean, really, like, especially as a new grad, you really should have some sort of like mentor, or a supervisor, somebody around that you can ask questions, right? So you're not like, nobody's alone by themselves, right? Theoretically, right? And if you are alone in the clinic, you can always reach out to somebody, or refer them to the hospital if it's really unsafe, right? Or call somebody to an e-consultation to a cold call thing like that, right?

But yeah, the other example that I ran into as a new grad that I really wasn't prepared for was the fact that there is a bit of a structural hierarchy in the primary care clinic, right? So you have providers, you have this support staff that support them to do their jobs, right? Because if you listen to the challenges of primary care, in the episode playlist, I talk about the business of primary care, is that the providers are the kind of money makers of the clinic where, as a provider see a patient, and you charge their insurance, that's what gives the clinic money, right? And so, everyone's job is basically to support that, because that's what brings in the revenue to support the company of the clinic. They're also grant funding things, but that's another episode for another time. But yeah, so you have the nursing staff, you have the medical assistance, you have the administrative staff, you have the lab technicians, right? You have all of these allied health professionals in addition to those people. And you may not necessarily be their boss, but you still are a leader in that role.

And there are some pieces in there where you need to learn how to talk to your staff members, how to ask for things, how to set boundaries, how to be clear in your communication, how to give feedback, how to clarify misinformation or clarify misunderstandings. And like I said, you might be a reluctant leader, but you are still a leader from day one in some sort of capacity, right? And I know everybody works in different types of clinics, right, there's private practices, there's something like a minute clinic where you're by yourself, right? And you do all the jobs, right? So that's a little bit different, but still, there is some sort of element of leadership as well, just in the patient interaction, right? Just in the way that you conduct a visit and then you are the guide, you're someone who's guiding the patient through this situation that they're going through. Right?

And now that I'm like recording this and I'm thinking about myself as a new grad, as a student, I'm like, oh my gosh, this is really overwhelming. And I guess, first of all, I see you. And second of all, I guess like the thing for me is when I feel overwhelmed or I feel like, I'm like, what am I doing? I don't know what I'm doing. For me, it feels like when I know what's going on, I understand the process, then I feel a lot calmer. Even if it's still hard, I understand like, oh, okay, this is why this is so hard, right? So I just want to share that with you that like sometimes when I conceptualize it in that way, it helps me kind of anchor into like, what are the sort of things that are going on, right?

So just as a recap, the first one is building clinical knowledge. The next one is trying to figure out how to navigate the healthcare system. And then the third thing is that role transition/stepping into leadership. And, again, this is not so overwhelming, but hopefully, you can kind of like it gives you idea that like if you're in that new grad position and you're like, oh my gosh, this is so hard. First of all, yes, it is. And all like, like, there's so many things to address. Like, there's so many places that you're growing, whether you're a student or you've been practice for several years.

There's always opportunity for us to push that edge of comfort. And then, like I said, when you're a brand new grad, you don't have a choice. You're going to just throw it into that. And so if you can kind of like bare minimum just acknowledge yourself or how much you like what volume of stuff you're learning. And then just, you know, like recognizing, like, okay, like there are pieces that are going to come that are going to come through and that will feel more comfortable over time, right?

So yeah, so I don't know. Hopefully that's helpful. I don't know. I feel like for me it's helpful to conceptualize those things, but now I'm like, worried, I'm like, oh gosh, I'm gonna be overwhelmed by this episode. I'm not sure. Please, please let us know if you have any thoughts about that. But yeah, I think, and I wish there was more accessibility for this. But I said this in a couple of different episodes. Mentorship is so important and I think my first episode that I ever made is still a classic, I look a little different which is funny to see but I can link to that here and you can take a look back at that episode but really like one of the pieces that I was so helped by when I was a new grad is that I had a colleague who basically was like I met with my supervising position for 15 minutes every week or half an hour every week sorry 30 minutes and 60 minutes, 60 minutes every other week, 30 minutes every week, whatever sort of schedule you can have. Like she was offered that, but that physician had left when I started, and so she was like, you just, you have to ask and you have to advocate for yourself if your clinic is not already doing that for you.

So that's something that I would definitely recommend thinking about or looking into, especially if you're feeling like really overwhelmed by this role, this transition of practice.

It is, it is really hard, and I see you. We do have a small number of mentorship spots available with Real World NP if you haven't seen that already. There's a waitlist for like our next cohort. We have both like group mentorship and then we have some one on one spots.

Our mentor is Breana. She's a Nurse Practitioner in Adult and Women's Health. And she's phenomenal. So if you want to, if you're interested in that with our company, with our people, you can hang on that waitlist.

And yeah, I always am on to look out for more mentorship possibilities. So stay tuned to be continued. But yeah, that's at realworldnp.com/mentoring if you want to join us there.

But yeah, I'm just I'm thinking of you and I see you in this in the struggle, if you're in the struggle.

But as I said, hopefully, this helps you kind of get a sense of orientation of where you're at and like recognize where you are and where you're going to be able to go.

So thanks so much for listening.