First Year as a Nurse Practitioner (NP) – What to Know
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Transitioning from being a student to a professional nurse practitioner (NP) can be both challenging and rewarding.
There is a huge learning curve during the first year of practicing as an NP. A new NP has completed several years of education but is used to having a preceptor with whom to consult. Now they are the ones making medical decisions for their patients. Bridging the gap from what is learned in school to the knowledge and skills necessary to practice can be difficult. It is impossible to learn everything needed to know in school. The NP education delivers a foundation, but hands-on experience is crucial.
Nurse practitioners are still considered a new profession to many facilities and patients. Thus, many new NPs may find themselves navigating a new environment while also having to “prove” themselves.
Fortunately, navigating a career as an NP only gets better with time.
Role Transition – From RN to NP
Leaving a comfortable job as an experienced registered nurse (RN) for a new career as an inexperienced NP is one of the toughest aspects of the NP transition to practice.
Coming from an RN background, nurses are used to having physicians call the shots. They follow written and verbal orders made by the physicians. RNs still need to have critical thinking skills because they must prioritize which patients to treat first. However, there is a big evolution when one is used to following orders versus now being the one making the orders.
Adjusting to a professional identity as an NP can impact self-confidence and impair the development of the new role. In fact, role development is a significant aspect of an effective transition. Many NPs agree that role transition does not happen during the education phase but rather after graduation.
Nurses are used to performing assessments and gathering a history. However, forming differential diagnoses is a new phenomenon when becoming a nurse practitioner. For instance, if a patient has a rash, the NP is using the history and exam to form possible diagnoses such as eczema or psoriasis. This will help them order tests and choose the right treatment.
RNs are comfortable performing certain procedures such as lab draws, wound care, and injections. As a clinician, NPs also will need to be proficient in advanced procedures such as intubation, pap smears, skin biopsies, and more. They will also be the ones to determine when these procedures are needed. Similarly, RNs and NPs are both used to being patient advocates and providing patient education.
Work Environment of New Nurse Practitioners
A new graduate NP should make sure to choose the right work environment. There should be a welcoming and friendly work culture. There should be several other providers on site that are available for any questions.
During the interview process, ask how the employer plans to foster the development of a competent and confident NP. If a new NP is applying to a job that would require them to be the sole provider of a practice, they should be sure that there is a physician that is easily accessible.
It would be ideal for the facility to have had previous nurse practitioners work there so that there is a good understanding of the role of NPs. Being the only NP at a site can exacerbate feelings of self-doubt. Research published in the Canadian Family Physician found that one-third of nurse practitioners leave their first position due to conflict in the workplace when other healthcare workers do not understand or accept their expertise. When a workplace is unfamiliar with the role of NPs, they often make them perform duties of an RN such as taking vital signs or starting an IV.
For the first position as a recent graduate, the NP should ensure a thorough orientation is provided. This can include a ramp-up schedule, where the NP starts the first few weeks seeing a limited amount of patients, which slowly increases each week once they feel more competent. The employer must provide a supportive environment with realistic expectations for a new NP. It is vital that new NPs receive proper time to perfect their skills and gain confidence in their decision-making with supervision from an experienced colleague.
The Mentorship of New NPs
It is important for an NP to find a mentor during their first position as an NP. Although having a previous nursing background and completing an academic and clinical program to become an NP is effective, mentorship can be essential in the success of a graduate NP. A mentor can help navigate complex patient scenarios and help the novice NP select optimal treatments. There is only so much one can learn from just books and in the classroom.
A mentor has a plethora of experience that they can use to guide the new NP’s decision-making skills. This would be the go-to person for the NP to ask questions. The NP should also foster relationships with the other providers at the facility because each clinician’s knowledge and background varies.
A mentor can assist in complex patient scenarios and advise mentees on how to manage support staff and workflow. They can serve as a role model and guide the new NP in navigating role confusion and insecurities. The mentor will know more about the nursing and medical field than the mentee, and as a result, will provide guidance and insight to help them avoid mistakes. Novice NPs who participate in a mentorship program are less likely to become overwhelmed in the workplace.
Some facilities offer mentors to their new providers. If not, a new NP can select a mentor on their own. They can also get involved with local and national professional organizations, such as the American Association of Nurse Practitioners. Through conferences and continuing education meetups, the novice NP can network with other nurse practitioners.
It is also very helpful to stay in contact with peers from NP school. They are likely in the same boat and can share similar experiences and study strategies. It is relieving to know that others in the same field are also struggling in the beginning. A support system is critical in smoothing a transition into a new role, both at the workplace and in one’s personal life.
Building Confidence and Autonomy as an NP
During the first year of working as a nurse practitioner, it is common to feel overwhelmed and incompetent. There is a lack of knowledge that will be gained with experience. Many novice NPs choose to join an NP residency program upon graduation to help with the transition from being a student to becoming a provider.
Postgraduate NP residency programs are usually one year long and can help new NPs become outstanding and expert clinicians.
A nurse practitioner can still be successful even if they opt not to do a residency. This means that after work, they will need to spend many hours studying throughout their first year of practicing. This includes reviewing pharmacology, screening guidelines, and managing complex diseases. The first job as an NP will be exhausting because the NP will be constantly learning and spending any free time looking up studies and other medical information.
While making the evolution from RN to NP, many new NPs feel imposter syndrome. This is an internal phenomenon where one perceives they are not as competent as others think they are. Imposter syndrome is not based on fact. It is only based on a feeling. It is not surprising to feel this way if the NP has been practicing as an RN for many years and became used to that role. For most NPs, it will take the entire first year to get over this syndrome. Once the NP sees that their patients are getting better medically, they will realize that they are competent after all.
In order to become an autonomous provider, the novice NP should be tenacious. They need to be willing to see all types of patients, both straightforward and complex. Additionally, they should be excited about learning and performing new procedures such as incisions, drainages, or suturing.
The physicians and expert nurse practitioners at the job site will be willing to teach the new NP if they see that they are being proactive. By working hard, the new NP is demonstrating that they are worth the time and effort to train.
The first year working as an NP is very important in the NP’s career in order to expand on the knowledge base that was established during their education. During this year, many of the skills and education that were gained during their graduate program are practiced and reinforced. This is when the NP begins the transition from being an RN. Having a mentor and finding the right workplace will allow a novice NP to become competent and gain self-confidence.
Even if the new NP is nervous during their first year of practice, they should stay positive. Challenges can be exciting, especially if they think back to why they wanted to become an NP in the first place. Getting out of their comfort zone and overcoming their fears will allow an NP to evolve.
Each patient encounter is another opportunity to grow. It is exciting to see patients progress and begin to trust the NP.
Sophia Khawly, MSNWriter
Sophia Khawly is a traveling nurse practitioner from Miami, Florida. She has been a nurse for 14 years and has worked in nine different states. She likes to travel in her spare time and has visited over 40 countries.
Being a traveling nurse practitioner allows her to combine her love of learning, travel, and serving others. Learn more about Sophia at www.travelingNP.com.