How did you survive right out of school?

[reeya]

I am yet to graduate but I am getting there. I just dont feel like I'll be prepared right out of school doing any kind of NP job. Need help from seasoned NPs regardless of speciality...please share what you did that worked for you to survive the first yr out of school? I am getting nauseous knowing how much I dont know. Do you still continue to study on your own, after work, free time, holidays ?? I know most of MDs, NPs subscribe to journals, do you still study text books?? What helped you most to be a competent provider after graduation?? I was thinking of getting a NP residency but there are only few residencies for NP and all are out of state which doesnt work for me.

[carachel2]

You are actually very, very smart and intuitive to "know what you don't know." You will be a wonderful asset to any practice and your patients will do just fine. Your classmates (every class has at least two or three!) who act supremely confident and roll their eyes at their own preceptor and who boast about amazing clinical diagnoses they made, etc. etc. are the ones to worry about.

Here is how you survive your first year or so: Have discernment when picking your first job. Try to be with a fellow NP or MD who enjoy teaching, who realize you are totally green and who will NOT mind being pulled into a room to help with a diagnosis. Cannot tell you how much I have learned from listening to my collaborating MD (who brings at least 25 years worth of practice to the table) ponder differential diagnoses out loud *with* the patient in the room. I turned down THREE jobs to be with this provider, at least two of which were in crazy crazy busy practices with quota requirements and doctors who clearly did NOT want to be bothered.

[mammac5]

Same sort of situation...graduating very soon and considering what type of atmosphere I need for my first job.

As for continuing to study - YES! When they kept talking about being a "lifelong learner" in NP school, they were NOT kidding! One thing I learned from my final preceptor was to have reference books you are familiar with close at hand. She had a little musculoskeletal book from the 80s that I'm trying to find online - concise down-and-dirty info you need to lay your hands on quickly.

Subscribe to one or two journals in your area of specialty. Too many journals just pile up on your shelves/desk/floor and are ignored. Continue to look up information on any diagnosis that is new to you, or any meds a patient comes in taking that you're not familiar with...just like in nursing school and NP school.

UpToDate, Medscape, and epocrates have become my best and closest friends and I look things up all the time. Keep your eyes open for continuing ed opportunities where you can get your required hours, but that also offer information updates in areas you feel weak. For me, that's going to include ortho exams/treatments.

I also agree with the previous poster that those of us who are smart enough to know what we don't know are safer providing care to patients than are those who think they know it all.

[BCgradnurse, MSN, RN, NP]

I agree with Carachel-picking your first job is very important. You need to be in an environment that is supportive and conducive to bringing along new grads. It's even better if you have an official mentor. My first job (and I'm still there 2 years later) is in a fast paced environment, but I work with wonderful providers (NP and MD) who are so willing to help eachother. I still study constantly. I have reference books that I use, and also use things like UptoDate, Epocrates, medscape, etc. I also go to as many relevant CE programs as I can. I will be studying the rest of my career. I was so scared when I started my first job, but made it through that crazy first year with the support of my co-workers. Things are much smoother now, but I'll always need to ask questions and study. Good luck with your career!