How not to suck!

Specialties NP

Published

I am an NP student who is doing fairly well in my program. I feel this program is challenging and is doing a sufficient job training me for a provider role. The only thing is I can't imagine being able to start a job as a provider when my schooling is over. I know a lot of people feel this way so can anyone give me some tips on how not to be one of "those" nurse practitioners. The ones the doctors complain about. What can I do now to help me become a better provider? All help is appreciated!

Specializes in Family Nurse Practitioner.
Other than the clinical parts, NP school is unfortunately too much like nursing school and not enough like PA school. I'm an RN, but my friends and colleagues that have made that transition attest to the first few years being a learning curve. But the same goes for MD residents. And just remember the MD residents got 4 years of school with clinicals, then get several more years of training after they do boards. Most things in medicine are also protocol driven, so you can have some reassurance that if you learn protocols for your specialty that you'll have a fail-safe for making decent decisions. To me, learning the decision/protocol/inquiry process is what makes a good provider. You can always learn the technical stuff with experience.

From what I hear much of the complaints about new NPs is the lack of ability to practice independently upon graduation and the expectation of a prolonged orientation. Personally I wish our programs were more comprehensive like MD and PA programs are and that would likely require a mandatory fellowship.

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Thank you all for your comments. I am especially proud to have Jules comment. Let me clarify, I am in no way saying that I am capable or able to practice. I see so many threads of people saying how unprepared and incapable many NP's they come across are. My school is decent but I do find it lacking in the necessary skills needed. I am looking for good habits now so that someday I can be a better practitioner. I want to do primary care in the future. Please, nobody take this as prideful.....I am more concerned for my future patients.

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Hate to tell you this, but as a new NP your are gonna suck or at least have many days where you suck. No matter how well you do in school it is a different world when the training wheels come off. Now, I have several friends I graduated (people who never cracked a book and studied the power points) with who claim they were brilliant from the moment they accepted their offers and I love and support them - i just would not want any of my family members treated by them. I think it is good to be humbled by the vast responsibility we walk into and the huge amount of knowledge we do not yet grasp. Someone tried to equate it as the transition to an RN and it is in no way like that. As an RN you are basically a task master, doing what you are told and as an NP you have to have the answers. However, it gets better the longer you do it and the more you look stuff up and ask questions. I have been told that even after 10+ years experience you can still have some bad moments and horrible days just like with every other job. but over time you develop skills and learn (whether you want to or not) and put fewer patients at risk LOL

This is very insulting to RN's. Task masters, indeed. Doing as you are told, yes indeedy do. And you are implying that no thinking is involved, no knowledge base is required. ROBOT.

May a cow leave a patty on your Rx pad - on a day you're running late.

Really arrogant you are.

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This is very insulting to RN's. Task masters, indeed. Doing as you are told, yes indeedy do. And you are implying that no thinking is involved, no knowledge base is required. ROBOT.

May a cow leave a patty on your Rx pad - on a day you're running late.

Really arrogant you are.

I was an RN for over 20 years. I have earned the right to call it like i have seen it. For your info I am not insulting nursing - the autonomy of the nurse has dwindled to the point of making sure all the boxes have been checked by the end of your shift. It use to be common for the ICU nurse to VO any order that you needed and now you do not advance a diet without an actual order.

I have walked several miles in those shoes!

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I am a neuroscience RN and wants to be a NP major in Psych, thank you for this input

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Specializes in Pediatric Critical Care.

May a cow leave a patty on your Rx pad - on a day you're running late.

Best insult ever.

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Specializes in Hospital medicine; NP precepting; staff education.
Most things in medicine are also protocol driven, so you can have some reassurance that if you learn protocols for your specialty that you'll have a fail-safe for making decent decisions. To me, learning the decision/protocol/inquiry process is what makes a good provider. You can always learn the technical stuff with experience.

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Excellent point. When I had my interview I was told my main responsibility would be to do ED admissions (so hospitalist admissions from the ED). I asked about protocols and was reassured there are several and then we use our clinical decision making to tweak them etc. This reassured me because I know some of the protocols in my organization were crafted with core measures and other metrics in mind. While I will not rely solely on those, it will support and guide me for some diagnoses.

I don't know what I don't know and I will be open to looking for those things and learning as I go. Fortunately I do have a great network of mentors and they've taught me more than school did.

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Specializes in Hospital medicine; NP precepting; staff education.
From what I hear much of the complaints about new NPs is the lack of ability to practice independently upon graduation and the expectation of a prolonged orientation. Personally I wish our programs were more comprehensive like MD and PA programs are and that would likely require a mandatory fellowship.

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This aspect is a focus point for me at the moment and I wholeheartedly agree. One attribute I've found in my search of literature is that for many, NP fellowships or residencies are so few and far between and for those that do exist, they are mostly specialty-related and specific.

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This is very insulting to RN's. Task masters, indeed. Doing as you are told, yes indeedy do. And you are implying that no thinking is involved, no knowledge base is required. ROBOT.

May a cow leave a patty on your Rx pad - on a day you're running late.

Really arrogant you are.

Most day to day nursing stuff doesnt require too much critical thinking. At least not nearly as much as the provider role. How is being called a task master insulting? Managing multiple tasks at once can be difficult without requiring too much critical thinking....

Also, robots can replicate most of what people can do, and sometimes do it better, so one cannot really equate a robotic task as being simple.

Enter: IBM Watson

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One thing that can help is doing as much clinical time as you can. Just doing the "minimum" hours doesn't cut it. The problem most NP students have is they still have to work so they wind up shortchanging themselves in regards to the clinical practicum hours. This is where you will learn the most...well...hopefully if you have good preceptors/mentors. I try to get my students to get more involved in the clinical rotations...I even do "projects" in which they need to research an actual patient scenario and come up with how they would evaluate, diagnose, and follow the patient. I cannot tell you how many times the answers are typical "nursing"...vital signs, oxygen, diet, some even tell me "what ever the physician orders". One of my pet peeves why NP students need more experience under their belts and be in positions where they have actually had to do critical thinking. Something to consider is while working as a nurse...look at your patient and consider what would you order? why? what about follow-up outside the critical setting?

So many providers (NP, PA and MD) have given me this advice and I am 100% taking it. I have the luxury of doing clinical full time (or more - basically whatever my preceptor works) so I'll end up with a few thousand hours by the time I graduate. How can you graduate after ~500 hours and feel like you are ready to practice? I had more than double that for my RN program. Why would I want to diagnose and prescribe with less? So bizarre.

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So many providers (NP, PA and MD) have given me this advice and I am 100% taking it. I have the luxury of doing clinical full time (or more - basically whatever my preceptor works) so I'll end up with a few thousand hours by the time I graduate. How can you graduate after ~500 hours and feel like you are ready to practice? I had more than double that for my RN program. Why would I want to diagnose and prescribe with less? So bizarre.

Since your dedicated you will almost certainly do well once you graduate. Not sure which books they have you use in the ACNP program your in but when I was in the ICU I pulled much of my stuff from MGH critical care review. It was pretty helpful. Combine that with a physiology text such as Costanzo and youll be good as gold for ICU. Also found "the ventilator book" to be helpful and if you want an easy/quick pharm review sketchy medical videos are pretty good, but they arent super cheap but well worth it. currently using them for USMLE prep

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Ok so as a student I seem to hear that the new grad NP's are not prepared etc and that the education is sub-par. Can I ask the practing NP's with years of experience what was done differently in your program? Or how did you prepare as a novice NP? I will say that there are quite a few NP mills but it is up to the individual to choose a quality program. I guess that as a NP student I find this community to be less and less supportive over the years. I started as nursing assistant and I am a always reading posts. But maybe it's just me but there seems to be a "all new NP's suck kinda vibe on here" I am just giving my 2 cents

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