Advice in NP school

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Hello everyone,

I am in my 4th semester of FNP program and wondering if I am ever going to feel more confident. I have a wonderful preceptor and she is very patient and interested in teaching me. There is just so much that I don't know and I leave clinicals feeling like such an idiot most of the time. I find myself being afraid to make a decision or take charge of a situation without second guessing myself. Has anyone else ever felt like this? Also, I feel like all I can do is keep up with assignments and don't have a lot of time to really study and read all my assigned readings. Any advice on any of this would be great. I tend to be a perfectionist and anytime I miss even a half a point on an assignment I start convincing myself I am not going to be able to do this. I recently started on some antianxiety meds and it has helped some. Any advice would be appreciated.

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I would also like to hear responses to this post, as I could have written this myself.

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Specializes in Internal Medicine.

Out of curiosity how long have you been a nurse before being in FNP school, what type of nursing did you do, and how many clinical rotations have you had? The reason I ask is many of my classmates that had less than a year of experience before jumping into an NP program had difficulty adjusting to the role of provider. Similarly, nurses with Med/Surg backgrounds seem to have a harder time compared to individuals with a higher acuity level of experience because of the differences in roles/autonomy.

In my case, I have been a CVICU nurse for 7 years, and most of that time as a charge nurse where making critical decisions and taking a leadership role is vital. Even with all of that, the first month or so of clinicals made me feel like a baby nurse again. We as nurses have a block in our heads where even the most veteran nurses that know what a physician is going to order beforehand, still depend on the validation from that physician before putting in the order. It takes a huge change of mindset to become a provider without that safety net, and for some it is much harder then it is for others.

Just think about how lost you probably felt your very first day of nursing school clinicals. If you were like me, you stood around, watched, maybe bathed a patient, and basically felt like you were in the way. My first day of work after I graduated from nursing school was very similar. See the trend? It always takes a while to become comfortable in a completely new setting and in our case a completely new role. The reason we do these clinicals is because they know that you, and I, and everyone else that has gone through these clinicals is very green. We need these experiences and to feel this way if we are going to be safe efficient care providers. You can't expect to know it all right away, and my preceptors tell me all they time they are constantly using the internet and desk references for a weird rash or a pathophysiology they don't quite understand.

Bottom line, just relax. It will eventually come to you. You're not supposed to be a hotshot NP right out of the gate. You're supposed to ask dumb questions and feel stupid. It is through these humble feelings that you push yourself more and strive to be better. It would be more frightening if you said "I'm doing clinicals and it's way too easy and I know everything".

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Specializes in Adult Internal Medicine.

By your final semester you should be making most of the decisions and presenting them to your preceptor. Your preceptor should be working with you to let you "own" the patient from exam to differential to plan. You have both the education and the experience necessary at this point to do this, be confident in your preparation. Start formulating your own plan of care and presenting it to your preceptor for evaluation, get feedback and make adjustments. This is part of the learning process.

I normally have my students start simple and work up: step one is identifying what is normal and abnormal, step two is a basic differential around the abnormal, step three is applying basic therapeutic plans including guidelines for treatment. If a student can see a patient and report back to me that "X" isn't normal and either say "I think X is d/t Y and we should consider treatment with Z" or say "something isn't right about X, not sure why, I could use some help" I am very pleased.

That being said, remaining humble is a major part of the job. You need the confidence to act when you need to act but the humility to ask for help when you need help. Both overconfident and underconfident providers are dangerous. Find a spot in the middle.

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Specializes in Nursing Education, CVICU, Float Pool.
By your final semester you should be making most of the decisions and presenting them to your preceptor. Your preceptor should be working with you to let you "own" the patient from exam to differential to plan. You have both the education and the experience necessary at this point to do this be confident in your preparation. Start formulating your own plan of care and presenting it to your preceptor for evaluation, get feedback and make adjustments. This is part of the learning process. I normally have my students start simple and work up: step one is identifying what is normal and abnormal, step two is a basic differential around the abnormal, step three is applying basic therapeutic plans including guidelines for treatment. If a student can see a patient and report back to me that "X" isn't normal and either say "I think X is d/t Y and we should consider treatment with Z" or say "something isn't right about X, not sure why, I could use some help" I am very pleased. That being said, remaining humble is a major part of the job. You need the confidence to act when you need to act but the humility to ask for help when you need help. Both overconfident and underconfident providers are dangerous. Find a spot in the middle.[/quote']

I bet your a good preceptor, and would makes great APN clinical instructor. You seem to really have thought of simplified ways to get students to grasp concepts and a jests seem to explain yourself well.

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I have been an RN for 16 years and work in a cardiac stepbdown unit and charge also. I had a health assessment clinical but this is my first clinical where I am going in seeing patients, presenting to preceptor,etc. I get really overwhelmed with the amount of information and have to remember I am not expected to know it all. My preceptor has told me that for where I am at in the program I am doing fine. I am just afraid I am not going to feel confident enough to make decisions when I get into my last practicum where I will be completly managing the patient. It's exactly what you said about feeling like a baby nurse all over again. I am much harder on myself in grad school because I am a nurse and feel like I should know more. The provider role is so different than my current role as a floor nurse and it is difficult to grasp that at times. You are right, I need to relax and remind myself I am still pretty new. Thanks for tour reassuance and advice. How much longer do you have until you graduate?

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BostonFNP,

Thanks for the suggestions. I am in my first adult clinical. My preceptor has told me I am doing fine for where I am in the program. I have 3 clinicals and a practicum to go so hopefully my confidence will develop as time goes on. I need to remind myself I am still pretty new at this. Thanks again for your advice.

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Specializes in Adult Internal Medicine.
BostonFNP Thanks for the suggestions. I am in my first adult clinical. My preceptor has told me I am doing fine for where I am in the program. I have 3 clinicals and a practicum to go so hopefully my confidence will develop as time goes on. I need to remind myself I am still pretty new at this. Thanks again for your advice.[/quote']

Sounds like you are right where you should be.

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That's good to hear from you since you are a preceptor. You sound like a great one too! Thanks for the reassurance. I need that a lot right now!

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Specializes in Internal Medicine.
I have been an RN for 16 years and work in a cardiac stepbdown unit and charge also. I had a health assessment clinical but this is my first clinical where I am going in seeing patients, presenting to preceptor,etc. I get really overwhelmed with the amount of information and have to remember I am not expected to know it all. My preceptor has told me that for where I am at in the program I am doing fine. I am just afraid I am not going to feel confident enough to make decisions when I get into my last practicum where I will be completly managing the patient. It's exactly what you said about feeling like a baby nurse all over again. I am much harder on myself in grad school because I am a nurse and feel like I should know more. The provider role is so different than my current role as a floor nurse and it is difficult to grasp that at times. You are right, I need to relax and remind myself I am still pretty new. Thanks for tour reassuance and advice. How much longer do you have until you graduate?

I graduate in a year.

You're right, it is overwhelming, especially when you are starting. The head of our program told us it usually doesn't really begin to click until the last semester halfway through your final rotation. I still find myself like a deer in the headlights when I see something I rarely see. My critical care experience has served me well in understanding pathophysiology and disease stages, but when I see a kid with a weird rash or have to do a pap smear, I feel like I'm just starting out. I'm sure with more experience and seeing similar things on a regular basis, just like you do in your role as an RN, you will become more comfortable and more familiar. I feel like all the reading and research is great, but until you see something on a living person, it isn't burned into your brain.

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I totally agree with you. I will never retain all of this information we have to read but I am starting to find out that once I see something I can remember it a lot easier. It's great to get an honest opinion from you. Whenever I talk to some students they come off as very confident and do not seem to feel the way I do. It's nice to know I'm not the only one feeling like a new nurse again sometimes. By the end of this I pray everything will really start to click and I will be glad I went through it! Thanks again for your comments:-)

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Specializes in Internal Medicine.
I totally agree with you. I will never retain all of this information we have to read but I am starting to find out that once I see something I can remember it a lot easier. It's great to get an honest opinion from you. Whenever I talk to some students they come off as very confident and do not seem to feel the way I do. It's nice to know I'm not the only one feeling like a new nurse again sometimes. By the end of this I pray everything will really start to click and I will be glad I went through it! Thanks again for your comments:-)

Absolutely. Confidence is great, but the ones that act like they know everything are really scary. If you're a student and you think this is easy, something is going terribly wrong. When with patients I like to project myself with confidence even if I might be clueless, but I'm also not afraid to tell someone like a physician or a preceptor "I don't know". There's another fairly recent thread on here about a new NP that tried to BS their way out of telling a physician what a trismus is, instead of saying that they didn't know, and the physician called them on it immediately. You might feel stupid if you say you don't know, but you look stupid when you pretend to.

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