Am I Missing Something?

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Specializes in Family Practice, Primary Care.

I graduated as an FNP in May and started my job at the beginning of June.

I really, really enjoy my job. I have amazing medical assistants and secretaries to work with, and a GREAT PA with lots of knowledge and she is always willing to back me up with a case, as well as two great pediatricians and midwife. My medical director is offsite but is always available by phone and I've felt immensely supported.

As a new grad, I shadowed my medical director for two weeks and he decided I was ready to be on my own because by the end of it, I was seeing 10-12 patients a day on my own without needing his input.

I feel fairly confident in my abilities. There are definitely cases where I think "OH MY GOD WHAT THE HELL IS THAT?!??!!?" and need to leave the room to look something up, but on the whole, I rarely feel so dumbstruck that I don't know what direction to go.

Since I've started, I've seen multiple patients under MD care that had several things missed by an MD that I caught and are now being treated (and these range from the minor to the life-threatening). I've caught weird endocrine disorders that required some research but only took me 2 visits to get a diagnosis and a referral to the appropriate specialty.

So, am I missing something? I know this sounds like I am tooting my own horn, but I don't want to be completely in the dark about something and be harming someone. As a new grad RN, I felt completely lost and definitely needed orientation, but as an NP, I don't feel that same fear. I know there are lots of things I don't know, so when I get that feeling I ego-check and look it up (something I think the MDs didn't do before me, hence why I have caught so many mistakes in care). But...I feel like if I feel so secure, that there must be something wrong.

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Specializes in Adult Internal Medicine.
I graduated as an FNP in May and started my job at the beginning of June.

I really, really enjoy my job. I have amazing medical assistants and secretaries to work with, and a GREAT PA with lots of knowledge and she is always willing to back me up with a case, as well as two great pediatricians and midwife. My medical director is offsite but is always available by phone and I've felt immensely supported.

As a new grad, I shadowed my medical director for two weeks and he decided I was ready to be on my own because by the end of it, I was seeing 10-12 patients a day on my own without needing his input.

I feel fairly confident in my abilities. There are definitely cases where I think "OH MY GOD WHAT THE HELL IS THAT?!??!!?" and need to leave the room to look something up, but on the whole, I rarely feel so dumbstruck that I don't know what direction to go.

Since I've started, I've seen multiple patients under MD care that had several things missed by an MD that I caught and are now being treated (and these range from the minor to the life-threatening). I've caught weird endocrine disorders that required some research but only took me 2 visits to get a diagnosis and a referral to the appropriate specialty.

So, am I missing something? I know this sounds like I am tooting my own horn, but I don't want to be completely in the dark about something and be harming someone. As a new grad RN, I felt completely lost and definitely needed orientation, but as an NP, I don't feel that same fear. I know there are lots of things I don't know, so when I get that feeling I ego-check and look it up (something I think the MDs didn't do before me, hence why I have caught so many mistakes in care). But...I feel like if I feel so secure, that there must be something wrong.

Likely you will be humbled at some point in time, as this is the nature of the profession (at least in my mind). It sounds like you are flourishing and you were well prepared for your role, and I am sure you have been focused and diligent. Keep up that focus. You will catch things other missed. They (hopefully) will catch things when you miss them.

Remember not to fly too close to the sun.

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Specializes in hospice.

I would bet there aren't many NPs out there suffering from God-complexes. There are WAY too many doctors who do.

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Specializes in PICU.

One thing to keep in mind when criticizing other's work is you don't know what the patient looked like when they went to see them, and you don't know what the patient's told them. What they tell you about it could be far from the truth. If someone sat down and reviewed all of your work, likely they would catch things as well. None of us are perfect. I'm sure you are doing a good job. But think about how different what you are doing is from what a new RN does. There is no one checking behind you, there is no one to correct any mistakes you've made. You address everything you recognize, but there is no way to be alerted to anything you may have missed. Whereas, as a new RN, too many RNs who follow you spend the whole shift looking for mistakes to point out to you. So, I think it's easy to get a false sense of accomplishment, because it could take a long time, if ever, to find out about mistakes.

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Specializes in Community Health.

I would also say that I've learned that sometimes, the diagnosis wasn't "missed", it was an incidental finding. I've caught a few alpha thalassemia's when I first started and the MD would always ask me, "ok, what are you gonna do about it?" Although this is not always the case but if the treatment is just gonna waste more money and not necessarily provide a better outcome for the patient, it's not worth chasing the dog down.

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Specializes in Family Practice, Primary Care.

The things I've caught haven't been hidden things; they're obvious lab results that were received and not followed up on, unfortunately. I haven't discovered anything that took extensive research; they were abnormal numbers on a page that should have been investigated further.

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