Beginning first Primary Care position in June, HELP!

Good morning,

I am starting my first primary care position June 6th (also my birthday...lucky me), and I could really use some help.

I have been working as an RN in a Mom & Baby (with level II NICU) unit for the past 5 years, and have also worked for a period of time in a Level III NICU. I obtained my MSN from the University of Cincinnati as a WHNP (my opinion of UC is best left to another thread). I FINALLY (YAY! ) was offered a position as a NP this past February, with a start date as listed above. All I can say is that it took a LONG time to find a job, and my background in Women's Health was far from helpful.

Since passing my NCC boards, and while looking for a job, I continued to work on my Mom & Baby floor as a Staff RN. Those of you that have experience in this area likely know how much 'care' patients typically need, so it has not exactly been the greatest way to keep my skills and knowledge up.

Since it has been a while since I graduated from my MSN (9/09) I am really feeling nervous about starting this new job. My primary concern is that they are hiring me to actually do Family Practice care. Initially I will be working in the main clinic, and seeing regular patients, but eventually they want me to work in the walk-in clinic/urgent care. The clinic is actually a Federally Qualified Health Center (FQHC), and the vast majority of patients are heavily under serviced, and there is a rather wide variety of acuity levels and complexity.

Currently the facility is transitioning away from mostly locum tenens providers. On staff currently will be 4 physicians (MDs and DOs), 2 NPs (an FNP and myself, however the CEO is looking to add a 3rd NP), and your various support staff (2-3 RNs, several LPNs, and other ancillary staff).

When I met with the CEO, along with my husband, we were both really impressed with what the direction of the facility was, as well as the overall facility and equipment. The CEO is an extremely ambitious individual, but also is VERY demanding. I know that he is really a very understanding and accommodating man, but he does really expect his PCPs to perform at a high level (what CEO should NOT expect that). He recently let go a Physician Assistant from his staff because the PA was just not working independently enough. Apparently the PA had been at the clinic, and this was their first job as a PA, for around 3-4 months (I believe). The Medical Director felt that the PA was asking them too many questions, I got the feeling that the PA wanted to clarify every Dx or treatment decision before doing anything. It apparently was so bad that it was causing the other PCPs to get behind in their patient care duties. So I am really worried about being too much of a burden.

Above and beyond all of this, the CEO is really hoping that I can come into the clinic, and within a short period of time begin to work on revising the Policies and Procedures for the NPs and Nursing staff. I did a large amount of this at my current employer because I was the chair of our practice council. In addition to this, he is hoping that I can develop into a strong leadership and mentorship role for the NP and Nursing staff, again because I did a lot of this at my current employer. I know that this seems like a HUGE amount (or at least to me) of things to expect from an inexperienced WHNP. I attribute a great deal of this to how well the CEO, Medical Director, my husband, and I hit it off together during the day we spent there. I am very proud that the CEO has this much confidence in my abilities, and I really just do NOT want to let him (or myself) down.

I have been talking to my PCP about what she did when she first established her practice. She told me that she really used the book The Resident's Guide to Ambulatory Care as a quick reference for anything she needed to brush up on. On her suggestion I purchased the book, and I must admit that it really looks like it will be a huge help for me. The facility, currently, does not have any services such as DynaMed, but they are looking into something for the future.

Are there any suggestions that you experienced NPs might have for me? Any books, journals, subscription services, computer/pda/iphone programs, or the like that you felt were a HUGE help to you?

I am worried, also, about looking stupid in front of my patients. The scenario that kind of worries me is with something like medications. If I am going to a Rx a med that I am not really familiar with I plan on looking it up to make 100% sure that it is the best treatment option for the patient. I really do NOT want to pull out a Drug Reference guide or PDR in front of a patient. Did anyone else have this kind of fear?

I really could use some help to calm my nerves down a bit.

Susie B.