Did you feel ready to practice upon graduation?

linearthinker, DNP, RN · Oct 6, 2011

Well, it's complicated, lol. 25 years of RN experience going in, mostly critical care, so it is really not at all applicable to primary care. I graduated last December. I felt ready in January, lol, but I didn't start working until this month (other than mission work). I don't feel ready anymore. I think I have forgotten everything I ever knew.

Trauma Columnist · Oct 6, 2011

I've been an APN for 5 years with total (when I graduated with the APN) nursing experience of 14 years - ER and ICU.

I went into a specialty area - nephrology/HTN where I had no experience. I was given 5 months of orientation and even after that, I had a lot of questions.

After five years I feel much more comfortable but still have questions - lol.

Birdwatcher1, RN · Oct 9, 2011

I have only 6 yrs of RN experience (non-traditional student in 2nd career). Graduated with honors & passed Boards for FNP in Dec, was really excited & felt ready to start learning & being a provider in the specialty practice I was hired by this spring.

Alas I have been forced (literally) to resign just recently as my "progress" was less than "they" thought it should be. Apparently I was expected to see the same complex problems as the docs and be able to deal with them without questioning despite my newby status. Was told "by now" (3 months after hire) I should demonstrate complete understanding of each of the disease processes in question down to changes that occur at the cellular level, and should be able to describe those processes verbally when questioned by the MD on the spot at any time. Same with each med down to dose & each side effect, plus the tx options and their dosages and side effects - yes this is a specialty practice not primary care. (Repeatedly told - in front of staff- that "questions indicate weakness and insecurity, why are you asking this?"). Never mind that the patients I saw stated they liked seeing an NP, and told me-and check-out staff- they felt I actually understood them better and they wanted to see me for their next visit.

Now, a couple of weeks after getting out of there, still feel shell-shocked, waking up in the middle of the night in a cold sweat with heart pounding. Right now I feel like I'm only qualified to work at a fast-food restaurant. Will take a little time to recover (hopefully only a little time). Now to find a new job, which is hard in my area even if one has tons of NP experience & confidence.

Can't imagine I'm the only one out there like this, but maybe so?

PMercier · Oct 9, 2011

Took 6 years of full time practice in a busy ER before I could honestly say that I was comfortable practicing.

Trauma Columnist · Oct 9, 2011

birdwatcher1 - what a bunch of idiots! I work in a very large practice (15 MDs and 5 mid-levels). With the exception of one MD, everyone was and still is very open to questions.

Did you talk with/shadow a mid-level in the practice? I shadowed two of mid-levels in my group and both were fantastic. Also - I'm the last mid-level hired and I've been there more than 5 years now - the others have all been there >10 years. That speaks well of the practice too.

mammac5 · Oct 9, 2011

Do I feel ready? My short answer would be yes. My longer answer would be that I can't possibly rely on how I "feel" from day to day.

I'm just getting started after graduating from a (great) bridge program. I was not an RN two years ago - I was a certified medical assistant working outpatient for many years, though. I had lots of experience in dealing with difficult/sick people, handling drug seekers, coding, and asking doctors lots of questions.

There are days when I feel like I'm completely on top of my game. I know the meds, I have the answers, I communicate well with colleagues and patients, and it's clear that I have something important to offer the healthcare team. Those days are rare!

There are days when I feel like a complete idiot, frankly. On those days I remind myself that I was accepted to and completed (handily, I might add!) a well-respected NP program. I remind myself that I did all the work necessary to get into that program and to excel in my courses. I remind myself that I had recommendations from physicians I'd worked with who felt I had great potential to be a practitioner. I remind myself that I was pursued for several open positions upon graduation. All these "experts" can't be wrong, so I MUST know what I'm doing!

If I went by my feelings, there are days when I'd never get out of bed.

bsnanat2 · Oct 11, 2011

I have only 6 yrs of RN experience (non-traditional student in 2nd career). Graduated with honors & passed Boards for FNP in Dec, was really excited & felt ready to start learning & being a provider in the specialty practice I was hired by this spring.
Alas I have been forced (literally) to resign just recently as my "progress" was less than "they" thought it should be. Apparently I was expected to see the same complex problems as the docs and be able to deal with them without questioning despite my newby status. Was told "by now" (3 months after hire) I should demonstrate complete understanding of each of the disease processes in question down to changes that occur at the cellular level, and should be able to describe those processes verbally when questioned by the MD on the spot at any time. Same with each med down to dose & each side effect, plus the tx options and their dosages and side effects - yes this is a specialty practice not primary care. (Repeatedly told - in front of staff- that "questions indicate weakness and insecurity, why are you asking this?"). Never mind that the patients I saw stated they liked seeing an NP, and told me-and check-out staff- they felt I actually understood them better and they wanted to see me for their next visit.
Now, a couple of weeks after getting out of there, still feel shell-shocked, waking up in the middle of the night in a cold sweat with heart pounding. Right now I feel like I'm only qualified to work at a fast-food restaurant. Will take a little time to recover (hopefully only a little time). Now to find a new job, which is hard in my area even if one has tons of NP experience & confidence.
Can't imagine I'm the only one out there like this, but maybe so?

Sounds like a dangerous bunch to work with! With that kind of thinking, it was undoubtedly only a matter of time before you would've been thrown under the bus for something. My unit deals with one doc like this, but the others are great. This one will NEVER admit when he is wrong. Once he was making post-op rounds and it was pointed out to him by a patient (in full view of several staff) that he "was NOT the one who performed her surgery, so how could he comment on it?", he never missed a beat and replied that "her surgeon had told him these things and that he had been an observer for her case.":uhoh3: He is in a different practice group and the pt.'s doc hates his guts. He will never admit when he is wrong and is regarded (even by other docs) as a dangerous surgeon. You were probably done a favor here. Only a fool never asks questions and someone who doesn't think they need to ask questions is ignorant of the fact that he is a fool. I hope you find something else soon.

Birdwatcher1, RN · Oct 11, 2011

Thanks TraumaRUs and bsnanat2 for your thoughts and support! Much appreciated! :-)

I was in a sizeable practice, but I was their first NP and had no opportunity to work with, or shadow PAs in the other areas of the practice, which were different specialty than my own. Despite other MDs feeling like I was doing well, the ones in question did not want to spend more time training me, or so I was told (and I never was given my own desk or phone--was that a sign?).

Thinking if I had a photographic memory and nerves of pure steel it might have worked, but oh well, at this point no sense looking back!

For now working as RN at agency for about the same $. Hope to find my niche eventually, whatever that will be!

Trauma Columnist · Oct 11, 2011

Good luck. Join your state's APN organization too - great way to network and you hear the good and bad about hospitals/practices.

nomadcrna, DNP, CRNA, NP · Oct 11, 2011

Do you provide mid-level care? :)

Or a different level of care then the MDs you work with?

birdwatcher1 - what a bunch of idiots! I work in a very large practice (15 MDs and 5 mid-levels). With the exception of one MD, everyone was and still is very open to questions.
Did you talk with/shadow a mid-level in the practice? I shadowed two of mid-levels in my group and both were fantastic. Also - I'm the last mid-level hired and I've been there more than 5 years now - the others have all been there >10 years. That speaks well of the practice too.

Trauma Columnist · Oct 11, 2011

Well, am not sure I'm understanding what you are asking?

If its what do I do? Yes, in the dialysis units, I do exactly what the MDs do.

When I round on nephrology its in the ICUs at hospitals, while I do a similar job, I have to ask more questions just because of my lack of knowledge base.