Did I make the right move?

[jessicatheNP]

Hi everyone,

So I'm hoping for some advice or just to connect with someone who feels similarly as me. So I've been a registered nurse for a little over 5 years. For 5 years I worked at a large well known hospital on an inpatient BMT unit. I loved it but about 2 years in I decided to go back to school because I didn't think I would want to do bedside nursing forever. I chose to do FNP route because let's be honest, I was talked into it because it would make me the most "marketable". I have now been working as a NP for almost 5 months at a federally qualified health care center doing primary care and I HATE it. I especially dreaded and hated the thought of having to do pediatrics. Kids absolutely terrify me, the though of missing something major in a child is a chance I'm not willing to take. So, I took a position that I will be starting in December at another well known hospital in NYC back on the inpatient BMT unit, this time as a NP.

Heres my dilemma now, do I regret becoming an NP? I miss my old job as a staff nurse. Is it the new responsibility as a NP that I am having a hard time dealing with? I think the position that I took as a new grad NP was the wrong move because I completely work independently, I only had a 2 day orientation and that was just to mainly learn the computers. I also hate working 8:30-5pm 5 days a week. I never get out on time and barely have time to do anything once I get out of work, and weekends seem to fly by and are not even enjoyable because I'm catching up on all my errands.

But most importantly, I feel like a complete idiot. This job makes me feel so incompetent and I have lost all confidence in myself. I am constantly second guessing myself and I constantly have that dreaded feeling of "did I miss something" or "did I order the write medications". The feeling eats me inside. I wake up every morning DREADING going to work. I always promised myself if I'm in a situation where I dread going into work, I have to get out. I have one more month left here and I'm done. I guess my biggest worry is, am I doing the right thing by going back into the BMT world inpatient at a hospital. If I think my responsibilities right now are too stressful, will I survive working inpatient? I feel like I don't know enough and I'm setting myself up for disaster. But then I try to remind myself that everyone starts from somewhere and this is how you learn and grow.

However, I find myself time and time again thinking of switching careers. Now I'm only in my late 20s and have plenty of time to figure things out. My real passion is working with animals. But do I go and pursue a career with animals? What about my BSN and MSN degrees, they won't pay for themselves. In no way am I doing nursing for the money (nor do I think anyone should) but I am realistic and know with a career working with animals I'll never be able to afford paying off my debts. I find myself sometimes jealous of people who don't work in the health field. However I have no idea what else I could possibly do. I loved being a RN on my old unit. I feel like why did I go back to school if I was perfectly content where I was previously.

I'm just hoping someone out there relates to how I'm feeling. My nursing friends think I need to give it more of a chance. My non nursing friends don't really understand and my very patient significant other doesn't really understand either although he tells me he'll support me whatever I decide to do.

Help!!

-confused NP

[traumaRUs, MSN, APRN]

Well first of all, I felt like an idiot when I got out of school.

With only 5 months NP exp, I would still expect you to be pretty green and unsure of yourself. It sounds like you have very little support from other staff members such as other NPs you can bounce ideas off of? This may not be the best fit for a new NP.

As to going back to the hospital on a BMT unit - you have mastered the basics of the specialty and at least have some idea of common order sets. How much orientation will you get?

And...as far as being an RN again - its possible to go back to that role but you really haven't given yourself a chance in your new role, have you?

[BostonFNP, APRN]

I decided to go back to school because I didn't think I would want to do bedside nursing forever.

I think part of your answer may lie right here: what really was your motivation for moving to the APN role? If you don't have a good solid answer for this question then the extra responsibility of the role will probably not ever be worthwhile to you.

Heres my dilemma now, do I regret becoming an NP? I miss my old job as a staff nurse. Is it the new responsibility as a NP that I am having a hard time dealing with?

Good news is you can always go back and you can always move laterally! In the first two years of practice, novice NPs are socializing to a new role, just like 1st and 2nd year residents are if you work in a teaching hospital. There is a huge difference in the level of responsibility. No one enters practice fully prepared and the change into the role of having the ultimate responsibility is difficult, especially at the novice stages. You, and every other novice out there, needs a good experienced mentor and collaborator. Think back to your first year nursing at the bedside? How did you feel then?

I think the position that I took as a new grad NP was the wrong move because I completely work independently, I only had a 2 day orientation and that was just to mainly learn the computers. I also hate working 8:30-5pm 5 days a week. I never get out on time and barely have time to do anything once I get out of work, and weekends seem to fly by and are not even enjoyable because I'm catching up on all my errands.

As you seem to know, this is an awful setup for a novice NP and is likely a major factor in your dislike of the job and the role right now. Remember the role doesn't change but the job absolutely can!

But most importantly, I feel like a complete idiot. This job makes me feel so incompetent and I have lost all confidence in myself. I am constantly second guessing myself and I constantly have that dreaded feeling of "did I miss something" or "did I order the write medications". The feeling eats me inside. I wake up every morning DREADING going to work.

This is healthy self-reflective practice! I gets better with time as you are able to compartmentalize it, but it is always there. The day providers stop thinking they may have missed something and engaging in self-reflective practice, they should get out of the business because they are either burnt out or don't care or are too proud and all of that is dangerous.

I always promised myself if I'm in a situation where I dread going into work, I have to get out.

Sounds like it's time! Give your new job some time you may find you really like it. If not there are other options: you can go back to the bedside, you can go into academics or administration, you can work in a different APN role like retail health or college health services, etc.

[caliotter3]

I suspect if you went back to an RN role, after a short period of time you would feel short-changed and be looking for an NP role again.

[Goldenfox]

Hi, you need a mentor...someone who you can discuss your cases and ideas with and who can help coach your clinical decision-making skills.

I will catch flack from some NPs for saying this but I have always believed that FNP programs do not properly prepare students for much of what will get thrown at them once they are out here in the real world of practice. I believe that an extra internship year should be added on the back end of all NP programs so that new grads don't feel so alone and terrified after they finish school. This is the reason why some states require that we practice with physician oversight. It takes a while to learn this stuff, and even after that while has passed we're still learning new things all the time. You are only 5 months in. That is hardly enough time. Stop looking back at the bedside RN role. That is a completely different discipline from being an NP. Are you working independently or with a physician colleague? If you have a collaborating, you should use that person as your mentor.

Do not allow anxiety to overwhelm you. You will always have at least some idea of what's happening based on what the patient tells you. It comes back to the interview, the patient's specific complaints, and your assessment findings. So you can know what diagnostic tests to order. Use clinical resources like UpToDate to guide your workups and your management decisions.

[curlygirlie3]

Yesterday marked 3 months for me as a working NP. I can sympathize with the way you feel. I am completely overwhelmed by the amount of work and responsibility...and I have a good mentor! I second guess my decision to change careers every Sunday night. Despite this, I just keep telling myself that things will become more fluid as I gain experience. My charting will be faster and maybe won't have to be done EVERY night and on the weekends, I will become more confident in myself, and I will build my NP network of speciality "phone-a-friends".

I suppose only time will tell. I do remember how I felt as a new RN on a busy surgical/trauma unit; it was a difficult role transition as well (though the change to an NP is certainly more intense). I wish you luck, patience, a good mentor, a great support staff, and slower weekends!

[TammyG]

All new NPs feel incompetent. I promise. It will get better. The BMT role sounds like a good one -- you can use your background in BMT from your RN role -- but you will be bored fast. The same thing happened to me. I went back to hospice/palliative care after a short stint as a primary care NP for the comfort, and was bored to tears in a few months.