My first week as an NP

Bumex, DNP, NP · Mar 14, 2017

I definitely feel like this will take time for sure. I kind of felt the same way when I first started as a RN. My collaborating physician has told me time and time again (we worked together before she hired me) that it will take time and a lot of patience, but we will beat the steep learning curve.

I'm about ready to start in a private medical practice as well- in a new specialty that I have never worked in.

BrnEyedGirl, BSN, MSN, RN, APRN · Mar 14, 2017

Hang in there! I am not quite a year out,..I honestly think that the hardest part of this transition was learning that I am now the decision maker! I worked as an RN for 17 years,..following orders, making sure I understood the orders, clarifying with the providers. Now I am the provider and I am clarifying the orders. It takes time to switch your mindset. Hang in there and keep learning, you will get this!!

Trauma Columnist · Mar 15, 2017

Hang in there - I went into a specialty practice where I had no experience - yikes!

It took me a year or so before I felt comfortable. Now with 11 years down, I've got it made!

Some hints I found useful:

1. Ask your doc for some recommendations for reference books

2. Join your states APRN organization for networking opportunities

3. Scout out resources from other APRNs in your area - use your college's alumni organization for this.

4. If there are other APRNs in the practice - take them to lunch and get advice.

5. Ask your doc specific questions, about the why of what they are doing, be specific though.

It DOES get easier!

CoolLikeThat · Mar 16, 2017

The first year can be tough. You graduate and feel you know stuff then go to work for/with providers who know way more and have so much more experience on top of that. It is intimidating and frustrating. There can be a huge learning curve and it takes time and hard work to get better.

I was so insecure and self-doubting for the first year. i often felt like a total idiot. I sometimes would talk to a patient and feel bad that i could not answer their questions as clearly or with as much confidence as my docs. I also faced the suspicious angry patient who would look at my badge and look back at me and because I was not the MD they would dispel everything I would say.

It takes time and hard work. It will get better as long as you listen, learn and work at your practice. I still have days where I feel dumb or ill prepared but those days are fewer than they were a few years ago.

Hang in there and good luck!

matthewandrew, NP · Mar 16, 2017

Thank you for sharing. I'm waiting to start my first NP position and reading these eases the anxiety. Thank you!

Nimrodel, BSN, RN · Mar 17, 2017

You should talk to him about calling you Dr. I could see that getting you into messy legal trouble if the wrong things happened to go perfectly wrong.

2bNotAnotherMaleNurse7 · Mar 18, 2017

I did. He said don't worry about it. His words were "If podiatrists can call themselves doctors, why can't you call yourself doctor" I still introduce myself as my first name, then the NP for him. I still don't know what I"m doing in the office, I feel way more comfortable at the hospital. I wish I could just do hospital but need to do office for him too.

Nimrodel, BSN, RN · Mar 19, 2017

I did. He said don't worry about it. His words were "If podiatrists can call themselves doctors, why can't you call yourself doctor" I still introduce myself as my first name, then the NP for him. I still don't know what I"m doing in the office, I feel way more comfortable at the hospital. I wish I could just do hospital but need to do office for him too.

That...makes no sense. Podiatrists have a doctoral degree (doctor . Unless you have a DNP, you do not. I know in some states its illegal for NPs, even those with a doctoral degree, to call themselves Dr - which you're not doing, but it could definitely be construed that way.

2bNotAnotherMaleNurse7 · Apr 1, 2017

Update: I still feel like I don't know what I'm doing. It's been 4 weeks. But I do think I'm better than my first week, I hope. I want to like this job, but the hours are long, and my doctor's charting I feel is way too detailed compared to other doctors. And his patients have alot going on with them, and they've known my doc for years. When I come in the room, they all are like "who are you" and "when am i going toto see the doctor". I kind of wish I worked for a bigger company/group instead of a private practice doctor, but it has only been a month. =/

Darth Practicus · May 2, 2017

This sounds intense. I've been in practice for 2 months now and so I can relate to some of the jitters. I certainly have my "sea legs" now, but I had some anxiety at first as well. I can't speak to your practice environment because my practice environment sounds vastly different than what you describe, but it sounds like there are some issues that are complicating your immersion:

1. Being introduced as a Dr. if you do not have that title is strange. Surely, your collaborator knows your right title, so he should be using it as a professional thing to do.

2. Coming in and "fixing" all of your charting is not a supportive method of onboarding. First of all, that action basically devalues what you are trying to do and instead of using it as a teaching moment, he is simply "taking the wheel and driving." This is hugely problematic and would likely increase anxiety in any individual trying to acclimate to the practice. He needs to recognize that you are not his drone and you may make some different choices with regards to documentation. You both might want to sit down and discuss some key points with regards to documentation (and frankly, it should be reflective of the requirements of billing for the type of visit you're doing rather than adopting whatever parlance he uses with his own charting), and thereafter, your documentation should be measured on that rather than any particular style or level of detail. So long as you're meeting the needs of accurate documentation then move on and allow you to come into your own in this regard. In summary: he needs to get off your lawn.

3. It seems, from reading your post, that there are some cloudy expectations between you and the provider you're collaborating with. Maybe sit down with him and say that you have some concerns about understanding what is expected and that could be remedied by setting some goals and mutual expectations about workflow, etc. Ask the questions: "If I have a question about a particular problem I see with a patient, what's the best way to work with you to collaborate?" Perhaps he will have an answer. Perhaps he will defer to you on it. Either way, come to an understanding. It will make the both of you feel better about the situation. You will build up trust with him that he will be supportive and he will enjoy that you are comfortable enough to come to him when you have a concern. That's how mutual respect is born.

4. You won't know everything there is to know. Not ever. Coming from being a highly-proficient and experienced RN to being a newcomer NP is a shock. But you don't have to be alone. I strongly recommend you subscribe to a medical reference that won't gather dust on a bookshelf and will constantly be revised to reflect the strongest evidence possible in terms of medical decision-making and treatment options. I use Up To Date and so do my colleagues. There is a monthly cost for using it that isn't the cheapest, but it's the best collaborator I could wish for. You can use it at the clinic, office, on your mobile device, tablet. You can download it onto a device when you're in situations where you don't have internet access. If you don't use it, I would highly recommend you give it some consideration. As a bonus, you accrue some nice CEUs for every article you read.

Best of luck.

Feel free to msg me privately if you need a colleague to decompress with. It's not easy being "green," as Kermit would say.

Darth Practicus, NP

Riburn3, BSN, MSN, APRN, NP · May 4, 2017

OP, it gets easier and over time you will be thankful your physician you are with is so detailed. It also sounds like he is very patient with you, so be thankful. This board is full of stories on new NP's having rough experiences because their physician partner is less than willing to help them out and teach. The fact that you feel like you are better off than you were when you started after a month is great progress, and I promise in a years time, you will absolutely be more at ease in your job.

Don't be discouraged. Keep your head up and keep at it. It sounds like you have a good work environment.