New Grad NP feeling Overwhelmed, Scared

Specialties NP

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Just graduated 2 weeks ago with my Family NP and am prepping for my boards. After all the excitement of finishing and graduation, I'm starting to slip into a kind of depression and I'm wondering if any other new NP grads went through this?

I didn't actively seek a position pre-graduation because it was so hectic towards the end that I literally didn't have the time and energy. While a few had jobs lined up, most of my peers didn't either, and many decided to focus on boards and taking a vacation or two before looking for work. I really wanted this time off myself just to decompress. Now I wonder if that was such a good idea.

If seems like the further away from the intensity of school and clinicals and being around all the patients and clinics I get the more anxious and disconnected I'm feeling from being an NP. TBH, I'm scared of not being able to find a reasonable place to start off as a primary care provider. Will I be able to taking on the responsibility and work of starting this career? What if it is way more above my head than I thought it would be?

I just need to hear if anyone else ever went through this and how they managed it.

19 hours ago, FNP2B1 said:

You shouldn't feel nervous as a new NP. At least you shouldn't let your patient's know you are nervous. If you don't have self confidence in yourself your patients will know it and won't trust you. To any other new NP candidates starting on this road I would suggest what I did to get ready for the real world. Ask your preceptor if you can shadow/work/learn more than the required hours by your university. I knew 500 hours wasn't enough. I asked the primary care MD/NP and the dermatologists who trained me if I could work with them on any weekends they were open, between semesters and after graduation before boards. I wanted to learn and be confident. I'm glad I did. I only needed 500 hours to graduate. I had over 1700. I knew what I needed to know and hit the ground running. If you want to be successful take it upon yourself to make the extra effort. Do what your peers aren't doing. Set yourself apart. The $$$ and the jobs will find you when you do.

This is a great suggestion but it is not always possible. I did more than the required hours each semester, but when the semester was finished I was not allowed to shadow for any extra time due to legal issues. Also, other students were scheduled to precept after my hours were completed. If it is possible to gain extra experience by doing extra hours then that is a great idea, but for many students it may not be possible. I personally don't think that being nervous as a new NP is a terrible thing, it would seem pretty natural and expected because we are dealing with patients lives on a whole new level. Also, because we are nervous we would double check to make sure we are doing whats best for the patient.

1 Votes
21 hours ago, futurexrn said:

Oldmanhubbard, I'm a newbie but am looking toward np in the future so I am trying to learn all I can. I fully admit my ignorance on this! What if the extra time was in a "shadowing" capacity, where an np student is not making decisions but is there as "fly on the wall" to observe & learn...would that have legal implications? Just wondering if there is a good way for a prospective np to gain extra experience in a safe/legal way?

I would be extremely surprised if anyone would allow you to shadow in an informal manner. Too many potential problems with it, even if you are not technically doing anything, just observing. You could also get into big trouble with your NP program for doing non sanctioned clinical hours.

I believe prospective NP's should work as RN's in the area of their desired specialty, and intensely study the cases they see every day. If you will do that over the course of 3 or 4 years, when the time comes you will be excited, not terrified.

Don't expect NP school and the very minimal clinical hours to prepare you.

Keep in mind that most clinical hours are just shadowing. There is no decision making. You will be allowed to be in the room and touch patients because you have had a background check, immunizations, mantoux, and insurance.

Your first day with the RX pad will be the first time you'll ever make an actual decision. Extensive self preparation is necessary.

2 Votes
On 5/23/2019 at 2:32 PM, FNP2B1 said:

You shouldn't feel nervous as a new NP. At least you shouldn't let your patient's know you are nervous. If you don't have self confidence in yourself your patients will know it and won't trust you. To any other new NP candidates starting on this road I would suggest what I did to get ready for the real world. Ask your preceptor if you can shadow/work/learn more than the required hours by your university. I knew 500 hours wasn't enough. I asked the primary care MD/NP and the dermatologists who trained me if I could work with them on any weekends they were open, between semesters and after graduation before boards. I wanted to learn and be confident. I'm glad I did. I only needed 500 hours to graduate. I had over 1700. I knew what I needed to know and hit the ground running. If you want to be successful take it upon yourself to make the extra effort. Do what your peers aren't doing. Set yourself apart. The $$$ and the jobs will find you when you do.

I did this during nursing school for my RN. I asked to shadow in the ER even though it was summer semester and I wasn't getting paid, just being in the environment helped me learn so much! At graduation everyone knew me including the director and was offered a job upon graduation straight into the ER. Although as an NP we are still trying to get those PAID hours to work...Definitely take the initiative to shadow with other NPs or MD's during your time off, it will help your confidence and help you decide what kind of speciality you would feel comfortable in.

On 5/22/2019 at 5:30 PM, Dodongo said:

This is why NP programs needs to increase their clinical hours into the >2000 hour range. The CCNE requirement of 500 hours is ridiculous and the majority of NPs graduate feeling unprepared (rightfully so, because they are).

It's really insane when you think about it.

I assume a lot of NPs take this 500 hours of experience, go to work, and try to learn as they go. This is not the best recipe for success.

The most competent NPs I've worked with have been in academic settings where they were being supervised and 100% of their cases staffed with a solid academic attending physician. This is the best environment to learn and become an competent clinician. If you want to become a good healthcare provider, I would at least consider looking for a job like this for at least the first few years out of training.

2 Votes

I was fortunate to get my first position in a forensic hospital. As a new psych NP, I had done extensive self preparation beyond school requirements. so I was fairly comfortable right from the beginning. I still appreciated working with a team that included some very good psychiatrists. Also some bad ones, haha, from whom I learned almost as much.

Plus, there was no pressure there to pump out 3 visits an hour. If I needed several hours to work on a case, and we had some very complex ones, I had the time.

The pay wasn't much, I earned less than many of the RN's, but the experience was invaluable.

I can't imagine getting out of school with 500 hours, and going straight to a clinic where you'll see 20 or more patients a day. Essentially, you'll be handing out whatever the patient is requesting. I see this quite a bit.

2 Votes
Specializes in Psychiatric and Mental Health NP (PMHNP).
12 hours ago, PsychMD said:

It's really insane when you think about it.

I assume a lot of NPs take this 500 hours of experience, go to work, and try to learn as they go. This is not the best recipe for success.

The most competent NPs I've worked with have been in academic settings where they were being supervised and 100% of their cases staffed with a solid academic attending physician. This is the best environment to learn and become an competent clinician. If you want to become a good healthcare provider, I would at least consider looking for a job like this for at least the first few years out of training.

There are NP residencies and the number is slowly increasing. However, we need more NP residencies, for sure. Some employers also have experience with new grad NPs and have reasonable ramp up times with lots of support. I was fortunate to find such an employer. A new grad NP does not have to have a supervising MD for support, an experienced NP can also provide the necessary support.

2 Votes
3 hours ago, FullGlass said:

There are NP residencies and the number is slowly increasing. However, we need more NP residencies, for sure. Some employers also have experience with new grad NPs and have reasonable ramp up times with lots of support. I was fortunate to find such an employer. A new grad NP does not have to have a supervising MD for support, an experienced NP can also provide the necessary support.

I don't know what an "NP residency" is, but it looks like a few months of extra supervision. I would be careful who you are getting this supervision from. Regarding a new grad not needing a supervising MD, I guess that depends what state you live in and what your goals are. I would strive to be the best clinician I could. An employer giving you an easy few months to get accustomed to the job or working with a more experienced NP is not going to give you the same experience as staffing 100% of your cases and seeing patients together with a top physician in his field for a few years.

1 Votes
Specializes in NICU.
2 hours ago, PsychMD said:

I don't know what an "NP residency" is, but it looks like a few months of extra supervision. I would be careful who you are getting this supervision from. Regarding a new grad not needing a supervising MD, I guess that depends what state you live in and what your goals are. I would strive to be the best clinician I could. An employer giving you an easy few months to get accustomed to the job or working with a more experienced NP is not going to give you the same experience as staffing 100% of your cases and seeing patients together with a top physician in his field for a few years.

It's becoming more popular around the country. It's basically an extended orientation, some places have didactics alongside it. I work at a children's hospital and the new grad PNPs spend a year doing clinical in various areas. I don't believe they get paid a "full" salary but the experience gained is invaluable during this "protected time." I've seen quite a few PICU residencies pop up. It's born out of a need to have NPs to help staff the hospital with traditional MD/DO residency hours being cut and increasing patient needs.

My specialty (neonatology) generally gets 3-6 months orientation. Our programs are different in that all RNs are required to have NICU RN experience in a Level III with the exception of 1-2 schools (I recently created an excel sheet comparing all the schools for NNP programs). This experience is usually at least 2 years. And we almost always practice in conjunction with a neo except for Level II NICUs and those NNPs are generally very experienced. One of the units I cover is a Level II and while the neo is there if I need them, it's not cost effective to have a neo there when the acuity is so low.

3 Votes
Specializes in Behavioral health.

Dolgre411

I can't speak from personal experience yet but every NP has told me the first year is challenging because it's a new and unique experience. You are continuing to learn and grow. Thousands have successfully made the transition before you and I guarantee they all felt the same way as you.

You are going to have to synthesize a ton of information. Thankfully in Primary Care, it is quite doable, and extensive research shows that NP's, even newbies, have similar, if not better outcomes for things like HTN and DM.

We excel at certain things, probably because we gain the pt's trust, bedside manner, and spend a little more time.

1 Votes
Specializes in Psychiatric and Mental Health NP (PMHNP).
On 5/26/2019 at 4:13 PM, PsychMD said:

I don't know what an "NP residency" is, but it looks like a few months of extra supervision. I would be careful who you are getting this supervision from. Regarding a new grad not needing a supervising MD, I guess that depends what state you live in and what your goals are. I would strive to be the best clinician I could. An employer giving you an easy few months to get accustomed to the job or working with a more experienced NP is not going to give you the same experience as staffing 100% of your cases and seeing patients together with a top physician in his field for a few years.

Others have given a good response to this post. Some clarifications:

Almost half of states, along with the VA, provide full practice authority to NPs.

NP residents receive a reduced salary, just as MD residents do.

I am in primary care, and I'd be quite confident getting my supervision from an experienced NP. I did a clinical rotation at a Johns Hopkins Urgent Care, and the MDs regularly sought the counsel of my preceptor, an NP with over 30 years NP experience. I think it's a safe bet that she knew more than an inexperienced MD.

There are very few organizations that can afford to pay an NP, even at a reduced rate, to see 100% of their cases together with a "top physician in his field" for a few years. My understanding is for MDs, primary care internship is 1 year and residency is 1-2 years. I would expect that in a clinic that has MDs and NPs, the NPs would be seeing the more straight forward cases, while the MDs would see the complex cases. Otherwise, what would justify the substantially higher pay of MDs?

2 Votes
47 minutes ago, FullGlass said:

Others have given a good response to this post. Some clarifications:

Almost half of states, along with the VA, provide full practice authority to NPs.

NP residents receive a reduced salary, just as MD residents do.

I am in primary care, and I'd be quite confident getting my supervision from an experienced NP. I did a clinical rotation at a Johns Hopkins Urgent Care, and the MDs regularly sought the counsel of my preceptor, an NP with over 30 years NP experience. I think it's a safe bet that she knew more than an inexperienced MD.

There are very few organizations that can afford to pay an NP, even at a reduced rate, to see 100% of their cases together with a "top physician in his field" for a few years. My understanding is for MDs, primary care internship is 1 year and residency is 1-2 years. I would expect that in a clinic that has MDs and NPs, the NPs would be seeing the more straight forward cases, while the MDs would see the complex cases. Otherwise, what would justify the substantially higher pay of MDs?

Peds, internal medicine, and family medicine are 3 year residencies after medical school. Some would also include obgyn and psychiatry (both 4 years) in this list.

I obviously don't know about everywhere and every different specialty, but at the two large academic teaching hospitals where I've been, NPs in my department had to staff 100% of their patients with their attending physician, and sometimes they would see the more difficult patients together. They had similar responsibilities as 2nd year residents.

As you said, NPs often are assigned more straight forward cases, and there's no reason well-trained NPs can't provide excellent quality care for routine things independently. But part of it is a prestige thing. Some patients have expectations when they go to a big name hospital that they will be seen by a world renowned physician. There was some talk at my last place to allow a couple of experienced NPs to manage a small inpatient caseload on their own, but it was shot down, I think mostly because it didn't look good.

As far as the cost goes, yeah, it would be cheaper if NPs all worked on their own without supervision, but not everywhere is always 100% profit driven, and NPs are still much cheaper than hiring additional physicians. A lot of doctors at academic centers are not seeing patients all day anyway. Many may only have a 50% clinical appointment. Many will have time allotted for supervising residents/NPs, teaching classes, doing research, and other admin tasks.

I was never try to disparage anyone, so sorry if it came across that way. Just was pointing out the most competent mid levels I've worked with have been in these type of environments. Being surrounded by bright minds, getting quality supervision on a daily basis, sitting in classes/journal clubs with residents, going to grand rounds, etc seems like an easier path to greatness than just doing 500 clinical hours and going at it on your own.

3 Votes
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