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New NP Blues

NP   (6,538 Views 21 Comments)
by malapata malapata (New Member) New Member

malapata has 5 years experience .

3,300 Visitors; 124 Posts

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Hi everyone, I am a recently graduated NP. I started my first job about 3 months ago at a specialty and primary care outpatient clinic. There are only three providers at the clinic including myself, one of whom is not always at the clinic the days I am. I'm reaching out to the allnurses community because I wanted to vent/express concern or frustration over not having a mentor or someone who is guiding me in my learning as a new practitioner. Our clinic is not extremely busy but when I see primary care patients I feel lost. I use online resources such as Uptodate and other clinical guidelines but it is cumbersome and time consuming. For example, I had a patient come in with possible UTI the other day and I struggled figuring out how to properly rule it out. Luckily, I have a lot of time to spend with these patients but I don't know if I'm learning good practice by having to figure things out on my own without the help of a mentor or seasoned provider. I worry I will create bad habits as a self-learner. I do compile information on a drive that use as a reference but I feel there might be other ways I could be conducting my examination or other secondary diagnoses I could be considering that I don't think of due to my lack of experience and expertise. These are things I feel a good mentor might help to nurture in me...

Has anyone every felt this way as a new NP? What did you do? How did you get through it? Does anyone know of any resources for new grads who are struggling? Any other comments/experiences welcome!! Thanks!

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synaptic has 5 years experience and works as a nurse practitioner.

5,247 Visitors; 249 Posts

What program did you attend? I think everybody should know how to at least diagnose a UTI before graduation. I am not knocking you but it sounds like whatever program you attended did not prepare you well.

It would probably be best to go home and read the material, its hard to absorb stuff reading wise at work unless it is applicable to the current situation. Uptodate is good but its so so in depth and not really needed for simple stuff. Epocrates is pretty good, 5 minute clinical consult online is good. If your program (which it doesn't sound like it did) didn't prepare you well I would probably pick up a copy of robins and cochran pathologic basis of disease. give ita read and understand all of its material.

I know it takes some getting used to but most people I know were able to handle most primary care issues by graduation, but we can fix that no worry. There are plenty of resources and in order to protect yourself from getting sued I would do some self study at home and run scenarios through your head.

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malapata has 5 years experience.

3,300 Visitors; 124 Posts

Thank you so much for these suggestions. I appreciate it. I'm not going to say which program I attended but I will say that if I had the chance to do it again I would not go there. I feel they did not prepare us.

Thank you for responding.

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orangepink has 3 years experience as a NP and works as a FNP.

7,660 Visitors; 289 Posts

It took me 3-6 months to get the hang of it. To find my rhythm. Looking back, I think one of the obstacles was I was still in "student" mode of thinking during the first few months of my job. So what I did was every day after work, I'd still study and go over patient cases until things become easier. No one ever stops learning as an NP. I think a lot of new NPs assume that since they pass the boards, they don't have to study anymore more so since they recently passed it. No NP program is perfect. Studying never ends IMO.

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4,411 Visitors; 178 Posts

That stinks, it does sound like your in a sticky situation, but here is the quickest fix I can think of.

Well the big thing is that everything is repairable knowledge wise. If you still have your physical exam and health assessment book I would finger through that too, in addition to what was stated above. The most important thing is just taking a good history and formulating a decent ddx. The rest of everything else is stuff that can mostly be looked up. I am not sure how strong your physiology and pathology is, but that does help too. Clinical decision making is pretty much the most important thing though and PE/health assessment books can help with that.

Looking up the most common chief complaint, memorizing the right questions to ask, most common etiology behind that complaint (pathogensis helps also but is not directly required for diagnosing at the PCP level), and be able to explain it to the patient is of high yield importance.

There are quite a few common chief complaints, but you can look up online and find the most common. Usually they include (insert body area) pain, diarrhea, fever, weakness, not feeling right, anxiety, depression, fatigue (different from weakness), MS injuries, abscesses, infections, lung issues (look up DDX for all of these), etc.

It is doable and as long as you take initiative you will probably be fine.

Drugs, treatment, etc can all be looked up at the time of the diagnoses so focus on those last, but many treatments are self explanatory. Understanding the red flag drug interactions are important though also, but epocrates and Medscape have a decent interaction calculator. It is highly sensitive and many of the interacts below the series/contraindicated level do not occur often.

At least you have a slow pace to work at though, perfect for learning. Self learning is a powerful tool if used correctly and a year from now you could kick some major a** once u get everything down

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evolvingrn works as a RN.

8,180 Visitors; 1,035 Posts

I'm new too! Hang in there. I work at a busy practice and so what I do is just briefly synapse the pt story and my thoughts and they usually give me some very quick feedback. What I'm finding is Everybody has there own pts and they don't want to take mine on to.... So I only ask on things I'm really unsure about now. Because I work at a big place I get my uas immediately and most blood results pretty fast so I can usually figure out what I need to know.

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malapata has 5 years experience.

3,300 Visitors; 124 Posts

Thank you, orangepink. That is very true and very good advice.

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malapata has 5 years experience.

3,300 Visitors; 124 Posts

Thanks, evolvingrn! That is great that you have those quick lab resources. I work with an undeserved population and lose a lot of patients to follow up. Sometimes I'm even unable to get labs on them because they refuse or want me to try to get records from elsewhere before poking them... It also seems that practically every primary care pt I get is also a new pt and so they come to me with a LOT of problems. It can be overwhelming. And then, like I said, many times they never come back after that initial visit I'm totally stressing out about!

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cayenne06 has 10+ years experience and works as a CNM.

13 Likes; 17,705 Visitors; 1,369 Posts

Does your practice have a protocol book? I relied on mine constantly for the first 6 months, and still keep it up on my desktop most days.

What kind of peer review or chart review do you get? I'd make sure you are getting regular feedback from SOMEONE. And never hesitate to refer a patient if you have no one to consult and you aren't certain you know what is going on. It's okay to refer and have it turn out to be a nothing; it's part of the learning curve and you will get some good feedback from reading the consult notes.

You don't have to know everything, and you don't have to make a firm dx by the end of a visit. You will be wrong- sometimes hilariously so. Sometimes you will make a mistake, and sometimes that will cause an adverse outcome in your patient and it will suck majorly. But if you are dogged about doing your best and seeking out feedback as much as possible, you will get better. ((hugs))

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PG2018 works as a Psychiatry NP.

21,451 Visitors; 1,413 Posts

Being a good NP necessitates being autodidactic. Reread physiology and pathology, review assessments, learn what your assessments including labs and rads are actually picking up, and start learning the ins and outs of common complaints. Pick a couple meds for each indication that you like and run with it.

To give you my path in psychiatry, NP training mostly made me an APA expert. So then I had to actually learn enough about physiology, neurobiology, neuroscience (are these distinct fields to anyone else), pharmacology particularly -kinetics and -dynamics, psychopharmacology, psychopathology, memorizing a good chunk of the DSM, and becoming generally better acquainted with neurology (neurocog, PD, HA, Sz.), endocrinology (mostly thy, adren, and DM) and sleep medicine. I do try to be somewhat abreast of primary care mostly because I think all of us should be aware of the interplay of life's sicknesses and injuries with our respective populations.

Some things I still am grossly uninformed about are CT and MRI interpretation, although I never see any images, and EEGs.

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4,411 Visitors; 178 Posts

lol all those big words they tend to dodge in any nursing curriculum. I talked to one of my friends who is in an online np program. she states they don't have tests.... ever.

They write papers and do discussion posts.

Let me repeat that

they write papers and do discussion posts

one more time

they write papers and do discussion posts

ok, you get my drift. np education is too lax and not formulated correctly at most institutions.

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