New NP insecurities

[bluecludwig]

I recently started my first job as a primary care NP. I am working alongside an experienced NP that has precepted students in the past. I have been using the 2014 version of family practice guidelines book to help with my treatment plans. When I present my plans to my mentor for review, she always has a different plan in mind for the patient that she thinks is better. I then check her advice against UPtodate. She is usually right according to UPtodate. Any ideas on reliable resources to keep me safe during this first year?

Yeserday I gave a mother advice to give her child liquid Sudafed for a few days to help with nasal congestion associated with a URI just like my family practice guidelines book suggested and later when I checked UPtodate I learned that there is no evidence to support using decongestants in children for URIs.

Also, I am being told that I am functioning at the level of a 1st semester NP student. How can I pull out of this? I want to do the best for my patients, but I don't know all the answers. Do I need to go back to school?

[Aniva]

I love using UpToDate. Even now, I still use it. It's not an end all be all, but gives great guidance. Keep in mind, all cases are never 100% black and white. Everyone has different practice styles. You pay prescribe one thing and others may not. BUT always have a good rationale as to WHY your prescribing something or implementing a certain plan. If you don't understand the rationale behind a plan another provider gives, ask why. If your mentor has a different plan, ask her what her rationale is and why whether or not she/he feels your plan is reasonable. For viral processes, don't always feel pressured into giving a medication. Sometimes, support therapy is an appropriate route of action (unless you have some concerning findings...).

[aprnKate]

I agree with what everyone says about UpToDate. I am also a New FNP in practice. I will be practicing 6 months on April 20 (lol! I am counting). I still have my insecurities of not feeling "good enough" a lot of times and I also feel like an imposter everyday (which I will wonder when this feeling would stop). My preceptor and boss is a PA and he will be changing the schedule next week where I will be in the clinic all by myself ( I do rural health) and basically run the show and just call him or my supervising MD for advice. I'm nervous but excited at the same time. I had a really good clinical in pediatrics when I was in school. He told me to create a chart with the mg/kg dosage for common antibiotics/meds used in pediatrics and he was right! I still use the same chart today and it saves me time to calculate. You should make a chart reference (I did mine in excel), print it out & put it on a cover sheet and binder for antibiotic liquid forms: amoxicillin 400 mg/5ml, cefdinir, smz-tmp, zithromax, cefprozil, tamiflu, tylenol, ibuprofen...just have that in handy and also know the maximum dose per day....(this saved me a lot of time...i didn't have to calculate..it is really worth the trouble of taking the time to create this chart). Also print out the CDC vaccine schedule in color for kids, adults and just have it for reference along with your mg/kg antibiotics chart. I liked to use the Domino's 5 minute clinical consult for preventive care timelines gives you screenings per age group but you can also find this at the usptfs website. Uptodate is really an investment that is worth it.

[cnmbfa]

Go low tech. Get an alphabetized pocket sized notebook. Every evening, no matter what, go to Up-to-date and write brief notes on various conditions, beginning with the ones you encounter most often. Eventually you will have an impressive pocket brain, and the act of writing the notes will probably help you remember the information, or be able to find it quickly.

Skip electronic versions--make your own.

Every night in bed, reread some critical content from school. Hopefully, you now realize that NP school gave you the bare essentials you need to practice, and that there is far more that you need to learn, fast. Go to Medscape and subscribe to get emails on your specialty areas or any areas you are week on. My other favorites that I skim through are Health Day and Consult 360. There is no reason not to be able to keep up, and often its easier than you might think. Ask your colleagues if they have any favorite sites.

Don't be hard on yourself, but don't EVER make excuses for yourself, and work diligently to master the learning curve. The mark of an excellent practitioner is that they always wonder what it is that they don't know that they don't know! That drives them to continually learn, even years after graduation, so that they can stay on top of their field.