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New NP looking for advice

by Patty47 Patty47 (New) New

I graduated with my FNP in May and will begin working in an internal medicine practice soon. I am really nervous that I am going to not know anything and my patients/providers will think I'm stupid. I was just wondering if anyone had any helpful advice for new NPs starting out to make them feel more confident. Thanks!

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

1. Have a structured orientation period whereby you initially follow a provider, then expand to seeing SOME pts, then handling your own caseload.

2. Use established and reliable references: UpToDate comes to mind. Get your practice to purchase it for you.

3. Build a rapport with the office staff.

4. Don't forget to obtain your own malpractice insurance.


Specializes in Adult Internal Medicine. Has 10 years experience.

Absolutely, top notch advice above.

The one thing I would add: if you think about it do it. If you aren't sure your patient needs a chest film and you think about ordering that's a sign to order it.

Sent from my iPhone.


First of all, know that what you are feeling is absolutely normal and actually reassuring. If you started your first NP job without any trepidation and thought you knew everything, that would be cause for concern. Your new role as an NP will be a learning experience everyday and I agree with above poster about up to date. This has always been my go to reference and it will

be your lifesaver!! Good luck!

I don't think I can offer much advice here but I certainly can commiserate. I spent my first year as an NP in a gyn clinic setting. Although it was a steep learning curve with a high patient volume I managed and gained some competency. After one year, I left to go to primary care. I have been there for a little over 2 months and am finding it very challenging as the scope of practice is so broad. It is a solo MD practice and although she was aware that I did not have any primary care experience she stated that she could teach me. I am feeling a lot of pressure to be able to see patients from start to finish without her involvement and sometimes this is not so easy since literally anything can walk in the door. I think the Doc is overwhelmed trying to manage her business like taking her billing in-house, dealing with the new Medicare requirements, etc. that the extra patients that have been added on to the schedule for me in order to justify my salary just add to her stress, especially since I do need her to see some of them as I am not always sure how to manage them. I leave work just about every day fearing that I will be fired. I don't really feel like nursing school prepared me for this and despite trying to read up on how to diagnose and treat common illnesses and review assessment skills on youtube I am not sure what else to do. I also feel the pressure of time and the need to deliver sooner rather than later. So, as I said I can commiserate! I just wish there were more resources for new NP's. All of the threads seem to be focused on passing boards, getting a job and negotiating contracts but not much for novice NPs experiencing that painful learning curve.