Hello everyone! I am a new nurse practitioner and have been offered my first job in a general medicine outpatient clinic. I will be seeing 15-20 patients daily (at my max) and there are a few others nps and physicians who work there. Salary and benefits seem great (everything paid, 5 weeks vacation, salary 100k + productivity)
Thing is, I am terrified. I feel like I wont know what to do when I see patients. Even if I have a vague idea of what to order I feel like I might miss something. like if someone comes in with high BP, maybe I prescribe an ace inhibitor but what if I should have also done a more thorough workup for hidden causes? If I tell someone to put hydrocortisone on a rash when I should have checked for another disease? I feel like I just need access to big book of guidelines to help me get started. Can anyone help?
1. What's a good resource book or website that can help me follow best care guidelines for patients so I don't miss anything?
2. Does anyone else feel this way at first? Aren't you scared of really screwing up and losing your license? Does it get better? What's the best way to gain confidence?
I'm freaking out, sick to my stomach about starting next week. Need advice please!
Specializes in ER, PCU, UCC, Observation medicine.
Thank you Boston. That's a helpful way of phrasing it. So a hypertensive patient who went from normal to high very suddenly would be abnormal, or if they already have some target organ damage, or were incredibly young I would ask for advice because it's not really a typical presentation. And a rash that was growing rapidly, or was associated with systemic symptoms, I would ask someone. Like that?
Reading your posts is concerning. You seem quite unprepared to medically manage simple issues. If you want resources, you should start reading your textbook for some sound advice, you remember that Primary Care textbook school made you buy? Did you read it? Rashes and hypertension are there along with recommended works ups and treatment. Also, try to relax some
I don't think there is anything wrong with admitting to being a little nervous as a new grad. I've been an APN for 10 years now and I ask questions too - true not nearly as many as I used to but I do ask questions when I need to.
There are lots of resources out there - apps, etc., that are easily used while seeing pts.
As to hypertension, I work in nephrology so I care for very recalcitrant HTN and many of my pts are only managed on max doses of five meds. HTN is not a basic disease process all the time.
It is good to be a little scared in the beginning. With practice and support, you will become a competent provider.
One way to manage anxiety is with structure. Have a consistent approach for each patient- a template. Have your own decision trees of when to ask for help. Negotiate for a reduced patient load for the first few months. Find a mentor. Find support. Try to stay calm. Best wishes. You can do it!
Specializes in ER, PCU, UCC, Observation medicine.
I don't think there is anything wrong with admitting to being a little nervous as a new grad. I've been an APN for 10 years now and I ask questions too - true not nearly as many as I used to but I do ask questions when I need to.
There are lots of resources out there - apps, etc., that are easily used while seeing pts.
As to hypertension, I work in nephrology so I care for very recalcitrant HTN and many of my pts are only managed on max doses of five meds. HTN is not a basic disease process all the time.
It is good to be a little scared in the beginning. With practice and support, you will become a competent provider.
I understand the nervous part. The other odd questions about HTN and derm though made me wonder what was going on during school and clinical. Some basic stuff if you ask me.
Anyway, I didn't know you were in nephrology. I just had a young girl, 24, with medullary sponge kidney / nephrocalcinosis, never seen that before. What do you guys do to work that up? I understand there's not much you can do, but do you work up the etiology? Her PTH was normal.
Fllow the guidelines they taught you in school and refer out when in doubt. Consult more experienced providers, and everything else people said above. Except aac. He's nonsense in corporal form
Hello everyone! I am a new nurse practitioner and have been offered my first job in a general medicine outpatient clinic. I will be seeing 15-20 patients daily (at my max) and there are a few others nps and physicians who work there. Salary and benefits seem great (everything paid, 5 weeks vacation, salary 100k + productivity)
Thing is, I am terrified. I feel like I wont know what to do when I see patients. Even if I have a vague idea of what to order I feel like I might miss something. like if someone comes in with high BP, maybe I prescribe an ace inhibitor but what if I should have also done a more thorough workup for hidden causes? If I tell someone to put hydrocortisone on a rash when I should have checked for another disease? I feel like I just need access to big book of guidelines to help me get started. Can anyone help?
1. What's a good resource book or website that can help me follow best care guidelines for patients so I don't miss anything?
2. Does anyone else feel this way at first? Aren't you scared of really screwing up and losing your license? Does it get better? What's the best way to gain confidence?
I'm freaking out, sick to my stomach about starting next week. Need advice please!
Just breathe....You will see the same old same old every day. Med adjustments, refills and labs with every now and then a UTI, Virus or if you are lucky some strep throat. You had clinicals and by the end you should have felt confidence that you were applying the information you learned in class.
I can relate to the fear of being new but it really becomes routine pretty quickly.
I get the feeling that this poster does not have prior relevant RN experience, or has very little experience.
From taking two graduate level NP classes (advanced pharmacology and advanced patho), I already know that there are resources and treatment algorithms out there for many common conditions such as hypertension, diabetes, and high cholesterol. It seems like this poster was not very well prepared.
I get the feeling that this poster does not have prior relevant RN experience, or has very little experience.
From taking two graduate level NP classes (advanced pharmacology and advanced patho), I already know that there are resources and treatment algorithms out there for many common conditions such as hypertension, diabetes, and high cholesterol. It seems like this poster was not very well prepared.
I'm not so sure most RNs have a great working knowledge of diagnosing primary vs secondary hypertension and associated differentials or really what meds work in what types of patients. There is a big distinction between knowing ACE guidelines and applying them appropriately to real-world patients.
YoutubeTheNP
221 Posts
Reading your posts is concerning. You seem quite unprepared to medically manage simple issues. If you want resources, you should start reading your textbook for some sound advice, you remember that Primary Care textbook school made you buy? Did you read it? Rashes and hypertension are there along with recommended works ups and treatment. Also, try to relax some