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!
Thank you trauma. Those are helpful. In clinical I often used up-to-date as my sole resource when treating patients. Example, if someone came in with a rash I would loosely follow the up to date guidelines for a rash combined with my own clinical judgement. Any other newbies agree with this strategy or is there another good resource i should add?
Agree with TraumaRUs you need to get on uptodate now and start looking up common disease processes that you will see. Ace wouldn't typically be first choice for primary hypertension- usually hctz or chlorthalidone. Ask another provider for a list of commonly seen diagnoses and start looking up treatment protocols.
Posts like these make our profession look poor as we strive for independent practice.. Please do not post this as many physicians and possibly politicians read our forums and it is important that we show them that we are indeed competent and ready to take on the challenges of primary care
So admins, please delete this thread.
Ask your supervising physician for help. That is what they are there fore.
That's rich coming from you. I believe you once posted that NP programs are great for poor students who struggle with academics and wouldn't hack it in medical school. I'm sure that does wonders for our reputation.
"Posts like these make our profession look poor as we strive for independent practice.. Please do not post this as many physicians and possibly politicians read our forums and it is important that we show them that we are indeed competent and ready to take on the challenges of primary care
So admins, please delete this thread.
Ask your supervising physician for help. That is what they are there fore".
Wow your post is very tacky. I cant believe you posted this. Admin please delete his post. I share in your anxiety, Original Poster. I feel 100% exactly like you. I just took my AACN Acute care AG NP exam on Oct 22, 2016. I didnt think I would pass, but i did. I needed 107, I scored 111. I was prepared to retake this exam after Xmas. So I feel just like you. My internship was very choppy, that I had to put together myself, as a result, my clinical experience was subpar compared to PA internship. Lucky for me, I work CVICU, and ICU float pool so my clinical judgement is pretty good. But I am still very nervous and unsure in my ability to be a top level provider. I know I will miss small things, but I wont miss any serious issues because I will be strictly following the standards of care guidelines on all the major health conditions. And I will have a systematic approach to providing care. This part I am confident.
You and I, and others felt these same sentiments as new RN's, and many years later, we mastered that role. So we shall master this NP role as well. We will do fine, like someone said we can lean on the more experienced providers when we are in doubt. Blessings to you, and all the new NP's experiencing doubt in this new provider role
Thank you everyone. I was discouraged by some of the responses but appreciate the insight from most of the posters. To clarify, I am nervous because my program set up my clinicals with ALL physicians. I learned a lot from them, but physicians do not often follow national guidelines and rely on their own way of doing things. That's why I was taught to start with an ARB or ACEI and skip the hctz class. I'm sorry if I offended anyone by asking for guidance from my colleagues, I am just nervous and would like to know where practicing new nurse practitioners go for guidelines and when they are treating something new to them since I never learned from NPs in school.
OP, you and I, and all new NP's should just stick to the standards of care guidelines for our practice on all recognized medical conditions, we encounter. It holds up in court, following what doctors do, wont. You will be fine if you keep it simple by sticking to the standards of practice, using a systematic approach for encountering patients; you will grow your knowledge and understanding of disease processes as it vary from patient to patient, better. Forget what others do, is my suggestions.
P.S. and become a reader of the nursing experts such as Fitzgerald, and others
That's why I was taught to start with an ARB or ACEI and skip the hctz class.
Its not that simple, school should have taught you: high renin hypertensives (young, white) or diabetics get ACE/ARB while low renin diabetics (African decent and eldery) get CCBs or diuretics first line.
Its not that simple, school should have taught you: high renin hypertensives (young, white) or diabetics get ACE/ARB while low renin diabetics (African decent and eldery) get CCBs or diuretics first line.
It's appropriate to generally start with hctz or chlorthalidone as primary treatment to start. ALLHAT trial showed us that they are remarkable effective for BP control and much better at preventing CVD when compared to other medications. Plus they are incredibly inexpensive.
But I would say OP when you are in practice you should use critical thinking as opposed to copying what other providers do. A scarily high number of them ignore the current research and go rogue.
ALLHAT CVD results were secondary endpoints and largely driven by ACE use in African-descent patients; in the 10-year follow-up there we no differences.
They are cheap and effective for many patients, as are the now-generic ACE/ARB/CCBs. I use them where their mechanism of action best suits the patient.
Starting practice can seem a bit overwhelming. I would be much more concerned if you were starting out overconfident-that makes for a dangerous provider. As others have pointed out, you will see the same conditions over and over, and will become very familiar with common diagnostic and treatment regimens. I utilize resources such as Uptodate and Epocrates, and my favorite derm site, Dermnetnz.org. And if you don't know something, then ask. There's nothing wrong with asking questions.
One year from now you will feel very differently. Best of luck to you.
It is natural to be nervous when beginning a new role. Impostor syndrome is very common in just about every profession. Many physicians report having the same fears you are expressing when they're starting out. Reassure yourself with the knowledge that you wouldn't have passed your boards if you didn't know how to practice medicine.
reggaemuffin, MSN, NP, CNS
106 Posts
Agree with TraumaRUs you need to get on uptodate now and start looking up common disease processes that you will see. Ace wouldn't typically be first choice for primary hypertension- usually hctz or chlorthalidone. Ask another provider for a list of commonly seen diagnoses and start looking up treatment protocols.