New NP: Nervous, need resources and advice!

FNP-Cgrad · Oct 30, 2016

Epocrates full version is a condensed more user friendly app. Straight to the point with the differential including TX and plan

Aromatic · Oct 30, 2016

Epocrates full version is a condensed more user friendly app. Straight to the point with the differential including TX and plan

yeah that was prob my fav back in the day. less time consuming for on the job references than medscape

PG2018 · Oct 30, 2016

Work up the chief complaint, treat what it most likely is, send home. If not fixed, treat the second most likely cause.

janandrewss · Oct 31, 2016

Epocrates is a great app to use!

NurseLauraM · Nov 4, 2016

I am also a new grad NP and, being in the same boat, I completely understand why you're nervous. However, unlike what some others are posting, I do not think your anxiety is a bad sign. I had a professor once tell us that new providers who are not scared, no matter how well prepared, are actually more likely to harm patients because they underestimate the serious responsibility of being an autonomous provider.

I also think that it is more harmful to our profession to discourage new (or even experienced) NPs from asking for support and advice from one another. People who are afraid to ask for help never grow.

Anyway, to address the OP's original question - one book I have been studying in preparation for my new job (I also have not started yet) is "Pocket Primart Care" by Kiefer and Chong. It's small enough to carry in your lab coat and it has all of the recent primary care guidelines. I can't say how it will be in practice because, as I mentioned, I haven't started yet. However, I have heard from a number of primary care clinicians (NPs and MDs, new and experienced) that it is very useful.

Best of luck and let us know how it goes!

NurseLauraM · Nov 4, 2016

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.

Actually, JNC8 guidelines recommend the following for initial treatment of hypertension: "ACE inhibitors, ARBs, thiazides or CCB in the general nonblack population or a thiazides or CCB in the general black population". So OP was not incorrect from what I can tell. This is why all NPs should reference good, up-to-date guidelines frequently. Not just the new grads!

ACNPmomof2, BSN, MSN, RN, APRN, NP · Nov 5, 2016

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

Hi lj774263 - I am taking the AACN acute care NP cert sometime in Jan/Feb after I finish the program in Dec. Super nervous about it as it doesn't seem like there is much info out there. What did you use to prep for the exam and it is similar to CCRN?

Also to the OP, my husband has been an ER doc forever. I always tell him how nervous I am to get out and practice. Thankfully as a critical care NP I will always have an intensivist there. But I am still nervous. He tells me that is what makes me a safe provider. If I have a question, I will speak up. He says the ones who do things from memory are the ones who are dangerous. Look it up. UpToDate is gold. Good luck to you!

FNPmomoffour · Nov 8, 2016

Hi I think we all felt that way upon working on our own with no direct supervision. I would go home and worry every night if I missed something. But I learned we won't catch everything at each appt because the patient may be in early stages of a disease process, or have confused the situation by trying their own treatments first (esp derm issues.)But find a mentor in your clinic with experience who can also direct you to other resources, and providers in your community for referrals. I used my phone apps a lot for pharm such as epocrates. But my book references are the "Practice guidelines for family nurse practitioners" 4th by Fernstermacher and Hudson, which has a lot of good clinical pearls. And another book was "The residents guide to ambulatory care" 7 th Ed. These both use latest clinical guidelines. I also keep a big binder with current guidelines for HTN, other charts, and peds stuff.....and your clinic may also have Standard operating procedures and guideline/protocol specific for their clinic.

I started to feel more comfortable with the more patients I saw. But it can be difficult with primary care because you can see so many different things in one day. Now working in diabetes, I find it easier to focus on that specialty. But things will get easier as you become more experienced:)

chiromed0 · Nov 23, 2016

Old thread but I think EVERYONE feels that for the first year or two, or anytime you switch specialties. Resources...Midlevel U website, here of course, Youtube!, books: 5 minute clinical consult (life saver), Family Practice Notebook website. Also, it IS okay to say you don't know and to get back with people later...also, don't solve every problem they have in one visit...follow up visit and go to the next room.

thomasc · Dec 5, 2016

Hi Flaring, I hope you are in a better place and have shrugged off that comment by AAC. You obviously care about what you are doing and don't want to do any harm. That's a good thing! We are all nervous at the start of a new career, milestone or whathaveyou. This is especially true in healthcare because the stakes are higher. You will find people you can trust who will guide you and point you in the right direction. It is crazy to try and do it on your own. Everyone consults with everyone. I see this every day at the hospital where I work. This is true for RNs, NPs, PAs and MDs. Just know that as you continue to practice, your confidence and skill level will increase. Don't be afraid to ask questions. You may find some people as closed as that commenter, but most will be willing to help. Good luck, you will be great!

mrl3fnp · Dec 20, 2016

Hopefully BostonFNP or Jules will respond.

Hahahaha! You are joking, right?

Anyway.....Back to the OP........YES, I think it's normal to feel this way..........Except for drugs, I have found an old-fashioned PDA is very reassuring. I would suggest a new drug book though for the prescribing.

If you don't feel supported or you don't feel you are able to ask questions from your associates then I would move on.......You are correct in the necessity to be able to diagnose correctly and yes your license is in jeopardy if you don't. So do what you need to do and live where you need to live until you feel secure in your decision-making ability.

guest769224 · Dec 20, 2016

Hahahaha! You are joking, right?

Enlighten us on why you find my post to be amusing.