Not board prep content or textbook medicine, but real-world things that blindsided you once you started practicing independently.

Examples:
• managing inboxes/labs/results
• time management/charting
• difficult patient interactions
• psych meds
• pain management
• skin issues
• when to ask for help/escalate
• handling uncertainty
• burnout/imposter syndrome
• productivity expectations
• documentation
• prior auths/refills/messages
• family dynamics
• feeling overwhelmed

I'm an NP and have been thinking a lot about how huge the gap can feel between graduating/passing boards and actually functioning comfortably in practice.

Would love to hear:
• what hit you hardest
• what still stresses you out
• what resources you wish existed
• what made you feel unsupported
• what finally helped things "click"

Especially interested in hearing from FNPs, AGPCNPs, primary care, urgent care, geriatrics, palliative, and hospital-based NPs.

I'm new to this community. I'm currently in a FNP program and am aiming to complete by December 2027. I've been a RN for about 9 years now with mostly a cardiac background. I decided to go back to school largely because I don't think I can physically keep up with it when I'm in my 50's-60's and I enjoy learning/desire some more autonomy. 

Some of my colleagues are also training to be FNP's and some have expressed the desire to start off in PCP or urgent care in the beginning to get a develop a good foundation. A colleague who is my unit's APP said she started off in a primary care office and learned a lot before transitioning into other specialities. My friends who are FNPs, however, advised that it's better to wisely pick a speciality instead. 

This conversation reminds me a whole lot of when I became a new grad RN - many people said it was better to start off in Med-Surg, while others pursued their desired specialities off the get-go. I was one who chose a specialty and have not regretted doing so. Unfortunately, I'm not so sure that I want to be a provider in cardiology as I can see that requiring frequent call (although I am glad to have a foundation in cardiology). I'm not against some call, but I can imagine cardiology being called a ton. Also, this does give me a chance to learn more about other specialities in general. I'm assuming specialities pay more as well? 

For the experienced FNPs, looking back, do you think it's better to try PCP/urgent care first and then specialize or do you think it doesn't matter?

I'm an FNP-C in Houston area working in Surgery (first assist, preop, and follow up post op care) Salary is 110k (negotiating to 115k), 3 weeks pto, 9 paid holidays, 1500 CME/yr, paid DEA, malpractice, 401k without match, 4 day work week (40-50hrs), on-call practically all the time (but only get calls on surgery days 2-3days/week). Overall I'm happy with the work I do.

What is your compensation package look like?

Also, as an FNP can we go see ID patients in the hospital for that ID MD? He will see all new consults, and wants me to follow up with his patients on weekend. 

Thanks in advance!! 

I have enrolled in a PMHNP program that is asking us to do use online AI driven software to do soap notes. I have looked into a few choices, and not happy at all.

Firstly, how HIPAA compliant is AI?

Secondly, I don't want to pay $ xxx for a stupid program that the school should have supplied.

Is this the norm now?

If so, are there free/cheap and safe options available for students?

Thanks a bunch in advance.

I will be graduating from my NP Program this December (2026) as a pediatric primary care nurse practitioner. I live in California and will be getting licensed in California and was wondering if anyone has gone through the examination/licensing process in California and about how long that process took from when you graduated. I work at a children's hospital currently as an RN and have a clinic within the system that is potentially interested in hiring me, but I want to provide them an accurate timeline of when I would actually be able to start working.

Janon 

"The district is one of the few true toss-ups in November's election . . . No matter how the residents of Virginia's 57th District feel about their would-be delegate doing sex work on a public platform, this revelation sure does complicate the election campaign Gibson, a nurse practitioner, is currently running against Republican David Owen, a retiree and former homebuilder . . . What's worse, Gibson dramatically outspent her Republican competitor in their respective primaries, putting her at a major financial disadvantage going into the general election. In the Democratic primary earlier this year, Gibson spent $300,000 of the $377,000 she has raised to beat rival Democrat Bob Shippee, while Owen, the Republican, spent just half his funds, since he had no primary opponent."

Regardless of Ms. Gibson's politics, this shows an appalling lack of judgment.  Part of me finds this funny, but it also is upsetting, as NPs have been fighting so hard for respect.  She can do what she wants, but to think this would not be discovered if she ran for office?  Unbelievable.

I am wondering; are there any current practicing nurse practitioners who have completed a residency/fellowship who would be willing to share about their experience? Thanks in advance!

Looking for some advice. I recently graduated (May 2025) with my MS FNP and have been searching for a job since about August. I waited to start applying after I had my daughter (July), which IDK if thats the mistake I made, but I had figured being certified and getting my NPI beforehand would make me more appealing. Anyways I have had 3 interview in total, a handful of recruiters who reached out and I never heard from again, and only 1 offer which locked me in for 3 years for less pay than an RN in my area, plus a noncompete clause that would have forced me to move if I left...I obviously rejected this offer. I cannot leave my current city, so moving is not an option, but I have applied to places up to an hour drive away. But nothing, crickets. I am in WNY and understand the area is saturated, but even postings offering 15k less than average for NP in the area do not get even a recruiter call. I have been using Zip recruiter and Indeed, many times the applications get viewed and nothing happens. The rural settings seem to be the only places that reach out to me. At this point my PT clinical instructor position is not cutting it, I reached out to nursing agencies and they are refusing me as I need med surg experience to have been within the past year....my last Med Surg position was in 2023....although I teach med surg clinicals they do not consider that experience, despite the 6+ years experience I have in Med Surg/Tele. So now I am applying to RN positions and getting rejection emails. I would not mind working in an ED and improving my skillset while I slowly wait for the right NP position....does anyone have any experience trying to get an RN job while being a board certified FNP. Do I leave it off my resume, my concern is if I do and they find it on the NYS website that they will immediately reject me. Any tips and advice would be appreciated. 

I just started in urology, the MD can see 50 patients a day.  He's been doing it for 30 years and knows everyone so it's usually quick and quick out.

Now here I come, they've hired me and now the head MA who helps him and organizes the rooming of his patients is telling me that I'm probably going to have to start rooming my own patients, because they can't do all of his and mine too.  What?

This isn't what I signed up for. I need quick advice because I'm losing sleep over this.

A new job is hard enough on its own, and I'm also in a new specialty with urology, that I don't want to be having to room my own patients as well, which is WAY down the hall as well.

I have no problem helping the team out on occasion, but I don't want to start doing this and then think this is the norm.

May I have some advice, please?

Thank you, Sherry

As an APP and clinical instructor for both NPs and PAs I would like to gain some insight from all of you into a few basic questions:  The answer to these questions could help new grads and soon To be new grads as well as experienced APPs transitions to different specialties.

1 - As almost to be new grads or new grads starting new jobs; where do you feel there is weakness in knowledge when applying it to real world/real patients.   Is it ABX stewardship? Diagnostic testing (imaging and labs) (what to order and when to order)? Specific med classifications, dosing?

2 - If you could have an extra month or two as a transitional phase/training/studying what would your curriculum include and focus on to make this transition smoother? Think of a "mini" residency focused on didactic.  This would be for new grads or APPs moving into working in outpatient (internal/family, EM, urgent care or peds)

3- Most common chief complaints (let's say top 10-20) that you feel soon to be or new grads struggle with the most in the outpatient setting? 

4- If you could tell yourself when you were a new grad or recommend to this population on some tips/tricks; what would they be?  What advice would you provide, what should they study/review and what should the always be open to ask for a better transition?

Looking forward to read all your comments and advice though your experience! 

Thank you!

I carry a load of 25 - 30 patients, she has 8-10. I prescribe everything from htn meds, insulin, suboxone,  and she only prescribes the mental health meds. I do physical assessments, she does not.

Is this difference in pay typical? Again, without sounding like an ignorant buffoon... why?

Demanding and understaffed work environment was getting the best of my mental and physical health. I thought it would be different in outpatient setting, since I'd be getting more respect and independence.

I did a thorough research about what I'd be doing as an FNP before starting the program, and it seemed really nice, way better than bedside. However, I didn't really know what primary care really was before I started my clinicals. And now I have 4 months before graduating, and I'm realizing that's not really what I want to do.

I just can't deal with people. I can't stand when they think that there's a magic pill to fix everything when they don't bother changing their eating habits or adding exercise regimen. Or when they come into the office not knowing what medical conditions they have or what medications they take.

It may not be a big deal to many healthcare professionals, but I just cant imagine dealing with this for the rest of my life. Maybe I'm just burned out. I don't know.

What can I do with my MSN FNP degree that doesn't require much patient contact?

This pt had been stable and doing well for a few years, but recently had PTSD triggered again after break up with romantic partner, which brought up many bad memories.  Given the patient's current mental state, they will not start college until Spring 2026 or Fall 2026.  Pt has never worked.

My honest assessment is that pt is likely not able to work at present and probably not for another year.  However, other than this recent retriggering, they have been high-functioning and there is no reason they could not work at least part-time after current sx resolve to previous level.

Because they have never worked, they are not eligible for the state temporary disability.  SSI is through Social Security and is needs-based; does not require work history (SSDI is for people who have worked), but does require the person to be disabled.  

My employer has a policy of not certifying for permanent disability, we only do temporary.  However, we can provide basic information like this is our patient, how long we have treated them and so on.  The patient would need to see a provider that does the permanent disability exams to get certified as permanently disabled. 

I just feel like how can this person know if they are too disabled to work when they have never even tried?  If they are capable of a fairly normal life, and even college, how can they be that disabled?  Normally, I am a soft touch, and this is the first time in several years of practice that I have not wanted to certify a patient as disabled.  Also, I have never had a high-functioning teen ask to be certified for SSI, when they are still living at home and family is not impoverished.

I have asked my boss for advice on how to handle this, but also am wondering how other NPs would handle this type of situation.  I don't know what to say to patient or how to express my misgivings.