Excuse my grammar and spelling as I write this in the midst of a migraine storm. I am an experienced critical care nurse, and recently I’ve had a reality check.
I’ve wanted to be a provider since I was a child. Being a physician was originally my dream, life however lead me down the avenue of nursing. To make a long story short, ever since I was in nursing school I planned on becoming a nurse practitioner once I gained adequate experience, so seven years later here I am in my second semester of graduate school.
This semester has been a reality check, as I dive into the world of physical assessments, proper documentation, differential diagnoses, and proper clinical reasoning. I’m truly stressed and scared. I’ve always been an anxious person to begin with, I think part of it is because I’m afraid of failing, and well I’m terrified of hurting a patient and I realize the responsibility is tremendous.
As if it wasn’t enough, the negative comments about NPs are rather excessive, particularly from Reddit groups and forums like StudentDoctor, where medical students, resident physicians, and even attending physicians rant and complain about “mid-level” scope creeping. They post horror stories of misdiagnosed aneurysm, peritonitis, and ectopic pregnancies. I’ve even seen one Reddit user that devotes his entire account to creating fictional tales of an NP, he portrays the NP in a satirical and sarcastic manner, magnifying their medical mistakes.
The pressure to succeed and do well is real. Firstly for my future patients, for I wish not to hurt anyone under my care. Secondly, I do not wish to appear as a fraud. I do feel like a fraud, like how in the world am I entrusted with this responsibility? Don’t get me wrong, I will never pretend to know something I do not know!
Lastly, maintaining full time employment whilst going to school. I know plenty of nurses that work FT and do NP school. The thing is that I’m extremely concerned with dedicating as much time as possible into my studies. Full time employment with school is stressing me out. I don’t have a family or anyone to support, so quitting is very tempting. The only thing I’m afraid of losing are my benefits. ☹️
I wanted to chime in on a few things here because I think it’s important for you abs your socialization into a new role.
1. I think it is important to acknowledge from the beginning that you are moving from a place where you have developed competency and expertise through years of work experience into a role where you will be starting fresh. Being an expert nurse only qualifies you to be a novice NP. There is no skipping steps, you need to rebuild that competency and expertise with experience in practice. I often see NP students that are experienced RNs putting far too much pressure on themselves to know everything from the start. It’s OK to be a student again and simply learn. There is a mantra of fake-it until-you-make-it in NP school; I make students dump that at the door because it creates stress and it ruins your learning experience in the clinical setting for sure.
2. We all make mistakes. We all misdiagnose. Some doctors enjoy pointing out when NPs do this but the truth is, if they are in practice, they’ve made the same errors. If they don’t think they have, they not only aren’t good providers they are dangerous ones. Self-reflecting practice is the hallmark of a good provider; it can be anxiety producing for students/novice providers because it means we actively look for our mistakes, but overtime the anxiety goes away and we are left with being able to accept our mistakes and grow from them. Remember there are lots of illnesses that you will come across as a PCP that have an average time-to-diagnosis of 5-10-15 years!
3. Primary care is far too broad to know everything; there isn’t a provider on the planet that knows it all in-depth. I tell patients frequently “ I don’t know”; the art of medicine is being able to create a plan from that! The MOST important thing a PCP can do, and it’s simple, is identify normal from abnormal. If you can do this simple thing (and the longer you practice the less simple it gets) you will have a solid foundation to grow on.
4. I may take some flack here but I am a firm believer that you are making an investment in yourself in a new career; working FT and doing NP student part time is not the ideal way to build a strong foundation. Would you rather see a PCP that did their education and training as their second priority? On the flip side, would you want an RN taking care of you that was focused on trying to learn something different? It’s a big investment of your money and time, make the most of it.
BostonFNP, APRN
2 Articles; 5,584 Posts
I wanted to chime in on a few things here because I think it’s important for you abs your socialization into a new role.
1. I think it is important to acknowledge from the beginning that you are moving from a place where you have developed competency and expertise through years of work experience into a role where you will be starting fresh. Being an expert nurse only qualifies you to be a novice NP. There is no skipping steps, you need to rebuild that competency and expertise with experience in practice. I often see NP students that are experienced RNs putting far too much pressure on themselves to know everything from the start. It’s OK to be a student again and simply learn. There is a mantra of fake-it until-you-make-it in NP school; I make students dump that at the door because it creates stress and it ruins your learning experience in the clinical setting for sure.
2. We all make mistakes. We all misdiagnose. Some doctors enjoy pointing out when NPs do this but the truth is, if they are in practice, they’ve made the same errors. If they don’t think they have, they not only aren’t good providers they are dangerous ones. Self-reflecting practice is the hallmark of a good provider; it can be anxiety producing for students/novice providers because it means we actively look for our mistakes, but overtime the anxiety goes away and we are left with being able to accept our mistakes and grow from them. Remember there are lots of illnesses that you will come across as a PCP that have an average time-to-diagnosis of 5-10-15 years!
3. Primary care is far too broad to know everything; there isn’t a provider on the planet that knows it all in-depth. I tell patients frequently “ I don’t know”; the art of medicine is being able to create a plan from that! The MOST important thing a PCP can do, and it’s simple, is identify normal from abnormal. If you can do this simple thing (and the longer you practice the less simple it gets) you will have a solid foundation to grow on.
4. I may take some flack here but I am a firm believer that you are making an investment in yourself in a new career; working FT and doing NP student part time is not the ideal way to build a strong foundation. Would you rather see a PCP that did their education and training as their second priority? On the flip side, would you want an RN taking care of you that was focused on trying to learn something different? It’s a big investment of your money and time, make the most of it.