Training for new NP's

NPOaftermidnight, MSN, RN, NP · Jan 12, 2020

When I started in a private peds office, I had never done peds before except in clinical. I got about 6wks working one on one with another NP before I was out on my own.

Nichole · Jan 12, 2020

Thank you for your response. It was very helpful.

29 minutes ago, NPOaftermidnight said:
When I started in a private peds office, I had never done peds before except in clinical. I got about 6wks working one on one with another NP before I was out on my own.

Samantha Zeller, MSN, APRN · Jan 12, 2020

Hi there, so training for NPs in any given specialty is widely variable depending on your employer. As it stands currently, there are no particular training guidelines for any given specialty for the NP (though they’re starting to make specialty track NP curriculum ) You by far learn on the job. Some employers have distinct training guidelines/requirements, but others may have nothing in place, particularly if they have never hired an NP for that role. It is up to you as a professional to inquire about the training and expectations of your new role. My first position in primary care had no training. They just started my schedule light then built upon my daily patient load. Quite quickly I might add. It was very stressful and I had to speak with my employer about the pace and expectations. My current position in peds heme/onc went much better. I had a one on one mentor who I worked with solely for several months. I handled a small case load at first and then built up. I also did additional training with education models specific to my specialty. For me, the mentoring was the key to me learning my specialty successfully. So my advice to you is ensure you ask about what will be required of you and who is responsible for training you, ensuring your success. As always, learning never ends. Ask fellow physicians and NPs in your specialty what books/education materials they recommended you read. Good luck!

db2xs · Jan 17, 2020

I don't work in gastroenterology but I do work in a specialty (hospice/palliative care) and am the only NP at my agency. For me, honestly, the MDs have been gold, sheer gold. They love to educate and are very happy to answer any questions I have (and I have a lot sometimes).

I received zero training as an NP in hospice/palliative care. I was in a palliative care post-masters program in school but the administration cancelled it after one semester (don't get me started). Although I am certified in hospice/palliative care as an RN, NP responsibilities are much different and I felt very ill-prepared when I started. And to top it off, I had only one day of training.

If you're super into gastroenterology, I would suggest joining a specialty professional group. Also, finding other NPs in your area who are experts in gastroenterology and taking CE courses tailored for NPs could really help as well.

TuxnadoDO · Jan 23, 2020

I’m curious - since your education is in primary care and not a subspecialty of internal medicine, how would working in a subspecialty be easier or less overwhelming? Wouldn’t it be less overwhelming to work in the specialty (family/internal medicine) for which you are trained? I mean, how much dedicated education or training do you have in GI?

no offense meant.

Emineminem · Jan 28, 2020

I've actually seen a lot of FNPs working for our local GI group(s). I could be entirely wrong, as my training is primary care, as well ... but it seems like the scope of what the NPs are doing in GI is a bit more limited than in Internal Medicine? GI is not my cup of tea. But, I could understand why a New Grad might be interested in taking on a more limited role initially, to get his/her feet wet. You never know what you're going to get in Family Practice.

During my clinicals, we sometimes had patients show up to the office with complaints or issues that really should be evaluated in an acute care setting, but the patient wanted to be worked up in the office first because going to the ER is viewed as an inconvenience. Once, a patient's daughter called and said her dad was just a "little short of breath today" and could we work him in? He showed up in an extreme CHF exacerbation and still, the family was arguing about why we couldn't just treat him "in the office." Just saying, there's a fair amount of triage that goes on, even in an office setting. And, you will be seeing and treating everything under the sun. Even when you "know your stuff", things can get hairy when you have patients that have spent too much time on Google and have bizarre requests about how they want their care managed.

I've had patients with terribly out of control Diabetes that are adamant about staying on a particular insulin regimen even though it is clearly not providing the desired therapeutic benefit. I've had patients with out of control hypothyroidism that refuse to take Synthroid (but, want you to Rx strange supplements you're not familiar with and which are not evidence based.) I've had patients show up that have recently moved into the area and were previously being seen by a specialist for rare conditions like "Postural Orthostatic Tachycardia Syndrome," and they want you to manage it for him/her, but it doesn't seem quite appropriate for primary care.

If, ultimately, your goal is to work in Family Practice or Internal Medicine - I think it would be better to go that route now, so you can build up your skillset. In an office with good support from your more senior providers, the complications posed by treating more complex patients should be mitigated by their mentorship. But, if you really are more interested in just specializing - I say, go for it.

Noodle411, ADN, MSN, RN, NP · Oct 28, 2020

Hi Nichole, Since your original post was in January, I am wondering what your experience ended up being (now that it's been nearly 10 months later). I am curious because I find myself in a similarly specific position -- I graduated in May 2020 (AGNP) and currently I have two job offers - one in GI and one in Hospice. I am currently leaning towards the GI office and am told that as a new grad NP, I would likely start off doing a lot of colonoscopy screening consultations for those who have recently turned 50 and the advice I got was to brush up initially on the most common GI diseases and build from there. Would you please post your recent experience in GI (if you accepted the position)? Are you feeling more comfortable now that some time has passed? Looking forward to reading your post.

Nichole · Oct 28, 2020

I did except the position at the GI office. Initially, I was told I would only do colonoscopy screenings but so many people that come in for screenings have other GI issues that have to be addressed during the visit. I have found that some physicians are not exactly the best at training NPs and that made it hard during the first 6 months. I do feel more confident and enjoy my job. I definitely think you’ll gain more experience in GI, if you choose to take the position.

Good Luck!

Emma88 · Jan 2, 2021

Hi, I’m a new grad FNP 9/2020 and recently hired at a family medicine office. I was wondering if anyone had any books or apps with diagnoses and treatments that you recommend reading ?

Samantha Zeller, MSN, APRN · Jan 2, 2021

I know its expensive but UpToDate is by far the most comprehensive medical resource I've ever used. I’ve been very lucky to have acquired it for free through my work, but I am aware not all employers offer this for their providers which is a shame. I also use drug apps such a Lexicomp and Epocrates. Im sure there are a ton more apps out there that fit your particular needs in family practice. You will typically find the best resources for you through other colleagues in your field and conferences that are geared toward your specialty. Good luck! The learning truly never ends!

Tegridy · Jan 3, 2021

Best thing to do is ask whoever your attending is.