Transition into the NP role

Trauma Columnist · Jun 13, 2009

My first year was horrendous! Sounds like yours is much more productive. I wish you well. After three years, I'm feeling much more comfortable though the experiences in my first year will stay with me for many more.

JDCitizen · Jun 13, 2009

Proper orientation and support helps improve the learning curve and the confidence and experience will come...

First year can be rough sometimes more so on yourself than necessary. Year one I agree was horrendous...

If the MDs are happy and from their perspective you are doing great; you probably are. Keep learning and improving and you should probably keep those MDs happy.

Overall I think (as above) after the third year the improved confidence was there. I am not saying I still don't go review some of my findings/lab/test results with the MD... I just don't have to as much.

Experience will come and what you will go through to gain that experience varies greatly from person to person, practice to practice. You will will remember the first year or two and that is not necessarily a bad thing.

Best wises...

allnurses Guide · Jun 13, 2009

Sounds like you are doing great!! My professors continually told us that we would experience the "imposter" phenomenon once we got out in the work force-whether you've been an RN for 20 years or are right out of a direct entry program. I'm starting my first NP job next month and I'm convinced I'm going to screw up the simplest things!! I've heard the first year is tough, but I also don't know anyone who didn't survive it. I hope I don't ruin that record!!!

rnsrgr8t · Jun 16, 2009

It is totally normal. Look to your leadership to guide you on your progress. If they think you are doing fine, then you are. Give yourself at least a year to feel comfortable and feel like you are contributing. You will find yourself over time, as you gain more and more knowledge, that you just start implementing things on your own that you used to have to ask about. I have been at my job for 4 1/2 years, and I realized the other day that I was changing a treatment plan on one of our patients and I knew exactly what to do and I did not have to run it by anyone. It is a good feeling... If you have a low threshold for asking questions and are proactive... this will start to happen naturally over time. My division chief, about 1 1/2 years into my job, challenged me to come up with a plan before I talked to him about a patient (I had a tendency at times, to leave it up to him when I had no idea), sometimes I was right, sometimes I was wrong... but helped me learn more and put things together. Be patient it will come!

Blessedx3 · Jun 18, 2009

And if you have a High threshold for asking questions?...Once I am comfortable and feel like I have great knowledge...I am happy---but I am worried that I will start clinicals in the fall...and want confirmation on every decision.....3 more months--and the real part of school will hit me!!!

MissDoodaw · Jun 20, 2009

Hi,

I just saw a Boot Camp for hospitalist NP's and PA's advertised. I was looking for coming up NP conferences and thought it seemed like a good idea. It is in Virginia August 12-16. sponsored by the AAPA.

http://www.aapa.org/index.php?option=com_xmlservices&view=event&pid=58&id=09AAPASHM&Itemid=44

lifelong · Jun 21, 2009

Thanks guys! You helped me realize this is just a phase...normal phase I must travel through. I spoke with my instructor and she also mentioned it usually takes 5 yrs before one is very comfortable. She said it comes with time, that I knew I was just hoping to provide value quicker. I appreciate your thoughts.

Tracey

JDCitizen · Jun 21, 2009

Benner's Stages of Clinical Competence

Stage 1: Novice

Beginners have had no experience of the situations in which they are expected to perform. Novices are taught rules to help them perform. The rules are context-free and independent of specific cases; hence the rules tend to be applied universally. The rule-governed behavior typical of the novice is extremely limited and inflexible. As such, novices have no "life experience" in the application of rules."Just tell me what I need to do and I'll do it."

Stage 2: Advanced Beginner

Advanced beginners are those who can demonstrate marginally acceptable performance, those who have coped with enough real situations to note, or to have pointed out to them by a mentor, the recurring meaningful situational components. These components require prior experience in actual situations for recognition. Principles to guide actions begin to be formulated. The principles are based on experience.

Stage 3: Competent

Competence, typified by the nurse who has been on the job in the same or similar situations two or three years, develops when the nurse begins to see his or her actions in terms of long-range goals or plans of which he or she is consciously aware. For the competent nurse, a plan establishes a perspective, and the plan is based on considerable conscious, abstract, analytic contemplation of the problem. The conscious, deliberate planning that is characteristic of this skill level helps achieve efficiency and organization. The competent nurse lacks the speed and flexibility of the proficient nurse but does have a feeling of mastery and the ability to cope with and manage the many contingencies of clinical nursing. The competent person does not yet have enough experience to recognize a situation in terms of an overall picture or in terms of which aspects are most salient, most important.

Stage 4: Proficient

The proficient performer perceives situations as wholes rather than in terms of chopped up parts or aspects, and performance is guided by maxims. Proficient nurses understand a situation as a whole because they perceive its meaning in terms of long-term goals. The proficient nurse learns from experience what typical events to expect in a given situation and how plans need to be modified in response to these events. The proficient nurse can now recognize when the expected normal picture does not materialize. This holistic understanding improves the proficient nurse's decision making; it becomes less labored because the nurse now has a perspective on which of the many existing attributes and aspects in the present situation are the important ones. The proficient nurse uses maxims as guides which reflect what would appear to the competent or novice performer as unintelligible nuances of the situation; they can mean one thing at one time and quite another thing later. Once one has a deep understanding of the situation overall, however, the maxim provides direction as to what must be taken into account. Maxims reflect nuances of the situation.

Stage 5: The Expert

The expert performer no longer relies on an analytic principle (rule, guideline, maxim) to connect her or his understanding of the situation to an appropriate action. The expert nurse, with an enormous background of experience, now has an intuitive grasp of each situation and zeroes in on the accurate region of the problem without wasteful consideration of a large range of unfruitful, alternative diagnoses and solutions. The expert operates from a deep understanding of the total situation. The chess master, for instance, when asked why he or she made a particularly masterful move, will just say: "Because it felt right; it looked good." The performer is no longer aware of features and rules;' his/her performance becomes fluid and flexible and highly proficient. This is not to say that the expert never uses analytic tools. Highly skilled analytic ability is necessary for those situations with which the nurse has had no previous experience. Analytic tools are also necessary for those times when the expert gets a wrong grasp of the situation and then finds that events and behaviors are not occurring as expected When alternative perspectives are not available to the clinician, the only way out of a wrong grasp of the problem is by using analytic problem solving.

[Reference: Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley, pp. 13-34.]

Looks really familiar especially when one looks back :-)