Five Things I Wish I Knew Before I Started Working As A Nurse Practitioner

I feel that everyone has one of these lists, and everyone has read at least three of them in the last week. However it’s the end of Nurses Week and also graduation season, so I figure adding my own two cents won’t do any harm!

1. Be Prepared For Everything To Not Look Like A Textbook Case Of Anything You’ve Seen Before

This is one of those things that you might be saying “duh” to, and I would have too. But the important thing to remember is to not beat yourself up when you have a really challenging case. I used to think I was completely idiotic and forgetting everything from school when I had a patient who had all these problems that I thought I had heard about before, kinda sorta, but couldn’t figure out exactly what was the problem. The reason why you can’t figure it out is because you’ve never seen anything exactly like it before, especially as a new provider!

All the textbooks and studying in the world can’t prepare you for every case because every person is different. Diseases will present with different symptoms, and sometimes they’ll only have just four of the twelve common symptoms listed, so does that mean it is or it isn’t?! People will have lab values that look completely normal but they present with so many danger signs, so what are you supposed to think!? It’s completely normal to feel like this, and because things don’t always look like what they do in your studies doesn’t mean it’s weird, it’s just life. Trust what you’ve learned in school, but now is the time to expand on it. These are great times to ask your coworkers and mentors for help, and I’m sure they’ll tell you all sorts of stories about patients who had confusing presentations that differ from the literature. You’ll learn more when you ask for help than you will burying your head in old textbooks.

A physical therapist I work with said recently that she takes the time to precept students because she wants to teach them everything she has learned in the last thirty years of practice, so that the new generation can learn all those things quickly, and then build on that knowledge to improve care. Real life experience is golden, and a lot of it isn’t written down, so you’re not expected to know it all. You just have to know what you don’t know.

2. Watch Your Time

As terrible as it sounds, this isn’t nursing school anymore. In most practices you won’t have the luxury of only having a patient an hour, and you can’t sit there discussing every single patient with a supporting and kind preceptor. You also don’t have time to look up every single thing in Up To Date. You are a working professional, and your time is valuable. As amusing as your patient’s story about her pet pig taking care of her baby are (true story), you are there to assess a problem and form a treatment plan, and then see the next patient. Often times we need to redirect our patients to the problem at hand, and see them over multiple visits to get the full story. That’s okay, that’s normal, that’s expected. In the short amount of time you do have with your patient though, you can make them feel heard by keeping good eye contact, sitting at their eye level, actively listening, and being observant. Then they won’t realize it’s only a ten minute visit and you’ve got three other roomed patients waiting for you as you fly out of the room, instead they’ll feel like they came and received the care that they wanted.

3. Your Dream Job May Not Be What’s In Demand When You’re Job Hunting

The needs in healthcare change quickly, and nurse practitioners and other medical professionals tend to last a long time in the most ideal positions. When you’re job hunting you might only come upon opportunities that don’t fit your perfect checklist, but they might still be an interesting opportunity. If this is your first job as a nurse practitioner, you definitely don’t get the pick of the litter. Also, you might not really know what you fit best with, so apply broadly. Make sure the position you do end up choosing pays fairly, offers you good educational opportunities, is supportive, and has good coworkers. The specialty might not be where you want to work in the future, but you’ll learn important skills every working day. I never thought I’d do any occupational health, but since it fit the most important things I listed above, I took the job and never regretted it. That experience taught me a lot of skills, and helped me land my new job in a place I’ve always dreamed of working at. Sometimes the best opportunities come when you’re not looking.

4. Keep In Touch With Other Nurse Practitioners

Only other nurse practitioners will understand what being a nurse practitioner is like. I’ve kept in contact with my mentor from school, my old classmates, and old NP coworkers specifically because sometimes you just need to talk to someone who has been in your shoes before. So stay close to them, teach each other things you’ve learned (I did a suturing workshop for my NP friends recently, we called it a “stitch and bitch,” so cathartic!), and call them when you have trouble. Everyone else will only relate to your career as an NP as either a patient or a coworker, only NP’s know what it’s like to work as an NP. They will be the best at listening and relating. Going to an NP conference is amazing in that you’ll be meeting thousands of NP’s, so try it some time!

5. The Good You Do Is The Only Thing You Have Control Over

There will be times in your early career where you feel unsure or lose your confidence, and thoughts will crowd your head about whether you picked the right career path. Acknowledge those thoughts for what they are, and then move on. You are embarking on a wonderful journey that has a million different paths you can choose. When you see patients, do your very best, take each problem one at a time, talk with confidence, acknowledge when you don’t know something and tell them you’ll research it, and follow your instincts. You will not be able to plan for every patient or problem, and not every patient will be showering you with gratefulness and love. But when you give it your best, you are changing things for the better, and helping your patients understand and make informed decisions about their health.

If today is tough, tomorrow will be better. But if tomorrow isn’t all that great, remember, nurse practitioners are in high demand and there’s always another opportunity awaiting. 🙂

Feel free to discuss any other ideas you have in the comments!

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