Surviving My First Year as a New Grad Nurse Practitioner

Survival

I survived my first year as a new grad nurse practitioner in 2019. It was a challenging rewarding experience! I had to dig deep many days especially at the beginning because it was so overwhelming. I remember my last class in NP school required us to write a paper about how we planned on getting through our first year as a nurse practitioner. I think my main survival strategies I had written in school were getting a good mentor and journaling the process out. I only journaled my first day or two, and UpToDate was my main mentor. Not really the experience I had in mind for my first year.

Imposter Syndrome

The imposter syndrome is a real experience. This is when you feel like you’re just faking it and don’t belong or are qualified for the role you’re playing.  I definitely felt it for the first several months and less often probably after 8 months or so into it all. I don’t think I really felt like I fit into my role as a provider until after a year or so. Even now, I will occasionally experience the imposter syndrome. It’s okay to feel this way sometimes as long as constructive growth continues to happen.

New Grad Myth Busting

I think nurse practitioner schools expect their new grad nurse practitioners to find a great mentor who will take them under their wings and guide their new grad into a skilled medical provider. First, the job market doesn’t support this mythical idea. I applied to dozens and dozens of jobs with little response. Most nurse practitioner jobs in my area are available to NPs with 1-2+ years experience. Why? The amount of on the job learning and development of clinical skills is astronomical that first year as a nurse practitioner. The healthcare industry is not currently looking to increase their risk and decrease their productivity training a new grad at this time. Second, new grad nurse practitioners are inadequately trained at NP school for today’s healthcare needs. New grad nurse practitioners should either have more clinical training in NP school or graduate into a residency program like their physician colleagues. I felt competent and trained primary preventative care or for treating most basic ailments like a provider would see at a minute clinic or outpatient urgent care, but family medicine has evolved into a more complex, chronic care management business. My typical patient is a 65+ year old with recent CVA with underlying COPD, HFpEF, DM2, chronic pain, and AFib. I’m seeing chronically sick patients. I’m not sure where all the healthy, younger patients are, but I don’t get to see them. I would love to be involved with primary preventative care, but that’s not where our healthcare system is at. New grad nurse practitioners desperately need not an extra year to do research but an extra year or two to hone clinical skills and knowledge.

Survival Skills

I went into my first year as a new grad nurse practitioner with these huge barriers. No lying about it. It was tough. I didn’t have a great mentor or on the job training program. I did have a physician who I could call and text my questions which helped me survive, but this is far from a mentor helping guide my experience. My primary tool of survival was and is UpToDate. I bought a 3 year subscription right away and read hundreds of hours of content my first year as a nurse practitioner. I would look up every medication and relied heavily on it for my clinical practice. I still do rely heavily on UpToDate especially for medications. I also put in a lot of long hours the first couple of months as a new grad nurse practitioner. This meant I needed a good routine outside of work. Exercise especially weightlifting was key for me outside of work especially for boosting confidence and mood. Regular sleep also was a cornerstone outside of work. My motto was work hard while at work and play and rest hard outside work. Even with a pretty good routine outside of work, I still often felt overwhelmed and an imposter. Mentally I had to break down the work week day by day and visit by visit. If I literally tried to think about getting through an entire week or even day, I would feel so overwhelmed and start shutting down mentally. I got a legal pad and wrote down notes while visiting with patients so I could remember stuff. Breaking my day and week into smaller chunks made life more manageable. With time, I became a more confident provider and my new job as a nurse practitioner provider became more natural and easy. I still have to manage the underlying uneasiness and fear I automatically sense sometimes on a Monday morning, but I can say I’ve survived my first year and looking back it was a challenging yet rewarding experience.