Several years ago now, I received my very own office for the first time in my life.
I had my own desk, a computer, a big black, comfy swiveling chair, and accompanying chairs across from me. I even had a door to close for privacy.
It was my first job as a nurse practitioner.
The first few weeks into practice as an NP were a blur. I felt a mix of anxious excitement at finally getting to do the job I had worked so hard for but also, straight fear.
I felt like I had convinced my employers to hire me when in reality, I felt I should have no business seeing patients.
In those first weeks, I was methodically going through what I thought I should be doing each moment of each day. Everything was so incredibly new, and there was never a moment in my first several weeks where I felt comfortable or that there was any sort of predictability.
There was chaos in my mind of what I was doing, what I needed to do, and what I probably wasn’t doing well. On the surface, I appeared calm (I hoped). I wondered if I had truly adjusted medication doses appropriately, carefully considering drug interactions. I wasn’t always quite sure of a patient’s diagnosis, and the lack of certainty terrified me—was it Major Depressive Disorder, Persistent Depressive Disorder, or a depressive episode of Bipolar Disorder which I knew was treated completely differently from unipolar depression?
I wondered what the patients were thinking of me and how I was doing. I marveled at times that I was doing this job and not “getting caught.”
Time went on, and these two sides of myself continued. I was playing the role of nurse practitioner and also feeling utterly terrified inside, uncomfortable with myself and my abilities.
To compensate for this chasm between my role and my feelings about myself, I spent hours outside of work learning all I could learn about pharmacology. I created a structured learning environment with a psychiatrist who was willing to meet with me regularly for private supervision to learn more. I also listened to AudioDigest in my car on my drives to and from work to stay updated on the latest research on mental health diagnoses and medications. My self-confidence was slowly building.
Then something interesting happened…
Several months in, I felt that it wasn’t my prescribing abilities (or inabilities, rather) that were the issue, but that I wasn’t helpful enough to my patients. My prescribing a medication did not make patients feel better always even when I diagnosed a condition accurately and prescribed the right medication.
I realized over time that I’m someone who needs to see improved outcomes to feel good about the work I do for patients.
It was during this time that I figured that I wanted to help people more holistically. I learned that handing a patient a script for Prozac and sending them on their way to treat depression doesn’t always do the trick. This is especially true for a patient who struggles with various issues such as generalized chronic pain, unemployment spending their days sitting around at home, and has no support network. This type of patient needs more than a script. They need holistic psychosocial treatment.
I was reminded of the ACE studies by Kaiser Permanente in the 1990s that gave thousands of adults surveys about their childhood experiences and current health status and behaviors. The study’s findings were monumental and found that as the number of adverse childhood events increases, so does the risk for negative outcomes such as chronic disease, risky health behaviors, and mental health issues1.
With this reminder that my patients needed more than a script to get better, I decided to learn more about Cognitive Behavioral Therapy. I knew I was hired in this role for my medication management services, but I also felt at a loss of words for how to effectively motivate and help my patients during our short follow-up appointments together. Many patients had therapists they saw, but I wanted to be more than a prescriber to feel confident in my role as a nurse practitioner.
So I spent a year getting certified to provide Cognitive Behavioral Therapy in my own time as I saw patients full-time at work. After the year of training and becoming certified, I thought, NOW I have the tools to be an effective provider.
At some point, I realized I was attempting to continually increase my competence to compensate for my imposter feelings. And unfortunately, I was still not always helpful to my patients. This frustrated me. I hadn’t realized it, but the fear I had of being an imposter was lessening over time. I was still frustrated, but now it was factors outside of my control that was frustrating me.
As I gained more experience, I’ve been able to advise and help new NPs in their transition into practice. Helping other nurse practitioners along their journey helps show me that my early experiences were not unique and also reminds me that I no longer feel the uncertainty and doubt that I once did. And it’s deeply gratifying for me to help a newcomer (essentially, younger me) become confident as a prescriber. Nothing makes me feel better than helping in this way.
The transition into practice is the hardest. It’s funny it’s called ‘practice’ because that’s exactly what it is. Nurse practitioners practice within their practice to become better providers to patients. Having grace towards yourself, reminding yourself that literally every other new NP feels uncomfortable in the role initially, and utilizing supports to strengthen areas you feel less than comfortable are all ways to make your way through.
If I could tell my former new-NP-self one thing, it would be that your feelings of doubt and uncertainty are incredibly common. And that on the other side, you will be an invaluable provider who helps more people than you may ever know; patients are helped when they feel seen, cared for, and receive quality treatment. I realized this myself when I decided to transition to a different agency after a few years at this job. A few of my patients surprised me by expressing how much I had helped them. Oddly, some of the patients I didn’t even feel I was truly helping were saddened that I was leaving and expressed their appreciation towards me.
You don’t always get to see full outcomes or know how you truly helped, but it will likely be much more than you think, regardless of nurse practitioner specialty. Know this when entering into practice so that your battle Within as a new NP is less of a struggle during your transition into practice as you become an invaluable nurse practitioner.
1 Centers for Disease Control and Prevention. (2021). National Center for Injury Prevention and Control, Division of Violence Prevention. https://www.cdc.gov/violenceprevention/aces/about.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Facestudy%2Fabout.html
