There are several things I wish I had known right after I became a licensed nurse practitioner, but one stands out in particular. I would have been less stressed out in the beginning if I had this insight.
It sounds cheesy but the main thing I wish I had known right from the beginning was that you don’t have to have all the answers right away. There is so much pressure and anxiety surrounding knowing exactly how to help a patient. You’re worried you don’t know what you’re doing but feel as though you should. To top it off, patients don’t always come to you with a singular issue that is neatly solved in that first encounter.
Sometimes a patient sits down in your chair for treatment of their depression, but you see that their blood pressure is out of control when you check their vitals and a glance at their most recent labwork shows that their CBCs are all out of whack. Maybe you see a bruise on their neck that looks concerning too. Their depression seems to be getting worse and the medication you are prescribing does not seem to be helping. In fact, they are more depressed than when you saw them last month. Is there some sort of underlying illness throwing off their labs like a cold or is it more serious like an infectious disease? Is the blood pressure related to all of this or is this chronically untreated hypertension that needs addressed? And why isn’t the anti-depressant working, are they metabolizing it differently than you anticipated or maybe the anti-depressant is interacting with another medication they are taking which is reducing its efficacy? This bruise looks worrisome too, is there physical abuse occurring that I need to address?
These are some potential hypothetical thoughts running through your head and they’re all valid. It doesn’t help that you are brand new and don’t know how to address all of these issues. Instead of outlining how I would solve this particular issue because this isn’t a case study, I’m going to highlight that while there’s so much going on with this patient, you don’t need to know how to solve every single one of these issues right in this encounter. You always have resources–whether it’s a colleague in your office, a collaborating provider you work with, a lab interpretation app or online resource you consult, or a social worker you pull into your office to provide supportive resources for victims of abuse. There is no one way to handle a complex patient, but the bottom line is that you don’t have to have all the answers right away.
Patients don’t necessarily expect this either. In fact, they feel respected when you are candid with some of your thoughts. Admitting that you aren’t sure when answering a question and want to check with a colleague to avoid telling them the wrong thing comes across as respectful and has quality to it. Now, you don’t want to swing too far and come across as completely unsure of yourself, but there is power to admitting when you don’t know something.
We seem to live in a culture where showing to others that you don’t know something is the absolute worst thing that could happen. How could you not know X?? You’re the provider?! But in reality, you don’t know everything, nor do you need to know everything. Your job is to provide quality patient care. How you do this varies from person to person but let it start with telling yourself that you don’t have to know everything.
There’s something funny that happens when you remove intense pressure from yourself by allowing yourself to be ok with not knowing everything. This allows you to think more clearly and utilize your resources better. Your patients appreciate you doing your diligence in providing the very best care to them, and you are able to do so not feeling as stressed along the way. Remembering this at the beginning of your NP career and throughout will lead to a much smoother transition into practice.