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My first day as a nurse practitioner (NP) was well over three years ago. I remember it like it was yesterday — a standard-sized office with one medical doctor, the front-end staff, over 20 patients, and me.
Even though I would be in orientation for the first few months, the anxiety and "what ifs" had set in.
What if they don't want to see me as their primary care provider?
What if I don't know their diagnosis?
What if they find out I just graduated from NP school?
What if the staff doesn't respect me?
No matter how confident I appeared on the outside — a freshly pressed suit, white coat, and a Littmann cardiology stethoscope around my neck — imposter syndrome reared its ugly head. With time, as with anything, my fear blossomed into confidence. It will for you, too.
Being a new nurse practitioner can be intimidating. However, with this guide, you won't completely feel like a fish out of water. Here, we discuss what to expect on your first day as a new nurse practitioner, the challenges of transitioning from RN-to-NP, and tips for surviving your first day on the job.
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Your First Day as a New Nurse Practitioner
Depending on where you work, your first day as a new nurse practitioner will include:
Meeting everyone in the office, including your direct report
Learning the electronic medical record (EMR) and filling out paperwork
Meeting the staff
You are part of the team now, so get ready to know the staff and their roles in the office. Knowing the staff by name and what they do can help with time management, organization, and delegation.
Getting to know the entire staff can be overwhelming, especially if you work in a larger office, but take the time to do just that. Be genuine and build relationships. It benefits you in the long run and helps you to become a better clinician.
You should already know your direct-report prior to your first day. In some cases, if your direct-report is on vacation or has the day off, there should be a designated person to help you navigate your day.
Your direct report or designated person should let you know:
- What the plan is for the day
- Your orientation process
- What will be covered in orientation
- The expectations for your role
- Which provider or providers you will be shadowing for the day
- Where you will be sitting
- When to take your lunch
- Which tasks you will be responsible for
- What you should do before you leave
- When your shift ends
Your first day as a nurse practitioner includes an orientation. You will gain familiarity with your facility and office, and learn the ins and outs of how the practice cares for, treats, and discharges patients. You may not see patients the first day. Instead, your direct report may use your first day to lay out ground rules and go over policies and expectations.
Learning the Electronic Medical Record and Paperwork
The electronic medical record (EMR) may not be the same as your previous facility, so take time to become familiar with the new EMR system. Some facilities may offer a prescheduled class to help you learn how to use the EMR. If you're lucky, you may already be familiar with the specific computer software used.
There is a lot of paperwork on your first day as a nurse practitioner. You have to read and sign the documents needed for you to legally practice in your state.
Common paperwork for new nurse practitioners includes:
- Malpractice insurance
- Medicare and Medicaid forms
- HIPPA information
- Policies and procedures at your facility
Transitioning from RN-to-NP: The Biggest Challenges
You face many different challenges during your first days on the job. The three biggest challenges I faced when transitioning from being a nurse to a nurse practitioner were:
- Mind shift
- Imposter syndrome
Although I knew I would care for my own patients, the mind shift from nurse to nurse practitioner may have been the hardest transition. The decisions you make to diagnose and treat your patients are purely based on your knowledge, training, and what works best for your patient. Although I did love this autonomy, at times, I found it difficult.
Sometimes patients didn't agree with my treatment plan, even though it was based on evidence-based practice. Occasionally, I didn't know which labs to order or which diagnosis was appropriate. Luckily, the doctor I worked with was very patient and loved teaching.
Another challenge was delegating. Although everyone is there to help patients as a team, not everyone in the office works for the right reasons. Some may not want to help you at all. A good way to combat this is to be nice and helpful.
Lastly, is imposter syndrome. I think I finally felt completely confident at about the seven-month mark. By then, I felt like I belonged to the team and truly helped my patients. I could see patients comfortably on my own and felt competent enough to discharge them without thinking they were going to die from a hangnail infection.
Tips for Surviving Your First Day as a Nurse Practitioner
Your first day as a nurse practitioner may be a breeze or a really bad thunderstorm. Nevertheless, you will get through it. Be proud of your accomplishments and know your patients and your community are lucky to have you as their provider.
As you settle into your new role, here are some simple and practical tips for surviving your first day as a nurse practitioner:
- Arrive early: You may get lost, have to look for parking, or struggle to find your office. Arriving early lowers your anxiety and gives you extra time to relax.
- Be prepared: Come with your lab coat (carry an extra one in your car just in case), stethoscope, badge, extra pens, water, snacks, and notes with the top 10 diagnoses and treatments so you can look them up quickly.
- Find a mentor: If you don't already have one, find a mentor willing to take you under their wing. With a mentor, you won't feel as alone. You will have someone to bounce ideas off or share issues you may be struggling with during your first couple of weeks or months.
- Ask for help: You won't know everyone when you first start, but make sure to ask for help when you need it. If your direct report isn't available, make a list of people you know who can help.
Remember: You Deserve to Be Here
Imposter syndrome and anxiety often come with a new job and the feeling that you don't belong. Unfortunately, this just comes with the territory. Remember that you deserve to be there. You worked hard for your degree and are ready to help patients improve their health and quality of life.
To combat imposter syndrome:
- Visualize yourself succeeding
- Know you have the degree and license to be there
- Admit that you don't know everything
- Be prepared and know your stuff
- Avoid listening to negative thoughts
- Confidence is a muscle. Exercise it
Remember to be kind and helpful to others, even if it is your first day. Your first impression is a lasting impression, so make a good one.
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