By Merissa May
As an NP who has just completed my first year of practice, the roller coaster of emotions and challenges are hard to forget. The good news is, with some good support and an awareness of what to expect, I can confidently say you will make it through. My hope is this blog will make you feel a little less anxious, a little more self-confident and a lot more normal as you navigate this journey!
Transitioning from the RN to NP role and the first year of practice can be a turbulent time. From the burnout of graduate school to finding a job and navigating system challenges, it can feel overwhelming. Once an expert RN, it’s a giant leap out of your comfort zone into novice NP practice. I very much moved through the phases of Brown & Olshansky’s Limbo to Legitimacy model and think it’s a rough outline of what your year may look like. While I know you may not want to hear more about theories, I’m going to use it anyway! I’ll also provide experiences from my own journey along the way. Knowing this process is “normal” and what to expect may ease the common anxieties and feelings that crop up during that first year of practice.
Stage One – Laying the Foundation
School is done and celebrating commences. There is pride in getting through this challenging phase and relief in the joy in getting back to “normal life”, hobbies and activities outside of textbooks. Then comes the overwhelming paperwork, licensing, etc. Just finding out what you need to do can be challenging, from getting a PRAC ID to enrolling in the triplicate program, and getting set-up with the lab to order diagnostics. Finally comes the job search…networking, perfecting resumes, writing letters, etc. What helped me in this phase was reaching out to other NPs to figure out how to go about all the paperwork processes, and ensure I was “ticking off all my boxes”. It also helped to have an open mind in the job search, embrace interviews as experience rather than defeat and get my name out with my contacts as much as possible.
Stage Two – Launching
Like many others, this was definitely the most challenging stage for me. I landed my first job…now what? The worries, self-doubt and feeling like I’d made a mistake in becoming an NP quickly set in. My vision of the role was replaced by the actualities of real practice, and all the system and relationship struggles that come with it. I quickly felt as if I was incompetent, that I was a “fake” and at any moment someone was going to figure me out – little did I know this has a name: Imposter syndrome. I only learned this after googling it one day because it was bothering me so much to feel that way! Questioning every decision, struggling to see patients within time constraints, feeling the need to validate all information and constant worry sum up this phase.
I also struggled with role confusion and social isolation. One NP once described it to me as “leaving the ship to head to sea in a lifeboat all alone”. This very much symbolized for me the feelings of leaving the RN profession I had known so long and all the social aspects that come with it. As a new NP I felt I didn’t quite belong with the nurses, and didn’t belong with the physicians, so I was suddenly alone in a vast new independent role. What helped the most was reaching out and finding a “squad” of NPs where I could express emotions, ask questions, and vent without feeling any judgment. Each conversation with a fellow NP brought me comfort because they had all been there and went through similar experiences. Establishing working relationships around me helped with feeling isolated, and focusing on what I did know helped me gain self-confidence. I encourage you to use every encounter to ask questions, gain knowledge, and reflect on how it helped you grow as a practitioner. Most importantly, it is so important to find a sounding board and ensure you are allowing yourself to experience and reflect upon all the emotions. It’s normal to feel frustrated, tearful, confused and anxious. Acknowledging this will allow you to transition through turbulence, maintain productivity and emerge stronger on the other side!
Stage Three – Meeting the Challenge
Slowly but surely you will start to feel like you can do this. Self-confidence grows, new skills and knowledge are gained everyday and you are beginning to settle into your new role. Most patient encounters are shortening, and you start to have an “autopilot” for some common presentations. You’ve taken important lessons from each experience, and are getting comfortable with clinical resources. When the fog of self-doubt and fear begins to lift, you may start to notice some system or process concerns, and may even feel confident enough to begin creating change. You may find the energy to tackle some quality improvement activities, reorganize forms, etc. In this phase, I sought out more learning opportunities, began to explore other resources for consults and felt confident to use them. This included more e-consults and phone calls for some advice rather than a straight referral to treat or take over care. And again, with each of these encounters, my self-confidence and knowledge only grew further.
Stage Four – Broadening the Perspective
With newfound comfort in client experiences, you are now able to broaden your horizons to participating in research, orientation of staff, get involved in system challenges/advocacy, and take on increased responsibilities. One noticeable difference for me in this phase was the ability to accept positive feedback and truly believe it because I felt more like a “real NP”. My butterflies with each patient encounter slowly disappeared and I confidently felt I could manage the majority of presentations. And for those I couldn’t, I had a foundation of colleagues and consult processes I built and could draw on. My advice here is to get involved as much as possible. There is a lot of system change occurring, and the NPAA is at the center of much of the action. Become a member, explore the website, use the tools for advocacy, and promote the NP role as much as possible. While there are still frustrations with the slow turning wheels of change, getting involved with the NPAA to better understand the issues and how they are being tackled, really opened my eyes and gave me hope for the future of NP practice. It also helps in establishing a sense of belonging and role identity, as there’s a great community of NPs out there.
Lastly, give yourself the gift of time. Know that it will get easier, the turbulence will gradually settle and that knowledge and expertise comes with experience. Before you know it you will be an expert NP ready to take on the world. Good luck in your future practice and I hope this blog entry has normalized your feelings if you’re starting out, increased empathy for the struggles of a new NP, or perhaps inspired you to get involved or broaden your horizons!
Editor’s Note: Stay Tuned for upcoming Student NP resources in our fall website relaunch. And – if you are not a member of the Nurse Practitioner Association of Alberta – consider joining as a way to help move our profession forward. Sign up at www.albertanps.com