I had a baby this year. It’s one of those rock-your-world type of life transitions that makes you think and reprioritize. While it’s not exactly the same kind of transition as in one’s career, it can lead to the same sort of reorganizing and mental processing. I initially published a version of this post several years ago and revisited it after thinking through all of the transitions 2018 has brought. They have made me empathetic for my new grad nurse practitioner colleagues and reawakened me to the feelings that you all with less experience feel in your initial year of practice. 

As with any life transition whether it be having a child or embarking on a new career path, there are changes, both welcome and feared, on the horizon for this new decade of my life. Just like having a baby brings natural points of life transition, if you are a new grad nurse practitioner, you also might be facing some of these all too familiar challenges of a major life change on the horizon as well.

The best way to tackle life’s transitions is to be prepared. A little practicality and foresight can help you brace for the challenges you might face. It helps you keep perspective when the $@^&#* hits the fan and you feel like giving up. Life as a new grad nurse practitioner won’t be easy. But, thinking through the coming months realistically will help you weather the storm. Here are a few truths to keep in mind.

1. You won’t find a job right away

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I once had a recently graduated nurse practitioner call me exasperated. “I mean, all throughout my NP program, professors were telling us how much need there is for nurse practitioners and how we are the future of healthcare. But, here I am three months out of school and I haven’t had a promising interview yet!”. I think a lot of new nurse practitioners share her sentiment

In reality, the process of taking your NP certification exam, getting licensed, and looking for a job can take weeks or more likely months. Yes, that annoying girl who sits in the front row of your pharmacology class may have found a job immediately upon receiving her diploma but it doesn’t happen to most people. Plan emotionally and financially for a months long job search process.

2. It’s entirely possible you will hate your first job

As a new graduate nurse practitioner, your options are somewhat limited when it comes to finding a job. Most employers are looking for someone with experience. So, you take what you can get. Until you get a little experience and learn the reputation of employers in your area it’s entirely possible you may end up in a less than desirable position. And that’s OK. Use the opportunity to advance your clinical know how. Take note of any mistakes you made in signing your contract. Plan to stick out the situation for about a year so it serves as a resume booster rather than a detriment. Then, in 12 months put your experienced, knowledgable, and more confident self back on the job market. 

3. Get out your checkbook- getting licensed and certified will cost you

I just renewed my DEA license. It cost $731. Talk about a hit to the bank account, even for someone who has been employed as an NP for over five years. A state nurse practitioner license will cost you a couple hundred bucks as well, not to mention the fee for taking your certification exam. Set aside $1,000 to $2,000 to put toward your certification, licensure, and job search (see a breakdown of projected expenses here). You don’t want lack of a DEA number to preclude you from applying to certain jobs. The upside? Some employers will reimburse you for these costs. 

4. You will be stressed beyond belief

OK, let’s face it. You don’t know what you are doing…yet. And, even when you do, your clinical decision making is clouded by a heavy fog of doubt. I asked about a million questions everyday in my first job. I’m not sure if the most stressful part of starting work as a nurse practitioner was worrying I was asking too many questions or the lack of knowledge that required me to do so. 

When I first started working in the emergency department I literally had to give myself a pep talk on the way to work every afternoon. Some days I seriously contemplated missing the exit for the hospital and continuing to drive until I reached Kentucky and eventually Indiana where no one could find me. But, my cell doesn’t work in Kentucky and Indiana winters are snowy so I dragged my behind to work and continued to ask question after question after question. Eventually the nerves subsided and I began to feel like I was good at my job. 

5. Patients will notice you don’t know what you are doing

Don’t you hate when you go in a patient’s room and they ask if you have experience doing the particular procedure you’re about to perform? Now, I can respond confidently that “this is the fifth laceration I’ve sutured today“, but as a new grad I likely could count the number of times I had performed said procedure on one hand. That is, if I could get my hands to stop shaking. 

The good news? Most patients are quite understanding. Put on a smile and helpful attitude and they’re willing to be gracious to you as well. Provided you have a supervising NP or MD in the room if you need help, patients understand you are learning

Remember, it’s always better to ask than make a mistake. If you aren’t sure or are not confident about something, ask! Trust me, your employer will be glad you did. Plan to pay it forward later in your career when you are training a new grad in the future

6. You will be a boss

Like it or not, healthcare is a hierarchy. As a nurse practitioner, you land near the top of the clinical or hospital provider ladder, at least higher than you did as a nurse. In some clinics, nurse practitioners are even responsible for hiring (and firing) their own support staff. Unfortunately, most NP programs don’t teach leadership skills.

It can be awkward as a nurse practitioner without experience, especially if you are young, to direct other hospital staff. As a new NP in the emergency department I found it difficult to navigate relationships with 60 year old nurses who had been working in the department for years when I was suddenly in charge of directing their actions. Through trial and error and a lot of understanding on the part of nurses, phlebotomists, etc. I developed my own leadership style. This can be hard to develop and takes time. Don’t be frustrated if you find these relationships tense or uncomfortable at first. 

Life as a new grad nurse practitioner is a learning process to say the least. Be patient with yourself, your employer, and your coworkers. You will slowly become more comfortable in your practice and new position but it will take some time and it won’t be easy. Stick out your first job learning everything you can. Remember, you can always reevaluate your employment situation in a few months and make changes in the future if necessary. 


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