Strategies for Mastering a NP Specialty Transition that Actually Work

I kicked off my nurse practitioner career in primary care. Two years in, I decided it was time to make the transition to emergency medicine which had always been my goal. The transition was not easy I felt like a new graduate all over again. As nurse practitioners, our schooling prepares us for a broad range of specialties. There are very few formal education options for NPs interested in a particular niche of medicine, so we learn on the job. 

Meeting the expectations of an employer while learning isn’t easy. Without a certain level of knowledge, it’s difficult to be efficient and effective in your new specialty position. Navigating transitions as a nurse practitioner is a blessing and a curse. On one hand, it’s nice to work in a profession that allows for some movement. On the other hand, starting over in a new specialty is a nerve-wracking, trying experience. I did learn a few things in my transition from primary care to the emergency department that might be helpful to you if you’re also switching nurse practitioner specialties

1. Review other providers’ charts

By far, reviewing charts written by other NPs, PAs and MDs in the emergency department was the most helpful learning tool for me. It helped me not only learn and understand documentation norms in the specialty but also what types of imaging, medications and follow up were required for specific conditions. It showed me how and when to refer. It gave me some specialty-specific vocabulary I lacked. If you’re switching specialties, read through your patient’s charts from previous visits to the practice/department or glance at other providers’ open charts. You’re bound to pick up a few practice pearls from this habit. 

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2. Spend any free-time shadowing someone more experienced 

Most employers don’t allow for a significant amount of job shadowing for nurse practitioners as part of onboarding. But, you can still try to fit observation in to your own personal transition plan. When you have downtime, ask another more experienced provider if he/she would mind if you accompanied him/her on a few patient encounters. This way you fit in some clinical and institutional education between your own patients. One of the most valuable learning tools for me as a nurse practitioner has been hands-down observing providers that have different practice styles. This allows you as a nurse practitioner to emulate the best practices of each individual so you can excel in your specialty. 

3. Identify go-to resources 

Alright, so this is something you at least should have been doing since you walked through the door of your first clinical site in NP school. But, transitioning to a new specialty may required that you compile a database of new go-to resources. Ask your colleagues what resources they find most helpful in your clinical area. This will help you identify clinical references more quickly. 

4. Learn colleague’s job responsibilities

Patient care involves much more than just the clinical. For example, as a nurse practitioner, you may need to integrate aspects of social work into a care plan. Clinical knowledge gaps seem the most daunting when you switch specialties. But, answers to your questions about the logistics of providing patient care may be held by individuals other than clinicians. In the emergency department, case managers were extremely helpful in answering my questions about the referral process for psych patients to name one example. When you’re in a phase of your career where you find yourself asking question-after-question, it’s nice to have a number of individuals to divide these inquiries between so you aren’t bothering one coworker too much. Ask for a breakdown of who does what within your department as part of your onboarding. 

How have you navigated specialty transitions as a nurse practitioner?


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