This morning I was engaged in a discussion with one of our ThriveAP+cohorts. This group of new grad nurse practitioners and physician assistants has been working in the primary care setting for about six months now so has a little practice experience under their belts. As we were talking, several themes emerged in the conversation. There were a number of challenges facing these novice NPs that they hadn’t anticipated.

As nurse practitioners, we understand that our clinical skills and knowledge must continue to grow once we begin practicing. We expect to have a number of questions and rightly have some anxiety about treating patients solo, without the watchful eye of a preceptor. But, what other challenges can you expect to encounter if you’re new to your practice? Here’s a head up based on my conversation.


NP students often get a pass on the day-to-day paperwork that comes with working as a nurse practitioner. But, once you’re officially employed, don’t expect a break. From prescription pre-authorizations to signing death certificates, filling out disability paperwork and reviewing lab results, there’s a lot that goes on aside from face to face patient care in the clinic setting. Nurse practitioners can expect to do a lot of paperwork. Not to mention, as your days are typically packed with patient appointments, you may need to complete this outside of regular work hours.

It’s All About Numbers

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Sure, healthcare facilities are set up with the mission to help diagnose, manage and treat disease, but they must also generate revenue to stay afloat in the process. Maintaining a practice requires a certain amount of cash flow and in the face of our country’s increasingly uncertain healthcare landscape, practices are paying attention to where their dollars and cents come from. In most facilities, providers are monitored closely when it comes to numbers like the how many patients they see and the revenue they generate from these visits. Employers may also monitor time metrics such as how long an NP stays in a patient’s room. And, if you’re not meeting certain metrics, you can expect to hear about it. New grads are often thrown off by their employer’s emphasis on numbers and the pressure this creates.

Think Psych

You may not be a certified psychiatric nurse practitioner, but you can certainly expect to work with patents carrying such diagnoses. Nurse practitioners participating in ThriveAP+ were surprised by the number of patients they treat with underlying psychiatric conditions. Even when patients are managed by psychiatric providers for these conditions, underlying disease conditions make treatment of other health issues more difficult. These patients may have more difficulty complying with treatment regimens or accessing resources. So, even if psych isn’t your cup of tea, brush up on your know how as you’ll see your fair share of this patient population in practice.

What have you been surprised by in your first year working as a nurse practitioner?


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Are you ready to Thrive?

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