Confessions of a Former New Grad Nurse Practitioner

These days, I think I may even take patients by surprise with my abilities in the emergency department. I look younger than my thirty (ugh) years, or so I am told. So, when I enter a patient’s room to suture a laceration or drain an abscess, I get that “Wait! you’re the one who’s going to be doing this?!” look. Then, when the patient sees the results of a perfectly placed set of sutures it becomes apparent I’ve done the same job everyday for five plus years. It wasn’t always this way.

As a new nurse practitioner graduate I felt anything but competent. Anxiety and uncertainty plagued my work day. Here are a few things I did in my early years of practice that I recommend you avoid.

I yelled at coworkers

When I started working in the emergency department I was stressed to the max. The high patient volume and increase in acuity compared to that I had experienced working in urgent care had me on edge. My coworkers took the brunt of my emotions. As a nurse practitioner you will often find yourself in a leadership position delegating to nurses and other staff. When you need something or have a request, ask nicely. Operating in a dictatorial manner won’t make you any friends nor will it help you operate more efficiently.

I was all about the Benjamin’s

As a single gal with my first decently paying job (meaning more than $8/hour), I was thrilled each time my paycheck came in the mail. And, I wanted more, more, more. My first few nurse practitioner positions paid based on productivity. The more patients I saw and the more tests I ordered the higher my paycheck. So, each time a chart hit the “To Be Seen” rack, I hopped to my feet. Some days this wasn’t a problem, but when the clinic or hospital was slow I should have deferred to workplace norm and shared the love, allowing each provider to see an equal number of patients so all could earn more evenly. I was not as discerning as I should have been in proving myself as a hard worker and ambitious earner.

I suffered from premature burnout

Along the lines of focusing too much on my pay, I picked up extra shifts like a crazy person. Excited about my new home purchase and wanting to be helpful and establish a solid reputation, I accepted extra work whenever a coworker asked. This left me utterly exhausted. At one point I even cried at work. In my boss’ office. I don’t recommend this route. Being a new grad nurse practitioner is difficult. You may find yourself struggling to keep up clinically making the average workday exhausting. Keeping your hours in check will help prevent burnout and keep you sharp so you can take advantage of learning opportunities that present themselves throughout the day.

I executed my job search terribly

I was very fortunate to land a job in a desirable location within a week of graduating from my nurse practitioner program. But, I still botched the process. Although I was offered, and accepted, a position, I didn’t do due diligence when it came to researching my prospective employer. I found myself in a clinic that compromised quality of care for cash and engaged in billing practices bordering on Medicaid fraud. Needless to say, I didn’t stay in the job long, but I should have been more selective in selecting my first position.

My clinical skills could have been described as “needs improvement” 

You might assume that having attended a well regarded nurse practitioner program that I stepped into my first position with sufficient clinical knowledge. False. I still had so much to learn. I asked my collaborating physician and NP coworkers questions about nearly every patient I treated. When I worked as the sole provider in the clinic on weekends, I frequently called my physician coworkers for assistance over the phone interrupting their precious Saturday afternoons. While I knew enough to ask questions rather than make clinical mistakes, I felt incompetent at times. I felt like more of a bother than an asset to the clinic given my inexperience. Be prepared to feel the same.

I almost got sued

One day I treated a patient who seemed to have medical problems beyond the scope of practice of the urgent care clinic where I worked. Thankfully, I recognized the state of his condition, consulted my collaborating physician, and recommended that he seek treatment at the emergency department. He opted not to follow my advice ending up with a medical condition requiring a surgical fix. Once he recovered, he sought legal counsel and threatened to sue. Fortunately, I had done the right thing and documented our conversation so nothing came of the threat. But, it was a stressful reminder of the responsibility I have a a nurse practitioner.

I made it!

Despite my initial misgivings in regards to my clinical skills and my occasional lack of professionalism, I learned to become a competent, confident nurse practitioner the hard way. While I still ask the occasional question of my superiors, I am prepared to diagnose and treat most patients presenting to the emergency department. I have become more laid back in my interactions with coworkers. Rather than snapping under stress, I use it to energize me. I’ve found a way to make time for both my work and personal life. Don’t worry new grads-you’ll be able to do the same!


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