Ready or Not, as a Nurse Practitioner You’re a Manager

When I accepted my first nurse practitioner position out of school, I expected a few bumps in the road. I knew the learning curve to becoming proficient in my practice would be steep in the clinical sense. I would learn to suture more complex lacerations, better manage patients with multiple comorbidities, and work at a speed acceptable to my employer. But, as I walked through the doors of the clinic the first day on my NP job, I encountered a few unexpected hurdles. No one had told me that as a nurse practitioner I would be a manager.

Whether you work as a nurse practitioner in a small, solo practice, for a multi-provider medical group, or in a large hospital system, as an NP you’re a leader. While aspiring nurse practitioner coworkers may naturally look up to you for personal and professional inspiration, your role demands that you have managerial and leadership skills. As a new grad, I was surprised when nurses turned to me asking what they should do next for a particular patient, or would make suggestions about care but ask for my OK before acting on their plan.

The role of a nurse practitioner was very awkward for me at first, especially when it came to managing nurses, medical techs, and phlebotomists who carried out my orders. While I wasn’t an owner in the practice and worked with multiple other providers, I had to make sure my orders were carried out in a timely manner. When the practice wasn’t operating as smoothly as planned, this required me to speak up, something I was certainly not comfortable with at the time, especially given my overall lack of confidence in my newfound profession.

Being a young nurse practitioner gave me further pause when it came to being directive in working with those reporting to me. I wasn’t in charge of hiring and firing nurses, but I was ultimately responsible for the care my patients received. Requesting things from nurses more than twice my age was uncomfortable to say the least. I felt awkward asking a male RN 30 years my senior to “please clean up the patient in bed 10’s accident”.

Then, there were the financials of the practice to consider. While I of course realized that patients were being billed for services I provided as a nurse practitioner, I wasn’t aware as a student of the pressure this can place on an NP. A medical practice’s revenue is tied directly to how many patients nurse practitioners and other providers treat as well as the cost for these visits. My eyes were opened as to way practices work to increase the average cost of a patient visit making me acutely aware of the tension between generating revenue and doing the right thing for the patient as well as my own revenue generating potential.

Pressure to increase patient volume was difficult as a new graduate. As a nurse practitioner you are often in control of the flow of the practice, at least when it comes to the patients on your schedule and those assisting you in their treatment. If you don’t work quickly enough, the practice loses money. If your staff isn’t doing their part efficiently, it affects your own revenue generating potential. Administrators watch this closely. So, as a nurse practitioner you often find yourself in the role of making sure other staff members are working efficiently. 

I would say I handled my managerial responsibilities adequately in my early years as a nurse practitioner. These weren’t skills I had been taught in my NP program. Overall, I was timid in the way in which other providers in my practice. I let my lack of confidence clinically keep me from being an effective leader. When I did speak up, I didn’t always do so in a manner that was well received. I learned by making mistakes in how I interacted with coworkers and received welcome feedback a time or two.

The first step toward avoiding similar mistakes and overall taking a while to catch on to your managerial role as an NP it not to be surprised by it. Right or wrong, the healthcare system is hierarchal in nature and if you’re a new grad nurse practitioner you’re about to take a step up on the ladder.

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