Almost half of my patients went on vacation during July, so my schedule was pretty open. I heard there was a new nurse practitioner at one of the other clinics that was struggling. I asked the medical director if I could help her out one day a week as long as my schedule allowed. Luckily, he thought it was a great idea. I was looking forward to helping a fellow nurse practitioner and having a change of scenery.
When I met the new nurse practitioner, she was ecstatic that I was there to help her. She confided in me that the other physician in the clinic was unapproachable and she felt alone. She struggled to find someone available to help her as needed. I understood her frustration and told her hopefully it would get better in the upcoming weeks when another physician returned from FMLA.
Fortunately, her schedule was still pretty light so we could take our time going through the motions. I shared some tips of approaching new patients (whether new to the clinic or new to her); considering I am constantly seeing new patients. For instance, I recommended she review all of her scheduled patients before the day started to have a plan in place. During this review, she can go ahead and order necessary INR tests, evaluate recent lab results, and consider any health screenings that are due.
Once the patient is made ready for her, I advised her to go ahead and start her note instead of waiting until she got in the room. This ended up being very beneficial for her because since English is her second language, I noticed she has a hard time typing on the electronic medical record while she speaks or listens to the patient.
Additionally, I taught her how to focus on the visits. Our patients come once a month and they are elderly. Thus, it is best not to change more than 2 things per visit or it may cause a lot of confusion for the patient. Hence instead of changing both blood pressure medication and depression medication during the same visit, just change one this time and plan to change the other at the following visit.
I observed that she had some gaps in medical knowledge. She has less than 1-year experience in a family practice environment, so I wasn’t surprised. She was used to seeing simple things such as cold symptoms and UTI. Versus a lot of our patients need treatment for co-existing chronic kidney disease, heart failure, diabetes, high blood pressure, coronary artery disease, osteoarthritis, depression, dementia – the list goes on.
I went through several scenarios with her in how to manage a patient properly. We discussed how to work up someone with chronic cough or acute abdominal pain etc. I reviewed pharmacology and initial treatment options. I recommended she do some reading after work and on weekends to review more chronic and complicated disorder.
Lastly, I mentioned to the medical director that she needs more mentorship so he said he will make one of the physicians at her clinic more available to her. She seemed overwhelmed initially but more comfortable by the end of the day with me. I told her she can reach out to me with any questions in the future. I’ll be sure to update you with her progress one month from now.
Wow, did I have a flash-back, to 23 years ago, went to my first day at a huge HMO, had a ton of pts on my schedule, and a doc who told me he was not interested in ‘training’ another new NP! The closest doc was waaay across the Clinic, so not available to discuss after coming out of a room.
That first day, a pt had had an X-ray ordered, I still don’t know who ordered it, but I was told it was ready for me to read!
Not only did I not know how to use their X-ray viewing program, I had had one class on X-rays during training.
Needless to say, I sank and was let go after 6 weeks.
I beat myself up about that for a long time. I eventually came to realize I was never given the support I needed as a new PNP, nor an orientation to the system that hired me.
I was lucky to land my next job with a solo Ped, who took the time to help me when I needed it.
I went on to inpatient work, with an awesome attending who essentially held my hand for the 7 years I worked with him! But, I learned everything there is to know about Hepatology!
Bottom line, we really should have some type of internship available after we graduate. I went from student on Friday, to provider on Monday. Not good!
Thanks for sharing! Yeah that’s why they are looking to start creating more NP residency programs.
Agree! Great comment! Unfortunately many nurses want to go direct from RN to NP without even basic nursing experience and there are programs that support that! We should never stop learning and should embrace opportunities to improve our practice! Internships would be a great option! I am a DNP FNP PMHNP and there are some internships through the VA for PMHNP which look really promising for new graduates! I hope to see more of these for entry level NPs!
Thank you for initiating that help. As we know, we are being trained at different levels and until nursing education finds a consensus we are going to have new nurse practitioners who are struggling as the first year is the hardest regardless of training ! Physicians are historically ( not always ) not prepared or invested to train us and healthcare is designed now with productivity in mind. I applaud you for stepping in and giving her hope! Your recommendations were spot on! We NPs need to do more of this to strengthen our profession !
It’s great that instead of bashing someone in our profession, you reached out and helped her. I hope it gets easier for her. I hate hearing NPs say they regret going from RN to NP.
Let’s all help each other out a little!!
So true!
Amen!