Nobody likes standing at the bottom of the ladder, gazing up at everyone above and knowing there’s nothing but time, labor and learning that will get you any closer to the top.
It’s a well-established phenomenon that nurses have a hard time transitioning from expert nurse to novice nurse practitioner. This makes sense- you’ve gotten really good at your job, knowing what every medication does, what those labs mean, what the physician is going to order next- and now you’re back at the starting line, feeling more insecure than ever, hating the fact that you don’t have all the answers anymore. If you stayed in your area of nursing experience, I can imagine that this transition is less jarring since you’re already accustomed to your future role but I think regardless of where you came from, the rules are different as a NP. And this can make for some serious anxiety.
If you’re entering into a new clinical environment like me then this transition may leave you feeling breathless, alone and scrambling to catch up. I spent my first six years as a nurse in a surgical ICU learning how to titrate vasopressors and check for compartment syndrome and draw ABGs. I will be thankful every day of my nursing life for the experience of learning to handle such acute patients in a tenuous environment because it gave me an extensive knowledge base about both medicine and people. Over a period of a few years, I rose through the ranks, climbing up the rungs, and finally found myself near the top, confident that I could handle any trauma patient that rolled in the door. But since I had always wanted to pursue a career as a NP, I felt it was the right time to move on and grow in my capabilities as a nurse.
So after years of hospital life now I’ve entered into the world of clinicals in a family practice outpatient clinic. On the first day I asked, “where’s the crash cart?” and everyone looked at me like I was crazy. Eventually I found the AED and that was it. They didn’t even have an IV start kit! Every bone in my body was rebelling, thinking what in the world would we do if someone codes? Call 9-1-1 and start CPR like everyone else, I suppose. The outpatient setting is vastly different and at first I wondered whether I would enjoy the slower pace or whether I would be sitting at my desk the first day of clinical thinking, oh my gosh, have I just wasted the past two years of my life? But thankfully, I have adjusted more easily than I even thought possible, finding the challenges of a clinic different but not less than, still experiencing the thrill of seeing patients except these patients can actually talk to me.
With two clinical semesters to go, I am still at the bottom of the ladder, dreaming about the breeze of graduation on my face and yearning for the freedom of practicing on my own in the high, clear air. After doing online classes for the past two years, I found that I had in fact learned a few things but I still came home everyday with more questions than answers. I spent my hours at home looking up articles, listening to podcasts, trying to be better. Fortunately, I had a preceptor who allowed me to ask dumb questions and look up answers and Google pictures of skin rashes. He made no ultimatums; he didn’t shame me in my ignorance and for that I will forever be grateful. Plus, I quickly realized that even after years of practice, you never stop learning. You never stop reading articles. You never stop changing your care plan based on the newest evidence. In short, I will be a learner for the rest of my career.
I had so many instances this semester where I felt out of my league. Patients who came in and hadn’t seen a health care provider in forty years. Patients with hemoglobin A1C levels so high the point of care machine couldn’t even calculate it. Patients with feet so disgusting that I literally didn’t know if I should send him to an emergency podiatrist (do they have those?) Patients who told me they had thought of committing suicide. Patients that were medical minefields with a list of diagnoses several pages long and too complicated for me to navigate without some help. Patients who asked me point blank what I should prescribe, in front of my preceptor, and I had to admit that I didn’t know. I was out of my league and that’s just part of adjusting to a new role, of being a student.
Even with my preceptor as a safety net, I still feel the weight of the job like a heaviness in my chest, the responsibility crushing at times. There is a holy reverence when you’re taking care of another human being because they’re putting their trust in you. They look you straight in the eye and believe what you tell them. They listen and consider and take the medication you prescribed. So even though I long for a day when I feel comfortable in my new position as a NP, I can’t too easily wish the anxiety away because it’s going to keep me from getting too comfortable and making a mistake. Hopefully, eventually, anxiety and reverence fuse, leaving me a great nurse practitioner with a holy level of fear.
Am I nervous every day that I show up to clinical? Of course. Will I carry that anxiety with me as I graduate, get a job, and start practicing? I’m sure of it. It’s like when I started in the ICU as a RN and someone told me it would be about a year before I was able to come to work and not be terrified that I was going to kill someone. And they were right; it took me a year to feel comfortable there. It’s like that. From what I’ve heard and read, there are some factors that help lessen this anxiety but nothing replaces years of experience.
So here I am, at the bottom and climbing my way back up. It’s a different ladder of course, one with no weekends and holidays and better pay and different responsibilities. It’s comforting to know that I’m not alone; that every nurse practitioner student in the world probably feels the exact same way- excited, nervous, and a little bit terrified at times. There is hardship in this transition but there is payoff too, mostly in the faces of the people I help or the exultation of knowing I made the right call. There will be falls along the way, missteps. Scraped knees and elbows as I try to hang onto the rungs.
But despite all the challenges, despite those days when I wonder if I can do this, I’m confident I’m headed the right direction. I can see the top from here, and it will be worth it.