You probably have a countdown app on your smartphone, and every passing day brings you closer to that moment when you can toss those 10-pound textbooks out the window as you pull out of the campus parking lot. There isn’t a night you don’t dream of finally being rid of the preceptor who you’re sure sits up every night thinking of who is the worst possible patient from her caseload she can assign you the next day. You’re reasonably certain you will never, ever want to see your professors again, and, if you do happen to run into them, you’re prepared to put on your best foreign accent and insist they’ve got the wrong person. In a word, you are done, and that official day of completion, with all its pomp and circumstance, can’t come soon enough.
While I agree that navigating a graduate school’s nurse practitioner program is akin to walking a path of burning sand, I often warn those about to exit that path about some hard-to-believe realities they should expect the first year, and I mix that reality check with a little advice.
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1. You will miss being a student.
As a student, you always have new and fresh information coming your way in the form of articles, practice guidelines, and late-breaking research findings that your professor has added to your never-ending syllabus. Until now, you may have carried out doctors’ orders to the letter, reasonably confident of the how but not always clear on the why. Your time as a student, I hope, has changed that. With each article and clinical experience, you’ve gained the tools necessary to determine not only what a symptom means but the pathophysiology behind it, how to diagnose it, and how to treat it. Now, you know which antibiotic to choose (or not choose) for a certain condition, and why. Admittedly, it’s pretty interesting stuff!
Career reality: Learning something new every day will be your responsibility. In the real world, no one is going to show up with a syllabus and a list of learning objectives. You will know what you know, but what you don’t know will show up one patient at a time. Part of your role as a clinician is to stay abreast of new developments—to stay current—so you can provide your patients with the best, evidence-based care possible.
Advice: Always be a student. While you may not have the time for daily scouring of journals to learn about the latest and greatest research, plan to keep up on what’s most important in your clinical specialty. Your first year out, keep a daily journal of clinical issues that arise that may stump you or symptoms that have you scratching your head trying to figure out a diagnosis. Make it your homework to read up on those issues, and make notes for yourself so you’re better prepared the next time they come around. Make a list of topics you least understood in school and, little by little, find a CME, workshop, or conference that address those topics or specialties so you’re more adept when they present.
2. You will miss having a preceptor.
As a student, you lived with the expectation that you could—and would—run out of the exam room in a state of sheer panic, not knowing what to do for that patient in front of you who has a rash you’ve never seen before. After all, “derm” is your least favorite specialty, and you were barely awake during the visiting lecturer’s presentation on common skin disorders. As a student, it was okay not to know what to do. Just when you were sure it was leprosy, there, with years of experience, was your preceptor, ready to save you and remind you of a commonly occurring fungal rash that could be cured with a $5 cream.
Career reality: Depending on where you work for your first job, there may or may not be a person willing to follow you down the hall and confirm your suspicions by taking a look at a rash or peeking inside an ear. To complicate matters even more, figuring out which medications to prescribe for which insurance plans will be your job and yours alone, regardless of what clinical guidelines say are “preferred treatments.” In many environments, your degree and certification translate into the assumption that you know what you’re doing and are safe to be on your own.
Advice: When interviewing for your first job, your first and foremost priority should be to inquire about the availability of precepted orientation. Find out how long the company offers orientation and who will be your resource person to go to for clinical questions that arise during your first few months. During your orientation, be honest about your strengths and weaknesses, and use that time wisely to acquire the resources and knowledge needed to make your transition as smooth as possible. Don’t buy into the media hype that doctors don’t want NPs in their territory. There are many environments where nurse practitioners are highly valued and appreciated. Take time to find a practice where this will be true for you.
3. You will miss your classmates.
As a student—part of a cohort—you have come to know one another in ways that you likely take for granted. You have seen each other during moments of extreme stress and gotten by with little or no sleep while consuming dangerous amounts of caffeine, hardly a set of images any of you would want showing up on Facebook later on in life. For some of you, there have been painful divorces and difficult breakups; children have eaten more take-out meals than you care to admit; and friends and family have long given up on you as missing without a trace. You and members of your cohort have studied together, cried together, and supported one another with words of comfort during a very difficult time. It’s an experience that only another person who has traveled the same path can understand.
Career reality: Your new colleagues can relate to some of what you have endured, but will never really understand what you’ve gone through. It is impossible for them to know and, honestly, it would be unprofessional of you to rattle off all your past miseries to people you’ve just met. You’re no longer a student and, early on, it’s important that you establish a confident and professional presence in your new environment.
Advice: Do your best to maintain friendships developed in your cohort. Your first year out of your program will offer a full range of challenges with people you don’t yet know. Having a circle of support is critical to strengthening both your knowledge base and your confidence level. As new graduates, you can network with one another on a pretty even playing field, sharing resources about potential jobs, starting salaries, educational conferences, and a vast array of other opportunities that come along.
4. You will miss having a schedule.
As a student, you always had somewhere you had to be and something you had to do by a certain time. There were exams to prepare for, papers to turn in, and clinical rotations that required you to be on deck and ready to go by a certain time every day—no excuses. Even in the midst of what seemed chaotic, there was order. You set goals for yourself and, to achieve the prized goals of graduation and a degree, you learned to prioritize your time and manage your resources.
Career reality: Prioritizing time and resources will be just as critical in your new career as it was in school, except now there won’t be anyone standing by—red pen in hand—holding you accountable and checking off what you did or didn’t accomplish. Years will pass quickly, and the vision you once held for your new career can quickly turn to dust and disappointment.
Advice: Ask yourself where you want to be in one year, three years, five and 10. Set goals for yourself, and work from Day One to achieve them. Take time to find the right “first job”—one that supports your goals and leaves sufficient time to work toward them. If your goal is to have your doctorate, start your own business, or even retire, it’s important that you have a map and a timeline to help you get there. Through frequent check-ins, that circle of friendships you’re continuing to nurture can provide support by holding you accountable.
5. You will miss a professor or two.
As a student, you were certain all of your professors were out for blood—specifically, yours. In the beginning, you took everything that was taught as unparalleled gospel, questioning little—if anything—and hoping one day to be so brilliant. What you’ve learned, over time, is not what to think but how to think. It was never the intention of your professors—really—to force-feed information to you but, rather, to give you the tools to decipher facts and apply knowledge to practice. You now realize the truth in the maxim that what doesn’t kill you makes you stronger.
Career reality: You will find that much of what your professors taught you was true but not absolute. Health care is both a science and an art. No two people practice health care the same way, and you will have to develop a style that works for you. There are thousands of guidelines and algorithms for clinical practice, but how to implement the guidelines in a way that is safe, efficient, and cost-effective for each patient is a skill that comes with time. Your professors have developed their own style of practice, based on experience, and now it is time for you to take the knowledge you’ve gained to develop your own.
Advice: See your professors as colleagues. Stay in touch with the ones you feel most strongly supported your goals as a student and helped you overcome challenges. Ask for suggestions on professional-practice issues, such as getting through the first interview, negotiating collaborative practice agreements, and deciding which professional organizations to join. For those in clinical practice, make a list, and refer your patients accordingly. Tap into their knowledge about certain specialty areas and conditions in which you are not as well versed as they.
In a few weeks, you will join the wonderful world of advanced practice nursing, deserving every gift you receive to honor your accomplishment. But the best gift you can give yourself is a moment to pause and absorb your last few days as a student.
For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.
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