An Experienced Clinician Reflects: Clinical Pearls for New NPs

By Vanessa Pomarico, Ed.D, APRN, FNP-BC, FAANP

After 24 years in clinical practice, there are a few things that I would tell my newbie NP self—bits of wisdom that I wish someone had shared with me when I was first starting out. There’s so much to include in nurse practitioner education that the business aspect of being an NP is often overlooked.  

  1. Negotiate your contract and salary. I had an amazing pediatric NP preceptor who emphatically shared with me that NPs need a good contract just like our physician colleagues. She was one of the first NPs in the state of Connecticut (and most likely in the entire country) who recognized that NPs commonly do not negotiate well for themselves. I had no experience whatsoever in contracts, much less negotiating a contract. How many nurses have had to do that? None that I knew. My preceptor’s wisdom inspired me to learn all I could about negotiation and employment contacts. Now I help empower other NPs to never accept a less than desirable salary or poor contract terms.  
  1. Don’t be afraid to admit when you don’t know something. A wise woman once told me “No one was born knowing.” The first year of practice is the time when employers and co-workers expect that you’ll be asking questions and seeking guidance. As nurses, we’re experts in our individual realms. When we become NPs, the learning curve shifts, and we become novices again — a role few people are comfortable embracing after being an expert for so long. If you’re not familiar with a condition, research it just as you would have done as a student. Prepare your list of differential diagnoses so that when you discuss the case with someone, you’ll be prepared to have an educated discussion instead of waiting for someone to just give you the answer.  
  1. Never stop learning! Nurses are lifelong learners. Healthcare is constantly evolving. It’s so important to stay on top of what is current in our practices: new medications, new therapies, changes in electronic health records. Get your CE hours annually and don’t wait until your certification is coming due. Attend conferences either in person or virtually. Those 5 years pass quickly. By doing your CEs annually, you’ll stay current on what’s new without scrambling when it’s time to renew your certification. 
  1. If your new practice has electronic health records, invest in the time to build templates and dot phrases. Ask about getting voice-activated dictation software if typing isn’t your greatest skill. This will save you time, especially on those long days where your schedule is full. Close your notes by the end of the day. Details are lost if you wait to document a day, week or month later. If your practice still has paper charts, develop flowsheets and patient encounter forms like sick visits, follow ups and physicals. This will streamline your documentation and decrease the time needed to chart after every patient encounter. If time management isn’t your strong suit, work with IT or someone who can help you manage your workflow so you can use your time more efficiently. 
  1. Take advantage of 401k and any financial planning that your practice offers. It’s so important to invest in your future. With all the stock market fluctuations, it’s wise to sock away as much as you can now to protect your financial future. Those years fly by quickly. When you get closer to the end of your working years, you’ll be grateful for having invested wisely. 
  1. Practice self-care. Taking care of yourself so you don’t suffer from compassion fatigue or burn-out is vital. Patients are sick, and our hours might be unpredictable. It is critical that you carve out time every day, even if it’s just a few minutes at a time, to reset and clear your mind. Commit to some form of exercise regularly. We need those endorphins to keep us mentally healthy! 
  1. Use your voice. Don’t be afraid to say no. We all have our limits. If you find that you’ve lost control of your schedule or are not comfortable seeing 25-30 patients a day, speak up! You must do what’s safe for you and your patients. Negotiate this upfront so there are no surprises. If you negotiated it and it’s not being honored, calmly discuss it with your supervisor or practice partners. Explain why it’s not safe to see more patients than you’re capable of seeing. New graduate NPs especially need more time to become acclimated with patient care.  
  1. Your first job is not necessarily your last job. If you find that your needs are not being met, if you feel like you are being overworked and underpaid, or are simply not happy where you are, discuss it with your supervisor or HR. Your employer is not responsible for you to feel challenged or fulfilled at work. If you are unable to resolve the issue, then update your CV and start quietly searching for a new position. Not every practice will be the same and you may find that yes, the grass really is greener on the other side. Just remember to honor your termination clause. Remember that leaving a position quickly and without proper notice can follow you and taint your professional reputation.  
  1. Find your passion. If you like diabetes care, consider becoming a certified diabetes educator. If you like specialty populations or want to offer services such as cosmetic procedures, consider getting more knowledgeable in that area so you can offer that as a subspecialty in your practice. Not only will you attract new patients to your practice, but you will also increase your productivity and financial contribution to the practice. 
  1. Find a mentor, especially during that first year or when changing jobs. It doesn’t necessarily need to be someone at your office. Having someone with whom you can discuss your development as a new NP, as well as other challenges that come along with the first year of practice, will help your growth as an NP. AANP offers a free Career Enrichment program to members. Applicants are matched with a Fellow of the American Association of Nurse Practitioners based on mutual interests and expertise.  
  1. Join your state and national NP organizations. It’s so important to be a part of these organizations who represent the voice of the NP both at the state as well as federal level. You can be an active member, run for a board position, or simply send letters to your legislators when asked to help bolster the efforts for full practice authority in your state. Even if your state has FPA, there is always some new piece of legislation that can affect our practice. There is always room at the table for your voice! 


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