New Graduate Nurse Practitioners: Keep Learning to Build Confidence

As a new graduate nurse practitioner, you're equipped with all of the latest information and guidelines to inform your practice. You demonstrate enthusiasm and compassion, and offer a fresh set of eyes in the medical field. However, you can't help but feel nervous, uneasy, and overwhelmed by the sheer volume of knowledge required to provide safe and effective care for a wide variety of patients. Understanding the important ways to support and advocate for yourself as a new grad is essential to your long-term success in this demanding field.

Build Confidence With a Fellowship Program

With varying credentials among nurse practitioners including MSN and DNP, formal education and hands-on clinic experience can vary at the time of graduation. Some universities and healthcare facilities are expanding post-graduate training to include NP residency and fellowship programs. These programs may focus on a particular specialty, or offer further training in the broad field of primary care. These programs offer support for new NPs in developing assertiveness, long-term patient planning, and critical thinking skills. According to JoAnne Saxe from the UCSF School of Nursing, "The community setting is demanding – even for those who are excellently prepared. The extra in-the-trenches learning of a residency not only solidifies skills, but also acts as a testing ground for future work experience."

Focus Your Skills With Specialty Training

Nurse practitioners are employed in nearly every medical specialty. Specialty training is critical for success in these focused fields. Specialty training may include:

On-the job training
Course work for specialty certifications
Conference training sessions

Many healthcare facilities and clinics offer specialty training after employment begins. This is a simple way to obtain extra training and gain invaluable experience while working as an independent provider. Attending specialty professional conferences that offer clinical training sessions is another skill-building technique. These hands-on training sessions are particularly effective for NPs moving into fields such as dermatology, cardiology, neurology, or orthopedics. Attending conferences is also beneficial for building a network of colleagues. Maintaining collaborative relationships with other providers both locally and remotely is a great confidence builder. Specialty professional organizations, such as the Orthopedic Nurses Certification Board or Dermatology Nurse Practitioner Certification Board, also offer coursework for certifications in these fields. Reviewing test-prep materials and educational resources for specialty certifications offer a deep understanding of current evaluations, diagnoses, and treatments for NPs who are motivated to pursue specialty practices.

Collaborate With a Mentor

As noted in a 2018 review in The Clinical Teacher, "the practice of mentorship may help to foster an understanding of the enduring elements of practice within these organizations. Mentoring involves both a coaching and an educational role, requiring a generosity of time, empathy, a willingness to share knowledge and skills, and an enthusiasm for teaching and the success of others. Being mentored is believed to have an important influence on personal development, career guidance and career choice."

Finding a mentor may be your most important task as a new grad NP. A good mentor is invaluable in any career setting, but it's particularly essential in the healthcare field. In addition to helping build confidence and skills among new grad NPs, mentors also offer the moral and emotional support that's critical to practitioners' success in today's demanding environment. A mentor-mentee relationship does not end when you become a seasoned practitioner. Mentorship is an important part of a career-long support chain that will eventually lead to you serving as a mentor. Healthcare providers must hold each other up, challenge each other to provide the best patient care possible, and protect each other during challenges to effectively maintain a passionate and progressive standard of care. A mentor may be:

An experienced physician in your clinic
An experienced NP in your clinic
Another new grad NP
A clinical professor
A previous clinic preceptor

As long as a colleague supports your ongoing learning, offers helpful and timely advice, and lends an open ear for any challenges you may have, you can consider them a mentor.

Get Comfortable With a Learning Mindset

Scientific studies, evidence-based practice guidelines, and treatment updates are constantly evolving. Therefore, it is critical to find resources that support your ongoing learning. Having a go-to toolbox is helpful for day-to-day learning during clinical practice. Programs such as UpToDate, 5-Minute Consult, and National Clinician and Consultation Center offer quick, concise, evidence-based guidelines for treating a wide variety of conditions. Finding a program that works for you is key. A pharmaceutical reference such as Epocrates, Physicians' Desk Reference, or Lexicomp is also useful for safely prescribing medications. Specialty organizations and the USPSTF offer convenient access to the guidelines for a variety of common health treatments and screening procedures. Additionally, learning continues outside of clinical practice. The variety of online and in-person CME products and online and print professional journals allows NPs to choose the format and topics they wish to study.

Ultimately, succeeding as a new grad NP requires a growth mindset of constantly gaining knowledge and adapting. Whether we are calling on a colleague, reading a journal article, or completing a hands-on clinical session, we are never done learning.

Varying Guidelines on Nurse Practitioner Full Practice Authority

Although there is growing evidence linking nurse practitioners to higher quality of care and safety for patients, shortages of care remains a long-standing discussion in healthcare – particularly for APRNs. Additionally, varying guidelines on nurse practitioner full practice authority continues to be an ongoing conversation. In fact, it's often a "regulatory barrier" for the profession and our ability to deliver care at our highest abilities for the communities we serve. This is primarily due to the fact that our licensure has been heavily regulated on the state level, as opposed to a federal level. This legislative regulation often makes it difficult to consistently ensure that nurse practitioners are able to deliver care without the challenge of legal and geographical boundaries that can leave some states far more restrictive in practice than others. While small advances have occurred over the years, they have been slow-coming up until now.

NP Practice Authority During a State of Emergency

Since the onset of COVID-19, we have seen an immediate shift in the various legislative barriers and regulatory practices that have served as a major obstacle for nurse practitioners. Governing bodies, both within the healthcare industry and on a national level, have also embraced the urgent need to reevaluate the traditional restrictions that have been in place since the profession began in the 1960s. One visible shift in this understanding has been made public in an evolving statement from the American Association of Nurse Practitioners, which details the various ongoing changes occurring on a policy level to temporarily suspend and waive practice agreement requirements. These waivers have been the solution to the growing need for competent health care providers to address the exponential necessity of access to care. This refers to cases that relate to the global pandemic of COVID-19, as well as primary care and population health needs that have been present all along. In the midst of social distancing guidelines and state lockdowns, one major tool that has helped drive this accessibility is telehealth.

The Rise and Impact of Telehealth on NP Practice

The presence of telehealth, or telemedicine, is not a new topic or concept. However, with the rise of technological innovations and societal changes that have occurred due to the global pandemic, the conversation surrounding telehealth has become the topic of our times. According to a 2018 article, Telehealth and Legal Implications for Nurse Practitioners, the most basic definition of telehealth is the "use of…telecommunication technologies to support and promote long distance…health care." The article further explains that telehealth's original goal was to meet the needs of underserved and rural patients. However, much like what has been seen in traditional primary care practices, there are regulatory barriers to telehealth as well. Requirements have often varied from state to state, which has ultimately led to confusion for NPs involved in the practice. Regardless of these obstacles, we have recently seen a drastic transformation in the extended permission of this valuable and urgently necessary tool for the practice of all healthcare providers. This change has truly represented a shift toward practice transformation, as hoped for in the 2011 Future of Nursing Report.

Approaching NP Practice in a Post-Pandemic Society

The major question on everyone's minds is, what's next? How do we approach NP practice in a post-pandemic society, assuming how quickly our trajectory changes? Even more importantly, how do we adequately equip future and new-to-practice nurse practitioners to be well-prepared to handle shifting policies, requirements, and ongoing credentialing needs? The need to implement unique ways to fulfill clinical requirements is now more important than ever. On a positive note, with the ongoing need for social distancing guidelines, future nurse practitioners are being strategically prepared to thrive in telehealth and technology-heavy health care systems. Nurse practitioner students, faculty, and (most importantly) policy-makers must continue to consider all of the possibilities in this "new normal." So, is full practice authority here to stay? If we truly hope to see a transformation in practice, we must aim to follow the pivotal 2011 report: be the future of nursing by leading change and advancing healthcare.

Category: Nurse Practitioner