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Survival Tips for New Advance Practice Nurses

Monday May 19, 2008
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The transition from successful nurse to novice advance practice nurse (APN) is not without its challenges. APNs need to jump in to action from day one. But the support of colleagues and the specialized education can make the transition smoother.

“That first day is daunting,” says Laura Carter, APRN, BC, recounting the beginnings of her career as an APN. “You walk in and clip on your pager, and before you know it, your colleagues are asking you to sign orders.”

After what she describes as many sleepless nights during her first year, Carter has weathered the initial storm of transitioning to a new role as an APN at St. Joseph Mercy Hospital Senior Health Services, Ann Arbor, Mich.

Rather than focus on the goal of becoming a savvy provider, Carter’s advice to new APNs is to value each moment and learn as much as they can from the people around them.

There’s a huge learning curve from successful RN to successful APN, Carter says. And although she plans her professional growth, Carter says she realizes that she doesn’t have to know everything about every disease right away. She knows the knowledge will come with time and experience.

“Listen to and learn from colleagues and patients,” she says. “They are your best teachers.”

Into the frying pan

“Some novice APNs feel lost at first, while others experience a ‘baptism by fire,’” says Joanne Pohl, APRN, BC, FAAN, president of the National Organization of Nurse Practitioner Faculties, a professor and associate dean for the Office for Community Partnerships at the University of Michigan School of Nursing in Ann Arbor, Mich., and a board member of the Institute for Nursing Centers.

Pohl experienced a nurturing transition to practice in a nurse-management center with six experienced APNs as support. She was given time to grow into the new role and gradually increase the numbers of patients.

“Most students today often go into medical practices as the lone APN and may lack the collaboration I encountered,” says Pohl.

When looking for that first job, Pohl tells new APN grads to look for a practice that’s a match with their preparation, to negotiate an incremental process for the amount of patients they would be expected to see (within a realistic timeframe), and to clarify the relationships with physicians — collaborating expectations versus supervision, which is dependent upon state regulations.

Before they accept a position, Pohl suggests novices spend some time in the practice and ask about the orientation process and the support system available, especially during that first six to 12 months.

“Most students return to school and report to us that they are happy with their practice and have grown into it,” she says.

Who am I?

Lack of the protective academic environment makes that first year especially challenging. New grads place high expectations on themselves and think they should be able to “handle it all.”

“Whenever you change to a new role, you may experience the ‘Imposter Phenomenon’ (belief in one’s lack of competence, as coined by psychologist Pauline Clance) — and it’s normal to feel that way,” says Carter.

Pohl says new APNs also may experience a loss of their sense of identity. “They need to remember how competent they were as RNs and realize that their feelings of incompetence will pass,” she says. “It gets better.”

Carter’s prescriptions to dispel feelings of discomfort on the job include tapping into resources for help. Find a mentor and be one to others form a key message Carter imparts to new grads. Also, she says, it can be difficult to work as an APN in the same environment one once worked as an RN. “The transformation from peer to a clinical leadership role may cause some confusion for patients and some ambiguity from peers,” she says.

“Surround yourself with positive people — colleagues and former classmates with whom you can share stories and know you’re not the only one struggling,” Carter says. Those in rural areas can make use of online support.

Pohl also encourages new grads to find mentors and to take special care of themselves, reduce stress through exercise, and engage in healthy lifestyles.
“The paperwork piles up because the workload is more than I’ve ever experienced in my 22 years as a nurse,” says Carter. “My biggest challenge [and what new APNs must learn] is to be more efficient to try to streamline patient visits and dictate between visits.” Carter also says learning to delegate is “crucial to daily success and survival.”

It’s important to try to achieve a balance between work and life,” says Carter. “If you’re not careful, work can consume every moment.”

On those late nights when Carter is still at work dictating, she wonders why she chose the APN career path. “What was I thinking?” she muses. “But I quickly answer myself. I can’t imagine doing anything else.”


Lorraine Steefel, RN, MSN, CTN, is a senior staff writer for Nursing Spectrum/NurseWeek. To comment, e-mail editorNTL@gannetthg.com.