Smoothing your transition from RN to NP

Transitioning to the nurse practitioner (NP) role is exciting—but it can also be stressful. Fortunately, taking certain steps can make it smoother.

I’m a family NP (FNP), board certified by the American Nurses Credentialing Center (ANCC). Before graduation, I worked as a critical care nurse for 5 ½ years. I still vividly recall the struggles I had as a new registered nurse (RN) and later as a new FNP. Here are some suggestions for easing your transition from RN to NP to launch yourself to your next career stage.

Become board certified

To make you more confident in your abilities and boost your marketability, I highly recommend getting board certified as an NP. State requirements for certification differ; be sure to find out what they are for the state where you’ll practice. The two certifying bodies are the ANCC and the American Association of Nurse Practitioners.

I suggest you study for the exam for 3 to 4 months, take a review class, and then take the exam shortly afterward. Putting off the exam only allows time for fear and selfdoubt to creep in. Also, stay in your current job until you take the exam so you’re not dealing with the additional stressor of a new work environment at the same time.

Choose the patient population

Part of transitioning to the NP role is finding your first position. Before starting your job hunt, decide which patient population you’d like to serve. This helps you focus your job search. For example, if you decide you want to work in a specialty area, such as cardiac, you can concentrate your networking on that specialty area.

Get your name out there

Stay in touch with the NPs or physicians with whom you completed your clinical hours. Even if their practice doesn’t need a new NP when your job hunt begins, they can help you get your name out there for other opportunities. Whatever you do, don’t take a job solely for the sake of practicing as an NP. That’s a path that’s likely to lead to dissatisfaction.


Evaluate potential employers carefully

When interviewing for a position, make sure to ask about job expectations, including patient load, how much time you’d have with each patient, and work hours. Also, make sure the services you’d be asked to provide align with your state’s nurse practice act. In addition, ask about administrative support (for such tasks as scheduling and paperwork) and clinical support (for assistance with complex patients you might need help managing).

One Canadian study examined the requirements for a successful transition to practicing as an NP. Sullivan-Bentz, et al recommend that primary healthcare practices employing new NPs ensure these NPs receive formal mentorship and support from physicians and NPs familiar with the role and that written resources and colleagues are available for consultation and support. Ideally, your new work setting should provide such resources.

Set realistic goals and expectations for yourself

Recognize that as a new NP, you’re a novice—again. Having unrealistic expectations of yourself can increase your anxiety as you transition to your new role. The “imposter phenomenon” can occur in new NPs. In this phenomenon, people feel they’re not qualified for their jobs and are duping their bosses into believing otherwise; they also fear they’ll be found out someday.

To counter such feelings, use self-reflection on a daily basis. Recognize that the learning curve for a new NP can be steep, just as it was with the transition from nursing student to RN. Selfreflection helps you focus on what you’re learning rather than on what you feel you don’t know or didn’t do correctly. You might want to keep a journal to record your reflections.

Remember that when you become an NP, you assume a new professional role. You’re now a primary care provider. Even though you may be a seasoned RN with years of experience, the NP’s provider role is new to you. Questioning your assumptions and actions is normal because you’re making different types of patient-care decisions than you’ve made in the past. This can be intimidating.

What you can learn from my experience

To demonstrate the above points, let me walk you through the barriers and challenges I faced in my first NP role. My first position was with a practice where I’d previously spent 5 months of clinical time. On my first day, I had 12 patients, which I found a bit overwhelming. After I voiced my difficulty dealing with such a high patient load, my schedule lightened up a little, giving me some time to look up clinical information I needed and finish my charting.

But by the third week, flu season was hitting hard. My daily schedule reached 25+ patients; in some instances, I was doubleand triple-booked. I continued to voice my concerns about the safety of such a high patient load and whether I could provide thorough care—especially in light of being a new NP.

Although I believed my schedule didn’t allow time to provide adequate care for complex patients, I did what I could to provide the best care under the circumstances.

To compound matters, two pediatricians in our practice decided they would no longer answer questions from or provide guidance to NPs. Now that we’d graduated, they said, we should know the answers. This lack of support caused feelings of inadequacy, self-doubt, and job dissatisfaction. I knew this wasn’t the way I’d envisioned practicing as an NP, so I left this position after just 10 months.

Currently, I work in a neurology practice. Although I continue to feel intimidated at times, I’m getting more support. My FNP training has been extremely useful, but a specialty requires much on-the-job learning and independent reading. I’m struggling a bit to handle this new role.

The value of time

Even in the best-case scenario, the transition to NP can be difficult. The best advice I can give is to realize that adjusting to a new role takes time. Give yourself that time to ease your anxiety and self-doubt. Setting realistic goals, having an employer with realistic expectations of you, and getting solid support from colleagues also can smooth the transition.

To address the issue of realistic expectations on a broader scale, educate the medical community about the NP role. Emphasize that we are not  physicians and can’t be expected to practice the same way as physicians. NP and physician roles have certain similarities—but distinct differences.

Find a collaborating physician willing to take the time to learn what an NP is and does, and be patient with yourself during the transition phase. These are the keys to your success as an individual practitioner—and to the success of NPs collectively.

Kimberly Poje is an FNP at the Brain Center of Hudson Valley in Newburgh, New York.

Selected references

Barnes H. Nurse practitioner role transition: a concept analysis. Nurs Forum. 2015;50(3):137-46.

Huffstutler SY, Varnell G. The imposter phenomenon in new nurse practitioner graduates. Topics Adv Pract Nurs eJournal. 2006;6(2).

Sullivan-Bentz M, Humbert J, Cragg B, et al. Supporting primary health care nurse practitioners’ transition to practice. Can Fam Physician. 2010;56(11):1176-82.

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