If you're having a few doubts about your life choices as you graduate from your NP program, ADVANCE for Nurse Practitioners is here to tell you, "Relax. You made the right choice."

It seems that NPs love being NPs. Data from the most recent National Salary and Workplace Survey of Nurse Practitioners show that 89% of practicing NPs are satisfied with their careers, and 49% report they are very satisfied. (Read the complete survey.)

And when we asked our editorial board members what, with hindsight, they would have done differently in their careers, they all said, "Not a thing." Well, one said she'd have become a nurse practitioner sooner!

What follows is their best advice for new NPs.

Finding a Good Job

Mary Margaret Gottesman, pediatric NP
Associate professor, Ohio State University, Columbus
Appreciate that nursing is both a profession and a career, not simply a job. Most of us work for many years of our lives and many hours most days of the week. When it comes time for graduate study and becoming a nurse practitioner, your specialty should reflect your passion in nursing. Too often I hear potential [NP program] applicants ask which specialty's graduates earn the most money. . We need to choose our education with our hearts as well as our heads.

Barbara Resnick, gerontologic NP
Associate professor, University of Maryland, Baltimore
I am a gerontologic NP, and in my state I can provide care only for patients 55 and older. Sometimes you don't know where life will take you, but if you have a mental health interest, don't go into an adult NP program because you won't be able to provide mental health services exclusively in some states. Bottom line: Get to know the scope-related issues in your state before you graduate.

Michael Zychowicz, adult NP
Orthopedics and Sports Medicine, New Windsor, N.Y.
Associate professor, Mount Saint Mary College, Newburgh, N.Y.
Never underestimate your value, economic or otherwise, to a practice. Negotiate and keep track of your worth in your practice setting. You may find additional value in your position by specializing in a niche set of patients within your practice. 

Andrew Craig, family NP
University of North Carolina Student Health Center, Charlotte
Don't expect to get a nurse practitioner job as easily as you did as an RN. There may be a nursing shortage, but there's not an NP shortage! Start developing contacts and looking early on. . Know the applicable laws and rules pertaining to your practice. Don't be a party to something illegal out of ignorance - for example, billing "incident to" when the physician isn't actually on the premises, etc.

Clair Kaplan, women's health NP
Assistant professor, Yale University, New Haven, Conn.
When negotiating for a job, find out how much and what kinds of support and back-up you will have for questions and consultation. . It is hard to not want to go for the job with the biggest salary, but in the long run, having the most support as a new NP is more important than maximizing the money.

Roger Green, family NP
Primary care consultant, Palm Springs, Calif.
Request that you shadow for a full day in the practice you intend to work for.  You can learn a great deal about how the practice treats NPs, patients and staff by observing for the day. You can also have an opportunity to see how the clinicians practice: Do they follow evidence-based standards? Do they give antibiotics to everyone who asks for them? 

Victoria Weill, pediatric NP
North Penn VNA Children's Clinic, Lansdale, Pa.
Associate NP program director, University of Pennsylvania, Philadelphia
In a perfect world you would work with other providers who would be willing to pull you into a room when they see "something neat," be willing to take time at the end of the day to discuss how you handle cases, and on occasion be willing to stop their patient flow to immediately consult with you about a perplexing patient. For your first job, try to choose a practice that has had an NP in the past.

Deborah Swenson, women's health NP
Perinatal Associates and OBSTETRIX Medical Group or Washington, Seattle
Don't jump at the first job that comes along unless you have that "ah ha moment" when you're interviewing. You'll know in your heart if it's the right position.  

Relating to Patients

Clair Kaplan, women's health NP
Assistant professor, Yale University, New Haven, Conn.
Keep a journal about what you learn (often about yourself) in particularly challenging patient interactions. You will find that unless you are partnered or live with another medical professional, there may not be so many people in your life who will listen attentively to all your stories. You need an outlet and can learn a great deal when you take time, perhaps a year down the road, to read back in your journal.

Mary Margaret Gottesman, pediatric NP
Associate professor, Ohio State University, Columbus
Make sure to learn as much about managing mental health and social problems and how to create effective partnerships with others as you do about managing physical illnesses.  ... I try to instill in my students that if I have only cared for the child, I have only cared for half my patient; and if I have only cared for the child's physical health, I have only met half or less of the child's health needs.

Laurel Halloran, family nurse practitioner
Danbury Hospital, Danbury, Conn.
Professor, Western Connecticut State University, Danbury
Remember those qualities in yourself that made you choose to be a nurse in the first place, and use those in your practice. Recently, I saw a patient who came in for her annual asthma visit. She said to me, "Last year I was coping very badly because I was having family problems, and my asthma was in bad control. When I got upset and started to cry, you just came and put an arm around me and let me be upset for a while and cry - and then we figured out what to do. That really helped me. I didn't have to feel embarrassed, and I know I couldn't have done that with one of the doctors." Remember the caring elements inherent in the role of nurse practitioner. 

Lynn Chilton, family and gerontologic NP
Professor, University of South Alabama, Mobile
Always ask if there is anything else that they would like to talk to you about.  Many times patients will come in with a minor complaint, but the real problem is depression, an STD, or some other condition that they may be afraid to talk about without encouragement. 

Victoria Weill, pediatric NP
North Penn VNA Children's Clinic, Lansdale, Pa.
Associate NP program director, University of Pennsylvania, Philadelphia
Work hard to sell yourself to new patients. Start off with a good bio to post in the waiting and exam rooms; emphasize your strengths and set a positive tone. I have seen savvy patients accept an appointment with the newly hired NP because other providers schedules were full, knowing full well that they are going to see the NP and then get into the office and demand to "see the doctor." . I personally have been able to say to the family, "Give me a chance. Let me do the visit, and if you still have concerns we can bring in the doctor." I've tried to wow them and then at the end even had the guts to say, "So how did I do?" Some diehards will never switch, but I have won over some families that way.  

Michael Zychowicz, adult NP
Orthopedics and Sports Medicine, New Windsor, N.Y.
Associate professor, Mount Saint Mary College, Newburgh, N.Y.
Remember that it is the patient's body and mind you are treating. I used to get very frustrated with patients when they wouldn't do what I prescribed for them to do. You can be persistent and educate them, persuade them and help them to make the best health choices, but you can't force them to do something they don't want to do to their body. By understanding their beliefs, fears, desires and goals, you can attempt to collaborate with patients in their health care. 

Relating to Colleagues

Barbara Resnick, gerontologic NP
Associate professor, University of Maryland, Baltimore
New NPs should start in positions in which they will have a team to work with.  They will have access to the clinical expertise of physicians and other nurse practitioners in an environment in which they feel comfortable to ask questions. But, I would strongly recommend not taking a position as an NP in a facility in which you have previously worked as a nurse. Others may have a harder time than you with role changes and may ask you to do your previous activities as per your RN role. With patients, be honest and open that you are the NP, not the physician, but that you work closely with your collaborating physician or others. This is a good thing, not something to be ashamed of. 

Deborah Swenson, women's health NP
Perinatal Associates and OBSTETRIX Medical Group or Washington, Seattle
Be respectful of your coworkers, and be willing to share your advanced knowledge with coworkers and RNs. 

Michael Zychowicz, adult NP
Orthopedics and Sports Medicine, New Windsor, N.Y.
Associate professor, Mount Saint Mary College, Newburgh, N.Y.
Never be afraid to say that you don't know something.  Never be afraid to ask another provider for advice or assistance or to simply refer a patient. Don't expect to know everything, and never hesitate to go to a reference book if you are unsure of something. 

Victoria Weill, pediatric NP
North Penn VNA Children's Clinic, Lansdale, Pa.
Associate NP program director, University of Pennsylvania, Philadelphia
Reception, nursing and support staff are your greatest allies. Make sure they know what you can do and what kinds of patients you would like to see. They can make or break you.  I have heard receptionists say things like "the doctor is booked, but if you are really desperate you can see the NP." On the flip side, a more positive "She's great, I know you will like her" from a respected staff member goes a long way to assure a potential new patient. 

Finding Support

Roger Green, family NP
Primary care consultant, Palm Springs, Calif.
Find a mentor who you can trust and seek guidance from about preparing a resume, negotiating a contract, securing malpractice insurance, and being politically involved. This mentor does not have to necessarily be someone you work with, but someone perhaps in the community who is well seasoned and someone who is respected by his or her peers. 

MJ Henderson, gerontologic NP
Rheumatology associates, Providence, R.I.
Always maintain a network of colleagues and friends for support. The best way to do this is through active membership in the NP professional associations. 

KC Arnold, adult nurse practitioner
Owner, The Diabetes Center, Ocean Springs, Miss.
Networking is key: Get your name out there and network with people.  Prioritize your association with NP colleagues, pharmaceutical representatives, and other health care providers at any possible opportunity. Attend continuing education meetings, teleconferences and web seminars.  The topic of an educational opportunity might not seem exciting, but connecting with other providers and keeping up with the local medical and nursing community is the goal. 

Victoria Weill, pediatric NP
North Penn VNA Children's Clinic, Lansdale, Pa.
Associate NP program director, University of Pennsylvania, Philadelphia
Create a network of support outside the workplace. Your former classmates are now your colleagues; don't lose them as a resource . They know what you are going through, they understand when you want to cry, "You won't believe what I did today." They can answer "how do you handle X?" Make sure to attend local NP group meetings at least once a year. 

Michael Zychowicz, adult NP
Orthopedics and Sports Medicine, New Windsor, N.Y.
Associate professor, Mount Saint Mary College, Newburgh, N.Y.
Join your state and national NP organizations. Not only do they support our profession and legislative advancement, but by being a member, you have a group of professionals among whom you can find a mentor to help you grow professionally. I still find great benefit in having a group of seasoned professionals that I can turn to about career advice, legislative or medicolegal questions and patient problems. 

Your Place in Health Care

Mary Muscari, pediatric nurse practitioner
Professor and director of forensics, Binghamton University, Binghamton, N.Y.
Follow your passion. If you do, you'll find that you'll love your job and work well with patients and staff.  It may sound simplistic, but if you choose a career path based on financial reward or convenience and void of passion, you'll find yourself always wondering where you went wrong. 

Laurel Halloran, family nurse practitioner
Danbury Hospital, Danbury, Conn.
Professor, Western Connecticut State University, Danbury
Your career is a journey and not a destination reached at graduation! You will not know everything when you graduate from your NP program. Hopefully, you will learn new things everyday and be faced with new challenges. Enjoy collaborating with colleagues, and don't feel that you have to be the expert on everything. 

Sandra Ryan, pediatric nurse practitioner
Chief Nurse Practitioner Officer, Take Care Health Systems
As a new nurse practitioner graduate, you are a leader and an invaluable element of the health care system. We are in a moment in history when there is more visibility for the role of the NP and the incredible benefits an NP provides the health care industry and patients. Never stop caring, never stop believing, and find your passion and follow it. Be present, be enthusiastic, and make a difference!