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I had worked in this facility as a pediatric ICU RN for 17 years prior to returning to school. Most of my coleagues thought I was crazy @ 53 to return to school. I chose to stay in the hospital setting but thought it was not in my best interest to work directly with the staff members that were previously peers. I stepped into a newly created position with the ER staff to see only the pediatric patients. Within the last two years the program has expanded to include seven pediatric ER/ICU physicians, myself and two PA's and continues to expand currently. The first few weeks were difficult as the MD's truly did not know what my role was;and perhaps I did not either. I think the most difficult part of the transition has to be the mindset change that has to happen. I found that I felt guilt when it was obvious that the nursing staff needed help and often tried to do my job and theirs as well. One physician said to me that I 'must stop thinking/acting like a nurse and start thinking/acting like a physician'. I sat down and thought seriously about his words. I still don't agree entirely with those words and believe that I am and always will be a nurse and believe that this is an asset not a deficiency. I am not a physician although I see the patients equally with them. I am now better at establishing boundaries. I have since found a happy medium between the two roles. It took a period of time to settle into what I believed my role to be and establish a good balance in the relationships between myself and the medical and nursing staff. I have developed a greater understand and ability to interact with the political arena that medicine provides. I have also established my role within my own mind and the nursing staff. This didn't happen over night as the nursing staff originally wanted to prove that they were better at the job than I was. I now believe that I have the best of all worlds. I have established in my own mind that I can do this job and know what my limits are. I have established a balance with and acceptance from the physicians and they now believe that my nursing background can be of great benefit with some patients; particularly in the education component. I have established a balance with the nursing staff where they now trust my judgement and we have created a team concept. This has taken some time and effort on all our parts. I think that any new grad must come out with a 'can do' attitude and trust their own skills and judgement. The stress level within the first year is very high; and I believe that it is very important to balance one's life with other positives to counteract the high level of stress. It is now very rewarding to feel as though I am an integral part of the program and that I have established strong relationships with my patients.
Andrea Storrie CPNP
Pediatric Emergency Room
Healthpark Medical Center
Fort Myers, Florida

Andrea Storrie,  CPNP,  Healthpark Medical CenterSeptember 24, 2008
Fort Myers, FL


I was lucky to have been accepted by the Emory University Nurse Practitioner program that was run through the Emory School of Medicine. I was lucky to have precepted at the St Louis County Public Health Department for 5 months.

I was not so lucky at securing a job immediately after graduation as the positions available for NP's in St Louis were not only full, but few in number.

However, a FEMA-supported position opened up during the flood in the Midwest in '93 and a friend of mine was the medical director of that clinic--and he hired me as the NP.

I went in there the first day with a confidence that only Emory could have given me after working at Grady Hospital while in school and the public health experience of preceptorship.

There was no one else but me there to take care of these displaced people--and I found some inner confidence I never knew I had.

It was the greatest experience anyone could have had--scared to death that first day, confident as heck, and lived to this day to tell the story.

Thank you for giving me the chance to re-live it.

Susan September 23, 2008

My first day on the job as an NP was bizarre.

First, I was told that I would be leading a team of nurses and case managers but only from a clinical perspective. It turned out that I had to be their administrative manager, too, which I (still) do not want to do. Then I found out that the other advanced practice nurse who started the same day was told that she was hired for my job. Our HR department did not even realize that they hired both of us for the same position. And she didn't have an office. Then my 'collaborating physician' had no idea about Ohio's law requiring a "standard care agreement" between us, so I had to do some educating. That was just the first day. It was unbelievable and quite difficult. I didn't start seeing patients for nearly two weeks until we could iron out all of the details. [sigh]

But now, I wouldn't trade my job for almost anything. I love the patients and most of the people I work for. And the administrative task has been reassigned to another person. So, I'm doing exactly what I want to do now.

John Chovan,  CNP,  North Central Community Mental Health Services, InSeptember 23, 2008
Columbus, OH

My first day as an NP was scary and my fears were realized. The first patient I examined had a breast lump which turned out to be malignant. At the time I was terrified to tell her what I had found. She took it well and had curative surgery. In retrospect, I may have saved her life so any anxiety I experienced was worth it.
I was luck to have gotten this NP position. I was in this particular primary care office as a student so I felt pretty prepared. I also must say my NP program was excellent and the faculty(practicing NP's) gave me a lot of support.

catherine sullivan,  ANP- BC,GNP-BC,  Island Nursing and Rehab CenterSeptember 09, 2008
Holtsville, NY

I was very disappointed with the training I got while studying for my BSN program over 36 years ago. The program was the brainchild of a misguided Nursing professional that had lead many of us astray in search of her dream. She was eventually replaced and pushed into an honorary position of Dean Emeritus for the program, but the rest of us had to deal with her mistakes almost daily, and I swore I would never subject myself to that kind of misguided leadership again.

Twenty-three years later, I saw where staff nursing in the ER was going, so I went into a part-time ARNP Master’s program. Five years later, I finally got out of that morass, and had an ARNP after my name. I had already confronted one of my instructors as to how poorly we were being prepared for the duties that would be expected of us as ARNP's.

She confided in me that the dirty little secret in ARNP programs is that about 20% of the people who go through ARNP training never have the courage to work as an ARNP after they graduate. I have never formally confirmed that figure, but I can say that there is a gut sensation that it is true. I was so poorly prepared for my first day on the job that I remember how nervous I was when I was faced with sick people who would be depending on me to service them properly.

I must say that 20 years in the ER and 2 more as a paramedic, and 5 years teaching medical students full time ACLS and Trauma Life Support Gave me the confidence to step out and do my best. I have made mistakes, but none of them as bad as I might have thought would happen. Nothing much came from my training to be really frank, but almost all of it came from years as a nurse, taking my knowledge seriously and performing as was to be expected.

The whole program needs to be revamped nationally. The push for theory and research is a field unto its own, and does not need to be pushed as heavily as it was pushed in my particular program. In my opinion, it is based on a certain insecurity that is rampant in the nursing education leadership today. I my self was involved in Paramedic education, and I know what works and what doesn't.

There is a practicality that must be at the heart of anything medical. My local medical school here has become more practical in their approach to student preparation. Even the testing of medical students and their ability to interact with patients is being mandated nationally. My son is a product of that medical school and he speaks of how much further he was simply then most of his peers simply because he had obtained so much more practical training while a ER tech during his initial College years.

I survived my first day on the job as a nurse practitioner, and I am learning new things every day. I see my medical colleagues, as not much better off then I am as medicine is an art as well as a science. Nothing can truly prepare you to just step onto the stage and perform at maximum capacity. However, the effort should be there to make it so much easier to accomplish then it seems to be currently.

Ronald Wohl,  ARNP,  Local County JailSeptember 01, 2008
Gainesville, FL

Due to licensing rules in California & my need for a job, I worked for about 5 mos as an RN after I finished my NP program. Finally, on the first Monday in December (I graduated in May), I began seeing patients as an NP at Planned Parenthood. Despite training at a Planned Parenthood in another state and having done hundreds of pap smears before, I still felt like I had three trembling hands and didn't quite know what to do with them all. I suppose the nerves came from not having touched a patient (exam-wise) for over six months - but thankfully that faded fast.

Kristel  Dumas ,  Clinician,  Planned ParenthoodAugust 18, 2008
Redondo Beach , CA

My first NP position was in a busy urban Emergency Department. I was fortunate enough to have some clinical training as a student and was taught how to suture early. My very first day as an NP in the ED a gentlemen was brought in with multiple large and deep lacerations to one of his lower extremities from a circular saw. The collaborating physician felt I was ready. Well, I rose to the occasion, suturing everything once I debrided and cleaned his wounds thoroughly However, it took me 1 1/2 hours! Luckily he was very patient and the lidocaine worked well. I was so exhausted and I've never had such an enormous task since.

Pamela Horn,  CNP,  Nationwide Children HospitalAugust 12, 2008
Columbus, OH

currently working in hospital setting. considering different setting

betty alexander,  arnpAugust 03, 2008
glasgow, KY


     

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