Journal of Gerontological Nursing

Guest Editorial 

The Top 10 Things They Didn’t Tell You in Nursing School

Brenda Hoskins, DNP, ARNP, GNP-BC

Abstract

Congratulations! You are a new nurse practitioner. Welcome to a very exciting time in your life and your professional career. Graduation and boards are behind you, and you are standing at the doorway of a brand new role. What do you need to know that may not have been included in your curriculum?

Your first job will not necessarily be your last. You may wish to pursue a position that is well structured within an organization for your first job. Depending on your locale, you may decide to hang out a shingle and open your own practice. You may begin as an employee, a partner, or as an owner of your practice. Know that wherever you choose to begin, it most likely will not be where you will finish. Nursing is a profession with opportunities that are limited only by your imagination.

Confidence in your abilities as a provider does not come with the diploma. Everyone experiences those feelings of inadequacies and self-doubt at the beginning of advanced practice. Suddenly, you are the one who is performing the assessments, interpreting the data, and making important decisions about your clients’ health care. Know that you are not alone in these feelings and that they will plague you less and less as you gain experience. After awhile, you will start to recognize the patterns of signs and symptoms in your patient population much more quickly.

You need to decide what your core values are. There will come a time when you will need to make important decisions about ethics and treatment. These may be relatively benign decisions or very significant ones. It is helpful to decide where you stand before you even begin. For example, will you give an antibiotic medication to a patient just because he or she demands it?

Night terrors are normal. Nighttime is when your brain decides to torture you. Did I write the correct strength on that prescription for that patient? Did I make the right call on that diagnosis? Everyone experiences night terrors to some degree. Questioning ourselves as providers and reexamining our clinical practice is what makes us safe and effective providers. However, try to participate in peer review, practice according to evidence, and get some sleep.

It is OK to rely on your colleagues. This is called mentoring. You are not bothering your colleagues and collaborators because you want to review a case or ask a question. Someday, it will be your turn to mentor someone else. The only stupid question is the one that goes unasked.

No one will be standing in line to hire you (unless you are really fortunate!). In this environment of unnecessary turf wars and perceived oversaturation of providers, you may not have a list of positions from which to choose when you finish school. Do not be afraid to create your own opportunities! A major skill advanced practice nurses have is the ability to assess the environment. Use this skill to determine where the need is and propose your services as a solution.

Business skills are crucial. You will need to be knowledgeable in contract negotiation, employment law, and finances. How will you be compensated? Will you receive a bonus in addition to your salary, and how will this be determined? How will your presence financially benefit the practice you join? One other thing—never sign a contract that contains a “covenant not to compete” clause. If you ever decide to leave, this will seriously affect your opportunities.

Keep an idea file. This file could contain clinical “pearls” learned along the way, ideas for an entrepreneurial activity, or topics…

Congratulations! You are a new nurse practitioner. Welcome to a very exciting time in your life and your professional career. Graduation and boards are behind you, and you are standing at the doorway of a brand new role. What do you need to know that may not have been included in your curriculum?

10

Your first job will not necessarily be your last. You may wish to pursue a position that is well structured within an organization for your first job. Depending on your locale, you may decide to hang out a shingle and open your own practice. You may begin as an employee, a partner, or as an owner of your practice. Know that wherever you choose to begin, it most likely will not be where you will finish. Nursing is a profession with opportunities that are limited only by your imagination.

9

Confidence in your abilities as a provider does not come with the diploma. Everyone experiences those feelings of inadequacies and self-doubt at the beginning of advanced practice. Suddenly, you are the one who is performing the assessments, interpreting the data, and making important decisions about your clients’ health care. Know that you are not alone in these feelings and that they will plague you less and less as you gain experience. After awhile, you will start to recognize the patterns of signs and symptoms in your patient population much more quickly.

8

You need to decide what your core values are. There will come a time when you will need to make important decisions about ethics and treatment. These may be relatively benign decisions or very significant ones. It is helpful to decide where you stand before you even begin. For example, will you give an antibiotic medication to a patient just because he or she demands it?

7

Night terrors are normal. Nighttime is when your brain decides to torture you. Did I write the correct strength on that prescription for that patient? Did I make the right call on that diagnosis? Everyone experiences night terrors to some degree. Questioning ourselves as providers and reexamining our clinical practice is what makes us safe and effective providers. However, try to participate in peer review, practice according to evidence, and get some sleep.

6

It is OK to rely on your colleagues. This is called mentoring. You are not bothering your colleagues and collaborators because you want to review a case or ask a question. Someday, it will be your turn to mentor someone else. The only stupid question is the one that goes unasked.

5

No one will be standing in line to hire you (unless you are really fortunate!). In this environment of unnecessary turf wars and perceived oversaturation of providers, you may not have a list of positions from which to choose when you finish school. Do not be afraid to create your own opportunities! A major skill advanced practice nurses have is the ability to assess the environment. Use this skill to determine where the need is and propose your services as a solution.

4

Business skills are crucial. You will need to be knowledgeable in contract negotiation, employment law, and finances. How will you be compensated? Will you receive a bonus in addition to your salary, and how will this be determined? How will your presence financially benefit the practice you join? One other thing—never sign a contract that contains a “covenant not to compete” clause. If you ever decide to leave, this will seriously affect your opportunities.

3

Keep an idea file. This file could contain clinical “pearls” learned along the way, ideas for an entrepreneurial activity, or topics for a clinical article or research study. Do not trust your memory; write it down.

2

It is essential to belong to your professional organization. I sincerely hope this point does not really need to be in the top 10. Organizations provide crucial support for your profession, including continuing education, networking opportunities, clinical information, participation in national standards and guidelines, and legislative activity that protects your right to practice. Join and participate. It is everyone’s responsibility.

1

Learning does not stop when school is out. Learning does not simply refer to the need for continuing education. There are many informal learning opportunities from which you will benefit greatly. As a geriatric nurse practitioner, I find that I learn most significantly from my patients. These are individuals who have lived through events I have only read about. Cultivate your desire to learn; feed it, and you will not only stay clinically relevant but will grow as a person as well.

The beginning of any new stage in a person’s life is at once exciting and terrifying. Try to balance the two as you launch your new career. Sincere congratulations to all new advanced practice nurses and welcome to our new colleagues!

Brenda Hoskins, DNP, ARNP,
GNP-BC
Assistant Professor, Clinical
The University of Iowa
College of Nursing
Iowa City, Iowa

10.3928/00989134-20080901-04

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