Author Elizabeth Moran, MSN, RN, CPNP-PC
Talk to any new advanced practice nurse (APRN) or Physician Assistant (PA) and you are sure to hear about the steep learning curve inherent to the first year in the role. Though some recent graduates may have mentally prepared for the difficulty to come, others find themselves shell-shocked by the gravity of this new responsibility. The career that everyone told them would be immensely fulfilling is instead stress-inducing and they find themselves up late every night charting from home.
An interview with a recent APRN graduate revealed some of her own deep introspection and helpful hints about how to survive—and avoid burnout—during this time of great transition. In this article, we’ll discuss questions to ask yourself while preparing for this new role and then provide 7 additional tips about transitioning, new responsibilities, knowledge and skills, the effect on peers/family, and dealing with the emotions of it all. We hope that these healthy reminders will help you to ride out any initial discomfort and recalibrate your balance so that you are reminded of why you chose to enter into this tremendous field after all.
Transitioning to your new APRN or PA role
Be honest with yourself from the start about any concerns you have regarding the transition to your new APRN or PA role. Consider: do I have the confidence to leave the RN role and start acting as an APRN? How can I learn basic patient care skills if I am a new PA? What are my knowledge gaps and how will I address these? Will I still feel the need to perform my nursing duties along with my APRN responsibilities, and how will that impact my workload? What concerns do I have about my patient load, and time management skills to both efficiently and effectively provide quality care?
New APRN & PA Role Effect on Peers and Family
How will my friends, family, and peers react to my new role? Will it have a negative or positive impact on my family in regards to my hours, stress, and free time? Will I enjoy downtime with them or be too exhausted to give them the time and energy they deserve? Those staying at the same workplace, but transitioning from the RN to APRN role may be wondering: will my nursing peers trust my judgment and follow the orders I wrote for patients? Will the other providers even view me as an APRN now? How will be in the practitioner role impact the strong relationships and bonds I’ve built with my nursing colleagues?
APRN and PA Role Responsibilities
Much of the discomfort for new APRN grads comes from the security of being an experienced RN, but lack of confidence, in large part due to lack of experience, in the role of an APRN. For PAs, you may experience the discomfort of limited prior patient care experience and feeling the need to ask a lot of basic questions about the ins and outs of healthcare. Both APRNs and PAs may be nervous, wondering: do I have the confidence and enough knowledge for others to follow my orders and judgment calls? Will I be able to round on my patients and remember everything that needs to be done? Many decisions need to be made regarding patient care—what if I miss something? Will I be able to delegate to RNs who may know some aspects of patient care more than me or who have become my close friends?
APRN and PA Orientation
Orientation is a process where the new APRN or PA learns the role, skills, and requirements of the job. It is equivalent to “on the job training” and most new graduates will have weeks to months of additional support and lighter patient loads before they are fully independent. It is typical to have doubts regarding this process. What if I don’t get along with my preceptor? Am I learning everything that I need to know at an acceptable pace, or am I acquiring the information and assimilating at a slow pace than expected and causing delays in revenue for the institution? There are so many new procedures that I need to learn—how much time will it take me to master them? Am I asking too many questions, or not enough? Am I proving worth their investment to take on a new graduate who requires training?
APRNs and PAs Do Not Do Shift Work
APRNs and PAs jobs are scheduled in shifts but you are not shift workers. You are providers and will not leave until you have finished the care and passed it to the next provider. Your scheduled hours (shift) can include work in the hospital setting on nights and weekends. You may be the sole provider or work with one other provider during those times. When evaluating a job where you will work nights and weekends, consider how you will adjust to night shift where you are singularly responsible? The new APRN we interviewed found it helpful that at her institution APRNs were not scheduled to be on with the new fellows until after 12 months in order to avoid two novice providers being on-call together. Many orientation programs schedule a separate orientation for night shifts after the day shift orientation is completed. The APRN and PA working at night usually have a larger patient load and will manage patients differently. APRNs and PAs, collectively called Advanced Practice Providers (APPs), are not shift workers in the traditional sense that they clock in and clock out; often they work beyond their scheduled shift lengths to meet unexpected patient care needs or to satisfy organizational or practice expectations.
Tips for the Novice Advanced Practice Provider
Find a Mentor
Mentorship is a process that is crucial for new APRNs and PAs during role transition; it is a relationship in which a more experienced or more knowledgeable person helps to guide a less experienced or less knowledgeable person. Mentoring involves a learning and developmental partnership between someone with vast experience and someone who wants to learn. The mentoring relationship is important for establishing the advanced practice role and for positive patient care outcomes. Thus, developing trust in a mentor is a key factor in successful role transition. Being mentored during the first year as a new APP helps to build skills and confidence in decision-making, which can increase productivity and job satisfaction along with career longevity. Of note, the ideal situation would be to have the same preceptor for the duration of one’s orientation, but with schedule conflicts, vacations, etc. this may not be possible. Regardless of the situation, be sure to identify one individual as your main preceptor and mentor—so be it your supervising physician or another APP that you trust and feel comfortable with. This person will be largely influential in your career progression.
APPs, unlike physicians, don’t typically have the opportunity to go through residency. If and when there is an APP residency program offered, it is usually only about one year in length, as opposed to the four years physicians complete in residency. Depending on their professional background prior to graduate school, some APPs are even novice to patient care. Novice APPs can start working soon after they pass the national board certification exam and the typical APRN orientation lasts only about 12 weeks. Melnic recommends closely evaluating the orientation process for any new job opportunity. Melnic suggests being willing to ask for more time or support, or to decline an opportunity if the level of support is not sufficient to meet your needs.
Finding a mentor to help guide and answer questions is vital for the new APRN or PA, and helps insure both personal and professional growth.
Look for Full Scope of Practice
The new APRN and PA should choose an organization that understands the role of the advanced practice provider and has hired APPs before. This will make for a smoother integration into the clinical setting if the employer has a clear understanding of the APRN and the PA profession. Otherwise, role confusion can take place and the new APP may be performing RN, resident, medical assistant, or scribe duties and as such, not performing to the full scope of his or her practice. A supportive and understanding environment is crucial since the first year of practice is truly about learning, growing, and caring for patients.
APRNs and PAs, Look for Roles with Learning Opportunities
Review your patients ahead of time, if possible. Have references at hand and know your resources. Be organized: carry a “cheat sheet” or note cards of handy protocols, standards of care, algorithms, formulas, etc. to help make role assimilation easier. Understand that some self-teaching and self-study will be necessary. If there is anything you see in your day that you did not know, plan to look it up that day in order to stay on top of your education and training. Many organizations also provide opportunities for learning. Attend lectures, educational rounds, simulations, journal clubs, and other opportunities to grow in your didactic and procedural education.
Make time for yourself: you are your most important patient. De-stress when able to. Take a yoga class, go for a run, or relax and treat yourself to a massage when you have the day off. Meditation can provide clarity, calm, and peaceful state. Melnic has found two apps to be helpful: Headspace and Insight Timer. Whatever your hobby, do it. Reflecting on all the skills you have learned and the new qualifications acquired is important, but so is enjoying time outside of work. Remember that you don’t need to be married to your job to be good at it.
Remember Why You Chose the APRN and PA Role
Remember your reason for choosing the advanced practice role. Whether it be for professional development, knowledge, or personal achievement, make sure you own it. Write down your reasoning for joining this profession, keep it with you during the day, and go back to it when the going gets tough.
- Prevent Burnout
Have a variety of interests. Get involved with other areas of healthcare such as research, technology, policy, and/or leadership activities. Don’t be limited to just
patient care. Many organizations provide protected time. This is the time to engage in research, quality projects or education providing an opportunity for you to contribute to the organization and provides the organization a higher return on their investment in you. See the Melnic Salary Survey for all the additional benefits your peers receive. Advocate for yourself before you accept a job and be honest if your workload becomes too much. Be honest with your employer about how much additional time you spend working from home. Work together to find a solution that works for you and your employer. Use your vacation time—all of it! Make time for the things, and the ones you love.
- Become Involved with a Professional Organization
Becoming involved with professional organizations such as the American Association of Nurse Practitioners, the American Academy of PAs, and/or specialty organizations and local chapters can offer networking, CEUs, mentorship, and professional advocates. It can also mitigate anxiety to meet others dealing with the same new role process, and those who have overcome their “newness” and become knowledgeable, confident APRNs and Physician Assistants.
The new APRN and PA role can be scary, but it can also be immensely rewarding if you let it. Once confidence is achieved and more experience is obtained, the novice will transform into an expert, but the best and brightest APRNs and Physician Assistants will never stop learning. Visit Melnic’s Learning Center.