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Ep #87: Graduating Nurse Practitioner School: What We Wish We’d Known with Anna

SMNP Blog - Ep #87: Graduating Nurse Practitioner School: What We Wish We’d Known with Anna

I’m back this week with the one and only Anna! With graduation season upon us, we’re here to engage in a conversation about the things we wish we had known before graduating from Nurse Practitioner school.

We understand that many of you listening right now are either in the midst of graduation or on the verge of completing your studies. If this is you, we’re hoping to give you a little boost and head start by sharing some of the most valuable lessons we learned about boards and the job search process when we were in your shoes.

Join Anna and me on this episode as we offer some of the things we wish we had known about boards before graduating, our insights on why perfecting your exam isn’t necessary, the importance of networking, and our top advice for anyone seeking their first Nurse Practitioner job.

 

If you’re looking for support, no matter what phase of your nurse practitioner journey you’re currently in, I have communities available for both students and new nurse practitioners. In these communities, we work to uplift one another and grow this profession together every day, so click here to check them out!

What You Will Discover:

  • What we wish we had known about boards before we graduated.
  • The only exception where taking both board exams might be a good idea.
  • What we wish we had known before we started looking for our first Nurse Practitioner jobs.
  • Why networking is vital, even if you don’t think you need it.
  • Our advice as it relates to your first NP job.

Featured on the Show:

Full Episode Transcript:

Welcome to Becoming a Stress-Free Nurse Practitioner, a show for new NPs and students that want to pass their board exam the first time and make that transition from RN to NP as seamless as possible. I’m your host Sarah Michelle. Now, let’s dive into today’s episode. Sarah: Hey, everyone, it is Sarah Michelle and Anna again. And we are here today to have a conversation about some things that we wish we had known when we were graduating nurse practitioner school.  So I know a lot of you out there listening right now are in the midst of graduation or you’re about to graduate, because it is the big May time graduation season. We’re about to have Nurses Week, which is one of the biggest NP graduation weeks of the entire year.  So we really want to give you guys a head start ahead of where we were when we were in your shoes. And so we’re going to talk about a couple of different things. We’re first going to start with some things we wish we had known about boards before we graduated. And then we’ll kind of transition and talk about some things that we wish we had known before we were looking at those first NP jobs.  So, Anna, does that sound good to you?  Anna: Yeah, that sounds great.  Sarah: Do you want to start us off with something that you wish you had known board-wise before you graduated?  Anna: Yeah, I literally remember I was in one of my very last clinical rotations. I remember sitting down after clinicals and being like, “What’s this whole board exam thing? What are my options? Why do I have two different boards I can sign up for? My school has not given me this guidance.”  And I remember trying to choose between AANP and ANCC and having so much anxiety about making the right decision. And so I wish I had known that it really doesn’t matter. There really is no wrong decision. You can truly choose either or and be okay. And I chose one and I emailed my program director asking for my verification of education form. And I literally remember him telling me, “And I recommend taking the other exam.” And I was like, “Well, why?”  Never got a response to that email. Never got a reason why, nothing. And you all like, I’m here to tell you it does not matter. You are truly going to be a real deal nurse practitioner no matter which one you pick.  Sarah: Well, can we just stop and appreciate the fact that it is so bizarre that there are two options in the first place?  Anna: Yes, it is just ultra confusion, especially now that renewal requirements are a little similar.  Sarah: Very similar.  Anna: Yeah. And so at least then, when they weren’t so similar, it kind of sort of made sense. But now, it just provides so much more confusion than is necessary.  Sarah: Yeah, I feel like we get so many students, and I think I was a student as well at least at one point in time, thinking you have to take both. Because why would there be two options unless you had to take both to be certified? And I remember the confusion, too.  A question that we get often from students, and a question that I asked my program director about AANP versus ANCC, because at the time I had my ANCC rescheduled like 55 times over and it was completely and entirely miserable. So I signed up for AANP as a backup. And I was going to schedule it, but I asked her, I was like, “So if I were to fail one of these exams, does it affect the other? If I pass one and fail the other, does that negate?” But no, they are entirely separate, which is also bizarre in its own way.  Anna: Super, super bizarre. But that does bring me to another good point I do wish I had known, there really is no benefit to taking both.  Sarah: That’s a great point.  Anna: So you do not have to take and pass both of these exams. It is not going to make any difference whatsoever. It is just going to be one more certification that you then have to keep up with and renew and worry about. And so, yes, I know, Sarah, you and I have both taken and passed both exams, but that is for a very specific reason as we’re teaching to these exams.  But for 99.9% of you, there is really no true benefit in taking and passing both exams. So do not add more stress onto yourself than you have to.  Sarah: Unless you’re out there running a board preparation company where you want to just literally experience both exams so that way you can know what other students are going through, 1,000% do not suggest taking both.  Now, I will say there is one caveat there, that if you are a super anxious student with a job lined up, I think that’s really the one exception because then if you struggle with one, you still have the other as backup and you don’t have to go through this long application process and it really just speeds things up. But I mean, it’s a lot of money to spend to take both exams, when literally even if you pass both, you can’t submit that to your state.  So I passed ANCC first and then I passed AANP. And so I went to send my AANP pass to the state of Kentucky, their Board of Nursing. They’re like, “Well, we’ve already got ANCC, we’re not even going to accept your AANP certification.” And most states are that way.  Anna: They are. And it’s truly okay, like if you do want to have that backup plan and that gives you some security, then by all means, I totally understand that. I get that. And I think had I had a job lined up, I would have been really nervous about passing. I know I was in a little bit of a unique situation, about to move and have a baby and go on maternity leave. And so I kind of waited to start my job hunt for a little bit.  But that is, I would say, the one exception. Other than that, y’all, do not worry about taking and passing both.  Sarah: Don’t make yourself miserable.  Anna: Yeah, do not make yourself more miserable than it already is with all this influx of new stuff. You’re graduating, you’re looking for a job, you’re taking your boards.  But also, I wish I had known, while we’re speaking of passing exams, that you don’t need 100% to pass. And I know if you’ve taken our courses, you have heard us say this. But you don’t have to know everything. You don’t have to know everything for the exam, you don’t have to know everything as a new provider. You’re never going to know everything.  Sarah: And nowhere even close. People are blown away when I’m like, the number is actually closer to 70%. On one of the exams it’s closer to 60%, and on the other exam it’s closer to 70%. But when you think about a 150 or 175 question exam, that gives you so much leeway, especially if you compound upon that thought and think about, well, there are trial questions that don’t even count.  So there’s a lot of opportunity to not be perfect on this exam and still pass because at the end of the day what the exam wants to decide is if you are going to be a competent and safe novice nurse practitioner. I wish I had known this exam is geared at novices. People who are entering into practice, people who are newbies. They are educated, but they are newbies.  And so it really just wants to understand, okay, is this person going to be safe to practice on their own? If so, okay, they pass. And if not, they need to try again.  Anna: Yeah, really it does not get into the nitty gritty like I thought it would of all of these specific conditions.  Sarah: No.  Anna: I would get so lost in heart murmurs, you all, like all the rabbit holes of heart murmurs. And when I actually took the exams, I realized this is making sure I know very basic, safe information to take care of patients. And then if I need to know all those nitty gritty details about whatever condition it is for my specific job, I’m going to learn that on the job.  Sarah: Yeah, that was definitely COPD and asthma for me. It’s funny now looking back, I love teaching COPD now. It makes so much sense in my brain, I’m like, you treat it with this, this and this. But when you’re a student, and all the information is just circling around, but then you get to the exam, and it’s like, “Oh, this was one question.” Why did I spend all this time stressing? Anna: Yeah, COPD is a great example. Do not go reading all 30 plus pages of the pocket book of the gold guidelines.  Sarah: No, do not do that.  Anna: Yeah, do not do it. I promise, it is information overload.  Sarah: And then if you want to be in pulmonology someday, you can deep dive into that, you can get really excited about it. But most of you are not going to do that. Especially I mean, we’re primary care focused, so a lot of you are going to end up in offices and urgent cares and more generalized areas too. Not all of us, but most of us.  Anna: Yeah, a lot of us are. But I want to point out, too, even if you are going into pulmonology, don’t stress about having to memorize all of those guidelines. That is information that you have readily available to you on the job. Those are resources you can use and read every single day. And so it’s not something they expect you to have memorized on the exam.  Sarah: Yeah, I tell students the same thing about drug dosages. I’m like, there are only a handful of drugs that you should know the dosage of. Other than that it is 1,000% look up information every single time. I mean, we are in 2023, you have the internet readily available at your fingertips on your phone at literally all moments.  Anna: Yes. And the exams are going to recognize those resources that you have available and encourage you to use in practice.  Sarah: Absolutely.  So to transition away from what we wish we knew about boards, because I feel like we talk about that a lot on this podcast in various ways. I now kind of want to talk about some things that I wish that we had known before looking at those first NP jobs.  And I think one of the biggest ones that stands out to me right away is that there are plenty of jobs available. Everyone on these social media forums is going to scare you and be like, “There are no jobs, there are no jobs.” You just have to be really effective and efficient in how you look for jobs.  And if you are applying to a generic LinkedIn post where 1,000 other people are applying, yes, it can feel like there are no jobs. But actually, we have an entire job hunt course where I coach you through how do you network? How do you make connections outside of LinkedIn posts, for example, so that you can really get in the door of places, get your face out to places, because that is how you’re going to find jobs. It’s going to be through friends, family, networking, and old preceptors.  All of that becomes so much more important than it’s ever been because in the regular nursing world, if you’re working as an RN we all know there’s an abundance of jobs available, we don’t even think about it. I think about the NP world the same way, you just have to be better at finding them.  Anna: Yeah, and I would even say be looking and be networking while you are in your clinicals.  Sarah: Yes, way ahead of time.  Anna: Way ahead of time. So if you are listening to this and you are still in your clinical rotations, take advantage of that.  Now, a really big point I want to bring up here is that it literally does not matter if you think, for example, like me, you are going to be moving. Like, okay, I have no point in networking because I’m going to be moving. Well, here’s my prime example, I did an asthma and allergy clinical rotation in Colorado. I loved the NP, I loved the physician there. Oh, the physician is moving to Tennessee where I now live.  Sarah: That’s wild.  Anna: And so it’s crazy those connections that you can make. And you want to have those good connections and those good relationships, because you just never know what’s going to come of it. So you should always be networking and using every single resource that you have, even if you don’t think you’re going to need it or that you’re going to use it.  Sarah: Yeah. And if this is something that you know that you struggle with, or something you know that you are afraid of, I mean, I am going to put a shameless plug in here for the job hunt course. Because in that course we literally walk you through, how do you find that job? How do you set yourself up for an interview in the right way? There’s even a mock interview in there that you can do and you can practice ahead of time. How do you prepare for clinical versus non clinical questions in the interview?  There’s a lot of pieces that go into a successful job hunt process. And I think just in the nursing world in general, we’re not very accustomed to this style of interview. It’s just different than what we’ve done in the past. And so being abundantly prepared will hands down help you find a job, and not only find a job, but find a job that you really want.  I think that’s something else I wish I had known, is that you can absolutely find that dream job, or apparently make your own dream job like I did. But you can find the dream job, you don’t have to – I think a lot of people get trapped in “I have to take the first job I get.” That is 1,000% not the case, and I would almost always suggest that you don’t do that.  I would much rather you find something that fits your life, fits your schedule, something you’re excited to go and do every day. Because if not, you’re going to join a very scary statistic of nurse practitioners who leave in their first year and don’t come back.  And so that’s obviously the last thing we want after you’ve spent three to five years in school, you’ve passed this big scary board exam, you’ve found the job. The last thing we want is for you to just go back to being the nurse that you were previously.  Anna: Yeah, I was going to say something very, very similar to having that successful job hunt, knowing these things before you are going into it, before you start that first NP job can really help set you up for success and help you just be as happy as possible in your new role. You do not have to accept that very first job. You do not have to settle for something that doesn’t meet your minimum criteria in a job.  You can truly find that dream job out there. Now maybe that is an NP job at a primary care office. Or maybe your dream is to go work as a primary care NP in a specialty office. I know we have some former students who are now cardiology or pulmonology, or even dermatology NPs. And you can have a non conventional job, like we work in a board prep company.  There are so many options out there. There’s teaching, there’s research, the possibilities are truly endless for you out there. And I wish someone had told me that.  Sarah: Yeah, you just have to open up your eyes and see them. I’m like they’re all around us. But it’s like people have their blinders on. I mean, I definitely had my blinders on as a student. I’m like, “This is my one job opportunity. I have to take it.”  And I remember how scary it was when I was thinking about taking my very first job that I ended up turning it down like three days before I was supposed to start for the sheer fact that they were like, “Oh, well, you could just bill under the physician’s name.” You know, we’ve all heard about incident to billing, we talked about that in the courses and stuff. But I was like, yeah, for how long? And they’re like, I mean, possibly indefinitely. And I’m like, oh, no, I have my own license.  Anna: That is not appropriate.  Sarah: What are you talking about? Yeah, this is not something I’m going to do. But it would have been really easy to be like this is the only job. I already got this job. Why wouldn’t I just start this job and see what happens?  Anna: And along those same lines, not every job is posted online. If you all want to know how I learned about the best job I’ve ever had, y’all, it was from an Instagram message. Literally reaching out to people who are old connections who you are networking with, you never know what opportunity is going to present itself to you. And so don’t limit yourself to what’s posted on LinkedIn or Indeed or whatever job site you’re looking at, because the job might not even be posted at all.  Sarah: Yeah, none of my NP job offers at all have come from LinkedIn, Indeed, or anything like that.  Anna: Same.  Sarah: They’ve all been from in-person connections every single time.  Anna: And that’s where you’re going to have the most success anyways. That’s where you’re going to stand out. That’s where not hundreds, if not thousands of NPs are applying to the same job that they see online.  Sarah: And you’ll be surprised too, when you start to talk to people and be like, “Hey, I’m a new nurse practitioner, this is the kind of thing I’m looking for.” Opportunities just start to magically become available. Because my first NP job I was offered, they literally, I mean, there was no job posting.  They weren’t even sure they were going to hire someone else. But I had already done clinicals there and then all of a sudden they had one of their NPs leave, so it was a really easy fit. They didn’t even think about anyone else, they immediately called me. So just making sure that you’re putting the good vibes out there, putting the information out there. Because if people don’t know, they can’t help you.  Anna: Nope, that is such a great point. And it doesn’t have to just be a past preceptor either. Connect with your friends, your friend’s parents, your hairdresser, whoever it is. It’s amazing how many people you will learn are NPs or work at an office with NPS who know an office manager. It is amazing how many random connections you will find once you start putting yourself out there.  Sarah: Yeah, the one I always think of, it’s not related to an NP job, but it’s related to an NP clinical. I might have talked about this on the podcast before, but essentially what happened is I had a clinical setup with someone who was an acute care nurse practitioner, but also a family nurse practitioner. And the week before I was supposed to start clinical with her, she let her family nurse practitioner license lapse.  So all of a sudden I no longer had a preceptor. Any of you out there that go to schools where you have to find your own receptor, you know I was sweating. I was literally in stress hives. It was awful trying to find somebody else. And I contacted my school, I was like, “Hey, I need help.” And they’re like, “I mean, we’ll try to help, but it’s like seven days away. You might have to take a hiatus for the next semester.” Which is obviously not something I wanted to do.  And I called my mom and I was like, “I don’t know what I’m going to do, we don’t know any nurse practitioners.” I was the first nurse in our family, we have no network here in any capacity. And she’s like, “Well, let me ask around.” And she’s a school teacher and so one of the parents of one of her speech and drama teen children knew a nurse practitioner who called them and vouched for me on my behalf and got me a clinical.  And it was the best clinical I ever did. I ended up staying with her for like two or three clinicals. But I mean, all it took was one random phone call from my mom to a woman who knew a nurse practitioner. So you just never know. You never know where the opportunity is going to come.  Anna: Even my kids nowadays, like we’re in activities and I’m not actively on the job hunt, but there is a parent of another kid in my child’s class who is a nurse practitioner. And I just happened to overhear a conversation one day about this. So these opportunities, you all, they will present themselves to you, you just have to be open to it.  Sarah: Yeah, another one I think about, Anna, actually, was a couple weeks ago we did headshots. So, y’all, we showed up to headshots and literally the photographer is a family nurse practitioner. I can’t even make this up. How did this happen? Like do you want to work for us?  Anna: It’s a small world and she’s applying right now. And never would she have thought to reach out to us, or find us, or even know this existed until we got talking. Until like, oh, well, what else do you do? What are you guys again? What is this company? It’s like, oh, yeah, we hire family nursing practitioners as instructors. She was like, “I would love to do that.” So just don’t limit yourself.  Sarah: I mean, obviously, we’re the best place to work. If you’re a nurse practitioner looking for a job, we are it.  Anna: I clearly agree.  Sarah: I think the last thing I want to touch on, just because I think it’s a mental shift that I wasn’t totally prepared for. I mean, I felt kind of prepared, I had seen it when I had an urgent care clinicals in particular, is that it is a big shift going from being a registered nurse, working as part of a team all the time, typically a pretty collaborative team, to being a little bit more isolated, to having a lot more autonomy.  It doesn’t necessarily have to be a bad thing to be a little bit more isolated, but it is very different. And I think if anything by far contributes to people leaving in their first year, it’s rolling up into a first or a second job or maybe they’re the only provider on that day. And that can be kind of intimidating.  Anna: Yeah, and that’s something to be looking for in the job hunt as well. Have they had nurse practitioners in the past? What are your resources? Even on the days when you’re the only provider there, there’s still resources there available for you. And so looking into that is so important, but it is, it’s a really big mindset shift going from RN to NP.  It is a completely different role. And I personally was not prepared for how I felt. I felt so uncomfortable and so new and so like a novice again. I was in my groove, I knew exactly what to expect, I felt like I was getting really comfortable. I knew the teams, I knew the specialty I was working in. And then I go into this completely different role, this completely different population. And it was a huge mindset shift for me to realize that it’s okay to feel that way.  Sarah: Yeah, and it’s okay to lean into your resources. No one expects you to become a nurse practitioner and be like, “Oh, I don’t need Up To Date or Medscape or anything else. I have all this information in my brain, I’m good to go.” No one expects you to be a robot.  Anna: I use Up To Date everyday.  Sarah: And everyone anticipates you needing help, and that’s okay.  Anna: And that’s going to be for your entire career, even once you start getting more comfortable. You’re not always going to feel new and like a novice again, and it’s going to take time to get acclimated to your new role. And that’s okay. But even once you’re 10 years down the road working as an NP, you’re still going to be utilizing your resources and you’re going to be amazed at how much more comfortable you feel in that.  Sarah: Absolutely. I mean, we’re coming up on the three year anniversary of the business in just a couple of weeks now, which is wild. And me and you both look up stuff all the time. We’re always trying to be in the know because things change all the time, too.  Nothing about what we do is stagnant in any way. And so even just preparing your mindset for that. Like things are going to be changing, I will always be looking things up and there’s nothing wrong with that, I think is really important.  Anna: No, I love Up To Date. I’m on Up To Date all of the time, right? Figuring out what guidelines they’re recommending, and another caveat there is sometimes Up To Date will say one thing, but then a different set of guidelines says another. And so it’s really leaning in to wherever you’re working, what guidelines are they following? Again, it is always okay to be able to double check yourself and look that stuff up.  You’re never expected to know it all for the boards, nor for your new NP exam. And even though it might feel isolating and it feels a lot different, you have support and you have resources. You just need to find them.  Sarah: And you will hit your groove again. The time will come again when you’re like, “Oh, I’ve got this.” But no one when they start a brand new job feels like on day one, month one, maybe even year one like, “Oh, I 100% got this.” And that’s totally okay.  Anna: No, and they don’t expect you. They don’t want you feeling that way. Going in overconfident is not the best thing.  Sarah: It’s scary.  Anna: Yes.  Sarah: All right, cool. I think this was a good episode, Anna. What do you think?  Anna: I think so too. I think these are all things that if someone had just told me, it would have given me a little bit of peace of mind.  Sarah: Maybe just a little bit more confidence in myself.  Anna: Yeah.  Sarah: I think that’s the biggest thing back then, I’m like I just didn’t have enough confidence in myself. I think that has really evolved in my journey as a nurse practitioner in particular.  Anna: Yeah, I would agree with that.  Sarah: And if you guys liked this episode, let us know because we might do a backwards series. So we kind of started at the end with things we wish we had known when we were graduating from nurse practitioner school. But maybe we’ll do things we wish we had known before we started clinicals. Or things we wish we had known before our first semester in NP school.  So definitely keep us posted. We’re all over Instagram, Facebook, et cetera. We would love to hear your guys’ thoughts. But that’s it for this week. As an extra bonus, friends, if you’re looking for support no matter what phase of your nurse practitioner journey you’re currently in, I have communities available for both students and new nurse practitioners. In these communities, we work to uplift one another and grow this profession together every single day. Links to join will be included for you in the show notes.  Thanks for listening to Becoming a Stress-Free Nurse Practitioner. If you want more information about the different types of support we offer to students and new NPs, visit https://www.npreviews.com/resources. See you next week.

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