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Challenges in the Workplace as an NP

Nurse practitioners have an outstanding job outlook, with an average salary of $124,680. They were recently named the “best healthcare job” by US News & World Report, and NPs have more options and opportunities than ever before.

However, that does not mean working as an NP is free of challenges. Some of these workplace challenges are specific to NPs, while others can be found in any healthcare job.

Challenges in the workplace for NPs include working in a restrictive practice setting; dynamics with coworkers; patient interactions; schedules; and transitioning as an RN to NP. These frustrations range from interpersonal struggles to physical demands.

Restrictive Practice Setting

When completing their education and training, NPs are taught to practice to the full extent of their profession. It may be a surprise to some NPs when graduating from their program, to realize depending on the state, there may be limitations in their role. Scope of practice laws vary from state to state. As of late 2023, 26 states and Washington, D.C. allow full practice authority for NPs.

NPs will enjoy practicing in states such as Washington and Colorado, where NPs have full autonomy. On the other hand, working in states such as Texas and Tennessee with restricted practice for NPs can be difficult. NPs must work under a supervising physician in restricted practice states. They will need authorization from a physician to prescribe medications and perform procedures. Additionally, some states require physicians to audit patient charts completed by NPs.

Restricted practice states cause limitations in NPs opening their own practice. NPs would need to pay a physician to be a medical director of their clinic. These constraints can be very frustrating to NPs, as they may limit the type of care they can provide.

Dynamics with Coworkers

Numerous physicians hire NPs to expand their practice and help with the patient load. While many physicians respect NPs, others see NPs as “mid-level” providers. This term is offensive to NPs because it means that NPs are providing mediocre service to patients. It infers that NPs are not as knowledgeable as physicians and not giving patients the best care.

The American Medical Association lobbies for limiting scope of practice for NPs. They support physician-led care and do not see NPs as equals. Some NPs have reported working in a hostile environment where their peer physicians have made nasty comments or even yelled at them. Some physician employers may micromanage the NP or counteract their clinical decisions.

Fortunately, these days, physician colleagues have become more familiar with nurse practitioners. In fact, they are approaching NPs with a collaborative attitude. If the NP has a question when treating a complex patient, they are available to help.

Patient Interactions

Serving as an NP can take a toll emotionally. NPs are working in a caregiver position and play a vital role in patient’s lives. Initially, NPs need to establish trust with a patient. Sometimes, a patient is unfamiliar with the role of an NP and may request to see the physician. At times, NPs may take this personally and feel that patients do not respect them. Yet, it is common for patients to eventually trust NPs once the NP establishes a rapport with them and follows through on their problems.

Dealing with patients can be challenging because there may be patients who are non-compliant. These types of patients do not follow the recommendations of the NP which can be disappointing when their health continues to decline. There may also be “difficult” patients who think they know more medicine than the provider or may be demanding. Patients may be anxious, fearful, angry, or aloof. Sometimes, the NP may know what the patient needs from a clinical standpoint, but this may not be enough to satisfy the patient.

NPs will have to engage with patients’ families, which brings additional perspectives and personalities they will have to work with. Even managing patients that the NP has an established relationship with can be tough. For instance, it is the circle of life that patients will pass away. This can be emotionally devastating for providers, and they may even have a sense of guilt. NPs offer compassion, empathy, and cultural sensitivity to patients. It is a struggle for NPs to avoid investing themselves in patients emotionally.

Schedule

Nurses are taught to provide holistic care. Medical organizations often push providers to take on more patients than they can handle to increase profit. It may be challenging for NPs to work in healthcare facilities that only allow 15 minutes per patient visit. This is typically not enough time to address patients with multiple problems. If a patient presents with a headache, the NP would like to assess for underlying anxiety or depression, review their social history such as physical activity and diet, complete a thorough physical exam, and order the appropriate tests. The NP would like to spend additional time providing patient education.

With the current fee-for-service model in healthcare, NPs are paid based on quantity, not quality. So, the more patients that are seen per day, the more money the healthcare practice is making.

This a big challenge for NPs because they feel like they do not have enough time with patients to give them the most optimal care. Seeing 30 or more patients per day can easily cause burnout in NPs. As a result, NPs will have to spend more than their scheduled 40 hours at work to catch up on documentation.

Transitioning From an RN to NP

Various new NPs find it difficult to transition from the RN to NP mindset. The transition can be stressful and turbulent, leading to decreased job satisfaction. As an RN, these novice NPs were accustomed to following orders from a physician. As an NP, they are the ones now placing the orders. As a result, an NP has more accountability, since they are responsible for a patient’s outcomes.

Novice NPs sometimes have a hard time finding that confidence. They have been an RN for so long that transitioning to a new role can be challenging. They are the ones calling the shots now, but they need to feel competent and confident in their decisions. Confidence as an NP usually comes with time. The longer the NP has been practicing, the more they feel confident in their decision-making.

Unfortunately, some NPs do not even give their first job a chance. If they feel intimidated, they just go back to their comfort level, which is working as an RN. Transition shock, described as “disorienting,” often occurs when there is a gap between what was learned in school and what is needed to practice successfully. Novice NPs need support and leadership to help them thrive.

How an NP Can Address These Challenges

To overcome the challenge of working in a restrictive practice setting, the NP should choose a state that allows autonomous practice. The NP should become familiar with their state legislation if this is not an option. They can try to find a supervisor who empowers them and allows them to work at the top of their legal scope and abilities.

If an NP feels like their colleagues are not respecting them, they can communicate with them and discuss expectations and frustrations. Before even accepting a job, the NP should try to assess the workplace culture. For example, during the interview, the NP can ask if the facility has worked with NPs before and what was the experience like for them?

When managing patients, the NP must learn to compartmentalize. They should maintain a realistic distance and detach themselves from patients and their treatment outcomes. NPs cannot take everything the patient says or does personally. Practicing self-awareness and working collaboratively with their patients can help NPs cope with reality. Building a trusting relationship with patients takes time, but it is important in providing patient-centered care.

If an NP feels overwhelmed with their schedule, they can talk to their employer about having administrative time to catch up on patient consult notes and charting. An NP must clarify how many patients per hour they are expected to see before accepting a position. The NP should communicate with their supervisor if they are feeling burnout. If their supervisor values them and their work, they will be invested in retaining them.

A novice NP may struggle during their first year of practice. They should study after hours, and not be afraid to ask questions to their colleagues. When choosing the right work environment, they should inquire about how long the orientation process is and if there is a ramp-up schedule. If the facility has a mentorship program, that would be a bonus. A novice NP should seek frequent evaluations and form successful workplace relationships.

Sophia Khawly, MSN

Writer

Sophia Khawly is a traveling nurse practitioner from Miami, Florida. She has been a nurse for 14 years and has worked in nine different states. She likes to travel in her spare time and has visited over 40 countries.

Being a traveling nurse practitioner allows her to combine her love of learning, travel, and serving others. Learn more about Sophia at www.travelingNP.com.