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What are New Nurse Practitioners’ Most Common Mistakes?

Being a nurse practitioner has many benefits. However, transitioning from the comfort of a registered nursing role to one of a novice NP can be challenging. Recognizing common mistakes new NPs make can help them better prepare for their responsibilities, and gradually build their skills and confidence. This will allow them to provide high-quality, patient-centered care.

New NPs frequently suffer through self-doubt or poor time management and may be afraid to ask for help. They are prone to burnout and may find it difficult to think outside the box or understand their scope of practice. New NPs should prioritize self-care and seek support from a mentor or a colleague. Below are some common mistakes made by new NPs.

Lack of Confidence

It is common for novice NPs to have imposter syndrome and feel self-doubt. They are used to practicing as a registered nurse and may feel uncomfortable in their new role. Many new NPs struggle with confidence in making decisions and conclusions in the provider role. They are unaccustomed to being the one calling the shots and making clinical judgments. This leads to hesitation in decision-making or enables them to defer too much to other healthcare providers. This can also lead to delays in patient care.

Building self-assurance takes time and experience but is crucial for effective and safe patient care. New NPs should seek professional development opportunities, such as additional training their workplace may offer. They may learn new skills or procedures that will allow them to gain confidence. They can attend conferences to learn more about their profession and medical topics. Novice NPs should seek a mentor that they can bounce ideas off with or go to if they have questions.

Not Thinking Outside the Box

Although medical guidelines are essential protocols for providers to follow, new NPs may lean too heavily on them. Normally, NPs must adapt standards to specific patient needs and complexity. New NPs tend to over-rely on guidelines. It is important to balance evidence-based guidelines with individualized patient care.

New NPs should spend time on comprehensive evaluations and use clinical decision-support tools to create a treatment plan specific to the patient. As nurses, NPs see patients holistically. For example, guidelines may recommend a patient with uncontrolled diabetes start insulin.

However, an NP’s assessment gathers that the patient will likely be non-compliant with insulin due to fear of needles and cost barriers. The NP should think outside the box and see how the patient responds to oral medications and diet treatment first.

Failure to Seek Help

Many new NPs hesitate to ask their supervising physician or colleagues questions for fear of appearing inexperienced or unintelligent. However, new NPs must collaborate with other healthcare providers and ask questions to improve patient safety and outcomes. It can also offer valuable learning experiences.

By asking questions, new NPs prevent misdiagnosis or delayed diagnosis of patients. At the same time, they can learn how to ensure patients follow up and complete appropriate tests. This includes recognizing the need for a specialist referral. Timely referrals can be crucial for proper diagnosis and management of complex conditions.

Nowadays, there are many online resources that novice NPs can refer to, such as UpToDate. These tools offer evidence-based information for healthcare professionals. UpToDate is a clinical decision support resource that NPs can use to help form a diagnosis or determine which tests should be ordered. It gives treatment options and even illustrates potential adverse reactions.

Medication Errors

Unfortunately, medical errors happen in healthcare. It ranks as the most frequent and preventable source of patient harm. Novice NPs may be prone to errors in prescribing, such as incorrect dosages, missing potential drug interactions, or not adjusting for renal or hepatic impairment. New NPs should stay current on pharmacology and use clinical decision support tools, such as Epocrates, to minimize these errors. Epocrates is a great tool to look up medication dosages, side effects, and pregnancy safety.

Comfort in prescribing medications comes with time and experience. New NPs should complete continuing education hours to further their knowledge in pharmacology. They should always double-check the medication prescription before sending it off. EHRs usually have a safety precaution pop-up window that NPs have to click through to address drug interactions. This is an additional safety measure NPs should pay close attention to.

Poor Time Management

Being successful working in healthcare requires excellent time management skills. It is essential for balancing patient care, administrative duties, and personal well-being. NPs work in busy settings, and time management can be a challenge. Effective scheduling can help direct time better. Overbooking or poor scheduling can lead to reduced quality of care and burnout.

Novice NPs often underestimate the time needed for patient visits. They allow patients to ramble on and do not guide the conversation throughout the visit. This is especially true in complex cases or geriatric patients with several medical disorders. There is a happy medium in addressing patient concerns without spending too much time in the patient room. This will be obtained over time to prevent feeling rushed or not spending enough time with patients.

At the same time, NPs must prioritize tasks and delegate as needed. They should require their medical assistants or nurses to recheck blood pressures and remove wound dressings to save the NP time. They can have systems in place such as having standard-of-care tests completed before the NP going into the room. These will make encounters for UTIs or cold symptoms a quick visit for the NP, and they can utilize that time elsewhere.

NPs need to complete documentation promptly as well. Efficient NPs are able to chart while with the patient. It is a mistake for a new NP to document entirely after the patient visit, as another patient is typically already waiting for them. They should also avoid over-charting, in which they document every single detail of the patient encounter. This information can be superfluous and waste valuable time. NPs can use smart phrases that will help them document common visit topics, in a shorter period of time.

Documentation Errors

As patient volume is high, this can increase the risk of documentation errors. New NPs may struggle to complete comprehensive and accurate documentation in a timely manner. Failing to document patient interactions, assessments, and care plans thoroughly can lead to gaps in patient care and potential legal issues. Nowadays, with the use of EHRs, there are fewer documentation errors related to illegible handwriting.

The most common EHR documentation errors include no review of systems, including only pertinent positives, and carrying information automatically from visit to visit without changes. Documentation errors include leaving out pertinent diagnoses or ensuring that the physical exam supports the subjective intake. Detailed documentation is necessary for quality care and legal protection. New NPs should address non-compliance in their note and have a specific status and plan for each disorder. They must document follow-up instructions meticulously.

Inadequate Patient Education

New NPs frequently focus on assessing and diagnosing patients. They might treat patients without offering sufficient education about lifestyle modifications and medications. They may overlook the importance of thoroughly educating patients about their conditions and treatment plans. Patient teaching helps patients make informed decisions about their health and helps them manage their expectations.

Educated patients are more likely to be engaged in their own healthcare, leading to better outcomes. Most patients require precise directions and education vital for compliance and effective chronic disease management. Delivering thorough patient education increases patient trust and enhances the provider-patient relationship as well.

Struggling with Scope of Practice

NP students learn how to practice as NPs to the fullest extent of their profession. Nevertheless, the scope of practice for NPs varies by state. Novice NPs may find it difficult to understand limitations in their scope of practice. They may be unfamiliar with state regulations and can easily overstep or under-utilize their competencies. Understanding their scope of practice is fundamental for delivering safe and effective care.

NPs can collaborate with supervising physicians to help clarify their role and acquaint themselves with state protocols. This will prevent them from accidentally overstepping their boundaries by performing procedures or making decisions outside their legal scope. For example, certain states allow NPs to prescribe controlled substances but may regulate the maximum amount of days a prescription may be given. Continuing professional development helps to clarify scope of practice limitations. NPs operating outside of their legal limits can result in disciplinary action and compromise patient safety.

Prone to Burnout

New NPs often underestimate the importance of self-care. With the stress of transitioning into practice and a new role, novice NPs regularly neglect a work-life balance. Not only are they working a full-time schedule, but they may have to work overtime, in addition to spending their off time studying or charting. This can easily lead to burnout.

Self-care is central to sustaining physical, emotional, and mental health. Neglecting self-care can also decrease job performance and compromise patient care. Maintaining work-life balance and seeking mentorship can help manage this stressful transitional period. New NPs should make time for regular exercise, relaxation, and a healthy diet. They must obtain support from colleagues and their supervisors when feeling overwhelmed. They should also establish boundaries with patients and avoid being available to patients 24/7.

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.