You survived the war that was nurse practitioner school; you landed your dream job; now you wait in fear for the next call, the next problem to arise. Who are you to make these types of decisions? How would you know what is wrong with or will fix this patient? You stress over the not knowing; the constant battle against negative internal dialogue telling you that you can’t actually do this.

These fears can be compounded by inadequate training or lack of on-boarding in this new role. Or they can exist simply because you are a high achiever. These thoughts and emotions can be pervasive and insidious. They can persist for so long that they derail all the hard work you just completed. They can rob you of your joy, passion, and for some, can send them back to the bedside or to something else all together.

Signs that you may have imposter syndrome:

• Highly self-critical and overachiever mentality.

• An inability to realistically assess your competence and skills.

• Attributing your success to external factors.

• Fear that you won't live up to expectations.

• Self-doubt.

• Anxiety.

• Hesitation to complete your work, talk to patients, staff, make decisions.

What Can You Do?

First things first, there is hope. You have to deeply understand and accept that this is a temporary place of discomfort. The anxiety or depression you are feeling is situational and will slowly improve as you develop competence and confidence.

The second key point is to recognize that even if no one talks about it or possibly outright denies it, every single NP was new at some point and experienced some degree of imposter syndrome. Knowing that colleagues you admire and emulate were once you lessens the blow.

Bringing awareness to the negative thoughts you are having and identifying the cause helps to isolate the feelings they emote. Allow space and time to feel the stress. Continuously repressing things or developing unhealthy coping strategies just delays or transfers the problem and can create collateral damage. You have to walk through the muck before you can get to the other side. One. Step. At. A. Time.

Know that your education does not end with your diploma. You will spend a good deal of time as a new grad nurse practitioner learning. My tip is to take it one subject at a time and teach yourself the crap out of it. Day one you deal with a patient dying of septic shock; go home and spend the next week focusing on etiology, diagnosis, and treatment of septic shock. Find resources, bookmark them, put them in your EMR as a dot phrase for easy reference, make a cheatsheet for yourself. Ask mentors, get advice, teach yourself everything there is to know about this. Other issues that arise that week, just fix to the best of your ability and move on, your focus is septic shock for the week. Next week pick a new problem. What you’ll find is that the next septic patient you encounter will be easier to sort out.

Yes, it takes time. A lot of time. Learning the world of medicine as a nurse practitioner with focused and fast education relies on a background heavy in bedside experience. Your time to competency and confidence depends on how extensive your background and education are. Therefore, the time frame varies for everyone.

For me, it took four months until I wasn’t staying late every day. It took six months until I wasn’t white knuckling the steering wheel driving in. It took a year for me to exhale and feel competent. It took two years before I felt confident that I could handle 95% of everything that comes in the ICU.

Give yourself patience, kindness, and acceptance. Walk through the hard. It’s supposed to be hard, otherwise everyone would do it. Use your fear to your advantage and make yourself stronger and wiser.

You’ll get there friend.