Health care is fragmented. Working in health care is no different. Too often any unity we experience is centered on things that are the most broken — the things that we aren't explicitly taught in school or in clinical rotations. There isn't much that is soft about these skills, and just because they aren't clinically focused doesn't mean they are any less essential to our learning, professional development, or role transition. 

I have a few of my favorite unexpected-yet-high-yield lessons here for your review. Whether you are a student, a practicing clinician, an improvement fanatic, or some combination of the three, listen up. And before you do anything else — buy an old school paper notebook. Small enough that you can carry with you on your person. Something that does not need a fully charged battery, that can't get a virus, and that you can't accidentally send to someone else. Keep it handy, take notes (you can start with these lessons), and look at them often. 

You Are On Your Own

I hear a lot of people talk about how they are "not taught" in graduate school. How the professors have them essentially teaching themselves. The reality is that any graduate program in any discipline at any school is intended to prepare you to be professionally self-sufficient. As a clinician, you are constantly going to be on your own with tricky problems to solve. If you can't move past this idea in grad school, that's a sign.

Once you are in practice, you are on your own. The buck stops with you. Even in the most well-supported setting, the decisions you make are yours and yours alone. The accountability is yours, as well. You may have staff that support you, you may have mentors that you can curbside for tricky cases, but you will be the person deciding on a diagnosis, creating the treatment plan, and being asked to back it up. Gone are the days of following orders written by someone else.

Many NPs find themselves less than ideally prepared for this transition once they get into practice, and it can make those first few years rough ones. Do yourself a favor and get in front of this as early in your training as you can. Find what makes you feel comfortable on your own, and drop whatever shakes that confidence. 

You Must Be Your Own Best Advocate

You've heard the flight attendants' speech about putting your own oxygen mask on in the event of an emergency. You're no good to anyone else if you aren't meeting your own needs, and no one is going to make sure that happens for you. 

If you find yourself waiting for your preceptors, employers, colleagues, or patients to check in and make sure you're OK, you're wasting your own time. It's rare that someone will ask you; it's up to you to tell whoever needs to hear it, and keep going until you get heard. Until the day comes that we all have lightened loads and the bandwidth to truly support our colleagues, or workplaces magically change to address the very real needs of clinicians, it is up to us to stand up for ourselves and get our needs met. 

You Must Decide What Is Acceptable To You And What Is Not

We all draw our own lines in the sand. We know what works for us, and what doesn't. No one can tell you. It's something that you have to figure out for yourself. Most often, this is done with trial and error, which works, but is slow. The people who keep this front of mind from Day 1 are way ahead of the curve.

I worked in a clinical setting with visits scheduled every 10 minutes. Some visits were simple – the patients didn't need to get undressed, there was no special equipment involved. Others were comprehensive annual visits, others were procedure visits. No matter the indication for the visit, the patients were always there for more than 10 minutes, and in most cases, the visits took more than 10 minutes of my time. There was no admin time to catch up on notes, no particular rhyme or reason to when specific types of visits were scheduled; it took a no show in order to get caught up. This didn't work for me. I handed in my resignation.

You Are the Only Person Who Can Decide What Is Important To You

Your school, employer, colleagues, patients — they all have thoughts about what is important. You probably share some of the same thoughts, but that doesn't mean that you should rely on anyone else to make that decision for you. What works well for one person can be disastrous for another. 

I have always asserted that more money won't make me more happy (as of this writing, no one has called my bluff on this, but I digress). While I certainly am not doing my work for free, the specifics of financial compensation aren't enough to make me happy. What is important to me is to have a level of autonomy, to be in a setting that allows for and encourages intellectual curiosity, to have time freedom. Without these factors, it's going to be very hard for me to be happy in a professional situation. What are yours? 

Get Comfortable Being Uncomfortable

Pivoting to nursing after a 15-plus year career in nonprofit management (in an unrelated industry) was a big shift. This required me to embrace being a complete novice, and open to all of the learning opportunities available. Some of my classmates and colleagues had only ever worked in health care; some had only ever worked in roles along the nursing spectrum. We learned together, and we also learned from each other.

No practicing clinician can know everything. There will always be someone who knows more, has been doing the same job longer, who has better procedural skills or patient satisfaction ratings, and it's not unusual for that to rattle you. But you can't let that stop you. Getting to a place of professional comfort is fine, and stopping there to enjoy the view for a bit is also fine. But in an industry that changes as quickly and profoundly as health care can and does, we have to remain agile. We must find comfort in being uncomfortable in order to challenge ourselves, to keep our professional skills sharp, and to do our best work. Being comfortable being uncomfortable allows us to stretch, to grow, to learn — to be the opposite of stagnant and defensive, which does much less good than growth does.

Extra Credit: Community Is Everything

When I worked in performing arts management, one of the most compelling things that kept me going was the shared experience of the audience. Witnessing that common bond among the audience, the relationship between audience and performers, was powerful and often moved me to tears.

I found that to be completely lacking in my experience as a clinician. We get thrown together with colleagues, and we do have an experience in common: we experience the drama of working in health care, but are we really sharing an experience? Offices in the same hallway, exam rooms that border on one another, seats near one another at the monthly medical staff meeting. That's not shared experience, that's coexisting. Many of us are stretched so thin in our daily work lives that we don't have the time, energy, bandwidth to seek out community, to find or build that shared experience (or maybe to even recognize when it is lacking). 

That lack of shared experience and community does us a disservice. No matter where we are in our careers, we need a touchstone that makes us feel less alone. New graduates need support as they transition to practice. Seasoned clinicians need to feel less like a number in the workplace. Those who are eyeing retirement deserve to have a complementary transition out of practice; after devoting so much of their lives and selves to this profession, what will become of them once they are not punching the clock every day? Clinicians who are struggling, who are overwhelmed, who are on the verge of burnout, who are going through personal or professional trials — they need community, too. 

The biggest lesson that I learned in my 10-plus years of education was not a clinical one, and it came in the form of a question. Who is caring for the carers? Schools and workplaces put a lot of energy into making sure that we get as much information into our brains as we possibly can, and that we then use that information to benefit patients (and the bottom line, let's be real). But who is caring for the carers? In most cases, we are on our own with that, and with mixed results. My advice: no matter what stage of your career you find yourself in right now, work as hard to find your community as you did to pass your boards, and maintain it. Lean on it when you need it, and be the source for someone else when they need to lean on you.  

And go buy a notebook.

What have you learned as an NP that you weren't taught? Share in the comments.

Jessica Reeves is a nurse practitioner as interested in the well-being of her fellow clinicians as that of her patients — and she's on a mission to make the work world a better place to live. She writes, works, and lives in the town that holds the world record for most lit jack-o-lanterns (really). Follow her at jessicareeves.net. Jessica was a 2023–2024 Doximity Op-Med Fellow and continues as a 2024-2025 Doximity Op-Med Fellow.

Illustration by Jennifer Bogartz