This month I will have been in practice as a Family Nurse Practitioner (FNP) for a whole year. In this time, I have concluded that I have nothing prophetic to say. It has most definitely been worth it, and I have found success and contentment in my work. I am well respected by my patients, the staff, and my peers. But, some days I just have this feeling that I’m an old circus performer trying to keep the plates spinning, or I feel like I’m trying to herd kittens.

The most insightful thing I can probably come up with is that everyone expects me to have the answers every single time. The hardest, yet most enlightening, thing I have done is admitted to a patient when I didn’t have an answer to their problem yet. I realized that patients appreciate the honesty, and they may even take pride in stumping a provider. These instances truly emphasize that we are all continuous learners. 

And that stuff in school that you assure yourself that you’ll never really need to know? You’ll need it sooner rather than later.

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There are days when I feel like all I am is a referral generator. Other days, I feel like a daytime talk show host, telling patients, “you get prednisone, and you get prednisone, and you all get prednisone.” And when I thought that I would never prescribe controlled substances for chronic pain management? Yeah, I manage chronic pain now, because there are not enough pain specialists to manage every patient, and I cannot let my patients leave without something for their pain, real or imagined. I also wish we had more education in mental health. Everyone has issues that are largely untreated or under-treated. This is such an issue in my area that I’m considering going back for a post-master certificate as a mental health NP. Don’t tell my wife I’m thinking that—she’s had enough of proofreading my papers.

All in all, some days I’m overwhelmed, and I feel like I’m going to sink, but most days are fine. I usually finish on time and my charting is almost caught up. I can honestly say that I know more today than I did a year ago, but I also know that there is so much that I don’t know, and I am ready to find out what that is and address it as it comes up. 

I’ve also learned that applying abnormal lab results to a coherent plan is much more difficult than I ever thought it would be. At the same time, the thrill, I guess, of comprehending that “the buck stops with me” is satisfying. I am no longer looking for orders or direction from someone else. Now I am the one who makes the decisions and gives those orders, and that is something I am very grateful to have finally achieved.

Sean P. L’Huillier, FNP-C, is a recent graduate of Georgetown University’s Family Nurse Practitioner program. He works and lives in northwest Arizona.