NR 500NP Week 6 New NP Professional Identity Paper Example

Professional Identity Paper: What I Will Sign For as a New Family Nurse Practitioner, What I Will Not Sign Yet, and Where Those Patients Go

Student Name

College of Nursing, Chamberlain University

NR 500NP: Foundational Concepts and Advanced Practice Roles

Instructor Name

Month Day, Year

Professional Identity Paper: What I Will Sign For as a New Family Nurse Practitioner, What I Will Not Sign Yet, and Where Those Patients Go

A Claim About One Person

This paper is about the clinician I intend to be during my first two years of family practice in a small rural clinic, not about the profession. The claim is that I will be a clinician who signs confidently for the common problems I have been trained to manage, who declines for now a short list of problems I have not handled often enough, and who sends those patients somewhere specific rather than nowhere. That claim can be checked: a colleague could look at my prescriptions and referrals in 2030 and see whether I kept to it.

Barnes (2015), analyzing the literature on nurse practitioner role transition, identified four defining features: taking in the new role, moving from delivering care to prescribing it, living between two professional identities for a while, and feeling mixed emotions about all of it. The second of those is the one this paper is about. As an emergency nurse, I have delivered care prescribed by others for eight years. The shift to prescribing is where my identity will change most, and where it most needs to be written down in advance.

What I Will Sign For

I will diagnose and manage, on my own signature, the common problems that make up most of a rural family practice day: acute infections such as ear, throat, sinus, skin and urinary infections; hypertension, type 2 diabetes and high cholesterol, including starting and adjusting the usual medicines; asthma and chronic obstructive pulmonary disease in stable patients; depression and anxiety of mild to moderate severity, including starting a first-line antidepressant; well-child and adult preventive care, including vaccinations; minor injuries; and contraception counseling. These are the conditions my program and my clinical rotations prepare me for, and they are the ones a rural clinic most needs a clinician to handle without referral.

What I Will Not Sign Yet

I will not, in my first two years, be the prescriber who starts long-term opioid therapy for chronic pain; who starts stimulant medication for attention-deficit disorder in children; who manages a new diagnosis of bipolar disorder; who starts insulin in a patient with type 1 diabetes; or who manages a pregnancy beyond the first prenatal visit. None of these is outside my license as a family nurse practitioner. Each is outside my experience, and each carries a risk that a new clinician in a clinic with no on-site specialist should not take alone. The list is not permanent. I will revisit it after each year of practice, and move items off it as I gain supervised experience with them.

Where the Declined Ones Go

Declining a patient without a destination abandons them. For each item on the list, I have identified where the patient goes. Chronic pain needing long-term opioids goes to the county's pain management program, with me continuing their other primary care. Children with suspected attention-deficit disorder go to the developmental pediatrician who visits the regional center monthly, and I will ask to sit in on those visits. New bipolar disorder goes to the community mental health center's psychiatric nurse practitioner, reachable by telehealth within two weeks. Type 1 diabetes goes to the endocrinology practice 50 minutes away, with a shared plan. And pregnancy after the first visit goes to the certified nurse-midwife practice in the county seat. Each referral is a plan I have written down now, before I need it.

A Patient Who Tests the List

A list like this is easy to write and harder to keep when a patient is in front of me. Imagine a 38-year-old farmer with years of back pain, already on a short course of tramadol from an urgent care visit, who asks me to continue it long term because the pain clinic has a four-month wait. He is polite, desperate and has no other clinician. Everything in me that wants to help will want to sign. The list says I do not start long-term opioid therapy in my first two years, and it tells me where he goes.

Keeping the list in that moment does not mean sending him away empty-handed. I would manage his pain with the non-opioid treatments I am trained to offer, refer him to the pain program with a note asking for an earlier appointment, arrange physical therapy closer to home, and see him again in two weeks. What I would not do is become, on my own, the long-term opioid prescriber for a patient whose risks I cannot yet judge well. Writing the list before I meet him is what makes it possible to keep it when I do.

Values Shown as Conduct

Values appear in this paper only where they can be seen in conduct. Honesty means telling a patient, "I haven't managed this often enough to do it alone, so I'm sending you to someone who has," rather than disguising the referral as routine. Humility means asking my collaborating physician or senior colleague about the first ten patients I start on any medicine I have not prescribed before, and keeping a note of what I asked and what I learned. Advocacy means following up on each referral to make sure the patient was actually seen, which in rural areas cannot be assumed.

What the Change Costs

The change costs me something, and the paper would be incomplete without saying what. It costs the certainty of the emergency department, where protocols and a physician on site made most decisions shared. It costs time: seeing a patient, deciding and documenting will take me longer than it takes experienced clinicians, and I will likely stay late in my first year. It will sometimes cost patients' confidence, when a patient hoped I would solve something and I refer them instead. And it costs some of my identity as a skilled nurse: I will be a novice again at the work that matters most in the new role. Barnes (2015) named mixed emotions as part of the transition; I expect them, and naming the costs in advance is my way of making sure they do not push me to sign for things I should not, just to feel competent sooner.

References

Barnes, H. (2015). Nurse practitioner role transition: A concept analysis. Nursing Forum, 50(3), 137-146. https://doi.org/10.1111/nuf.12078