I’m a unique member of a team, not an in-between!

By Samantha “Sami” J. Smith | 10/10/2018

A nurse practitioner shares this and other lessons learned. 

I’m a unique member of a team, not an in-between!

Ten years of experience as a neonatal nurse practitioner have given the author insights about her practice and life that she wishes her younger self had known.

Samantha “Sami” J. Smith As a novice neonatal nurse practitioner (NNP), I naively reflected: “In many settings, a nurse practitioner feels lost in his or her new identity. We are recognized for our physician-like roles, but we are not physicians. We are nurse practitioners who struggle for understanding among our peers­—both nurses and physicians. We are the in-betweens.”

Ten years later, as an experienced NNP, I see things differently, and my heart reaches out to my former self and softly speaks: “You’re mistaken. You are not an ‘in-between.’ Yes, you are a bridge that connects nursing with medicine, but you are more than that. You are a unique member of a healthcare team that includes physicians, registered nurses, and many others, and the role you perform is critical to achieving positive patient outcomes.”

As I look back over the past decade, I recognize that my NNP practice has deepened with increasing layers of experience, knowledge, evidence-based research, and incredible mentoring from others on my multidisciplinary NICU team, composed of nurses, respiratory therapists, case managers, dietitians, NNP colleagues, residents, and physicians. These experiences have shaped my perspective and approach to the care I provide and the life I live to fuel my practice.

I find it weird to say I am a “seasoned” NNP, but after 10 years, I’ve learned many lessons. Here are five I’d like to share with other NNPs. Perhaps readers in other disciplines will also find them useful.

1. Trust your assessment and gut.
Throughout your educational journey, you will read articles about nursing intuition and expertise. A nurse’s “gut feeling” rings true in care. I have learned that, if something doesn’t sit right and crosses my brain more than once, question it. Re-examine, take a closer look, involve the multidisciplinary team, and do further literature review. It’s important to stand back, to look at the full picture. Involve the bedside nurse and other members of the team in discussions on how to further evaluate and develop a treatment plan.

2. Ask questions, and have an open-door policy for discussion.
Neonatal nurse practitioners must question and examine their plans, orders, and care. A questioning attitude is critical to patient safety and excellence in practice. As a new NNP, building your practice is intimidating. You want to feel as if you know it all from the start. But it’s important not to appear arrogant to others on the team. Be approachable, encourage questions, ask others for their opinions, observations, and care concerns. Good communication strengthens the team, aiding in quality care.

Working alongside physicians is a wonderful opportunity to strengthen the group, build trust and camaraderie, and deliver excellent care. I have had wonderful and fulfilling career moments working side by side with the attending physician and NICU team during critical events. Contrary to how it is often portrayed in the media and elsewhere, it should never be “us against them.” A nurse practitioner should be able to accept questions graciously and evaluate the situation objectively, providing necessary clarification and guidance.

Some of my most memorable moments as a neonatal nurse practitioner have been when a physician, nurse, respiratory therapist, and I have come together, each with our unique expertise and knowledge, trusting one another to provide the best care possible in a critical and fast-moving scenario. Whether it’s an unexpected code or an emergency delivery accompanied by severe perinatal depression, together we spring into action and provide leadership within each of our roles. Anticipating each step, we jointly give our all to save a life and bring the full spectrum of care to families and their babies. For the system to work, everyone plays an integral part. Healthcare is about healing and caring for the ill, and a unified care team is essential.

3. Cultivate your practice with help from colleagues, and never stop adding to your knowledge library.
Allow expert NNPs to mentor you. Say yes to help when it is offered. Listen and watch. Give back by nurturing novice nurses and NNPs who join the ranks. Reject the idea that nurses eat their young. Encouraging the growth of the group strengthens everyone’s practice. Read a lot, and continue to delve into the latest research in your field. I enjoy going to monthly journal clubs, continuing education events, and conferences. Conferences are a wonderful opportunity to learn, fuel your passion for evidence-based research, and socialize with fellow nurse practitioners. 

4. Remember that work and life walk hand in hand.
A positive work-life balance is vital. To provide excellent care to the families and babies you serve, you must take care of you and your family first. Learn not to sweat the small stuff. Be kind to yourself, and learn to say no! You cannot provide the care you want to give if you are overextended. If you feel worn down—that you are walking the steps, but not feeling them—that is a red flag that it’s time for a self-care day. Kick up your feet with a nonmedical book, take a long uninterrupted nap, meditate, exercise, and watch a movie with your family.

5. Never stop loving what you do!
The key to longevity and joy in practice is remembering why you became a nurse practitioner. Take that memory with you every time you walk onto a shift. Pause to smile and bring joy to those around you. When someone says, “I hope you got your roller skates on tight for this shift,” respond, “Always, we got this.”

Remember that nurse practitioners, together with other members of the healthcare team, have a unique role to perform. We are not the “in-betweens.” We are bridges that connect nursing with medicine, and we are members of a team that brings collaboration, education, professionalism, and efficiency to this ever-changing landscape called healthcare. RNL

Samantha “Sami” J. Smith, MSN, RN, NNP-BC, is affiliated with Pediatrix Medical Group, a division of MEDNAX, and Dell Children’s Medical Center of Central Texas, located in Austin, Texas, USA.

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