Let’s sit down for a minute — coffee or tea optional, honesty required.
If you’re thinking about your first nurse practitioner job, or you’re in the thick of it right now, questioning every clinical decision you make, this one’s for you. Because your first NP role? It’s part school, part trial by fire, and a whole lot of “Why didn’t anyone warn me about this?”
I’m going to tell you exactly what happened in my first NP job — the salary mistake I almost made, the physician who walked away from me mid-sentence, and the moment six months in when something finally clicked.
If you’re earlier in your journey and still deciding whether NP school is the right path, I shared three questions to help you think that through in a previous article.
How to Negotiate Your First NP Salary (And Why Most New NPs Don’t)
When I was finishing NP school, I had a specific window to find a job. I’d received a grant that required me to move to New York City and work there for two years — on a deadline. So I went to a job fair, found a table that had just opened up, applied, interviewed, and got a call in the middle of a busy ICU shift offering me the position.
There was just one problem: I told the physician straight up — I know basically nothing about GI.
Her response? “We will teach you.”
And honestly, that was enough for me to say yes. But then the offer letter arrived.
The salary was lower than what I was making as a nurse.
I know I’m not the only NP who has experienced this. It happens more than people talk about. And the pressure of my deadline made it even harder to push back. But I did it anyway. I emailed the employer and laid it out clearly: the offered pay didn’t cover the cost of living in New York City, and it was less than my RN salary. I couldn’t accept it as written.
They met my number.
Lesson one: Look at the full picture of the role — but do not skip advocating for your salary. The package matters. The flexibility, the schedule, the learning opportunity — those are real. But so is your rent. So is your financial stability. Advocating for yourself isn’t aggressive. It’s necessary. Know what you need to cover your expenses, your life, and the version of yourself you’re building. Then ask for it.
What the NP Learning Curve Actually Looks Like in Your First Year
Here’s the story I think about the most when I talk to new NPs.
My first GI role was in a small community hospital practice — three physicians, one secretary, and me. No fellowship, no structured orientation. I was seeing 15 to 20 patients a day in a specialty I had essentially no background in.
One of the physicians had a particular way of working. I’d start presenting a patient, and he would literally stand up and walk down the hall into the patient’s room — while I was still talking.
So I adapted. I tried talking faster. I followed him down the hall, still presenting, voice raised slightly over the footsteps, trying to get him the information before he got to the door.
He still went in and asked the patient the same questions I was covering.
I was frustrated. And confused. He couldn’t quite articulate what I was missing, and I couldn’t figure out what he needed. But I kept showing up, kept seeing patients, kept learning.
Then, about six months in, something shifted.
I was presenting a patient, and I finished — completely — before he even stood up from his chair. He walked in, looked at the chart, looked at me, and said: “You finally got it.”
That was it. No fanfare. Just four words that told me everything.
I had stopped presenting information and started synthesizing it. I wasn’t just reporting — I was thinking like a provider. And that shift didn’t come from a textbook or a lecture. It came from hundreds of patient encounters and the slow, uncomfortable work of getting it wrong until I got it right.
Lesson two: The thinking will click — but not on your timeline, and not because someone hands it to you. The transition from nurse to NP isn’t just a role change. It’s a complete rewiring of how you process and prioritize clinical information. Give yourself the grace to be in that process without expecting it to feel comfortable.
Going from RN to NP: The Transition Nobody Fully Prepares You For
I came from a hospital with full support — social workers, case managers, a whole team around me. In my GI practice, it was just me. No nurse. No case manager. I was doing prior authorizations, managing families, coordinating care, and seeing a full patient panel every single day.
There were moments I genuinely questioned whether I had made the right choice.
But here’s what also happened: I got to know my patients deeply. Really deeply. I knew the families. I knew the kids. I knew which formula a child had already tried and failed and why. After a year or two, staff were coming to me with questions. Patients were specifically requesting me. I wasn’t just filling a role anymore — I was making a real difference in that practice and in those families’ lives.
That felt powerful in a way I hadn’t expected.
The hard first year and the meaningful second year are part of the same story. You don’t get the second without going through the first.
New NP Advice I Wish Someone Had Given Me Before I Started
If I could sit across from you right now — coffee in hand — here’s what I’d tell you:
Your first NP job is part school and part trial by fire. Walk in knowing that, and you’ll be less blindsided when it feels hard.
Advocate for mentorship like it’s part of your compensation. If you’re going into a role with no orientation, no structured support, no one to call when you’re unsure — that matters. Ask about it upfront. A toxic or isolating environment will cost you far more than a lower salary ever would.
Give yourself at least one year before deciding if the role fits. Not six weeks when you’re still drowning in the EMR. Not three months when you’ve barely found your clinical rhythm. A full year. Because who you are at month twelve looks almost nothing like who you were on day one.
Is It Normal to Feel Lost as a New NP? Yes — Here’s Why
The doubt you feel in your first NP job is not a red flag. It’s evidence that you’re paying attention. It means you understand the weight of the responsibility you’ve taken on and you’re not taking it lightly.
Stay curious. Keep advocating for yourself and your patients. Commit to the learning even when it’s uncomfortable — especially when it’s uncomfortable.
Because the thinking does click, and when it does, this role opens doors and creates impact you genuinely could not have predicted from where you started.
Are you in your first NP role, or getting ready to start one? Drop a comment below — what’s been the hardest part, or what are you most nervous about? Some of your answers might become a future post right here.
About the Author
Amy Anne Felix is a nurse practitioner and the creator of The Nurse Sabbatical, a thought-leadership platform exploring nursing culture, rest, identity, and life redesign. Through storytelling and systems reflection, she examines how mid-career nurse practitioners can build aligned, sustainable careers without abandoning their identity.
