I want to see a “real” provider

meeting room

I have a very clear memory of a time I felt completely out of place as a nurse practitioner. Annoyingly, this wasn’t even in my first few weeks or months into being a nurse practitioner. I was probably about a year into practice as a nurse practitioner when I was suddenly jarred into feeling like an imposter in my role as a nurse practitioner (not for the first time, but it had been a bit since I had felt like an imposter regularly).

That particular day, I was scheduled to do a psychiatric evaluation with a new patient— an older woman in her mid-70s presented for evaluation for depression. When the woman was brought to my office for our appointment, I began in my usual way, explaining how the session would proceed, including asking many questions to help her most effectively. I explained my role as a nurse practitioner, and I asked her if it would be ok if I typed while we talked, and when she confirmed, I began our session by asking what brought her in to see me. She was hesitant but answered the question, explaining that she was on many medications and struggled with depression.

A few minutes into our assessment together, the woman paused and asked what my role was. Was I a doctor? Where was the doctor? She expressed irritability that a nurse practitioner would see her—I don’t understand what that is, I want to see a real provider.

It was tough to hear these questions and comments. I had been professional and clear with explaining my role and how I could help her when our session began. I was most surprised by how I felt because I wasn’t expecting to feel so quickly brought back to a place where I felt I didn’t belong. I had been practicing for about a year at this time and had successfully treated some really challenging patients. I knew I could help this woman too, but not if she didn’t think I could help her.

Despite the gut-punch of inferiority I felt, I let her know that she absolutely had the right to see a physician instead and that I could connect her with one. I think she was caught off guard by how I responded because she didn’t immediately agree. She asked more questions about my role, assessing my level of competence. I answered all her questions and reiterated that she could meet with a psychiatrist instead, if she preferred, who would also conduct an assessment and provide quality treatment. I think she was surprised or confused by my confidence and ease with which I understood her perspective and desire to see “a real provider.”

On the inside, I was frustrated, angry, and sad that I had been so quickly broken down to “not good enough” as a provider. The ironic thing is, as a nurse practitioner, I compensate for not feeling good enough at times (pesky imposter syndrome) by working as hard as I can, staying up to date on evidence-based practice, meeting with a collaborating provider regularly to review difficult cases, and being very intentionally present so that I gather accurate assessment data.

It is because I worry that I am not where I belong that I work so hard. So, when I was so bluntly faced with a patient who dismissed me so quickly, it wasn’t a fun feeling. The patient ultimately left our session partway through, opting to make another appointment to see a physician instead, someone she felt could provide quality care.

I certainly understand that not everyone wants to see an APRN. Especially when the role of a physician is much better understood by the public and has been around for such a long time. APRNs are newer, and the general public doesn’t always have the best understanding of what an APRN is (in fact, I’m often asked by family and friends what exactly I do). I get it. And I know, unfortunately, I’m not the only NP who has experienced the same situation I encountered.

Imposter syndrome can certainly creep up and be emphasized by the people around us as mine was with this particular patient. I think it’s important that we debrief these situations with trusted colleagues who believe in our abilities and can validate our experiences. Nothing is worse than allowing imposter syndrome to take hold and keep us from being in a place, in a role, we truly belong.

I may not be right for every patient. But for patients willing to give me their trust, I provide quality, evidence-based treatment because it is my professional duty and because I feel responsible to represent NPs in a positive and accurate light.

Working to surpass expectations and represent NPs well is something I always strive to do, and other NPs do too. Still, it needs to come from a place not of imposter syndrome but security and confidence in our profession and ourselves. It is from this place that we make the most impact.

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