One of the single best decisions I made early on (one of few) in practice as a new nurse practitioner was to decide to find an experienced clinician to meet with regularly for private supervision or consultation.
At the time, I didn’t know there was a structured name for what I was looking for. I just knew that I felt lost, especially with prescribing medications. And because prescribing medications was my primary role, I knew I needed to do something to gain greater competence and confidence.
Of course, there was a wealth of information available to me in textbooks and apps for reference when prescribing medications, but I wanted something more individualized and less overwhelming. I wanted (in theory, not reality) to re-take Advanced Pharmacology to really understand the pharmacokinetics and pharmacodynamics of medications. I wanted to have a very clear understanding of all my possible medication options for whenever a patient entered my office with “X” condition. I essentially wanted to become very skilled in the area I was hired for.
That doesn’t sound unreasonable, right?
I was just frustrated with the resources I saw available to me. Textbooks. Medication apps. Texting a colleague for advice. I wanted more.
I happened to be talking to someone about this frustration I was experiencing, and they suggested I find a provider to do “private supervision” with. If you haven’t heard of this term before, you’re not alone. I had no idea what “private supervision” was.
I learned that it’s common for new providers to utilize support systems such as “private supervision,” sometimes called “private consultation,” to gain greater clinical competency. It works by finding an experienced provider who is willing to meet with you regularly to review patient cases, answer any questions you have about prescribing medications, charting, and handling difficult patients. Really anything you are struggling with.
Private supervision is a common practice for new physicians, but it can be facilitated with any provider such as nurse practitioners. Private supervision is often a paid service where you pay a provider for their time in exchange for their knowledge and expertise.
I can’t believe this isn’t standard practice for nurse practitioners. My school definitely didn’t talk about it as an option when I graduated from my MSN program.
As soon as I learned about this concept, I decided I needed it and would find someone to do private supervision with. I was a few weeks into practice as a new nurse practitioner, and I desperately wanted more guidance with prescribing.
I thought about all the experienced clinicians I had ever encountered. Most of these experiences were during my practicum hours in my MSN program. I was lucky to have clinical experiences with many different providers in a variety of settings.
In reflecting on who I wanted to reach out to, one provider came to mind. He’s an experienced psychiatrist who I met in the final semester of my MSN program. He was not the main preceptor I had worked with during my practicum hours, but I had the opportunity to shadow him a few times. He was so incredibly knowledgeable, open to teaching me, and answered all my questions without making me feel dumb.
It had been a few months since I had shadowed this provider, and I wasn’t sure if he’d remember me. But I decided I had nothing to lose, and I needed the help, so I emailed him. I reminded him of who I was and thanked him again for being one of my preceptors during my clinical rotations. I let him know I had found work and was seeing patients but wanted to hone my prescribing skills. I asked him if he was open to doing paid private supervision with me to review difficult cases every week for a period of time. I also added that I understood he may be unavailable and inquired if he knew anyone else who might be willing to meet with me.
Now I want to pause and acknowledge that asking for help from someone with lots of experience in an area where you are weak (and they are very busy) can be intimidating. For me, it helped that my inquiry for help wasn’t in person, so that the response wasn’t immediate. It was also helpful that I asked if he knew anyone else who might be available or willing to do private supervision so that he didn’t feel obligated to say yes.
Know that not everyone may have the time, energy, or desire to meet with you for private supervision. That’s ok if you get some “no’s.” The importance is that you keep asking around and asking if people know other people who might be available because the value you receive is priceless (more on that in a bit).
Luckily for me, he said yes to meeting with me weekly for private supervision. In my time meeting with this prescriber, I learned so much.
I received weekly, individualized time to review difficult, current cases I was wrestling with. I learned to establish patterns in the types of patients I saw and the medications I was prescribing. I was receiving a weekly masterclass in pharmacology that no school would have been able to give me.
Over the following weeks and months, I became confident in my prescribing abilities and skills. I also received validation from the prescriber that some of my struggles and frustration weren’t just happening to me. He, too, found some of my patient cases to be complex and was annoyed as I was when reviewing patient cases where medications were in complete disarray when patients came to me on initial visits. I felt bonded to another provider, which helped with some of the stressed isolation and is-this-only-me feelings I had been experiencing.
Now you may be thinking, “that all sounds great, but what about the money? I can’t pay someone to meet with regularly for private supervision.”
My answer to you is this: Yes, you can. Even if you received a low-ball salary in your offer negotiation, you have the $100 per hour, give or take, to meet with an experienced provider once a week or a few times per month to gain valuable information. I say that because, in exchange for a few hundred dollars, especially at the beginning of your career as an NP, the value you receive is so incredibly high.
What price can you put on the feeling of knowing you are supported as you consult with an experienced provider on difficult patient cases? Knowing your clinical decisions are in part guided by the advice of someone with experience? This extra support reduces your stress, uncertainty, and doubt, which desperately needs reducing early on as a nurse practitioner.
A potential occurrence with private supervision is that you may find a provider willing to meet with you for free (that’s what happened for me), but I recognize this is rare and not often the case. And again, I would have gladly paid significant amounts of money to obtain the value, knowledge, support, and confidence (and also friendship that came from it) I received along the way.
You may also be wondering how to handle having a collaborating provider. Maybe you live in a state that requires one; should you just meet with them regularly instead? While a collaborator can be helpful, they don’t offer the same level of support as someone you arrange to meet with regularly (often outside of work hours).
Collaborating providers are sometimes just there on paper (someone you meet with a few times per year to show you have a collaborator to meet state requirements). While that type of arrangement is great a year or so down the line (because NPs should have full practice authority), in the beginning, it’s nice to be able to meet with an experienced APRN or physician to review difficult cases and have your questions answered.
I can’t recommend finding an experienced provider to do private supervision with highly enough. This is the single best thing you can do to gain greater confidence and competence in areas you feel you are clinically lacking as a new NP. I’m not sure why schools don’t talk about this more, but I want you to know that it’s available to you and incredibly valuable. Make one of the best decisions in your transition into practice by finding one too.
