Role Transition from RN to APRN

by Elizabeth Russ, FNP

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    00:01 In today's video, we'll look at what changes occur in terms of scope of practice, legal things and ethics.

    00:07 When you make the role transition from registered nurse to advanced practice registered nurse.

    00:12 And I'll also share some tips that I think will help make your transition to practice maybe a little bit smoother.

    00:18 Plus, we can talk about the question I get asked most often from new Aprns as they're switching roles, which is how long exactly until I feel more comfortable in this new role because this whole transition, it's a lot, which means we should probably get started.

    00:35 So when you are moving from the RN to Aprn role, your scope of practice is of course going to change.

    00:42 As a nurse, you assess patients to see how they're doing, and then you implement the prescribed treatment plan as needed based on those assessments.

    00:51 And then you sound the alarm when things are not going as expected.

    00:55 But as an aprn, you add in the layer of deciding what is going to happen when the alarm is sounded.

    01:03 There's usually less implementation in the aprn role, and instead you spend your time assessing, diagnosing and treating patients.

    01:12 And that comes with a huge a huge responsibility shift.

    01:16 And if I'm being completely honest, I totally underestimated that when I went to NP school.

    01:23 Like I knew I would be making diagnostic and treatment plan decisions, but the reality and the weight of that is definitely something that hit different once I started going in and being the final one to decide what treatment plan to pursue and what diagnosis a patient would carry with them, maybe forever in their chart. And if you haven't sat with that to make sure you're comfortable with it, I would encourage you to do so.

    01:48 And if you think that it might be something that would cause you some anxiety, which is super, super common for this to cause anxiety, start brainstorming how you're going to manage that.

    02:00 One thing that you could do now is start asking your clinical instructors or your clinical peers how they handle some of those feelings when they come up around this.

    02:11 It's common for the weight of that new responsibility for it to be a little bit difficult to navigate.

    02:19 And by the way, you are gaining responsibility in more areas than just direct patient care.

    02:26 You are much more responsible for your own learning and keeping up to date with evidence based guidelines.

    02:33 You typically are also responsible for your own little team within your place of employment.

    02:40 Often, as an aprn, you will have a medical assistant working with you and if you are lucky, you might have a nurse as well.

    02:47 And while you did delegate as a nurse, it sound like a whole new level. Now you can decide how you want your visits to be set up, what information the Ma will collect for you at the beginning of the visit.

    03:01 Based on the visit type, you'll be creating protocols that will be Standard and decide if the nurse working with you can give standing meds.

    03:09 If so, what are the protocols surrounding that? And you'll also need to figure out how to work as a cohesive unit, even when working through things like conflict.

    03:23 You'll also be an advocate for your team to make sure that they're being treated fairly at work, while also having a good relationship with the office admin.

    03:34 It's honestly like it's a whole new little dance to learn and you can do it.

    03:39 It's just going to take a little bit of practice now.

    03:42 Again, starting now, it's probably a good idea to when you're in clinical, go and observe.

    03:49 See does this team run well? Does your preceptor have a good system with the Ma they work with and the other staff that's there, or is it a hot mess? You can honestly learn a whole lot from both.

    04:03 And seriously, just start taking notes so that you can implement these things later on down the line without having to try to remember them now already.

    04:14 That was a lot and we barely started, but I promise you it will be okay.

    04:18 You will be okay. And there is there is good news.

    04:21 You already know the basics of a lot of this.

    04:25 You have already been assessing patients as a nurse, so we just need to build on that. You already have been around a lot of diagnoses, so start reading progress notes right now and listening to rounds to hear how they kind of weed out differentials, to get more of the hang, of how those thought trains actually work in real life.

    04:46 And the best news of all is currently, you probably do a lot of patient education and patient advocacy, and you're going to do a lot of that as an aprn as well.

    04:58 But you already do it as a nurse, so there's not much.

    05:00 Change there honestly, and that is hard to learn.

    05:03 So that's one huge thing that you don't even have to worry about now.

    05:07 Next, I want to talk about legal things to consider when going from an RN to an Aprn role.

    05:14 And most importantly, you need to know where you can work, what type of patients you can see, and what you can actually do for them.

    05:22 As a nurse, you can work in whatever setting that nurses can work in and with pretty much any patient.

    05:29 And that is not is not the case.

    05:33 As an aprn, your care is very specific to patient and setting based on your certification and your training.

    05:41 And it's not black and white.

    05:44 It's not black and white at all.

    05:45 And it's something that you will need to look up based on your own state laws.

    05:49 And you need to personally reflect on what training you have had, even if the patient is technically in the right population and in the right setting for your certification.

    06:01 I would personally ask myself if I were to care for this person with this diagnosis, could I, in court, confidently defend my ability to have cared for them by listing all of the ways that I was then trained to do so? And if the answer is no, you need to solve that by either getting more training or not working with that patient population or diagnosis.

    06:24 And please do not rely on your future employer to know what is in or out of your scope of practice, because many employers are not sure exactly the types of patients that you can and can't see.

    06:39 So it's your job to research that and to let them know if they're trying to have you practice outside of your scope, which you should never, ever, ever, even if they ask really nicely, do, because you are now very responsibly, legally for actions that you take with your patients. Like, yes, you were responsible for those things as a nurse as well. But there was also some shared responsibility for many of those roles.

    07:06 Malpractice insurance.

    07:08 Yeah, you may have had it as a nurse, but you absolutely need to have it as an aprn and you want it with tail coverage.

    07:16 That means that you have coverage for events that occurred while you were at the practice, and will continue to have coverage for that, even if you are no longer working there. It is crazy expensive, but you need it and it can often be negotiated into your employer contract.

    07:33 Those are the basics.

    07:36 Now, what is even more fun than talking about legal things? Ethics, which I actually spent far more time pondering as a nurse practitioner than I ever expected.

    07:48 First, the easy ethical stuff.

    07:51 Remember how we discussed you having way more responsibility for things like your own learning? That's really an ethical thing.

    08:00 Your patients deserve to have the most up to date and evidence based guidelines that apply directly to them, and that takes a lot of work on your end to keep up with that type of thing.

    08:11 You you, yes, need to get CEUs for your license, but the driving force behind you keeping up with learning is now patient safety because you decide what policies need to change based on what knowledge you obtain from journals and other resources that you use to keep up with, like your current practice.

    08:32 Now, will you personally be combing through journals trying to find the latest and best evidence? Probably not.

    08:38 There are services and associations like ones published by your specialty, that will do that for you and give you like a nice little summary of the topic.

    08:46 But you do need to actively go out and seek and learn that information. What database and journals should you use for this? This is an excellent thing.

    08:56 Again, to ask your preceptors while you're in clinical.

    08:59 Ask them how they keep up to date with information.

    09:03 There's amazing apps and podcasts and websites and journals, etc.

    09:07 that can be really good learning tools, many of which you can honestly use while you're doing things like commuting.

    09:14 I would just write all of them down now, even if you don't start utilizing them at this point, and that list will be a phenomenal resource for you in your future, in your aprn practice.

    09:25 But what happens when your patient can't afford or access the evidence based care that you so dutifully researched for them? This is an ethical dilemma that we can't solve today, but it's one to start thinking about.

    09:41 Start learning about resources in your community to help you meet those gaps that are left in our health care system.

    09:48 But I do have some general advice for making your transition from RN to Aprn a little bit smoother.

    09:57 And the biggest tip that I can possibly.

    09:59 Offer you is to take your time finding your first job.

    10:04 Work your nursing job that you have until you find a really good aprn job.

    10:10 Because the biggest thing that's going to determine how your role transition to practice is actually going to go is who you are taking that journey with.

    10:18 You want to work with people who want to work with you, who don't mind all of your questions because you are going to have a lot of them.

    10:26 You want colleagues and office admin who understand that you're going to be really slow in the beginning, but who also realize that you do have value and deserve respect from day one.

    10:41 And when negotiating your job, I want you to advocate for a ramp up schedule for your onboarding so that you aren't starting seeing 20 patients a day. Instead, you see one patient per hour while you're learning things like the charting system, and you're looking up every single thing constantly throughout the day. And then slowly appointment times decrease as you get faster and more comfortable, because you will get faster and more comfortable. It just takes time, and you can jump start this whole process of getting comfortable by asking your employer for a list of like the 10 to 15 most common diagnoses and reasons for presentation that they see at your office, and then you can prepare HPI questions, assessment findings, differentials, diagnostic workups, and treatment plans for all of those before you ever see patients, which will give you a huge confidence boost for those visits when they do happen.

    11:41 And also it gives you something to do with all of that nervous energy you have before your job starts.

    11:48 And if you want to save even more time later on, create some basic templates for charting.

    11:54 For those commonly seen diagnoses.

    11:56 Type them up in a document and paste them into a template as soon as you have access to it. Or you can do it as you reach the patient.

    12:04 Encounters. In practice, charting takes up a ton of valuable time, and templates are a great way to help combat that issue a little bit. Also, ask if your institution has any templates that are pre-made. I would still edit them and make them your own, but it's a huge time saver if they have already started them.

    12:27 Communicate often with your office supervisor.

    12:31 They may have resources that you don't even know about unless you ask. They can also help troubleshoot your schedule.

    12:39 Sometimes, even if they can't give you longer appointment times or give you more admin time, they can help block it so that you don't have more than three new patient visits a day, so that your last appointments of the day will be simple quick follow ups or acute sick visits, which are usually much quicker and less complicated than other follow ups.

    13:01 All of these things can help improve your workflow and decrease overwhelm, which is so, so important.

    13:10 Remember, asking for help is okay and they can't offer help if they don't even know that you're struggling to get your assessment skills up to speed.

    13:19 You have great basics from your nursing life, as we discussed, but there are a lot of new assessment skills to learn and the best way is to just do it a bunch.

    13:30 Whatever you are struggling with assessing, assess a lot of normal ones. The abnormal will then become much clearer.

    13:38 And of course, when in doubt, use the buddy system and pull someone in whenever you aren't sure of what a finding is.

    13:45 It's very normal.

    13:46 It's very okay.

    13:48 And last but not least, the answer to the ever popular question how long will it take to feel comfortable after transitioning your practice from an RN to an Aprn? For most people, 2 to 3 years.

    14:03 That varies by person, obviously, but that's the general timeline I've seen in myself and many of my peers the first six months of being an aprn just complete overwhelm.

    14:16 But remember, it was like that when you became a nurse too, and you probably just forgot and you did that.

    14:22 So you can do this and it does really get better every day.

    14:26 And then around like one year, you're usually no longer scared to go to work, and you can do quite a few diagnostic and treatment workups and plans on autopilot, but are definitely still looking up a great number of things throughout the day as more patient encounters come in and you're looking up symptoms and meds and stuff, and then by two years you're kind of coming up for air, you can start to be curious again and learn things other than what you're looking up for, your patient encounters that day that are on your schedule because you might.

    14:59 Don't be looking up 1 or 2 things a day at that point.

    15:02 So you just have a lot more brain space, which really feels it feels glorious.

    15:07 And then at three years, it it really takes a lot to faze you at this point and make you nervous.

    15:14 You just feel a lot more confident.

    15:16 And you're often used as a resource for other people in the office, which is super, super cool.

    15:23 This whole thing, it's a long process, but you will get there and it's okay to not love it. It doesn't mean you made the wrong career choice if you completely hated it first. That's okay.

    15:34 It's a ton to learn and that can be really not fun.

    15:38 You probably hated being a nurse for a little while when you were new.

    15:41 And now look at you. You went back to school for nursing, like, of all things, your nursing career.

    15:46 It's a great foundation for your future as an aprn.

    15:50 There's a lot of changes that come with that transition to practice as we discussed, but you can do it.

    15:56 I hope this gave you a little bit of insight into what that practice transition will look like, and give you some tips for navigating it.

    16:03 You got this.

    About the Lecture

    The lecture Role Transition from RN to APRN by Elizabeth Russ, FNP is from the course Role Transitions (APRN).

    Included Quiz Questions

    1. RNs focus on implementing the treatment plan.
    2. APRNs do not diagnose or treat patients.
    3. APRNs need to sound the alarm.
    4. Neither RNs nor APRNs assess patients.
    5. RNs prefer not to implement the treatment plan.
    1. Listen during patient rounds
    2. Briefly skim progress notes
    3. Avoid difficult conversations with patients
    4. Ask subordinates to bring you coffee
    5. Ask for feedback only as required
    1. APRNs should carefully consider their training, experience, and certification with each patient encounter.
    2. APRNs should carefully consider their certification and productivity bonus with each patient encounter.
    3. APRNs should carefully consider their scheduling preference with each patient encounter.
    4. APRNs should consider ways to expand their scope of practice.
    5. APRNs should only consider patient wait times when seeing patients in the clinic.
    1. APRNs can ask their preceptors for recommendations on resources to study to stay current on care.
    2. APRNs should remain in highly populated areas to provide care to patients who already have access to this level of care.
    3. APRNs can demand institutional access to medical journals and references such as UpToDate.
    4. APRNs can ask their patients to call the office less frequently and look up their medical conditions via internet search engines.
    5. APRNs should refer all of their problematic patients to specialized providers.
    1. Ramp-up schedule over time
    2. Prepare for the most commonly seen conditions
    3. Create basic documentation templates
    4. Demand an empty clinic schedule on Friday
    5. Ask to see the most challenging cases
    1. 3 years
    2. 1 year
    3. 6 months
    4. 5 years
    5. 10 years

    Author of lecture Role Transition from RN to APRN

     Elizabeth Russ, FNP

    Elizabeth Russ, FNP

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