10 Biggest Challenges Of Being A Nurse Practitioner And Ways To Overcome Them

Written By: Lauren JacobsonLauren Jacobson MS, RN, WHNP-BC

Lauren Jacobson is a registered nurse and women's health nurse practitioner who is passionate about global health and specialized in sexual and reproductive health and rights (SRHR) and gender-based violence. She currently works as an International Health Consultant in Amsterdam, The Netherlands. Read Full Bio »» MS, RN, WHNP-BC

There are many benefits and positive aspects to working as a nurse practitioner, but like any job, it comes with its challenges. Some of these nurse practitioner challenges can be found in any healthcare job or any emotionally demanding work. Others are more unique to being a nurse practitioner. From physical demands, interpersonal struggles, all the way to emotional health, being a nurse practitioner can be tough. As challenging as it is though, I promise it is even more rewarding. Here we will review the 10 top challenges of being a nurse practitioner and provide you with ways to successfully overcome each one of them.

What are the Challenges of Being a Nurse Practitioner?

(Following are the 10 Biggest challenges of being a nurse practitioner and ways to successfully overcome each one of them.)

1. Emotional work

Any type of caregiver position can be emotional work. As a nurse practitioner (NP), it doesn't matter what specialty you are in, you are going to play an important role in people's lives. This work can be intimate, heartbreaking, inspiring, fulfilling, and more. An essential part of being a nurse practitioner is developing a trusting relationship with your patients. Guiding people to better health during some of the most difficult and vulnerable periods of their lives can take its toll. One of the top nurse practitioner challenges is to not carry these emotional situations home with you.

How to overcome:

One of the best ways to separate the emotional aspects of your work from your personal life can be to check in with yourself at the end of a workday. What challenges did you face today? Where is your headspace? How can you go home and not take this with you? If you do have to take it with you, what coping strategies can you use and what’s your support system like? Practicing self-awareness and leveraging emotional support when you need it can be the best way to cope with the emotions that stem from caring for others.

2. Varying hours

Working as a nurse practitioner can have a lot of flexibility when it comes to your schedule, and often this can be a good thing, but not always. Depending on your specialty and the department you work in you may have a 9 to 5 job, or you may work in varying shifts. If you have an NP role where your work hours are changing, long, at night, or otherwise somewhat inconvenient, this can take a toll on your personal life. One of the biggest challenges of being a nurse practitioner is work-life balance, and a changing schedule or working overtime can impede this.

How to overcome:

One way to navigate this challenge is to know yourself and your needs. If you are looking for an NP job and you know you do not cope well with working nights, then you can avoid this situation by talking about shift schedules during your interview. Maximizing your days off can also help cope with an unpredictable schedule. What things do you do to relax? How do you like to spend your free time? Even if your days off are a Tuesday and Wednesday, find ways to treat it like a weekend. Like with any job, support systems are crucial. Having people in your life who understand that your work is important to you and who empower you to take care of yourself can help you cope.

3. Working with people

Working in health care is often like customer service. Not only do you have your very human coworkers to work with, but your customers are patients who come to you with very important and personal concerns. When people are worried about their health, or untrusting of the healthcare system for whatever reason, it can present additional challenges. Whole families are often involved in patient care and this brings additional perspectives and personalities that you may need to work with. Patients may be angry, fearful, anxious, sad, demanding, or seem like they don’t care, and more. Working closely with people can be great, but it can also be one of the major challenges of being a nurse practitioner. Sometimes, you may know what a person needs from a clinical standpoint, but this may not seem to satisfy them.

How to overcome:

When you feel like you are having a hard time working with certain people, it can help to be direct and ask them what they are hoping to gain by seeking care with you. This can not only help you identify the root cause of their issue and provide them with the holistic service they are looking for, but it also earns you trust points. Building a trusting relationship with patients can take time, but it is essential to providing patient-centered care.

4. Power imbalance and hierarchy

Whether you are a nurse, a nurse practitioner, or a doctor, it’s no secret that there can be uncomfortable dynamics in nurse-doctor relationships. This is not limited to the doctors. This can be pervasive in the nursing community as well, and if you work with other nurse practitioners who have more experience than you or have been at your place of employment longer than you, it can perpetuate this hierarchy. This often stems from the age-old hierarchal medical system which can present one of the biggest challenges of being a nurse practitioner. On paper and legally you may have full autonomy to provide care independently to your patients, but the people you work with may micromanage, seem not to trust you, counteract your clinical decisions, and just present overall barriers to you providing the type of care you would like to. Not all coworkers can be like this, certainly, you can have collaborative and empowering relationships with the people you work with.

How to overcome:

When you do find yourself caught up in the hierarchal medical system, there are a few things you can do. The first step is to "read the room" and then communicate. Once you figure out how your coworkers think and receive feedback you can decide how to communicate your expectations, needs, and frustrations in a way that can strengthen the relationship while allowing you to express yourself. One of the best things you can do is try to assess this dynamic before you take the job. During your interview, ask how everyone works together and what their professional hopes are for you to be there. Are they committed to your growth? Do they want to provide you support as you need it but also empower you to make your own decisions safely? Have they worked with nurse practitioners before? What was that experience like for them? These types of questions can help you gauge the work culture before you get swept up in it.

5. Not being able to help everyone

As a nurse practitioner, there is no doubt that you want to help people heal and recover. One of the greatest nurse practitioner challenges is coming to terms with the reality that you will not be able to help everyone. This doesn’t mean you give up or don’t try. It just means that you are realistic and better equipped to cope with the scenarios where (for whatever reason) you cannot help a patient in the way that you (or they) want you to.

How to overcome:

Sometimes the reason why you can’t help someone is clinical; there are certain medical conditions that no matter how advanced the technology, a patient will not recover. Other times this can be due to patients not complying with treatment, not agreeing with a care plan, financial barriers, or simply you not being the right person for this patient to see. Practicing self-awareness, leveraging the expertise of your colleagues, and working collaboratively with your patients can help you cope with this reality when you encounter it.

6. Restrictive practice settings

Depending on the state you work in, you may or may not have independent practice. One of the challenges of being a nurse practitioner is that each state can be a bit different in terms of what you can and cannot do. These state laws can influence whether or not you have a supervising physician and what the dynamic of that relationship may be like. If you work in a more restrictive setting, you may find that your scope of practice limits how you would like to provide care. Restrictive regulations also reinforce the inaccurate idea that nurse practitioners do not provide safe and comprehensive care in comparison with doctors. Evidence shows that nurse practitioners provide high-quality care to their patients that is similar to the quality of care doctors provide, yet many people are not aware of this fact.

How to overcome:

One of the ways to overcome this challenge is to know what you are legally allowed to do in your state. Another option is to be open to moving to a location where the state practice environment is not so restrictive. This may provide you with more growth opportunities. No matter what the regulations are where you work, try to find a supervisor and coworkers who empower you to work at the top of your legal scope and abilities.

7. Being challenged too little or not enough

No matter your age or experience level, if you are not being challenged where you work, you will get bored. On the flip side, if your work is beyond your current capabilities or scope, it can create undue stress and be dangerous. Either of these scenarios can lead to toxic and unhealthy work environments.

How to overcome:

Vetting your potential employer during your interview can help you find a healthy way to be challenged professionally. Asking questions during your interview about what kind of support you will have from coworkers, how many patients you are expected to see in an hour, and what type of clinical situations you are expected to manage can help you choose a work environment that is right for you. If you find yourself in a situation where work is too challenging, or not challenging enough, communicate this to your supervisor and be clear on what you would like to see change and why. When your supervisor values you, your work, and your professional growth, they will be invested in retaining you. Clear communication can go a long way.

8. Charting, charting, and more charting

Being a nurse practitioner is not just all about seeing patients. Writing clinical notes and charting after each patient interaction can be time-consuming and dull, but it's necessary. After a long day, you may find yourself with numerous clinical notes left to finish and all you may want is to go home and relax. Every person is different and one of the nurse practitioner challenges is charting in a way that optimizes your time and energy.

How to overcome:

It may take some trial and error for you to figure out what works best for you. Are you happier if you go home right when the clinic closes and finish your note in the morning? Do you have admin time in your schedule where you can catch up on your charting? Is it less stressful for you to finish your notes before you go home and leave with a clear head? In my experience, getting the notes done before you go home is the best way to keep them from causing undue stress. Then you are not taking work home with you, and you are more likely to remember important information from the visit that should be included in the chart.

9. High-stress levels

Having someone else’s life or wellbeing in your hands takes its toll. Every job comes with generalized stress at times but the numerous challenges of being a nurse practitioner can make it extra stressful. When we care for others, we can easily put our well-being on the back burner.

How to overcome:

Being proactive with your stress management can help prevent it from getting out of control. Some of the things you can do to help you manage your high-stress levels include striving for 8 hours of sleep a night, exercising regularly, eating well, journaling, and if needed finding a professional mental health counselor to talk to. Don't wait until you are at your wit's end to care for yourself. Create healthy habits from the start and then you will be better able to cope in the long run.

10. Skill maintenance

During NP school you likely learned many clinical skills and/or procedures to help care for a variety of patients. Whether you are a new NP getting your first job or an experienced NP switching specialties or departments, one of the challenges of being a nurse practitioner is keeping skills you have learned when you are no longer using them. These can be things like biopsies, remembering what signs and symptoms warrant ordering certain tests, and various exam techniques.

How to overcome:

Overcoming this challenge involves a few things. First, understand that you can always re-learn skills from another clinician in the future if you need to. Second, whatever job you are taking, talk with your supervisor about which skills you would like to retain or learn so that they can help you maintain these skills. Ultimately you will always be learning as an NP, and there is always the option to learn from others. Just evaluate your professional needs and desires and communicate what is important to you.

Summing It Up

Being a nurse practitioner is a tough but rewarding career. You will be constantly learning about yourself and others as you grow. These 10 top challenges of being a nurse practitioner are not designed to scare you, but rather prepare and reassure you. You will never have a job that is not challenging at times. Being aware of some of the challenges that nurse practitioners experience and how you can navigate them can help you build resiliency, grow, and be a better caregiver.