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Making It Fit

Bailey, Meredith, MSN, BSN, RN, PMH-NP

AJN The American Journal of Nursing: June 2014 - Volume 114 - Issue 6 - p 72
doi: 10.1097/01.NAJ.0000450439.73619.6e

A new NP on a psych unit finds her professional identity must be redefined.

A new NP on a psych unit finds her professional identity must be redefined.

Meredith Bailey works as a psychiatric NP at Yale-New Haven Psychiatric Hospital, New Haven, CT. Contact author: Reflections is coordinated by Madeleine Mysko, MA, RN: Illustration by Jennifer Rodgers.



I work on an inpatient psychiatric unit and introduce myself as an advanced practice nurse or an NP. Often, patients look at me curiously and respond with something like, “So you're the head nurse?” Then I explain that no, I'm not the head nurse. I'm in charge of their treatment plan, medications, and discharge planning. This is followed by, “So you're like a doctor?”

Most of the time, I sigh and say yes, I suppose I'm kind of like a doctor. But my whole being rebels at defining my nursing practice as “like a doctor.” I'm not a doctor. I'm a nurse. In my newest nursing role, it's been challenging to be trained by a psychiatrist and not initially welcomed by nursing colleagues. When I walked onto the unit my first day, expecting to be embraced by the nurses, I was dumbfounded and hurt that my own profession didn't accept me with open arms. The inpatient unit is a melting pot of professions, and I found that I didn't necessarily fit with the doctors, the social workers, or the staff nurses.

I was a new APRN, but I'd worked as a staff nurse in a pediatric ED for six years. I had been through a lot in the ED, personally and professionally. I'd come to consider my nurse colleagues as friends and teammates. We had each other's backs through the best and worst of times. In the chaos of an ED, it's imperative that the nurses unite, and we did. I'd assumed that this feeling of being a team carried across departments, hospitals, and roles.

I was wrong. There were staff meetings for nurses only and I wasn't invited. I was expected to go to medical staff meeting weekly—except on the weeks when the meetings were physicians only. I received a message, loud and clear, that I was something different, and I didn't like it.

I didn't experience nurses “eating their young.” It was worse—they ignored me. At first I cried. I left each night feeling like I'd made a mistake in leaving the ED and entering this new role. I didn't want to be an APRN. I wanted to go back to being an RN. I felt like everything was backward. I now had residents and medical students following me around and doing rounds with me. My only experience with residents up to that point had been in the ED, and certainly not in a supervisory role.

It took time and a lot of patience, but eventually I started to accept and engage with my new role. The attending I work with is a psychiatrist and we often have nurse versus doctor debates. He helps me become an independent practitioner and I help him be more like a nurse. He also helps me navigate the challenges presented by my patients, the unit, and the hospital.

The medical consulting APRN also befriended me, and after my first month I told her my worry that the other nurses didn't accept me. She bluntly told me I wasn't a staff nurse anymore, so I should buck up and things would get better. That felt like nurse advice, and I didn't feel so alone any longer. Realizing that I couldn't be the only person experiencing this, I started to organize a meeting of all the psychiatric APRNs at the institution.

During my second month, some of the nurses realized that I could put medication and diet orders in and that I'm more accessible than my attending, so a few started speaking to me. During my third month, there was a seizure on the unit and I was the only provider on the floor. I handled myself well, and after that all the nurses began talking to me. I have done blood draws on hard sticks on the unit, and I drop by electroconvulsive therapy three times a week to place ivs so I can keep my skills up. It took time and energy, but I proved that I'm not scared to get my hands dirty and I'm definitely not “like a doctor.”

After six months, a few of the nurses invited me to dinner. I immediately accepted, and while we were having our meal we talked about the difficulties they'd had with me and I'd had with them. We laughed because it seemed silly now, but in the beginning they didn't know where I fit into their world and I didn't know where they fit into mine. But I knew I was going to make them fit—because, like I said, in my heart and in my practice, I'm a nurse.

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