Journal Logo


Bridging the gap

Career clarity and a challenging patient

Nyhus, Julie MSN, FNP-BC

Author Information
doi: 10.1097/01.NURSE.0000659296.09452.2a
  • Free

GRADUATING from nursing school is equal parts exciting and unsettling. When I was an FNP student nearing my second graduation, I could once again feel mounting anxiety surrounding the looming certification exam and beckoning job market. I knew I would soon have to make the mental shift from floundering student to confident professional.

As a new graduate nurse, I remember feeling inundated with medical facts and struggling to remember nursing procedures and the corresponding critical thinking infrastructure to support them. Veteran nurses told me things like, “No one expects you to know everything”; “Ask lots of questions”; and “You are human. You will make mistakes, so be sure to learn from them.” Even as I transitioned from an RN to an FNP with a résumé full of nursing experience, each of those statements still applied.

Having worked full-time as an RN while attending graduate school, I was initially convinced that the uncertainty of my new role would not affect the clarity of my old one. I thought I would be ready to don the advanced practice label and ace my FNP certification exam. As graduation approached, however, I felt paralyzed with ambivalence and confusion, much like the first time.

While studying to be an FNP, I worked as an RN admissions coordinator for a home healthcare company. One experience stood out as a lesson in applying my nursing expertise to my new role.

Challenging circumstances

On a patient assignment, I pulled up to a dilapidated, two-story house with a bright orange eviction notice stuck to the front door. I was there to see “Mike,” 68, a retired high school history teacher who had a left below-the-knee amputation and two amputated toes on his right foot due to diabetes. He greeted me by yelling “come in” from the couch, and his next few words to me were sexist, crude, and demeaning.

Mike seemed to have the market cornered on unpleasantness and sat surrounded by filth and clutter in his living room. The plastic urinals had overflowed, and I could hear vermin scurrying through the walls. With a chuckle, he assured me they could not get in. A blood-stained gauze was twirled around Mike's amputation stump, and a handgun peeked out from under his right buttock. Two rounds of nursing school had not prepared me to care for patients with handguns. I had to step back, contemplate my next steps, and remind myself that this was not the first patient to test me as a nurse.

According to the latest annual Gallup poll, the public rates nursing as the most trusted profession in the US, with consistently high levels of honesty and ethics.1 Nurses have earned their badge of trust by encouraging students and colleagues to remain nonjudgmental about patients. Mike needed and deserved optimal home healthcare, as well as a referral for a social services consultation to help with his living conditions.

My approach was one of empathy and tolerance. I could not effectively provide care without taking the time to demonstrate where I drew the lines of respect and safety with my patients. This required me to trust the knowledge I had acquired during my first experience in nursing school and return to the basics of therapeutic care that benefits both the patient and the nurse.

I inquired about Mike's concerns and fears as I took his health history and vital signs, performed medication reconciliation, and changed his dressings. He told me about his daughter, who had been staying with him until she was taken to prison the previous night, and about his fears of losing his other leg and being alone. He talked and I listened.

Bridging the gap

Nursing is full of brief, intimate encounters that allow nurses to step into patients' shoes and experience their concerns and fears. They earn this privilege by building trust. Standing in Mike's condemned house, I had briefly let my school struggles make me question things I already knew as a nurse. I found myself thinking, “Now what do I do?”

At some point in their careers, all nurses will face a gap between their eagerness to care for others and the reality of a challenging situation. That day with Mike was my opportunity to bridge that gap. If we could discover a place of trust and connection, then perhaps I could learn to trust myself through the FNP graduation process.

Ready or not

Looking back, I am thankful that the uncertainty surrounding my graduation did not blind me to the fact that, at its core, nursing is about caring for people. I had become so focused on my education and studies that I let myself become stymied by the learning process. Ultimately, this realization did not do much to halt the mounting anxiety of graduating, but it did ground me for a moment as I cared for a patient in need.

As I neared graduation, my experience with Mike brought a fresh sense of certainty regarding the things I already knew about nursing. I had to trust myself and my desire to treat all patients with equal respect because, ready or not, graduation was coming.


1. Reinhart RJ. Nurses continue to rate highest in honesty, ethics. Gallup. 2020.
Wolters Kluwer Health, Inc. All rights reserved