TL;DR (Fast Track Summary)
- Purpose: Your first year as a new NP or PA is hard. The learning curve is steep and the support can feel nonexistent. But there are practical ways to survive your first year in practice with less stress and more confidence.
- Do this first: Get comfortable being uncomfortable, and know exactly where to go for help, mentorship, and feedback.
- Red flags: No mentorship, unsafe patient loads, unrealistic expectations, or constant charting anxiety.
- Key lesson: You’re not failing, and you’re not alone. The goal isn’t perfection. Find the systems that help you grow, stay grounded, and build real clinical confidence.
Your first year as a new provider is wild. You work so hard to make it through long lectures, rotations where you constantly feel in the way, and the stressful process of board and think, “Ok, I made it!”.
Then, day one of your first job hits and suddenly, you’re buried in charts and second-guessing every single decision you make.
Trust us, it’s not just you. Every new NP or PA goes through the same thought process. You’re trained for medicine — not the hundreds of other factors that go into patient care.
Here’s what no one tells you, and how to make it through without burning out.
A Reality Check
Most new grads walk into their first job and realize within one shift that “orientation” means a half-day shadowing session and the requisite compliance training. After that, it’s sink or swim.
New providers online say the same thing again and again:
“My first NP job, I was there 1 hour, handed a laptop (no training on EMR), and told ‘go see patients, you know what you’re doing.’’’ Oldmahubbard, AllNurses Forum
“I’m in FM now and supposed to be seeing 30 patients in an 8 hour shift. It’s insane. … Charting at home stinks but I have no choice.” Mayamom, Physician Assistant Forum
It’s not that you’re unprepared or unfit. The problem is that the “system” simply isn’t designed for new providers. But there are ways to survive it:
- Don’t measure your self-worth by your job. Medicine is only one part of your life. Protect the things that make you feel human. Spend time with people who matter and prioritize the activities that fill you up.
- Find ONE person at work who has your back. It doesn’t have to be your attending — just someone who answers questions without judgment or irritation.
- Block time to chart DURING your shift. Don’t leave it for the end of the day or the weekends. Protect your personal time.
- Take feedback, but don’t internalize it. Learn from people who want you to grow, not those projecting their own burnout or resentments. There’s a difference between coaching and criticism. Absorb what’s useful and let the rest go.
- If you feel miserable every day for months, it’s not you. It’s the job. Some environments just aren’t the right fit for a new provider.
The Questions Every New PA and NP is Secretly Asking
Why does this feel SO overwhelming?
Because it is! You’re not just practicing medicine for the first time. You’re learning ten new skills at once — workflow, team dynamics, charting, billing, administrative responsibilities, patient flow. On top of that, you have to pretend you are fully confident. It’s normal to feel like you’re drowning for a while.
How long before it gets better?
Honestly, usually 6–12 months. It doesn’t happen all at once, and the sooner you get comfortable being uncomfortable, the happier you’ll be. One day you’ll realize you finished your shift on time and didn’t have to look up every single chief complaint.
How do I know if I’m in the wrong place?
If you’re scared to ask for help, seeing unsafe patient loads (hi 45 patients in UC!), or dreading every shift for months on end — you’re probably in the wrong place. Read more about this below.
What should I focus on learning first?
Get comfortable managing the 5 most common diagnoses you see in your specialty. After that, focus on time management and documentation. You can survive the personality clashes and learning curve of a new job but you won’t survive years of charting on nights and weekends.
What if I’m already thinking about quitting?
Stop and take a breath. Get some space from the situation. Try to find small wins and fixes first — a new perspective, fewer shifts, better structure, firmer boundaries. But if you’ve been asking for help and nothing changes? Leave.
When the Job Itself Is the Problem
Sometimes, the job isn’t right for you. And that’s ok.
Below are common red flags for new NPs and PAs starting their first jobs and how to handle them.
| 🚩 Red Flag | What It Means | What to Do |
| High turnover | Burnout factory | Ask why people left before you. Honest workplaces will tell you. |
| “Figure it out” culture | No mentorship or onboarding | Push for structured shadowing or start creating your own workflows (ex. “patients with chest pain should always follow this workup model”). |
| Unrealistic patient volume | Unsafe expectations | Speak up early. Safety issues are non-negotiable. |
| Constant anxiety about charting | Poor systems and lack of support | Learn templates, macros, and shortcuts ASAP. Ask others how they keep up. |
| No feedback | Stagnation and burnout | Request short feedback once a month. |
| Being told “you’re too slow” | Toxic productivity culture | Set your own benchmarks. Quality care should be your top priority. |
A Real Story
An NP in an urgent care posted that she was seeing 20+ patients a day with zero orientation. She cried after almost every shift.
Her fix wasn’t magic. She started batching charts, asked to shadow a senior NP for a week, and joined an online NP support group. Within two months, she still wasn’t thriving, but she at least felt like she had her footing.
That’s what this first year is about: small wins and persistence.
The Bottom Line
You’re not supposed to know everything on day one. Imposter syndrome is real and the learning curve can be brutal.
Building confidence will come, slowly but surely. Every shift, every patient, every note that takes five minutes less than last week are are small, simple steps in the right direction.
You also don’t have to white-knuckle your way through your first year. There are a lot of resources out there that can help. Blox was built by providers who’ve been there — to help you chart faster, think clearer, and feel less alone. Check it out here.