Starting out as a nurse practitioner can feel like trying to drink from a firehose. The transition from RN to NP is exciting, rewarding, and—let’s be honest—completely overwhelming. You’re expected to lead patient care, make diagnostic decisions, and navigate new levels of responsibility, all while adapting to a different clinical identity.
If you’re feeling a little lost, you’re not alone. Every year, thousands of new NPs step into their roles and realize pretty quickly that school didn’t teach them everything they need to know. And while making mistakes is part of the learning curve, some are more common—and more avoidable—than others.
Let’s break down the top 5 mistakes new NPs make, and more importantly, how to steer clear of them so you can thrive in your first year and beyond.
Mistake #1: Not Asking Enough Questions
Many new NPs feel a self-imposed pressure to prove themselves right out of the gate. After all, you’ve earned the title “nurse practitioner” and you don’t want to look like you don’t know what you’re doing. But here’s the reality: you are still learning. And one of the most dangerous mistakes new NPs make is pretending they’re not.
When you avoid asking questions out of fear of looking inexperienced, you risk making decisions that can negatively impact patient care. You also miss valuable learning opportunities from colleagues who have walked this road before you.
How to Avoid It:
Normalize curiosity. Seek out a mentor, consult your collaborating physician, and tap into your team’s collective experience. Make it a habit to ask, “Can I run this by you?” It doesn’t make you look weak—it makes you look like you care.
Mistake #2: Overprescribing (or Underprescribing) Out of Insecurity
It’s common for new NPs to feel unsure about treatment plans, especially when it comes to medications. Some may overprescribe antibiotics or medications “just in case,” out of fear of missing something. Others hesitate to prescribe at all, worried they’ll make the wrong call.
Both extremes stem from the same root issue: lack of confidence in clinical judgment.
How to Avoid It:
Build your confidence by reviewing evidence-based guidelines and keeping resources like UpToDate or Epocrates handy. Stay humble but decisive. It’s okay to say, “Let me double-check the latest recommendations,” and follow up with a clear plan.
Also, remember that prescribing is only one piece of the care puzzle. Educating your patients, considering lifestyle changes, and setting up proper follow-up are just as important.
Mistake #3: Thinking You Have to Know Everything
One of the biggest misconceptions new NPs have is that they’re supposed to walk into practice fully formed—as if becoming a nurse practitioner meant you downloaded all the answers overnight.
Here’s the truth: even the most seasoned NPs and physicians still Google things, phone a colleague, or crack open a reference book. Medicine is vast and ever-evolving. You are never going to know everything—and that’s okay.
How to Avoid It:
Give yourself permission to be a beginner. Set a goal to learn something new every day. Keep a “clinical wins and lessons” journal to track your growth and areas for review. Surround yourself with peers who normalize lifelong learning.
New NPs who embrace the learning process without shame tend to build deeper competence and confidence faster than those who pretend to know it all.
Mistake #4: Not Setting Boundaries With Patients
In school, the focus is often on providing compassionate, comprehensive care. And while that’s essential, many new NPs struggle when they realize that not every patient will be pleased with their care—even if it’s clinically appropriate.
You may feel pressure to refill medications you’re not comfortable with, order unnecessary tests to appease a patient, or squeeze in “just one more” appointment during your lunch break.
This is a fast track to burnout.
How to Avoid It:
Set clear expectations from the beginning. “I’m happy to manage your care within my clinical judgment” is a powerful phrase. Practice saying no with kindness but firmness. You can be empathetic and still hold your ground.
It’s also crucial to protect your time. New NPs often feel obligated to overextend themselves, but remember—you cannot pour from an empty cup. Boundaries are not just for patients; they’re for your own longevity in this career.
Mistake #5: Neglecting the Business Side of Healthcare
One of the most shocking realities for new NPs is just how much of your job will involve understanding billing, documentation, and productivity metrics. No one really talks about it in school, but in the real world, healthcare is still a business.
Poor documentation can lead to denied claims, missed revenue, or worse—legal liability. And if you don’t understand your clinic’s goals, it’s hard to advocate for yourself in terms of compensation or resources.
How to Avoid It:
Take time to learn about CPT codes, proper charting techniques, and your organization’s productivity benchmarks. Ask to shadow your billing team for a day or attend a webinar on documentation best practices.
Understanding how the system works empowers you to work smarter—not harder—and advocate effectively for both yourself and your patients.
Bonus Tip: Community is Your Superpower
Let’s be real—this transition can be lonely. Imposter syndrome is loud, and the stakes feel high. But you’re not the only one feeling this way.
The most successful new NPs are the ones who find community—whether it’s in a mentorship program, an online group, or through clinical supervision. Sharing the highs and lows with people who “get it” will remind you that you’re not failing—you’re just growing.
Final Thoughts
If you’ve made one (or all) of these mistakes already, take a breath. That doesn’t make you a bad nurse practitioner—it makes you human. Every single experienced NP you admire has been exactly where you are.
The goal isn’t to be perfect. The goal is to grow with intention, stay humble, and prioritize patient safety while honoring your own learning process.
To all the new NPs reading this: You are needed. You are capable. And you are absolutely allowed to ask for help while you become the exceptional provider you were meant to be.
Summary of Key Takeaways:
- Ask questions early and often. Don’t let pride get in the way of safe care.
- Trust evidence-based guidelines over fear or people-pleasing.
- Ditch the myth that you’re supposed to know everything.
- Set boundaries with patients and with your schedule.
- Understand the business of healthcare—your license depends on it.
New NPs are the future of healthcare. Let’s make sure that future is confident, competent, and supported every step of the way.
Want More Support?
If you’re a new nurse practitioner looking to level up your clinical skills, navigate the business side of medicine, and avoid burnout, consider joining a mentorship program or clinical coaching network. You don’t have to figure this all out alone—and you shouldn’t.
Let this be your reminder: You’ve got this.