Yes, You Can Deliver a Plan of Care with Confidence

Do you ever feel awkward as a nurse practitioner when you give a patient a diagnosis and begin to discuss next steps? Maybe you are a new grad and aren’t entirely sure what the next steps should entail. Or, perhaps a definitive diagnosis hasn’t been determined, and you’re worried your patient will find you inadequate if you can’t deliver the exact answer to their problem. Or, maybe the plan of care for your patient is one they will not be happy with, so you are anxious about sharing the information. Whatever the reason for your hesitation, it can be difficult at times to have confidence as a nurse practitioner. 

As NPs, we must become accustomed to interacting with all kinds of patients in a wide variety of settings. Personally, for me as a nurse practitioner, this is more difficult at some times than others. I may lack confidence when telling a patient they need more time or testing before I can make a diagnosis. Sometimes I am timid when I let a patient know that I am unable to ‘fix’ their problem, and that their undesirable symptoms may persist for a period of time. 

When we face these situations as nurse practitioners, how do we gather our thoughts and present our findings and plan of care to patients with confidence?

Know Your Audience

While not having all the answers may leave you feeling inadequate, according to a British Medical Journal study of 1.5 million patients, ‘being taken seriously’ had the strongest association with confidence and trust towards healthcare providers. By merely listening to your patients and addressing their concerns, you inspire confidence. So, just say ‘no’ to that voice in your head that’s telling you that you’re not good enough. 

Share What You Do Know

It’s common in healthcare that making a diagnosis or developing a plan of care takes more than one encounter. So, offer a piece of the picture to your patient even if you haven’t had a chance to put the clinical puzzle entirely together. You might use some of the following verbiage to help: 

• ‘The good news is we know that you don’t have…’ – Share a little bit about the conditions you have ruled out. 
• ‘While we aren’t sure of the cause of your symptoms, we can treat the symptoms themselves…’ – Offers a partial solution in the event that you are awaiting or unable to make a diagnosis. 
• ‘Based on…my thoughts are…’ – Share your line of thinking with your patient. This helps the patient know that they have been heard and that you are working towards a plan of action, even if some information is still missing or you don’t have all the answers. 

Get a Second Opinion

While you may feel like a total failure as an NP when you have to ask questions in the clinical setting, studies show that your patient’s don’t mind. Saying ‘Let me find out!’ and then consulting references or more specialized or experienced colleagues is a perfectly acceptable plan. By using the resources available to you, you are taking the patient’s situation seriously and sourcing helpful information, even though you may not have it yourself. 

Practice

Stepping into the nurse practitioner role isn’t easy. You will interact with patients who are older than you and with patients of different genders or backgrounds. You may treat patients who are more educated than you, or work with parents of patients both young and old who seem impossible to satisfy. Whatever the circumstance, it’s normal to face situations where you lack confidence, especially early in your career. So, you must approach these interactions with intentionality.

Watch this TED talk where researcher Amy Cuddy discusses how your body language shapes who you are. Put it into practice. Observe how holding your head up, your shoulders back, and speaking with authority changes the way your patients react to you. Suddenly, delivering a plan of care seems to go more smoothly. 

Developing confidence in your practice as a nurse practitioner takes time. And, there are moments, when even as an experienced NP your confidence will waiver. Try implementing these practical tricks in those moments to overcome insecurities and deliver patient care with confidence!

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