Part 1: Using Brown and Olshansky's (1997) model, describe what interventions you
plan to do during your first year of practice to help you navigate the changes described
during in each phase.
The four phases of Brown and Olshansky’s (1997) model include Laying the
Foundation, Launching, Meeting the Challenge and Broadening the Perspective.
Navigating through these stages that are discussed will be a challenge, but in order to
be successful having a great support system will be key. Throughout this program I
have gotten to know a few of the other students very well and we have helped to hold
each other accountable and encourage each other, as well as having co-workers at
work who went through and finishing their programs and certification exams already
who have been extremely encouraging and helpful. I feel as though these relationships
have greatly helped me to be successful throughout the program and will help me to
continue to be successful throughout navigating these stages.
When it comes to the Laying the Foundation phase, I know that there will be a lot of
“worrying” as Brown and Olshansky (1997) discuss and I can already feel that need to
attend to other parts of my life that have been on hold during this time. I’ve even been
thinking for the last few months, that when I graduate I need to spend time with my 5.5
month old little girl and my family and how I cannot wait to be able to have some time
with them. With this said, and knowing that this is something that I need to rejuvenate
me, my husband and I have discussed me working PRN at my job from graduation until
taking my certification exam, for at least a month, in order to enjoy my family and best
prepare for my certification exam and then I will go back to work full time as I look for a
new job. I was extremely worried about the time I would need to study and prepare for
the certification exam but creating this plan with my husband has made me feel like I will
have the time needed to prepare for my exam but also that I will have the time much
needed with my family before looking for a new position.
The next stage, Launching, that Brown and Olshansky (1997) discuss, has to do with
moving from school into the first primary care work environment. Brown and Olshansky
(1997) note that this seemed to be the most painful part of the first year of practice. This
stage is one that my last preceptor actually discussed with me stating that I would feel
like I was faking it and as though I did not know what I was doing, but that it was
important to remain confident. Brown and Olshansky (1997) say that the four
subcategories of this stage include Feeling Like an Impostor, Confronting Anxiety,
Getting Through the Day, and Battling Time and that the key issue was to be able to
cope with anxiety in order to mobilize problem-solving skills enough to function and
meet the responsibilities of diagnosing and treating patients. I can absolutely see how
this new role would be stressful and anxiety filled especially in terms of scheduling and
system demands and “staying on time” throughout the day. In clinical, I have seen this
be difficult for doctors and nurse practitioners who have been doing this for years, so
how am I as a new NP supposed to be able to stay on time and meet the demands?
Some interventions that I plan to incorporate during this phase is to remain confident in
my ability to know and access the most current guidelines for decisions I make for
patient treatment. Through this program, I have gained confidence in accessing clinical
This study source was downloaded by 100000838234991 from CourseHero.com on 07-18-2022 16:33:51 GMT -05:00
https://www.coursehero.com/file/80077302/NR607-week-1-discussiondocx/
, guidelines and realize that there are clinical guidelines for almost everything, it is just
knowing how to access them. I am confident in my ability to understand these
guidelines and use them to make the best clinical decision for my patients and I think
that if I do this, that that will take away much of the anxiety that comes with a new NP
position in terms of making decisions. As for managing my time, for one I will remember
that the patients come first, the charting can come later so that the system can remain
on schedule. With that said, I do not want to be so far behind everyone else that the
clinic needs to be open much later, however I do know that this may happen. It will be
important to seek out other providers who have been successful in finding a way to
manage their time well and seeing what worked for them that I may be able to
incorporate into my practice. It also may be a good intervention to see if there is any
way I can familiarize myself with whatever system I will be using before I start my new
position.
Next is the Meeting the Challenge phase. Brown and Olshansky (1997) explain that this
is the phase where new NPs significantly started to feel more settled and legitimate and
less anxious. The three subcategories of Meeting the Challenge were Increasing
Competence, Gaining Confidence, and Acknowledging System Problems (Brown and
Olshansky, 1997). This phase incorporates the idea that with repeated opportunities and
repeated experiences, confidence is gained in managing patients and procedures. This
makes perfect sense, as this is exactly how I felt coming out of nursing school and
within the first few months I found myself much more confident in my abilities and timely.
This was due to getting to know the charting system, knowing where to find what I
needed when I needed it and knowing who to go to for help when I did run into a
problem. This is exactly the intervention that needs to take place early on in order to
help me get to the Meeting the Challenge phase hopefully a little quicker. I need to be
diligent in learning where resources are located at the clinic and familiarize myself with
the charting system. If I can get a hold of these aspects quicker than that will save time
in itself and hopefully give me more time to focus on other aspects of practice.
Lastly is Broadening the Perspective. In this phase, the NP develops and affirms
capabilities within the larger system, as they understand their system greater (Brown
and Olshansky, 1997). Broadening the Perspective included three subcategories:
Developing System Savvy, Affirming Oneself, and Upping the Ante (Brown and
Olshansky, 1997). In order to do this, it will be important to form connections with other
providers and other clinics, as this is what the “Developing System Savvy” subcategory
is all about. In terms of affirming oneself and upping the ante, as a new NP when I make
the right decision for patients and they are thankful and give praise for how I diagnosed
and treated them, this is how the affirmation happens and this is when it is important to
continue to grow and use that self-esteem gained in order to take even more
challenging patients on or increase patient load and have shorter appointment times
(Brown and Olshansky, 1997).
Part 2: We are seeing rapid change in primary care as stakeholders are demanding
higher quality healthcare at reduced costs. After reading the Cuenca (2017) and Shi, et
This study source was downloaded by 100000838234991 from CourseHero.com on 07-18-2022 16:33:51 GMT -05:00
https://www.coursehero.com/file/80077302/NR607-week-1-discussiondocx/
plan to do during your first year of practice to help you navigate the changes described
during in each phase.
The four phases of Brown and Olshansky’s (1997) model include Laying the
Foundation, Launching, Meeting the Challenge and Broadening the Perspective.
Navigating through these stages that are discussed will be a challenge, but in order to
be successful having a great support system will be key. Throughout this program I
have gotten to know a few of the other students very well and we have helped to hold
each other accountable and encourage each other, as well as having co-workers at
work who went through and finishing their programs and certification exams already
who have been extremely encouraging and helpful. I feel as though these relationships
have greatly helped me to be successful throughout the program and will help me to
continue to be successful throughout navigating these stages.
When it comes to the Laying the Foundation phase, I know that there will be a lot of
“worrying” as Brown and Olshansky (1997) discuss and I can already feel that need to
attend to other parts of my life that have been on hold during this time. I’ve even been
thinking for the last few months, that when I graduate I need to spend time with my 5.5
month old little girl and my family and how I cannot wait to be able to have some time
with them. With this said, and knowing that this is something that I need to rejuvenate
me, my husband and I have discussed me working PRN at my job from graduation until
taking my certification exam, for at least a month, in order to enjoy my family and best
prepare for my certification exam and then I will go back to work full time as I look for a
new job. I was extremely worried about the time I would need to study and prepare for
the certification exam but creating this plan with my husband has made me feel like I will
have the time needed to prepare for my exam but also that I will have the time much
needed with my family before looking for a new position.
The next stage, Launching, that Brown and Olshansky (1997) discuss, has to do with
moving from school into the first primary care work environment. Brown and Olshansky
(1997) note that this seemed to be the most painful part of the first year of practice. This
stage is one that my last preceptor actually discussed with me stating that I would feel
like I was faking it and as though I did not know what I was doing, but that it was
important to remain confident. Brown and Olshansky (1997) say that the four
subcategories of this stage include Feeling Like an Impostor, Confronting Anxiety,
Getting Through the Day, and Battling Time and that the key issue was to be able to
cope with anxiety in order to mobilize problem-solving skills enough to function and
meet the responsibilities of diagnosing and treating patients. I can absolutely see how
this new role would be stressful and anxiety filled especially in terms of scheduling and
system demands and “staying on time” throughout the day. In clinical, I have seen this
be difficult for doctors and nurse practitioners who have been doing this for years, so
how am I as a new NP supposed to be able to stay on time and meet the demands?
Some interventions that I plan to incorporate during this phase is to remain confident in
my ability to know and access the most current guidelines for decisions I make for
patient treatment. Through this program, I have gained confidence in accessing clinical
This study source was downloaded by 100000838234991 from CourseHero.com on 07-18-2022 16:33:51 GMT -05:00
https://www.coursehero.com/file/80077302/NR607-week-1-discussiondocx/
, guidelines and realize that there are clinical guidelines for almost everything, it is just
knowing how to access them. I am confident in my ability to understand these
guidelines and use them to make the best clinical decision for my patients and I think
that if I do this, that that will take away much of the anxiety that comes with a new NP
position in terms of making decisions. As for managing my time, for one I will remember
that the patients come first, the charting can come later so that the system can remain
on schedule. With that said, I do not want to be so far behind everyone else that the
clinic needs to be open much later, however I do know that this may happen. It will be
important to seek out other providers who have been successful in finding a way to
manage their time well and seeing what worked for them that I may be able to
incorporate into my practice. It also may be a good intervention to see if there is any
way I can familiarize myself with whatever system I will be using before I start my new
position.
Next is the Meeting the Challenge phase. Brown and Olshansky (1997) explain that this
is the phase where new NPs significantly started to feel more settled and legitimate and
less anxious. The three subcategories of Meeting the Challenge were Increasing
Competence, Gaining Confidence, and Acknowledging System Problems (Brown and
Olshansky, 1997). This phase incorporates the idea that with repeated opportunities and
repeated experiences, confidence is gained in managing patients and procedures. This
makes perfect sense, as this is exactly how I felt coming out of nursing school and
within the first few months I found myself much more confident in my abilities and timely.
This was due to getting to know the charting system, knowing where to find what I
needed when I needed it and knowing who to go to for help when I did run into a
problem. This is exactly the intervention that needs to take place early on in order to
help me get to the Meeting the Challenge phase hopefully a little quicker. I need to be
diligent in learning where resources are located at the clinic and familiarize myself with
the charting system. If I can get a hold of these aspects quicker than that will save time
in itself and hopefully give me more time to focus on other aspects of practice.
Lastly is Broadening the Perspective. In this phase, the NP develops and affirms
capabilities within the larger system, as they understand their system greater (Brown
and Olshansky, 1997). Broadening the Perspective included three subcategories:
Developing System Savvy, Affirming Oneself, and Upping the Ante (Brown and
Olshansky, 1997). In order to do this, it will be important to form connections with other
providers and other clinics, as this is what the “Developing System Savvy” subcategory
is all about. In terms of affirming oneself and upping the ante, as a new NP when I make
the right decision for patients and they are thankful and give praise for how I diagnosed
and treated them, this is how the affirmation happens and this is when it is important to
continue to grow and use that self-esteem gained in order to take even more
challenging patients on or increase patient load and have shorter appointment times
(Brown and Olshansky, 1997).
Part 2: We are seeing rapid change in primary care as stakeholders are demanding
higher quality healthcare at reduced costs. After reading the Cuenca (2017) and Shi, et
This study source was downloaded by 100000838234991 from CourseHero.com on 07-18-2022 16:33:51 GMT -05:00
https://www.coursehero.com/file/80077302/NR607-week-1-discussiondocx/
