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Nurse practitioners (NPs) play integral roles in many types of healthcare settings. They provide care in rural, urban, and suburban hospitals, urgent care centers, clinics, and private practices. They diagnose and treat a range of conditions, order diagnostic testing, prescribe medications, and much more.

And their numbers are growing. The American Association of Nurse Practitioners (AANP) reported that there were about 355,000 licensed NPs in the US in 2022 and nearly 385,000 in 2023.

In 2025, those numbers have increased to over 431,000 NPs, according to the AANP. 

To become a NP, you must first be a registered nurse and then complete a NP-focused master’s or doctoral nursing program, and then pass a national NP board certification exam.

To learn more about what that first year on the job is like, we talked with Lani Orellana, NP in the Medical Intensive Care Unit at Christiana Hospital in Newark, Delaware. She recently completed her first year as an NP after more than 13 years as a nurse.

New Skills, New Responsibilities

For Orellana, becoming an NP meant building on skills learned during her previous career as a nurse, while developing new skills and finding ways to adapt to some big changes in responsibility.

“One of the biggest revelations this past year has been the shift in identity from being an expert nurse to becoming a novice provider,” she said. “My years of nursing experience, time spent at bedside, and a rigorous nurse practitioner program gave me a strong foundation for this transition. But it was not until I started practicing that I truly understood the weight of the responsibility that I felt.”

Orellana’s role in patient care shifted quickly. “Suddenly, I went from patient advocate and receiving orders to being the one giving them,” she recalled. “Nurses began looking to me for clinical decisions. It was a humbling experience and one that I hope I never lose sight of.”

Orellana’s first year as an NP also opened her eyes to just how complex the role of NP can be and how much there is to learn. 

“Even after years spent at the bedside and countless hours in the classroom and clinic to reach the point of graduation and taking our boards, it feels as if a whole new set of skills then needs to be developed,” she explained. “It may feel overwhelming at times, but our roles demand that we continue to strive for new knowledge and develop expertise so that we become experts in our nurse practitioner roles.”

Your Best Doesn’t Have to Be Perfect

All that new responsibility and learning can seem overwhelming. But Orellana recommends first stepping back and thinking about how you want to interact with patients and the other professionals on your team.

“My biggest piece of advice to a new nurse practitioner is to imagine the kind of provider others enjoy working with and that patients and families would feel lucky to have,” she said. “Strive to be that person.”

Keep in mind that you have already worked in demanding situations and learned how to be a compassionate and cooperative healthcare provider. Use that knowledge to help you with the challenges ahead.

“As nurses, bedside experiences give us a unique perspective that adds to the value that nurse practitioners bring to the care team,” Orellana said. “We can take our bedside experiences in caring for our patients, building relationships with families, and patient advocacy and use that to foster trusting relationships with not only patients and families but our coworkers as well.”

And while you probably hold yourself to a high standard, remember that your early months and years on the job are going to have ups and downs. Even veteran NPs find themselves learning from mistakes along the way.

“Give yourself grace if you ever feel like you may have made a mistake,” Orellana said. “I often remind myself, ‘You never learn anything from the easy ones.’ That mindset has helped me turn challenges into learning opportunities and build confidence with each new experience.”

Be Ready to Assist and Be Assisted

Regardless of the setting in which you work or the degree of autonomy you have, there will always be times when you’ll be called on to help a colleague and have a colleague help you.

Just remember to stay humble and professional, Orellana said. “As nurse practitioners, we are leaders in our field, and it is our responsibility to uphold the standards of our professional practice,” she said. “Also, always reach out for help when you need to. Never make a clinical decision if you are uncertain or second-guessing yourself. There should always be a resource available to you for those times you may be faced with challenging clinical situations or even if you need to run an idea or thought by someone else who is more experienced.”