5 Challenging Aspects of Working As a Nurse Practitioner

What are the challenging aspects of working as a nurse practitioner?

1. Emotional stress

One of the most challenging aspects of working as a nurse practitioner is managing the emotional toll that comes with patient care.

This is especially true in one of the hardest NP specialties—Adult-Gerontology Acute Care Nurse Practitioner (AGACNP)—where NPs work in high-stress environments like ICUs and emergency departments, making life-or-death medical decisions under pressure.

The weight of these responsibilities can be overwhelming, leading to burnout and emotional exhaustion.

Tip: Setting boundaries and prioritizing self-care can help prevent emotional exhaustion. Learning to balance empathy with professional detachment is crucial for maintaining mental well-being in these high-pressure roles.

2. Fighting for Recognition

One of the hardest parts of being a nurse practitioner is the ongoing struggle for professional recognition.

Despite their advanced training and critical role in patient care, many NPs face resistance from physicians, hospital administrators, and even patients who may not fully understand their scope of practice.

This can be especially frustrating in states with restrictive practice laws, where NPs are required to work under physician supervision, limiting their ability to provide care independently.

Tip: Staying informed about state regulations and actively participating in NP advocacy groups can help push for greater autonomy and recognition. Building strong professional networks and educating patients about the NP role can also improve acceptance and trust.

3. Clinical decision-making

For a new nurse practitioner, one of the biggest challenges is making independent clinical decisions.

Transitioning from a registered nurse role—where physicians often make the final call—to taking full responsibility for diagnosing and treating patients can feel overwhelming.Unlike seasoned NPs who have years of experience to guide their judgment, new nurse practitioners often struggle with self-doubt, second-guessing their treatment plans, and feeling the weight of every decision they make.

Tip: Seeking mentorship from experienced NPs, using evidence-based practice guidelines, and continuously refining clinical skills through professional development can help new nurse practitioners gain confidence and improve their decision-making abilities.

4. Competitive Job Market

For fresh grad nurse practitioners, one of the hardest realities to face is that landing a job isn’t always immediate.

Unlike RNs, who can often find employment quickly after passing the NCLEX, fresh NPs frequently struggle with job market saturation, experience requirements, and competition from more seasoned practitioners.

Many employers prefer candidates with at least 1–2 years of NP experience, creating a frustrating cycle where fresh grad nurse practitioners can’t get hired because they lack experience—but can’t gain experience without getting hired.

Tip: Expanding job searches beyond hospitals, considering telehealth or rural healthcare positions, and networking with experienced NPs can improve job prospects.

5. Managing Complex Care on a New Team

One of the biggest challenges for nurse practitioners, especially those new to a practice, is navigating complex patient cases while also adapting to a new team dynamic.

Whether it’s a busy hospital unit or a fast-paced outpatient clinic, managing multiple high-acuity patients requires strong critical thinking and organizational skills.

Tip: Building strong relationships with team members and establishing clear communication channels early on can help ease the transition. It’s also crucial to seek feedback and stay open to learning from more experienced colleagues to improve patient outcomes and confidence in decision-making.

What is the hardest part of NP school?

One of the hardest parts of NP school is having to learn pharmacology - one of the hardest courses due to its sheer volume of material.

(Check out some of our best np review courses if you are struggling or if you want to find out the best degrees for becoming a nurse practitioner.)