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Beyond surviving: Thriving as a nurse practitioner
Dec 18, 2019, By: Tanya ter Keurs
Nurses talking beside a window.

Takeaway messages

In this article, you will learn:

  • Innovative strategies for influencing professional relationships and culture.
  • How a coach-coachee relationship can transform your professional and personal self.
  • The power of standing in choice and having an identity outside of work.

“Physicians are the medical experts, and we are proud of this. We do not provide a service; we have worked hard to be the experts. When we are lumped in as primary care providers, our expertise is being minimized and our autonomy is being eroded.”

These were the honest sentiments shared with me by a well-recognized physician leader. The context was a discussion of the so far tepid acceptance of the nurse practitioner (NP) role.

If you are like most NPs, myself included, your initial instinct might be to respond with eye rolls and exasperation. On this occasion, however, I managed to take a deep breath and respond with collegiality: “We value the medical expertise that you bring to the team, and there is no way that I want to practise without my physician colleagues. I do not want to replace you. I do not want your autonomy. I also bring something of value to the team. I want my own autonomy. I want to stand shoulder to shoulder with my physician colleagues and advocate for better care for our communities.”

The physician’s response to this statement was encouragingly positive. As we went into meetings the next day, this physician leader was my biggest advocate for autonomy, recognition, and working to full scope. I left that day of meetings feeling that the groundwork had been laid for me to thrive.

This got me to thinking: How do I not only replicate this experience but build upon it in order to create relationships and cultures that allow NPs to thrive? I have worked in interdisciplinary clinics where the professional relationships among team members would be considered the gold standard, a utopia. I have also, too often, experienced the opposite. As NPs, how do we show up in ways that allow us to influence our relationships and working culture to move toward harmony?

I propose three main actions: (a) stand in choice; (b) create purpose and identity outside of work; and (c) find a thought partner or champion.

Stand in choice

I was at a particularly low point in my career when someone said to me, “You are choosing to be there; you can always leave.” Choose? I couldn’t believe what I was hearing! My family needed my income, we had just bought a house, and this was the only NP job for hundreds of kilometers. It certainly didn’t feel like much of a choice. I felt like a victim of circumstances. Let me tell you, this is not the best way to show up at work when you are trying to thrive.

I took a mental step back. I did have a choice. I could make a drastic choice to leave, but I could also make small choices that would influence how I experienced my workplace. I could chart with my office door open or closed; I could resign from the committees that were zapping my energy; I could choose to leave work at work or stew about it all evening—and the list goes on.

If you are reading these examples of choice as a checklist and mentally crossing them off one by one with reasons as to why you don’t have choice in that area, then you are probably in the victim place that I was in.

I challenge you: In what areas do you have choice? How will you activate this choice?

Standing in choice gives you internal power and a new perspective on difficult situations. When I take the perspective of choice, I no longer react to those around me. Instead, I proactively influence my circumstances.

Create purpose and identity outside of work

“Hello, my name is (your name here). I am a ________”

Quickly, how do you finish that sentence? Did you finish it with your occupation? If so, this next section may be for you. Are you defined by your work? Does a crappy workday define your weekend? Does a disparaging comment directed at you or the NP profession push you into a dizzying tailspin of self-doubt and emotion? What is it about what you do for a living that defines the very core of who you are?

What else defines you? Are you a parent or a spouse? Is your garden a sight to behold? Or can you shred a black diamond like nobody’s business? When I remember that I am larger than my profession, I show up differently to challenging situations.

Have you ever worked with a triathlete? They always seem so happy! I’m sure some of this has to do with the endorphins coursing through their veins, but I would also propose that it is because they are excited and defined by an all-consuming purpose greater than work. The trials and tribulations of politics and interprofessional dynamics in their working lives pale in comparison to the monumental challenge for which they are training.

So try the exercise at the beginning of this section again: “Hello, my name is __________. I am a __________.”.

Find a thought partner or champion

Finally, I would recommend finding a thought partner or champion. I used to look to my spouse, colleagues, or a friend to fulfill this role. But the truth is that these are two-way relationships, healthiest when there is give and take; they should not be jeopardized. I would exhaust and dominate the relationship as I tried to process work-related angst.

An effective thought partner or champion is more than a friend and more than a mentor; this person is a coach. The coach–coachee relationship is transformative. My coach has stood beside me as I work through complex and difficult situations, bringing new perspectives and challenging questions. Working alongside my coach has transformed the way I show up at meetings, nurtured the confidence that enables me to pursue professional opportunities, and helped me face challenging work dynamics. As a coach myself, my passion for supporting other health care providers creates a safe place for NPs to be challenged, encouraged and thrive. NPs across Canada can find a coach through the International Coaching Federation or a specific NP coach through Coaching for Better Care (see additional resources below).


Nurse practitioners are relatively new to the health care landscape in Canada, and with this novelty come the trials and tribulations that all pioneers face. Let us develop daily practices that will allow us to thrive.

First, we must recognize that we have stepped into this amazing and challenging profession through choice. By daily standing in choice, we will discover the power we have to influence our world.

Second, each of us must build an identity that extends beyond the letters after our names. What activity, hobby or environment sparks joy in your very being and makes you lose track of time? The seeds of your identity can be found there.

Finally, find your coach—that person who is 100% supportive of you. They will encourage you and challenge you, all in pursuit of your becoming the best person you can be.

If each NP embraces these three recommendations, I propose that nurse practitioner will become synonymous with positive workplace culture, and we will each have happier and more successful careers. We will all thrive.

Additional Resources

Coaching for Better Care. Coaching for health care providers.

Dweck, C. 2008. Mindset: The New Psychology of Success. New York, NY: Ballantine Books.

International Coaching Federation

Tanya ter Keurs is a Family Nurse Practitioner who works in primary care and telehealth. She is also a sessional instructor with Athabasca University and founder of Coaching for B.C. (Better Care). Tanya is passionate about supporting health care providers in thriving both professionally and personally.