Expert to Novice Again: Starting Over as an Attending, Student & a "Soft" Nurse

Every career in healthcare includes fresh starts. Some are planned, like becoming an attending after years of training. Some are chosen, like leaving the bedside or going back to school. In this episode, three former ICU teammates describe what starting over has actually been like.

Hosts & guests
- Abby, NP of 8 years and the one still holding down the ICU
- Kaleigh, nurse of 18 years who moved from the CICU to an oncology clinic
- Allison, former ICU and ECMO nurse, now a full-time perfusion student
- Dr. Armando, critical care physician and new attending after 14 years of training


Timestamps
03:25 Armando on becoming an attending and learning to run a practice
05:09 ICU to outpatient: do you miss the adrenaline?
07:43 Allison on going back to school as a perfusion student
10:16 The novice-to-expert continuum, and why you’ll keep moving along it
15:02 Monday–Friday life, PTO, and finally having weekends
16:53 What a predictable schedule changes
21:35 Abby’s fear of being bored outside the ICU
22:53 Burnout, heavier patient loads, and shifting priorities
24:49 Mental health after stepping away from ICU trauma
26:02 Missing ICU camaraderie and building a new team culture
29:07 The first “I’m really the attending” moment
31:03 Why writing the orders is harder than asking for them
33:18 Changing fields, student loans, and resetting your lifestyle
40:59 ICU ego and owning your “soft nurse era”
42:59 Patient relationships outside the ICU
47:37 Advice for anyone starting something new
50:06 Wrap-up: they all left Abby behind


Key takeaways
- Moving from expert to novice is a normal part of any new role. It doesn’t mean you’ve lost your expertise.
- Leadership and running a practice are separate skills from clinical medicine, and training rarely covers them.
- A healthy dose of fear is useful. Overconfidence is what makes a clinician dangerous (see our earlier Dunning-Kruger episode).
- A slower setting can still be hard. The challenges are just different.


Advice from the guests
Armando: Keep a notebook. At the end of each day, write down what you didn’t know and how you handled it.
Kaleigh: Tell people you’re new and ask questions freely. Set up an organization system before day one.
Allison: Get organized and build in stress relief. You learn better when you aren’t running on empty.