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CHRONICLES
Clinical Education for NP Students & New Graduates
Why
the Best NPs Read Outside Their Lane
Career
Development | Clinical Reasoning |
Reflections on Practice
Ask any nurse practitioner how
they spend their limited free time, and “reading medical journals for fun”
probably isn't high on the list. Between clinical hours, charting, CE
requirements, and whatever's left of a personal life, most of us protect our downtime
fiercely. So when a colleague hands you an article, a book, or a podcast
recommendation that has nothing to do with your specialty, the instinct to
politely decline is understandable.
A recent Op-Med essay by
psychiatrist Houston Paul Putman, MD, makes a case worth sitting with: that
instinct, while protective, might be quietly working against us — not just as
clinicians, but as people. Dr. Putman's reflection on reading outside his specialty
offers something NPs in every practice setting can use, whether you're a new
grad still finding your clinical voice or a seasoned provider who's settled
into a comfortable routine.
The Trap of the Familiar Lane
Dr. Putman describes a common
tension: he's happy to read articles friends and family send him about general
health topics, and he welcomes colleagues' recommendations within psychiatry.
But suggestions to read something entirely outside medicine — a novel, a
history book, an unrelated nonfiction title — often feel like an intrusion on
already-scarce time.
That instinct isn't unique to
psychiatry. Nurse practitioners face the same pull toward narrowing focus. It's
tempting, and often efficient, to read only what's directly relevant — the
latest guideline update, a drug interaction alert, a case study in your exact
patient population. Efficiency has its place. But Dr. Putman's essay raises a
fair question: what does staying entirely in that lane cost us over time?
Heteroglossia and Why It Matters
at the Bedside
The essay draws on a concept
from literary theory: philosopher Mikhail Bakhtin's idea of “heteroglossia,”
writing or thought that holds multiple voices and perspectives at once, as
opposed to “monoglossia,” a single dominant, authoritative voice. Dr. Putman
applies this directly to clinical practice: patients rarely hand us their most
important information directly. It arrives sideways, in offhand comments, in
what's left unsaid, in the way someone frames a complaint. Clinicians who've
only ever practiced within one narrow intellectual register — medical
literature and nothing else — may be less equipped to catch those indirect
signals than clinicians who've spent time absorbing a wider range of human
experience through fiction, history, or unrelated fields.
For NPs, this has an obvious
parallel. A patient who mentions their sleep is “fine” in the same breath as a
flat, exhausted affect. A teenager who answers every HEADSS question correctly
but won't make eye contact. A caregiver whose answers about “how are you
managing” get shorter every visit. Catching those cues isn't purely a function
of clinical training — it's also a function of how broadly we've learned to
read people, context, and subtext. Dr. Putman's argument is that reading widely
trains exactly that muscle.
|
CLINICAL BOTTOM LINE Clinical expertise built
entirely within a single specialty's literature can become a silo. Reading
and engaging outside your specialty — medical or not — broadens the range of
perspectives and communication patterns you recognize, which can sharpen your
ability to pick up on what patients aren't saying directly. This isn't a
replacement for clinical CE; it's a complementary habit that supports the
“soft skills” side of assessment and rapport. |
Why This Resonates for NPs
Specifically
Nurse practitioners are, by
training and by role, already accustomed to moving across boundaries. Many of
us trained in nursing before moving into advanced practice, which means we've
already had to translate between two professional languages — the nursing model
of holistic, patient-centered care and the medical model of diagnosis and
management. That background arguably makes the case for intellectual
cross-pollination even stronger, not weaker: it's already part of how we're
taught to think.
•
NPs
frequently work across multiple specialties within a single day, especially in
primary care, urgent care, or rural practice — which means a habit of reading
broadly may pay off faster and more often than it would for a narrowly
subspecialized physician.
•
The
therapeutic relationship in NP practice is often built on time and rapport as
much as on diagnostic precision. Anything that improves how well we read a
patient's unspoken cues has a direct line to better adherence and outcomes.
•
New
graduates in particular are often told to “just focus on clinical knowledge” in
the first year. Dr. Putman's essay is a useful counterpoint: clinical knowledge
and the capacity to understand people are not competing priorities, and neither
has to wait for the other.
A caveat worth naming
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NUANCE TO FLAG None of this is a substitute
for staying current in your own specialty. Dr. Putman is explicit that he
still prioritizes articles colleagues flag within psychiatry — he's simply
arguing against treating everything outside that lane as automatically disposable.
For NPs balancing CE requirements, certification maintenance, and clinical
currency, reading outside your specialty is a supplement to core competency,
not a replacement for it. If your CE hours or guideline review are behind,
that comes first. |
Practical Ways to Build the
Habit
Dr. Putman's own solution wasn't
to overhaul his schedule — it was to loosen his grip on how tightly he
protected his reading time, and to start carrying a notebook to capture ideas
that cross-pollinated from unrelated material into his clinical work. A few
low-friction ways to try this yourself:
•
Say
yes to one non-clinical recommendation a month from a colleague, friend, or
patient — treat it as data about how other people think, not homework.
•
Attend
a lecture or seminar outside health care once a quarter, even virtually. Dr.
Putman specifically mentions university talks on physics, political science,
and history as sources of unexpected clinical insight.
•
Keep
a running note (paper or digital) of ideas or phrases from outside reading that
unexpectedly connect to a patient encounter or a teaching point — you won't
always see the value immediately, and that's fine.
•
Extend
the same principle to journal clubs: occasionally read outside your specialty's
literature, not just outside medicine altogether. A psychiatry NP reading a
cardiology paper, or a family NP reading a palliative care piece, gets a
version of the same benefit.
The Bigger Point
Dr. Putman's essay isn't really
about reading logistics. It's about resisting what he calls the “narrowing
mindset of expertise” — the quiet pull toward believing that depth in one area
is best protected by walling off everything else. For NPs building a career,
especially early on, that pull can feel like discipline. Dr. Putman's
reflection suggests it might sometimes be the opposite: a limitation dressed up
as focus.
As his own mentor once told him,
“You can't take people farther than you've been yourself.” For clinicians whose
job is fundamentally about understanding other people well enough to help them,
that's a reasonable standard to hold ourselves to — in the exam room and in
what we choose to read when we finally get a quiet hour to ourselves.
Reference
Putman, H.P. (2026, July 16). The importance of readin
