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Here are important things to remember before you start your clinical rotation:
1. First of all, clarify the site's and your school's expectations in advance. This will save many headaches in the end. 2. Help fill out the paperwork for the office as much as possible to make it easier for the clinical site. If the preceptor can just sign the paperwork, that is helpful for him/her. 3. Try to be more of an asset and less of a burden to the practice. Help when you can. You have skills and talents that can be valuable to them. Offer to make a hand-out for something that may be beneficial to them. Then make it! Offer to take back the next patient, do vitals, and start the history. This will help make precepting more efficient. 4. Everyone is a learning opportunity: the lab tech, front office, medical assistant, billing person…they are all usually experts in their own area! Learn from them. If it is ok, spend some time in each area. Or perhaps follow a patient all the way through from check-in to check-out. This will help you to understand patient flow and you may be able to help here and there. (This is obviously individual to office settings/preference, and schools may not consider this time "clinical" but that does not mean it is not valuable.) 5. Look for ways to say thank you. Whether it’s bringing homemade cookies, coffee or just a great, friendly and helpful attitude, it all makes a difference. 6. Remember, your actions affect students after you!! We can’t tell you how many times we have heard “We don’t take students anymore because the last one we had…” Don’t contribute to preceptor burnout or be the reason a preceptor/site stops taking students! 7. If you mess up/feel like someone doesn’t like you/don’t feel you are learning…keep this in mind: Every experience, even an undesirable one can be a useful learning experience. Take away the good and the not-so-good. Use it to help make you a better provider. Back to #6: Make an effort to fix the situation. Don’t be afraid to sit down and talk to your preceptor/office staff if you feel friction. Politely say something like, “I really appreciate being here. I value the time you and others are giving to help me grow. Is there something I can do to help this situation?” Find a way to say something positive about them: “You are so good with patients, and I want to learn from you.” Or, “You are amazingly organized, and I want to learn how to emulate that…” Watch your tone and attitude. Remember, they are sacrificing for YOU! They do not “need” YOU. You need THEM! Bring your faculty in if needed. 8. Patients need to accept you too. If it is available, look at what is noted as the reason for the visit. Sometimes it’s on the schedule or the MA may have written it. You may want to quickly look something up before entering the room. After you have been cleared to see a patient and instructed how much you can do on this visit, enter the room with a warm, friendly smile. A friendly attitude will warm up the grumpiest patient. Look the patient/family in the eyes and introduce yourself to everyone. You can decide about shaking hands. If they are sick, you may just do introductions. Find out who is with the patient today, if applicable. Note that. (“Patient is here with husband, George.” “Patient is here with his mother, Anne.” Ways to introduce yourself include, “Good morning! I’m Lynn McComas, and I am the nurse practitioner student who is working with Dr. Smith today. We will be working together to see you today. Tell me what is going on/what brings you in/how we can help today…” 9. Ask your preceptor what types of patients they typically see and what are some things you should be familiar/comfortable with before starting clinicals. This is super important! Make cheat sheets; review material; have immunization tables... Look at our Resources Page. Walk into clinicals as prepared as possible, and you will feel better and make a good impression. 10. Please read the post I wrote on LinkedIn: A Message to FNP Students Doing Their Pediatrics Rotations. Read this no matter what rotation you are doing- even if it is not peds! The advice applies to all rotations. 11. Know what you should bring to clinicals: laptop, lab coat, lunch, nametag, any special reference books or apps you might want to get. 12. Ask about attire. You want to fit into their practice. Be professional, clean and appropriate. Do they wear scrubs or street clothes? No plunging necklines, short skirts, tattoos or multiple piercing showing. If you aren’t sure- clarify and err on the side of conservative. 13. Make sure you know what needs to be accomplished for you to start well in advance: EHR training; immunizations; criminal background check...Every site has different requirements, and we can't track every site. It is up to you to ask and follow through. Do it early! 14. Ask how they prefer you present a patient, then practice that. Some clinicians are very particular about this. Make up your own cheat sheet. Here are some references for you: Great resource! https://meded.ucsd.edu/clinicalmed/oral.htm Clinical Links to many great sites (Thank you, UCSD.) https://meded.ucsd.edu/clinicalmed/links.htm Great Tips for those being precepted: https://lms.rn.com/getpdf.php/1789.pdf 15. Find out when you should be there for clinicals- start and end of day. Don't assume you can leave early. Expect to be there the same schedule as your preceptor. Many times, preceptors complain that students leave early and that frustrates them. Stay and help as much as possible. You chose to go to school at this point in your life. Please don't make excuses for daycare, work, or traffic. Don’t make that the preceptor’s problem. 16. As your rotation progresses, you should be able to be an asset to the practice. You should have a system in place and know how to “roll!” Don’t be afraid to fly! You will wish you had when you are on your own. On the other hand, if your preceptor isn’t ready, you need to respect that. Refer back to #7 and #8. 17. Preceptors generally want a relationship with your school faculty. Encourage and foster that. Help make the process as easy as possible for them. 18. You can do this!! Utilize every minute, every patient, every opportunity. You will be glad you did when you are taking your exams and out practicing! We wish you only success in your clinical rotations and hope these suggestions will help ensure that! You got this!!! Warmest regards, Lynn McComas, DNP, ANP-C President and CEO Preceptor Link and PL Team
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Dear FNP students,
I recently had the pleasure of spending 3 days with some amazing pediatric nurse practitioner (PNP) colleagues at the National Association of Pediatric Nurse Practitioner (NAPNAP) Conference in Denver. I met some of the most wonderful nurse practitioners from across the spectrum: PNPs, students, faculty members, Deans of Nursing, and other types of nurse practitioners (NPs). It was a sincere pleasure networking with so many nurse practitioners who have dedicated their professional lives to improving the lives of children and their families. As I heard several times over, “Children are NOT little adults!” They were enthusiastic and earnest in their desire to increase their pediatric knowledge base and to connect with colleagues. Interspersed in the energy however, I repeatedly encountered a recurrent theme I would like to share with you. These nurse practitioners are inundated with requests for preceptors. Most love to teach and want to share their knowledge and passion with the next generation of NPs. The problem they report is that the next generation of FNP students often appear apathetic and lackadaisical about learning pediatrics! This disinterest in learning pediatrics is causing these pediatric preceptors to feel disheartened and disinterested in teaching FNP students. Here are some of the comments they reported FNP students have said in their pediatric rotations: "I am only here to get my hours done and become an FNP.” "I am not going to do peds when I get out- I am only doing this because I have to do this to graduate." Even if the student doesn’t directly verbalize this, the disinterest is obvious to these dedicated practitioners (and the office staff). This attitude is unacceptable and troublesome, and it’s causing preceptors to quit precepting. These pediatric preceptors (whether NP, PA or MD) are dedicating their time to educate you! Precepting results in decreased productivity, which often results in less income. They spend their time and energy compiling educational material and carefully crafting teaching plans for you. They miss out on family and personal time so they can stay late and work with you! They want you to be excited and interested about pediatric healthcare! It is not fair to these dedicated professionals to act otherwise. We must train our FNPs well in pediatrics because children and their families deserve quality healthcare. FNP students, a disinterested attitude is NOT ok! FNP faculty, please counsel students that this is NOT acceptable. FNP schools, please carefully screen students. Regardless of the area in which you end up working, you must be respectful and appreciative of your preceptor and his/her specialty. Soak up every morsel of knowledge you can from every clinical rotation. Before you know it, you will be out and practicing, and lives will depend on you. (If nothing else, it will help you on Boards.) There is a serious preceptor shortage, especially for pediatric rotations, and this is only making the problem worse. I am dedicated to helping improve the preceptor problem for nurse practitioners, and I continue to search for ways we can help with this issue. Students, being gracious and interested in your clinical rotations will motivate preceptors. If preceptors don’t feel appreciated, they won’t precept! Compassion and passion are some of the characteristics that make nurses special. Demonstrate those behaviors at every clinical rotation. The profession and your future patients need you and are counting on you. We have all seen it. The symptoms are undeniable and can be very distressing for family, friends, and especially the patient him or herself: Depression, anxiety, G.I. disturbance, increased occurrence of unrelated medical problems… Patients are often seen crying, complaining, yelling out expletives, despondent and doubting their future and past choices. They are very difficult patients to help because, quite frankly, as things stand today there is no good cure. Preceptor Shortage Traumatic Stress Disorder (PSTSD) is undeniably an increasing challenge for the medical profession today.
So I jest, but not really. There is nothing funny about the current situation and The Preceptor Problem. (Yes, I am capitalizing that on purpose.) It is absolutely tragic that students have to struggle so much to find mentors. Sadly, from what I see, the problem seems to be getting worse. Perhaps it’s my slanted and unique perspective, but I see it everywhere and most of the people who are complaining/begging/angry/crying are not clients. I see it on Facebook, LinkedIn, at every nurse practitioner meeting I attend, and I hear it from every practice, student and medical provider. I know this is a huge, nationwide problem and not just something seen in a small population of students. In this post, I’d like to bring up some issues that I would like our profession to consider. Be kind in your remarks! Let’s work together for some positive changes to The Preceptor Problem and find a cure for PSTSD! It was hard before, but some schools are making it even harder for students. In a perfect world, nurse practitioners would predominately precept nurse practitioner students. However, we are far from a perfect world. Due to many factors, there is an undeniable preceptor shortage. Yet some schools are requiring more time with a nurse practitioner and allowing less or no time with physicians, physician assistants (PAs), Certified Nurse Midwives (CNMs) or other qualified providers. Let’s face reality: First of all, there are more physicians than nurse practitioners practicing. Additionally, more often physicians own the practice, and they can make a decision about whether to take student or not, so it’s easier to find physician preceptor. On the other, most often nurse practitioners have to ask permission of administration, and, due to many factors, they are often declined even if they’re willing to precept. There’re many other reasons it’s easier to find a physician preceptor but those are the major ones. Then there are the schools that have increased the requirement for family practice rotations. They are denying wonderful sites that provide geriatric, urgent care, home health, adult, and even pediatric populations because they are not “Birth to Death Family Practices.” Family practices are inundated with requests for preceptors. As medicine has changed, “birth to death family practices” are becoming less common. Often there are other sites available and willing, but because they don’t fall into a narrow definition mandated by the school they are denied. Since we work with so many different schools we know that there are requirements for students but the requirements seem to vary drastically from school to school. Why is it fine for some and not others? Fortunately, not all schools have such restrictive requirements. Some allow some specialty hours as long as a majority of general hours are completed. And, of course, some schools help students find preceptors. Power to these schools! The reality is, however, even if every school helped find preceptors there would still be a shortage of preceptors. I just think we have to look at different alternatives to our current system. We must be open to these alternatives and stop trying to do things the way we used to do them. Another way schools could help students is to be less restrictive with dates for clinical rotations. Some schools are flexible and even allow students to start early. Bravo! But other schools do not allow that flexibility and some will not even allow a student to complete hours over a short period of time, instead mandating that the rotation be spread out over several months. This is a huge problem for students who are willing to move to other areas in order to complete his/her rotation. If the student can get his/her hours done over a shorter period of time and then return home it reduces travel costs substantially. Why is it that some schools allow this and others do not? No, it is not ideal to get the hours done over a short period, but it seems we need to make some concessions given this challenging situation. We have a wonderful, respected and growing profession. Many methods we use to train our students are still valid and effective, but we must be willing to change with the times. There are things our profession can do to make it better and not harder for students. Let’s be open to these ideas and changes. Let’s not make requirements so strict and narrow that it makes it nearly impossible to find what students need in order to graduate. I don’t know if changes are being made because students are not passing the Boards or because schools feel philosophically it’s the way it should be done…I just don’t know. What I do know is that, as we speak across the nation there are countless students suffering from the cruel and devastating consequences of PSTSD- Preceptor Shortage Traumatic Stress Disorder. Let’s work together to stop this devastating problem! PreceptorLink (formerly Advanced Practice Link) is in the ridiculously difficult and often thankless business of matching students to preceptors. We have a team of people working 24-7 to help find preceptors because we know how difficult it is for a student who works part/full time and has a family at home to find time to search for a suitable and willing preceptor. We are dedicated to finding solutions to The Preceptor Problem and will continue to work on this issue. Part I addressed the Schools. Part II is directed towards Nurse Practitioner Students. As mentioned in Part I, issues related to the Preceptor Problem for Nurse Practitioner Students are multi-factorial.
Dear NP Students: You are the future for the profession! Keep this in mind when you are out there: We support you! First of all, hang in there. You can get through this and will have “NP” behind your name…eventually! For the most part, it’s a great profession with many opportunities. Here are suggestions and input from my perspective as a NP of 20+ years and business owner: Most students are not guilty of some of the worst “offenses” mentioned here, but it only takes a few (or one!) to turn off a potential site or preceptor. Please do not think this commentary implies that I put the sole blame on students for The Preceptor Problem for NPs. (And, yes, I have heard every one of these comments from preceptors!) As I said, the issues are multi-factorial but this commentary addresses The Student. First of all, I am sorry that it is so difficult to find a preceptor these days, but it is the reality until things change- and many things need to change. Here are some tips in the meantime:
I love being a Nurse Practitioner and am a huge advocate for Advanced Practitioners in general, but there are things that concern me about the direction we are going as Nurse Practitioners (NPs). In my current roles, I’m in a unique position to really see the issues from many different angles. In this first blog, I’m directing my thoughts to NP schools. These are the places where it all begins: our alma maters. Are there some things the schools could do to help with this problem? These are my thoughts on a subject of which I have become quite versed. Follow up blogs will address the same issue in regards to the student, the preceptor and the practice sites. I believe there are things we can do in all of these areas to address the problem of the Preceptor Shortage.
We all see schools pouring out students but then see countless students struggling to find preceptors. This is not news to anyone in our profession and the situation is getting worse. This problem affects all of us in the field! The balance is just too far off and, if this continues, I am concerned it will damage our profession. Current research studies demonstrate positive outcomes for nurse practitioners (NPs), but if we can’t train quality NPs this trend is not likely to continue. I’m concerned that we are setting ourselves up for trouble. I frequently hear practice sites saying things like, “We only train med students, so we don’t take NP students; We don’t take students from XXX University; We are too busy to take students; It is too much work to take students,” or just plain, “We don’t precept.” The current system is unsustainable. Something has to change before it’s too late. Here are my thoughts on the challenges we face in this growing profession and some ideas on how we might change them: To the Nurse Practitioner Schools:
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About Lynn:As a longtime NP with a desire to help and make positive changes to her beloved profession, Lynn often writes opinion pieces about the NP profession. Archives
March 2020
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