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A message to FNP students who are doing their Pediatrics rotations...

3/20/2017

1 Comment

 
​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. 
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Preceptor Shortage Traumatic Stress Disorder (PSTSD) Nationwide Incidence on the Rise!

9/27/2016

1 Comment

 
​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.
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Part II: What We Can Do About The Preceptor Problem for Nurse Practitioner Students: A Message To Students

3/16/2016

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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:

  1. Start early. Many sites are booked a year in advance. 
  2. Be a professional. Act and dress in a manner worthy of respect if you want to be valued and respected.  (Even if your preceptor doesn’t dress professionally or says jeans are ok, youdress professionally. You represent the profession.)  No mini skirts, plunging collars, studs and visible tattoos.  Save that for after work if you must. 
  3. Be polite and professional at all times. Consider clinicals a trial run for a job- even if you wouldn’t work there.  Consider it a job interview. You are a reflection of NPs and future students.  If a site decides “never again” after you, that is not fair to other students!
  4. Show up on time for clinicals!  Every day.  One would think I don’t need to say this, but I do. 
  5. Realize the preceptor is doing you a favor, and make it as easy as possible for them. Offer to fill out paperwork so they don’t have much to do.  Be polite to office staff!  You are not their priority.  Starbucks, fruit or homemade cookies for the office will go a long way.  Again, fill paperwork out for office staff as much as possible.  Believe me, I know you are more than burdened yourself, but you have to make it as easy as possible for preceptors!
  6. Regarding paperwork, as appropriate, talk to your school about simplifying paperwork for sites. If, time and time again you hear that your school’s paperwork is more burdensome than other schools, clearly there is a problem.  There is power in numbers.  Get together with your classmates and request/beg that they make changes to lesson this big problem.  (Schools- please help here!!  Not all school’s preceptor paperwork is so burdensome!)
  7. Don’t be over-confident and talk about how “you can’t wait to open up YOUR own NP practice.” It’s great to have dreams, but you are just getting started, so keep those to yourself for now.
  8. Don’t be too timid, but at the same time, don’t be pushy.  It’s normal to be nervous, but you have to get in there and see patients to ever get over your nerves.  Ask questions. Look things up.  Take initiative!  Take notes. Then ask and research later so as not to interrupt flow. Have some good books and apps on your phone. If you use them in clinical, explain that you are checking a medical app (even show the patient), not texting so you don’t appear rude. Most patients appreciate that we check things.
  9. Don’t “correct” your preceptor in front of the patient (unless it is a life threatening mistake). Make a note and ask a polite question later. (If you really need to, slip them a subtle note.) There are many right ways to do things in medicine.
  10. If you don’t know the answer, say, “Let me get back to you on that.”  Then look it up.
  11. Find ways to be helpful.  Do some things for the preceptor so he/she will be less burdened while precepting. 
  12. If your preceptor is not working out, try to sit down and talk to him/her and then talk to the school.  Sometimes it just doesn’t work though. See # 5 above.
  13. If something happens and you will not be doing the planned clinical rotation anymore, please politely let the preceptor and office know ASAP!  This might open up a spot for some other student!  (Yes, this happens!)  It’s not fair to the preceptor or to other students who might be able to use your rotation.  This is another case where “thank you cookies” might pay it forward for other students. It is a tremendous of work to do paperwork and contracting and then be told, “Never mind, I don’t need you now.”
  14. You must be flexible with your clinical dates!  If your preceptor can only take you on certain days, you must work around him/her…don’t expect anything else.  Please don’t send your preceptor the schedule you can work!  (Unless they ask for it.) Your preceptor is already taking time to precept you and will often cancel if they feel the student is being too demanding or inflexible.  We’ve seen it happen!
  15. Confirm your preceptor’s vacation dates ahead of time.  Sometimes colleagues will allow you to follow them a few times.  (If your school allows this.  Schools, please allow this!)
  16. Discuss what will happen if your preceptor has an unexpected absence. (See 16 above.)
  17. Even if you/your school is providing an honorarium to the preceptor, please realize that this is nowhere near “payment for their time and expertise.”  It is a token of thanks.  All of the above guidelines still apply.
  18. Make sure there are clear expectations and goals at the beginning of a clinical rotation.  (Understand your preceptor’s expectations regarding history taking, charting, questions, etc.  Realize that these may change as he/she assesses your abilities.)
  19. Discuss all of this with your preceptor ahead of time to find out his/her preferences.  Perhaps review this commentary and get his/her take on things. This will show respect and openness to learn.
  20. Breathe!  Take good care of yourself.  Eat healthy.  Pray. Meditate. Exercise. (I literally tie my laptop to my treadmill and stair-stepper and work!)  Get enough sleep.  Be kind to your family.  Don’t neglect your spouse/loved ones. Sing.  Laugh.  Support each other.  Pet a dog/horse/cat… One step at a time.  It sounds impossible, but you will get through it.  And then some day, you can be a preceptor!  And don’t forget, PreceptorLink will give you an honorarium to precept too!
  21. If you can’t find a preceptor on your own, please let us know, and we will see if we can help!  http://www.preceptorlink.com/
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My Two Cents: Thoughts About The Direction of Our Great Profession and the Preceptor Problem... Part I:  A Message to Nurse Practitioner Schools:

11/2/2015

2 Comments

 
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:
  1. First of all, I understand that there are requirements for the various NP degrees, but perhaps it's time we revisited these requirements.  Just because we've always done it that way doesn't mean it is the only way or even the best way.  I don't pretend to know the ins and outs of running an Nurse Practitioner program, but based on my unique perspective, I do have some ideas that might help the situation. At least consider these thoughts...
  2. There are so many students looking for the same thing: Family Practice; OB/Gynecology; Pediatrics.  As everyone knows, there is a shortage of family practice providers, so how can we pour out more students and expect them all to find family practice sites?  Yes, Family Nurse Practitioner (FNP) students need to see family practice sites, but to have time in endocrine, cardiology, dermatology, orthopedics, wound care, occupational health, urgent care, emergency room, nursing homes…so many other sites would be beneficial too! Many of those sites will take students but don’t get asked. Please consider looking outside the very limited boxes of Family Practice, Pediatrics and OB/Gyn. Physician Assistants (PAs) do varied rotations and many end up working successfully in primary care.  Those specialty areas are all things we see in primary care. Students would still need some time in Family Practice (FP), but please allow students more hours in specialty practices. That will help unload the multitude of students all looking for family practice sites. The same is true in Pediatrics. Pediatrics preceptors are VERY hard to find, especially for the FNP student. There just are not enough available/willing sites for the number of students.  Please allow students in Pediatric rotations to do some specialty Pediatrics practice.  And allow them to do their Pediatrics rotations in a Family Practice that sees a fair number of children.  
  3. Consider allowing students more flexibility with whom they can use as preceptors.  It is very helpful when schools allow NPs, M.D.s, D.O.s, Physicians Assistants (PAs), Certified Nurse Midwifes (CNMs) and other Masters-prepared and higher preceptors. Please don’t make requirements so narrow: “FNP students have to work with an FNP for pediatrics and not a Pediatric NP.”  That makes it nearly impossible!  “Must be a primary care Internal Medicine practice.” Those are a dying breed these days and very hard to find!  “Can’t work with the same preceptor for more than one term.”  If the student finds a good and willing preceptor, please allow them to continue!  Finding preceptors is HARD!! Please don’t make it even harder.
  4. If possible, be flexible with the order of rotations.  It’s not always doable, but that would help this situation.  If they find an OB/Gyn preceptor willing to take them for a rotation, allow them to do that rotation at that time.  I know some schools do the didactic portion followed by the clinical rotation, so this might not work in that case. 
  5. Consider adding Nurse Practitioner-run clinics.  It works for medical schools and it works for NPs.  One of our local schools does it, and it is a great solution. It’s a lot of work, but it benefits the community and students: http://www.csusm.edu/nursing/studenthealthproject/
  6. Please, please, take only quality students and give them a quality education.  The profession is counting on you for this.  Train them how to do the things they need to do to be competent (preferably excellent) practicing NPs.  If you can’t provide hands on (online schools), consider sending them to trainings where they can do hands on.  It is very hard to teach a student to do a pelvic or rectal for the first time on a patient in clinic.  Who would want to be that patient?  A paid pelvic model is much better for learning.  It just makes our profession look like we don’t train our students well enough.  We are under the scrutinizing eye of the public and medicine as we push forward to get full practice authority for NPs nationwide. We need to make sure we are putting out quality practitioners.
  7. Thank you, NP programs for helping train the next generation!  We are a great profession and we want to stay that way. 
Next blog will continue the discussion and be directed towards Students. 
2 Comments

    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. 

    She has written articles for KevinMD as well as several posts on LinkedIn. Her writings have been shared over 50,000 times, and her article entitled "A Message for FNP Students Doing Their Pediatrics Rotations" is often shared by schools of nursing to FNP students. 

    Lynn would love to connect with others who want to make positive changes to the NP profession,  especially related to the preceptor problem. She can be reached at: 
    ​lynn@preceptorlink.com

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