Not Seeing Enough of a Certain Patient Population In Clinicals? Tips On What To Do!

You searched and searched, and you finally did find a preceptor! Yeah! You recently started clinicals, but now you aren’t seeing enough patients or certain types of patients that you need! If it’s not one thing, it’s another! 
I frequently hear nurse practitioner students complain about this, so I wanted to share some tips on how to increase your patient census, especially if you're an NP student struggling to fill your schedule. (This approach works for new grads or clinicians who are new to a practice as well!)

Understanding the Challenge

Many NP students find it challenging to get enough patient hours. Sometimes, students are just not getting enough hours in general, but frequently, they are short on patients in a specific area like pediatrics or women’s health. It’s important that students have quality clinical rotations and see all ages and as many types of patients. This is especially vital since fewer physicians are going into pediatrics anymore.  Not seeing a diverse population of patients can prevent you from obtaining your necessary clinical hours, hinder your learning, delay your progress, and keep you from your goals: graduation, being prepared for clinical practice, and finding a nurse practitioner job! 

Whether it's a low census period, such as summer, or a need for more specialized cases like pediatrics, women’s health, or geriatrics, there are effective strategies to address this issue. Below, I outline practical approaches to help ensure you meet your clinical requirements.

Communicate with Your Preceptor and Office Staff

So what do you do? First, communicate with your preceptor. Make sure they understand your need for more patient interactions. Frequently, your preceptor can suggest people for follow-up, but sometimes they just don’t have the time to do this in their busy day. In this case, the Office Manager or the scheduler can often help you identify potential return visits. If they are willing to take the time with you (bringing them a cup of coffee from their favorite coffee place can help incentivize them!) and review potential patients together.

Look for patients who have what you need for optimal learning (and clinical check-offs. Let’s keep it real!) Patients who are due for follow-ups – blood sugar checks, failure to thrive assessments, pap smears, breast exams, imaging, or lab work. Is there a diabetic or hypertensive patient due for follow-up? Use Electronic Health Records (EHR) to identify these patients efficiently too.

Another approach is to bring up a follow-up with a patient you are currently seeing. “Kelly, it’s been a few years since we did a pap smear on you. Would you like us to schedule you for follow up on that?” “Mrs. Smith, did you ever get that follow-up breast exam.” “Samantha, I see that we see your kids here as well. Do you want to schedule their sports physicals now before it gets too busy?” Build the patients you need into your schedule. 

This approach works when you are a new hire and you are trying to fill your schedule, too! 

Create Follow-Up Visits

So, you’ve identified some patients. Now, what do you say when you call? (Or, if it’s the scheduler, what can they say?) I suggest something like this, “Hi, Mrs. Jones. This is Lynn McComas, and I am an NP student working with NP Smith. She wants you to come in for a follow-up on your XYZ problem. We’d love to get you in for a visit. How does this Friday work for you?” Or, “Good morning, Mrs. Jones.  I’m Lynn McComas, an NP student working with NP Smith. NP Smith mentioned that you are due for a follow-up breast exam. We have an opening on Tuesday. Would that work for you? Great! Let me hand you over to the scheduler!” Suggest days when you are in the clinic, of course, but you may even need to come in on a day that you weren’t planning on coming. (Again, get the ok from your preceptor on this! They may have other students on that day.) You have now “pre-introduced” yourself to the patient, which will make the follow-up introductions even easier. 

A friendly reminder call can go a long way in making patients feel valued and cared for. The clinic benefits, the patient benefits, and you can get your needed hours and experience! Plus, you can study up a bit on the visit before it happens. Win, Win!

Create Visits with Existing Patients

Sometimes, opportunities for the required patient encounters can be created during visits with existing patients.

1. Leverage Family Visits: If you need more pediatric patients, ask parents during their visits if they can bring in their children for check-ups.
2. Expand Women’s Health Visits: For women’s health, bring up discussions about birth control, frequent UTIs, dyspareunia, menopause, or their last pelvic or breast exam. Schedule follow-ups based on these discussions.

Leveraging Technology

Utilize patient portals to identify patients who are overdue for visits, labs, or imaging for easy scheduling and for automated reminders. These tools can significantly reduce no-show rates and keep your schedule full. Then, for best results, follow up with a phone call.

Expanding Your Network to Other Providers

Network with other healthcare providers in the practice or hospital. This can be especially helpful for Acute Care or inpatient settings, but really for any sites that have multiple providers. Let them know your needs and ask if you can see any [peds, women’s health, cardiac, etc.] patients with them. (Once again, be sure to get your preceptor’s permission for this first.) This not only helps you see the patients you need, but it also helps you meet other providers (for future clinicals or general networking).

Conclusion

Finding the types of patients that you need for clinical rotations can be challenging, but with proactive strategies and a positive attitude, you can turn this around. Communicate with your preceptor, take initiative, and utilize available resources to maximize your clinical experience. These strategies, grounded in practical experience, can make a substantial difference in achieving your clinical rotation goals. 

Remember, every challenge is an opportunity to learn and grow. Keep pushing forward, stay patient, and continue to build your skills. Keep on learning! 

About the Author: Lynn McComas, DNP, ANP-C, is an experienced nurse practitioner and an expert on the topic of precepting. Determined to make a difference in “the Preceptor Problem,” Lynn went on to obtain her Doctorate in Nursing Practice (DNP) at the esteemed Duke University, where she focused on finding solutions to the preceptor shortage. She is the owner and founder of PreceptorLink®. The company’s goal is to simplify and streamline the process of preceptor matching while maintaining quality and professionalism throughout. www.PreceptorLink.com 

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