A question for NP's - What if our school preceptorship isn't so great?

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Am in my adult rotation clinical now. I have 2 NP's who are my preceptors. Both are very good, very experienced. But somehow my clinical experience on some days just isn't all that hot. I have to beg for hours, and just don't seem to see that much of a variety of patients.

The other half of the clinical is in an acute rehab type nursing home facility. The patients are very acutely ill a lot of the time. It seems my preceptors have me doing the routine chart checks, while they work the harder patients ...I just sometimes don't feel I get the chance to work thorugh the really tougher patients. Maybe they don't think I'm ready ..I just don't know.

All I wonder is what if our "school" clinical experience is not that hot? Does it really matter after graduation? One of mypreceptors seems to say that I really won't learn "the real deal" until I'm out ...i don't know what to think.

[ghillbert, MSN, NP]

One thing i really learned from medical students - they are much better at presenting patients on rounds and coming up with a plan than NP students are that I have seen. Perhaps we doubt ourselves more, or don't want to be wrong, but you are MUCH better off to come up with a plan that is "wrong" for whatever reason (and invites discussion and teaching as to why on rounds) than to say "um er..." when asked what your plan for the day is. Even if you come up with 1 or 2 goals for the day, it shows that you're thinking. Tell your preceptor what you feel you're missing. You are much better to focus on a couple of patients and feel you have a complete idea of the assessment, diagnosis and plan than to get a little bit of a lot of patients' plans.

[kguill975, MSN, APRN, NP]

I think that the clinical experience is very valuable in terms of future practice. Preceptors can't just wave away clinical by saying that you won't learn the "real deal" until you start to work. I saw complicated patients from the second day onward - now I often run into situations and disease processes that I did not encounter during my clinical rotations, but I'm glad I got as much exposure and experience as I did. My preceptors were faculty for a residency program, so I got the benefit of learning from physicians who were passionate about teaching. If you have the opportunity, spend as many hours as possible in a county clinic or a location that serves low-income populations - it is quite rewarding work, the variety is interesting, and the staff are often eager for more help. Interjecting your plan as part of presenting the patient is an excellent idea, and maybe you'll get more feedback.[/quote']

I agree. My best rotations ever were at VA and county hospitals. They will let you loose, and you come back with the assessment, diagnoses, and plan. If it's wrong, they'll just tell you why, but you had better have something written down.

To the OP: I think you should work up the pt as if you're the NP for the day, that way you can compare your diagnoses and plan to theirs. You never know, you may be on target, without them having taught you. Hang in there, it'll be okay.