lying about clinical hours - page 7

I have an issue and maybe some of you can make light of it for me. I am a practicing FNP and have been asked to be a preceptor for someone whom I work with. He is in FNP school and thankfully I am... Read More

  1. by   Riburn3
    not really sure how when clinical hours is very poorly defined in the first place at the state level. Is it total patient care hours? Total hours onsite? Total hours spent doing all of the above including case reviews and charting after the fact? The state of Texas says 500 hours of practice in your advanced practice role. Some states are starting to count on campus skills sessions as part of this requirement.

    Providers bill for acuity often based on total time spent reviewing the chart, notes, labs, and physical time at the bedside. A huge chunk of that can be done while in bed and they might be in the patient room for 10 minutes. As a student reviewing clinical logs and entering them into Typhon is arguably more time consuming and tedious than actual patient charting and requires in some cases a lot more detailed patient info. (Can't remember the last time I check what type of insurance a patient had in my hospital job)

    I wish NP programs would make a shift similar to what CRNA programs do requiring a total case load in addition to hours, versus just counting clinical hours. The NP student seeing 10 patients in an 8 hour day isn't getting the same experience as the NP student seeing 20 patients in that same time frame.

    Im wrapping up my ACNP right now and it scares me when I hear about some students seeing 7 or 8 patients in a 12 hour day.
  2. by   WKShadowRN
    Indeed. On days I saw 20 as a student you bet I had to keep moving and it helped me streamline my process. I am infinitely grateful for one provider who encouraged me to organize my presentation in the medical model. Not only did it make my work efficient, I am recalling that uniform approach now daily at work, unlike the long drawn out care plans in nursing school. ( which are important in developing critical thinking but I think are moot after years of practice).
  3. by   Skippingtowork
    Quote from WKShadowRN
    Indeed. On days I saw 20 as a student you bet I had to keep moving and it helped me streamline my process. I am infinitely grateful for one provider who encouraged me to organize my presentation in the medical model. Not only did it make my work efficient, I am recalling that uniform approach now daily at work, unlike the long drawn out care plans in nursing school. ( which are important in developing critical thinking but I think are moot after years of practice).
    As an NP what other model would there be, except the medical model? I haven't seen any other. Please enlighten. Also the type of patient is as important as the volume. I've seen many diseases go undiagnosed because of the quickness of the visit. There are some people that are just slow even when evaluating a grain of rice, and others very quick and thorough with the most complicated patient. It all depends on the situation. I for one, believe that students should see limited patients on their own at the beginning of each rotation and study up on anything new or unfamiliar, then increase number of patients for efficiency training. Just a thought.
  4. by   Rnis
    I'm not sure that its 'scary". I often only had 7-11 pts at my clinical rotations. I think the slower pace actually allowed me to spend time with patients and allow for actual mentoring from my preceptor.
  5. by   WKShadowRN
    Quote from Stepney
    As an NP what other model would there be, except the medical model? I haven't seen any other. Please enlighten. Also the type of patient is as important as the volume. I've seen many diseases go undiagnosed because of the quickness of the visit. There are some people that are just slow even when evaluating a grain of rice, and others very quick and thorough with the most complicated patient. It all depends on the situation. I for one, believe that students should see limited patients on their own at the beginning of each rotation and study up on anything new or unfamiliar, then increase number of patients for efficiency training. Just a thought.
    Gradually increasing patient load as a student is preferred and was my pleasant experience. I was vocal on what I felt comfortable doing as I wanted to be thorough and learn, which was the point. As to other approaches, I've heard reports or cases presented from other NPs that meandered and was inconcise so as to not really paint an accurate picture of the patient. Heck, I've received better RN shift reports. What I find those do not offer is the assessment and plan and until this simple but valuable skill is learned, progressing as a provider is hindered.
  6. by   Skippingtowork
    Quote from WKShadowRN
    Gradually increasing patient load as a student is preferred and was my pleasant experience. I was vocal on what I felt comfortable doing as I wanted to be thorough and learn, which was the point. As to other approaches, I've heard reports or cases presented from other NPs that meandered and was inconcise so as to not really paint an accurate picture of the patient. Heck, I've received better RN shift reports. What I find those do not offer is the assessment and plan and until this simple but valuable skill is learned, progressing as a provider is hindered.
    I agree. The lack of good preceptors sometimes puts students in the position of being additional staff, without any sort of structured learning. I have had great preceptors who wanted to teach and did not see you as part of the practice. You were a student and the purpose for your presence was to learn.

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