NPs: How did you learn clinical skills??

Nursing Students NP Students

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  1. Did you learn clinical skills in your NP program, such as suturing, etc?

    • 11
      Yes - As part of a separate class
    • 12
      Yes - As part of another class
    • 9
      Yes - In clinical only (no class lab)
    • 25
      No

57 members have participated

To all NPs out there:

I'm still up in the air about NP vs PA. I feel NP makes more sense as I'm an RN and would need no additional coursework. PA, however, definitely has a stronger curriculum and more clinical hours, which I would prefer. One thing I've noticed is that many PA curriculums include a separate lab course designed to teach important clinical skills using models and cadavers. For example, learning to suture on pigs feet. I don't see this class in NP curriculums. I'm wondering if it's included in some other class?

Did you all learn these types of skills in NP school? If so, which class was it part of??

I know that we'll have a suture lab in the last semester, as well as a few other skills labs. But mostly it's learned in clinical. I randomly got placed in an ED for part of my pediatric rotation. My awesome preceptor taught me how to do suturing, I&D, and reductions, and sought out patients for me. Now I am a suturing and I&D machine!!! My intention is to go to the ER for another rotation, since it was the most procedure rich experience. I look forward to being a preceptor and teaching these skills!

Specializes in ACNP-BC, Adult Critical Care, Cardiology.
I was thinking of things like this:

12-lead ECG interpretation

Chest x-ray interpretation

Hemodynamic monitoring

Suturing

Spirometry & peak flowassessment

Local anesthesia application

Papanicolaou smear test

Central venous line insertion

Arterial puncture/cannulation

Intracranial pressure monitoring

Sedation for procedures

Defibrillation/cardioversion

Chest tube insertion

Endotracheal intubation

Wound debridement

Discontinuation of chest tubes

IABP management

Wound packing

Superficial abscess incision& drainage

And considering the paper I just found showing how few of these skills are taught in NP school, I am quite worried again. I bet PA/MD schools wouldn't show such poor performance.

http://www.mc.vanderbilt.edu/documents/CAPNAH/files/skills taught in acute care np programs.pdf

- You can learn 12 lead EKG's as an RN

- Basics of CXR interpretation is taught in assessment lab in NP school, then you get exposed to it in clinicals. You can develop this skill easily in clinical practice if you work in a setting that forces you to look at films everyday (ICU, ED, hospitalist roles).

- Hemodynamic monitoring is a skill most ICU nurses possess. In my ACNP class, it was touched on but only for the benefit of the students who were non-ICU nurses. Using hemodynamic monitoring as a guide to drive clinical decision making should be more of the priority in ACNP programs.

- Simulation is done in skills lab (i.e., pig's feet like you said). There are numerous opportunities to suture in an ED rotation.

- Spirometry and Peak Flow assessments are taught in theory. Unless you do a focused Pulmonary rotation you likely won't get hands-on this.

- Local anesthesia application can be learned in an ED and ICU rotation.

- Pap Smear is more of an OB/Family practice skill. You will do plenty of pelvic exams in an ED rotation!

- Central venous line insertion is taught in simulation during skills lab. If you do an ICU rotation, you will likely get to place a line on a real patient. We allow our ACNP students to place lines with our supervision. As an ACNP myself, I have placed thousands of central lines.

- Arterial lines (see central lines)

- ICP monitoring is a skill Neuro ICU nurses have. You may be able to place EVD and Camino's if you do a Neurosurgery rotation. NP's who work in Neurosurgery likely possess this skill set.

- Sedation procedure is learned in an ED or ICU rotation, again, it's a skill you'll learn if you work in a procedure-heavy specialty.

- Defibrillation/cardioversion can be done by RN's. It's part of ACLS training.

- Chest tube insertion is a skill you might learn in a Thoracic Surgery rotation. I worked previously in an ICU where us NP's inserted chest tubes. I've done many but not a skill I like doing personally.

- Basics of intubation can be learned in an ED or ICU rotation. It takes skill to be good at it so the more you do the better you become. Intubation does not just involve dropping an ET tube. Learning the history, deciding how to induce, and using the right equipment can be the tough part.

- Wound debridement can be learned in a surgical specialty or wound care rotation.

- Chest tube discontinuation is done by RN's in some facilities. It is an easy skill to learn.

- IABP management is a skill done by CCU RN's. I've not known of any NP who has inserted IABP's but I've pulled them and I don't particularly care for holding pressure on the groin for 30 mins - we usually ask interns to do it (lol).

- Wound packing can be learned in a wound care rotation

- I&D can learned in an ED rotation

You don't have to stress over these to be honest. As a preceptor of ACNP students, we are more concerned with how a student follows a patient in the unit, how the student presents the case on rounds, how the student processes his/her thoughts on differential diagnoses and ties it with physiological rationale, how the student assesses risks and benefits of doing procedures, etc...anyone can be trained to do procedures but having the cognitive ability to understand the reasoning behind them is more important.

Specializes in Peds Med/Surg; Peds Skilled Nursing.

Are you looking at Acute Care or Primary Care Programs?

In class we learned and practiced suturing, PAP smears/GYN exams, Testicular exams, I &Ds and local anesthesia. I have also have done this in clinical with preceptor guidance.

Spirometry & peak flow assessment and interpreting Xrays i learned in clinical

As a RN I already have experience in and have done ICP monitoring, discontinuation of chest tubes, wound debriedment and wound packing.

And the other stuff you mentioned i did not do in school because my program is Primary care. These thing most likely would be taught and reinforced in an Acute care program.

I think whoever said "it's hit or miss" depending on your program nailed it. I've met NPs who never learned to suture at all and don't do it as a part of their practice, and I've met NPs who routinely suture, lance, and an stick assorted myriad of items into patients, lol. I met a NP who won't look at radiographs because as she put it, "they didn't teach me that!" However, the ones I know who did the suturing, etc. above did evaluate their own radiographs.

My program has students come to class and engage in practical skills one day a week during a certain course. In it, such skills that the school and the state deem all APNs, APRNs, or whatever they're going by now should know. These include advanced health assessment techniques including otoscopic and fundoscopic exams, pelvics, anorectals, suturing from the dermis up, 12 lead EKG, and x-ray interpretation. However, as this sounds good in theory it really isn't. I think there was a singular day devoted to 12 lead, about four hours for x-ray, and maybe a couple of hours for suturing pig feet. As I am in a mental health NP program I pray I won't ever do any further pevlics or rectals, lol, but I hope those in the family, adult, and pediatric programs get to redo this time and time again while in school. I know many of my family practice NP student colleagues rotate at a local family practice physician group clinic and are told, "you can't touch any patients, but you can shadow me" so they do this for the 750 (?) clinical hours of their program. Sad really.

I believe PAs do have a much better program that we should press are NP schools to mirror as much as possible. Where as I have taken numerous courses related to research, advanced research, advanced community health and program planning, nursing theory, and other woopty doo classes I could've taken more practical course work. I don't feel like I did anything in theory except type out the required papers, and a BSN course in research that was identical to my MSN research course was overkill not to mention and advanced research course that had me doing an assignment identical to what I did in BSN research, lol. Yes, research and EBP is important, but three classes?! I digress.

Specializes in Peds Med/Surg; Peds Skilled Nursing.
I think whoever said "it's hit or miss" depending on your program nailed it. I've met NPs who never learned to suture at all and don't do it as a part of their practice, and I've met NPs who routinely suture, lance, and an stick assorted myriad of items into patients, lol. I met a NP who won't look at radiographs because as she put it, "they didn't teach me that!" However, the ones I know who did the suturing, etc. above did evaluate their own radiographs.

My program has students come to class and engage in practical skills one day a week during a certain course. In it, such skills that the school and the state deem all APNs, APRNs, or whatever they're going by now should know. These include advanced health assessment techniques including otoscopic and fundoscopic exams, pelvics, anorectals, suturing from the dermis up, 12 lead EKG, and x-ray interpretation. However, as this sounds good in theory it really isn't. I think there was a singular day devoted to 12 lead, about four hours for x-ray, and maybe a couple of hours for suturing pig feet. As I am in a mental health NP program I pray I won't ever do any further pevlics or rectals, lol, but I hope those in the family, adult, and pediatric programs get to redo this time and time again while in school. I know many of my family practice NP student colleagues rotate at a local family practice physician group clinic and are told, "you can't touch any patients, but you can shadow me" so they do this for the 750 (?) clinical hours of their program. Sad really.

I believe PAs do have a much better program that we should press are NP schools to mirror as much as possible. Where as I have taken numerous courses related to research, advanced research, advanced community health and program planning, nursing theory, and other woopty doo classes I could've taken more practical course work. I don't feel like I did anything in theory except type out the required papers, and a BSN course in research that was identical to my MSN research course was overkill not to mention and advanced research course that had me doing an assignment identical to what I did in BSN research, lol. Yes, research and EBP is important, but three classes?! I digress.

That's horrible that all those students get to do is shadow. How are they suppose to learn? That's really messed up.

I learned to suture at work. No experience during school, so my new employer put me in a room with a surgeon and some pig feet. My collaborating MD was there start to finish for my first patient who needed sutures, just the business parts of the next few, and now only looks in if I ask for a second opinion. Same thing with eye injuries. I wish I had more experience in skills such as I&Ds, xray interpretation, etc, but a lot of that is better learned through multiple experiences than one didactic class. I'm dual ANP/WHNP, so I graduated fully competent in standard pelvic exams and largely independent in IUD insertions and endometrial biopsies.

Specializes in OR Nursing, Critical Care, Med-surg.

I do not start my program until Fall 2016, but we have a separate course for this, Advanced Skills. For this course, first, we complete a skills lab where instructors review common skills NPs practice in family medicine then we practice the skills. After that, we must complete 50hours with an approved preceptor; it's completely different than Advanced Heath Assessment, which is in my 2nd semester - this is in my 3rd semester.

Specializes in ER.

I paid out of pocket for a class to learn how to suture. We had one or two PAs and a lot of NPs in the class. Some doctors have taken the class before. I liked learning in a low-pressure environment. The guy that taught the class was a NP but before that he was a First Assistant.

Our school has several days where we come to campus to learn skills before we start clinicals.

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