NPs: How did you learn clinical skills??

  1. 0 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??
  2. Poll: Did you learn clinical skills in your NP program, such as suturing, etc?

    • View Results
  3. Visit  IcySageNurse profile page

    About IcySageNurse

    From 'Florida'; Joined Nov '12; Posts: 134; Likes: 234.

    17 Comments so far...

  4. Visit  mcnacht profile page
    0
    My NP program didn't require suturing, but offered it as an optional class. I had already learned in in my ND curriculum, so I opted out. Really, the only way to learn suturing is to do it on a lot of real, live patients, which I did in some of my preceptorships and then honed in my urgent care job. I'm not sure which other clinical skills you're referring to. EKG reading? It's not hard to learn to apply the stickers, but it takes a LOT of practice to be able to competently read EKGs.

    As far as your base question of PA vs NP, it depends partly on personality, partly on future career goals, and largely on which program accepts you first. This has been the case for several RN friends who applied to both schools simultaneously, and let the schools make the decision for them. In most cases, your future practice and career is what you make it.
  5. Visit  myelin profile page
    2
    Quote from mcnacht
    My NP program didn't require suturing, but offered it as an optional class. I had already learned in in my ND curriculum, so I opted out. Really, the only way to learn suturing is to do it on a lot of real, live patients, which I did in some of my preceptorships and then honed in my urgent care job. I'm not sure which other clinical skills you're referring to. EKG reading? It's not hard to learn to apply the stickers, but it takes a LOT of practice to be able to competently read EKGs.

    As far as your base question of PA vs NP, it depends partly on personality, partly on future career goals, and largely on which program accepts you first. This has been the case for several RN friends who applied to both schools simultaneously, and let the schools make the decision for them. In most cases, your future practice and career is what you make it.
    Agree. I think way, way too many people get caught up in the educational models of PA vs NP and can't see the forest because of the trees. At the end of the day, PAs and NPs typically do a similar job. Most agree that a few years into practice they are interchangeable and people do their learning on the job. I used to think PA residencies were an advantage, but I'm seeing tons of NP residencies as well (including dual PA/NP residencies), so if you want extra training you can do it following either path.

    Instead of focusing on the educational model, I'd focus on what I want career-wise. Are you interested in a specialty that is more PA or NP friendly? Is your area where you want to work PA or NP friendly, or both? Which is going to cost you less? Do you care at all about teaching, research, policy, or owning your own practice? If so, then NP makes more sense. If you're really into surgery or emergency medicine then I think PA is the more straightforward route, though people can do it as a NP as well.
    BCgradnurse and nomadcrna like this.
  6. Visit  IcySageNurse profile page
    0
    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/documen...20programs.pdf
  7. Visit  nomadcrna profile page
    0
    Quite a few other clinical skills.
    Fracture reducing.
    Casting
    I&D
    Central lines
    Intubation
    LP
    US/radiology
    chest tubes
    joint injections
    eye procedures with slit lamp
    IUD & PAPs

    just off the top of my head.
    Quote from mcnacht
    My NP program didn't require suturing, but offered it as an optional class. I had already learned in in my ND curriculum, so I opted out. Really, the only way to learn suturing is to do it on a lot of real, live patients, which I did in some of my preceptorships and then honed in my urgent care job. I'm not sure which other clinical skills you're referring to. EKG reading? It's not hard to learn to apply the stickers, but it takes a LOT of practice to be able to competently read EKGs.

    As far as your base question of PA vs NP, it depends partly on personality, partly on future career goals, and largely on which program accepts you first. This has been the case for several RN friends who applied to both schools simultaneously, and let the schools make the decision for them. In most cases, your future practice and career is what you make it.
  8. Visit  nomadcrna profile page
    0
    You won't get all those in PA or MD school either.

    It is pretty much hit and miss and much depends on which type of NP program you are taking. IF ACNP, you will have many of those included. If FNP you will have others included. Much can be learned during clinicals and after by seeking out mentors.
    Quote from IcySageNurse
    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/documen...p programs.pdf
    Last edit by nomadcrna on Jul 6, '13
  9. Visit  BlueDevil,DNP profile page
    0
    I selected "as part of another class" because we were taught all of those things as part our adult acute conditions course. I don't recall what the course was actually titled. We had a year of acute conditions, a year of chronic conditions. Most of those skills were in the acute sections, IIRC.

    There was also an additional intensive course aimed at doing nothing but those types of interventional skills that was taught over one summer inbetween. It was an elective and I did not take it.
  10. Visit  kguill975 profile page
    2
    Quote from IcySageNurse
    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/documen...20programs.pdf
    Got all of it, except for the Pap (no thank you). You need an ACNP program. We had a cadaver lab, in collaboration with the physical therapy doctoral students. We had a critical care lab that included CT insertion, intubations, LP punctures, and suturing. I got further experience in suturing, splinting/casting, local anesthesia insertion, I&D of abscesses, wound debridement, and wound packing in my ER rotation. I got art line insertions/ central line insertions/CT insertions & discontinuations /intubations/ paracentesis/IABP/ & ICP monitoring in my critical care rotations in SICU/Neuro ICU & Surgical Tele/Stepdown. While these concepts are taught in class/lab (including peak flow & spirometry, CXR interpretation, and 12 lead EKG) you won't really get a grasp until you're in clinical, so the key is to only accept clinical assignments that will give you these things. Another important aspect is to consider the specialties of your instructors. One of my instructors was an ENP, so she knew where to put me, based on what I wanted to do (surgery). My other instructor was an ACNP/FNP, so he knew where to send students based on their desire to do critical care or an office based specialty practice. You can look at the professor's bios on your school's website. Also, ask your colleagues about what programs they're in, and what's offered. No offense, but I wouldn't rely on journals to make this decision, you need real time info. What do you want to do???? I knew I was going into surgery based on my experience as a RN, which is the ONLY instance that I advocate for PA. I couldn't go the PA route because I needed to work full-time and go to school part-time. Everything else you get a good foundation in NP school, and learn the rest in practice. Once again, what do you want to do???? Who do you want to treat???? No kids for me, no thank you. I knew it was adult and acute care. Good Luck to you making your decision.
    jmuhammad10 and JRJohnson like this.
  11. Visit  IcySageNurse profile page
    0
    Is there an FNP/ACNP combined program?
  12. Visit  nomadcrna profile page
    2
    Yes, a few. Check out Vanderbilt and there is another in Texas. Don't remember where though.
    Quote from IcySageNurse
    Is there an FNP/ACNP combined program?
    jmuhammad10 and sethmctenn like this.
  13. Visit  jaznia15 profile page
    2
    My program is a hybrid program at a brick and motar state university. For us it is 90% online and 10% in class. All our class lectures are online and you can choose to go to the school or get tests proctored. The program mandates days in certain classes where we go to the school. In advanced assessment we had skills days. In that time we had a partner from class in which we obtained a thorough history. During the skills days we had different activities to do (microscope practice, otoscope/othalmoscope practice, etc). At the end of the days, we performed a head to toe physical assessment on our partner (excluding private parts) in front of our teacher. We were given a time limit of 15 minutes to complete this task and given feedback after both partners completed the task. There was also a day when a male and female instructor came in and we performed a breast exam, pap smear, DRE, and male genital exam on both live models. It was kind of weird but I am very appreciative that we got that experience before clinicals from people who were able to offer guidance in our techniques. Each semester we have also went to the local medical school and used the same exam rooms as the medical students. We are given patients (actors) and given a certain amount of time to perform the examination. After the examination we submit a write up just like we would with a real patient with differential diagnoses and our plan of care. The patient encounters are recorded on camera and we are given feedback/grades for both the written and physical encounters. In adult 1, we did basic suturing on pig's feet and in practicum we will do advanced suturing.

    I debated doing 100% online school before getting accepted to this program and I do not regret one bit my decision to attend this school. I love the fact that this program has offered such opportunities to practice skills and get feedback before hitting the clinical courses. The simulated patient encounters were actually more nerve wracking than when I began seeing actual patients at clinicals. Doing these skills days put me at ease in my clinical sessions. If NP is really what you want to go for then I would research different programs in your area to see what is offered. Its alright to shop around, at the end of the day you are paying for the education you receive.
    jmuhammad10 and caddywompus like this.
  14. Visit  IcySageNurse profile page
    0
    Quote from jaznia15
    My program is a hybrid program at a brick and motar state university. For us it is 90% online and 10% in class. All our class lectures are online and you can choose to go to the school or get tests proctored. The program mandates days in certain classes where we go to the school. In advanced assessment we had skills days. In that time we had a partner from class in which we obtained a thorough history. During the skills days we had different activities to do (microscope practice, otoscope/othalmoscope practice, etc). At the end of the days, we performed a head to toe physical assessment on our partner (excluding private parts) in front of our teacher. We were given a time limit of 15 minutes to complete this task and given feedback after both partners completed the task. There was also a day when a male and female instructor came in and we performed a breast exam, pap smear, DRE, and male genital exam on both live models. It was kind of weird but I am very appreciative that we got that experience before clinicals from people who were able to offer guidance in our techniques. Each semester we have also went to the local medical school and used the same exam rooms as the medical students. We are given patients (actors) and given a certain amount of time to perform the examination. After the examination we submit a write up just like we would with a real patient with differential diagnoses and our plan of care. The patient encounters are recorded on camera and we are given feedback/grades for both the written and physical encounters. In adult 1, we did basic suturing on pig's feet and in practicum we will do advanced suturing.

    I debated doing 100% online school before getting accepted to this program and I do not regret one bit my decision to attend this school. I love the fact that this program has offered such opportunities to practice skills and get feedback before hitting the clinical courses. The simulated patient encounters were actually more nerve wracking than when I began seeing actual patients at clinicals. Doing these skills days put me at ease in my clinical sessions. If NP is really what you want to go for then I would research different programs in your area to see what is offered. Its alright to shop around, at the end of the day you are paying for the education you receive.
    Thank you! Very helpful
  15. Visit  NJprisonrn profile page
    0
    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!


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