NP rotation

  1. 0
    I am in a FNP Program. I never feel like I have the adequate knowledge to assess, diagnose, come up with a treatment plan during my clinical rotation. I try very hard to prepare myself...study required info, go over case studies, labs etc..But when I am left in a patient room alone...I feel so dumb, omit questions that I should be asking..then my preceptor comes...and I have these "DUH" moments every single time. I feel like a complete idiot. I am starting to question myself if I can be a family practitioner or I have to specialize to get good at something like psych, peds, womens, NNP etc..Family is killing me. Any thoughts how to get it going?

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  2. 9 Comments...

  3. 3
    First, specializing is NOT easier than FNP so get that thought right out of your head.

    Second, take a deep breath and think logically. There is no rocket science going on in an exam room with a patient. What is the pt's complaint? Once you know that you go through a logical questioning process pertaining to that complaint. You've got to pull your anatomy/physiology, psych, chemistry, pathophys, all together at this point and use them with the pt's history...and think. This process can be impeded by trying to hurry, so don't. Better to learn a logical thought process and be able to apply it every time, then you can speed up later on.

    For instance, let's say the complaint is "cough". Well you know anatomically that cough is going to involve the respiratory, cardio, and/or GI systems. Look at the pt's history...any hx of asthma, COPD, allergies, chronic sinus infection, tobacco use, HTN, CHF, GERD, etc. can help point you in the right direction OR eliminate one possible direction entirely.

    So let's say our "cough" pt is a long-time smoker who is using 2 inhalers on a daily basis...now you have some direction for your exam and your differentials.

    What if the "cough" pt says his cough is worse at night, but he also gets it when he's in gym class...now you have direction that might lead you to testing for asthma.

    Ask the questions, listen to the answers, and most of the time the patient will tell you what's wrong with them.
    missvictoriat, CCRNDiva, and reeya like this.
  4. 0
    Quote from mammac5
    First, specializing is NOT easier than FNP so get that thought right out of your head.
    I would think focussing on 1 area like Peds, Womens, psych etc would be easier than seeing all types of pt groups with all different kinds of problem. May be I am wrong to think that way. May be I am just overwhelmed.
  5. 0
    Specializing is much more in-depth than "generalist" FNP. (Please don't get mad at me, all you fine FNPs out there, I'm not dissing you!)

    Take Women's Health, for instance. The program is just as long as FNP with just as many clinical hours and a national certification exam. The WH folks have much more in-depth knowledge and experience in treatment of the entire women (not just the GYN stuff), chronic disease prevention/treatment, hormonal issues, depression, injuries common to females, etc. than do the FNP folks. Surely the FNPs get some exposure to that content, but they also have to cover peds, immunizations for all populations, male health, etc. and so can't possibly be as well-versed in WH as the folks dedicated to that specialty. Heck, I have an FNP friend who I don't believe performed one Pap/pelvic while he was in clinicals.

    For the record, I'm not WH...just using that as an example to show that NPs are not equivalent and the training is just as rigorous and demanding.
  6. 0
    What you are experiencing is absolutely normal.

    When I was doing clinicals I felt dumb as a stump! the minute I entered the exam room my mind just went blank. And not to discourage you, but in my case, it never did improve. But I guess I learned in spite of myself.

    I was frantic the whole time I was in the program about how I was actually going to take care of pts when I never could figure it out in clinicals.

    But a strange thing happened. After I went to work as an NP, almost from day one it all just came to me. I hardly ever had to confer with anyone. It was like all the information went in my head even though I couldn't put it together in clinicals.

    And once you are working at your own practice, you will see how many things you will see over and over and you will learn with experience. If I don't know something, I look it up and then I never forget it. If I just ask my collaborator it's too easy and I won't remember it. So I figure it out on my own as much as possible.

    Hang in there. It's totally worth it. Seriously, I thought I would surely kill someone when I started working but it turned out great.
  7. 0
    Quote from mammac5
    Specializing is much more in-depth than "generalist" FNP. (Please don't get mad at me, all you fine FNPs out there, I'm not dissing you!)
    Are u in sub specialty? Wouldn't it be nice to get an in depth knowledge in one area?
  8. 0
    Quote from Dixiecup
    What you are experiencing is absolutely normal.

    Hang in there. It's totally worth it. Seriously, I thought I would surely kill someone when I started working but it turned out great.

    Thank you for the reassurance. I hope it is like that because right now I just question myself if this is right for me.
  9. 0
    Half the time I didn't agree with my preceptors anyway, lol. Just use your head, you will be fine.
  10. 0
    Quote from reeya
    Are u in sub specialty? Wouldn't it be nice to get an in depth knowledge in one area?

    I'm finishing up an Adult NP program and practicing preventive care and chronic disease management in the 12+ year old population is enough for me! I do love diabetes care, but have not decided yet where I will work so not sure about subspecializing.
  11. 0
    I'm a CNS who is in nephrology, specifically mostly dialysis! Talk about a sub-specialty. Had no experience with dialysis prior to taking this position, never even seen it done as an outpt. I got hired because they liked my ability to think on my feet (my nursing background is ER and ICU). LOL - had no clue what bone metabolism was and had never heard of kT/V.

    However, after 5 years, I'm much more comfortable. The first year was especially rough for a variety of reasons.


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