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Do NPs get training?

Hello. I'm a new grad FNP and just started working about 1 month ago. I was able to shadow the MD one week prior to starting. When starting, I then saw my own patients and would present the cases to the MD so he could diagnose and create the plan. Now I am expected to be able to manage the simpler cases by myself . I take about half an hour per patient. I am constantly having to ask questions and find it very time consuming to look up things while the patients are waiting. I'm just wondering how other new grads were introduced into their new role. I feel unprepared.

Jules A specializes in Family Nurse Practitioner.

I did not receive any orientation what so ever for my clinical role as a new NP or a patient load reduction. Fortunately I had years of psych RN experience and excellent MD preceptors so I was white knuckling it but able to perform as expected. It sounds like more places are realizing how deficient our education is and are offering extended orientations but personally believe this is both embarrassing and a large failure on the part of the NP programs.

traumaRUs specializes in Nephrology, Cardiology, ER, ICU.

We are a nephrology practice and offer 4-5 months. However, that is necessary due to the time it gets to credential at all facilities. Also, once the orientation is over, you are on your own completely, handling unstable and sometimes coding pts on your own. Our physicians and other NPs are not on site - you are alone (often in very rural places where EMS response time can be up to 20 minutes).

So - in our case its not that we feel NP education is deficient but due to other factors.

casias12 specializes in Cardiology nurse practitioner.

Welcome to the real world. Most provider groups are small, and can't afford the luxury of extended training for someone who has been trained to a Master's degree level. I imagine he is putting you under a "stress test" to see if you will sink or swim.

A new tactic a few of my colleagues are using during interviewing is scheduling the interview at the end of office hours, and having a prospective NP do an exam with a real patient during the interview.

You may try looking for a job in a large institution, or maybe try looking to see if one of the many Medicare Advantage plans (United, Humana) are hiring for their clinics or home visits.

Unless this is a very understanding physician, you days are probably numbered.

casias12 specializes in Cardiology nurse practitioner.

"I have visited some of the best and the worst prisons and have never seen signs of coddling, but I have seen the terrible results of the boredom and frustration of empty hours and pointless existence."

Warren Burger was a man with many statements, but no solutions. A quack and embarrassment for the Supreme Court.

I have spoken to a few newbies and everyone's orientation has been different. I have a friend who basically given a full load of patients in her second week and she struggled for months before getting a handle on it and she thinks that forced her to get her stuff together.

My experience was basically shadowing the doc for 4-5 weeks and discussing the treatments along the way. I benefited as I saw how he handled the patient encounter and asked as many questions as I could. I would be grilled about patient situations and would miss a lot, but would go research immediately. I kept a list of things to go back and research that night just so I could be better prepared the next time around.

Eventually I started seeing a few patients until I was up to a full load. I still have questions and I still look stuff up all the time. i get frustrated when I forget stuff I looked up a month prior, but I still do it. I keep a notebook and everyone I learn something new I make a note about it. I hope one day to organize all my notes online - maybe to help who comes after me.

I think maybe you have a bit more homework to keep up. The training wheels come off and you got to keep peddling

Good Luck

Jules A specializes in Family Nurse Practitioner.

We are a nephrology practice and offer 4-5 months. However, that is necessary due to the time it gets to credential at all facilities. Also, once the orientation is over, you are on your own completely, handling unstable and sometimes coding pts on your own. Our physicians and other NPs are not on site - you are alone (often in very rural places where EMS response time can be up to 20 minutes).

So - in our case its not that we feel NP education is deficient but due to other factors.

In a complicated specialty like nephrology where it would be unusual for any NP to have come out of school with much exposure it makes sense although 4-5 months of orientation sounds delightfully generous to me and maybe I'll consider joining you in the frozen tundra because I'd imagine I could be brought up to speed with that luxury. :D One of my friends who is an ED doc always says the kidney docs are the absolute smartest in the profession. I would have figured neuro but nope she says nephro and in fact one of the to 10 docs I have had the pleasure to work with is, you guessed it, a nephrologist. My hat is off to you and your specialty.

If I were a NP student interested in nephrology or whatever specialty that is where I'd do as much of my clinical rotations as allowable to not only hopefully secure a position in the practice but give myself a leg up on starting blind. Dang that kind of sounds like a control freak.

BCgradnurse specializes in allergy and asthma, urgent care.

I had a few days orientation, mostly to learn the EMR and organizational policies. I was started with 1 patient every 30 minutes, but was expected to ramp up to a full patient load within a few months. There were always providers around to consult with, but I was expected to handle the routine cases independently. OP-I am a little concerned that you're taking so long to handle a simple case. Did you not work up cases from start to finish in your clinicals? Is this a knowledge issue or is this a confidence issue?

A new grad should not be an expert by any means, but should know how to handle common issues like basic prescribing for HTN, 1st line treatments for diabetes, diagnosing and treating a simple URI. Review these and other common issues. I would go home from work when I was a newbie and study every single night. I still study on my own to stay abreast of current and new practices in my area.

I think your physician is giving you a decent orientation. The basic training should have happened in your clinicals.

we need to know what type of practice this is and what the definition of simple case is. I mean if its a primary care practice and by simple case you mean like sinusitis or pneumonia, then wow, not sure how to help there... thats what school is for.

need more detail

traumaRUs specializes in Nephrology, Cardiology, ER, ICU.

Agree that the practice type and size is important. Our neph practice has 19+ MDs, 8 APRNs, 1 lone PA, and our own amb surg center and we cont to grow.

I did none of my clinicals in neph - all my clinicals were done in ER/ICU as that is where I wanted to be. However, I graduated and there were no jobs - ugh.....so here I am. For me I needed that orientation and since after orientation you are really truly on your own, its for the best to be competent.

We do primary care also for our neph pts so I do have some primary care exp too but derm always gets me and I refer out if its not calciphylaxis, shingles or yeast - lol....

TheCommuter specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I take about half an hour per patient.
How fortunate your patients are...I have never received more than 10 minutes of face time with any type of provider (MD, DO, NP or PA-C) in the outpatient setting.

I'd prefer not to post too much information, but it is a specialty practice. I was given a VERY different version of how things would start the first couple of months (eg. severity of patients, amount of time booked per patient, the fact that each pt would be presented) and so I wanted to know the general experience of others. I see that it's a combination of factors, including poor clinical experience contributing to a lack of confidence. It is sink or swim. Thank you all for your replies!

I'd prefer not to post too much information, but it is a specialty practice. I was given a VERY different version of how things would start the first couple of months (eg. severity of patients, amount of time booked per patient, the fact that each pt would be presented) and so I wanted to know the general experience of others. I see that it's a combination of factors, including poor clinical experience contributing to a lack of confidence. It is sink or swim. Thank you all for your replies!

Rules are a little different when considering family vs specialty practice. Family you get the run of the mill mix of everything and you do see the same things over and over during certain times of the year. Plus, you get pretty adept at the HTN, DM and HLD management.

Specialty practice has its own prickly nuances. Starting with the fact that your physicians are experts in certain areas in addition to their basic training. It can be quite intimidating coming directly from school. It also required you work harder to get up to speed so your physicians are not in a constant eye-roll. Also, your patients expect you to know, in detail, how to treat their condition.

I am not sure what area you work in, but I do know every specialty practice sees many patients who can be easily handled by PCP and these are most likely the once you should focus on and be prepared to see. Look back at prior treatment plans and try to draw on similarities of conditions with treatments. Also, know your guidelines - cannot emphasize that enough.

Palliative Care, DNP specializes in Family Nurse Practitioner.

I work for a hospital conglomerate. I oriented in 3 facilities with physicians that completed residencies in Palliative Care for 2 weeks each. So a total of 6 weeks of working directly with a physician. I see 14 patients a day typically but with this specialty each can be quite time consuming as we are also dealing with families and end of life. I utilize references and ask questions when I don't know the answer. I also take notes of new things daily and look up/study when home.

casias12 specializes in Cardiology nurse practitioner.

Someone once said a cardiologist could be replaced with an app, a primary could be replaced with a Wal-mart greeter.

I took that to mean that PCP's just refer patients out, loosely, by the body system, and specialists get so used to seeing the same thing, they can write orders in their sleep.

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