First week of NP clinical! HELP!!

RameyGurl · Sep 25, 2016

I know it, I just need to be able to apply it. I have resources and I keep a book of everything I have questions about. I guess the lack of guidance is making it difficult. I've trained so many RNs along the way and I know what works, this doesn't.

bbcewalters, NP · Sep 26, 2016

So I am guessing you are with an MD. My first family practice rotation was very difficult at first. Listen carefully to the way the PA student interacts with your preceptor and mimic.... I know my preceptor had me in the room alone to get the "scoop" from the patient. When I came out he wanted a VERY BRIEF SOAP on the patient. Then he would say ok what next. There was no spoon feeding or hand holding....

For example:

26 yo F C/O sore throat x 3 days.

Subjective- pt denies cough, fever, HA, NVD, difficulty swallowing, sick contacts. Admits to "sinus problems/allergies in past" sneezing and rhinorrhea, Has not used any OTCs except motrin (don't forget when they last took it) ..... (OLDCARTS is your friend)

Obj- ASSESSMENT!!! from head to toe... Eyes: PERRLA, Ears: describe tympanic membrane and canal, Nose: describe turbinates and any discharge, Throat: (Looking for strep features vs sinusitis vs URI....) is there lymphadanopathy, palpate sinus cavities, describe if a skin rash is present. Listen to heart and Lungs, maybe if warranted abdominal assessment Make sure to use medical terms, not RED but erythema, not pus, exudate ect...

Assessment/Plan what do you think top 3 differentials, any tests needed (rapid strep), then plan....antibiotics/watch and wait/ reassure viral....

Don't get discouraged it will get better... In my experience, your preceptor wants to hear you formulate this info OUT LOUD in a SUCCINCT manner. They expect you to be able to properly assess the patient, however, knows you will need guidance on why one differential is more likely than another.

Remember these appointments are booked for 15min.... you have to be quick and accurate.

Take this FWIW as I am still a student (I graduate in May 2017) I know others will have better thoughts or ideas....I just wanted to say I was very scared my first rotation till I got the hang of a verbal SOAP. I practiced at home in the mirror with cue cards and made up patients.... It helped a lot!!!!

allnurses Guide · Sep 26, 2016

26 yo F C/O sore throat x 3 days.
Subjective- pt denies cough, fever, HA, NVD, difficulty swallowing, sick contacts. Admits to "sinus problems/allergies in past" sneezing and rhinorrhea, Has not used any OTCs except motrin (don't forget when they last took it) ..... (OLDCARTS is your friend)
Obj- ASSESSMENT!!! from head to toe... Eyes: PERRLA, Ears: describe tympanic membrane and canal, Nose: describe turbinates and any discharge, Throat: (Looking for strep features vs sinusitis vs URI....) is there lymphadanopathy, palpate sinus cavities, describe if a skin rash is present. Listen to heart and Lungs, maybe if warranted abdominal assessment Make sure to use medical terms, not RED but erythema, not pus, exudate ect...
Assessment/Plan what do you think top 3 differentials, any tests needed (rapid strep), then plan....antibiotics/watch and wait/ reassure viral....

Always positives before pertinent negatives!

This is how I would expect my students to report to me:

"Jess" is a 26yo previously healthy woman with a complaint of acute onset of sore throat three days ago with sneezing and rhinorrhea, history of seasonal allergies without fever, chills, known sick contacts, dysphagia. On exam she has scant white patchy cryptic tonsils, 2+, worse on the R, slight serrous effusion bilaterally without erythema, shotty tender anterocervical lyhphadenopathy bilaterally. Chest and lungs are otherwise normal. Concern would be strep pharyngitis vs viral/allergic pharyngitis; would plan a rapid strep and throat culture and pend treatment on results. In any case she's likely need some APAP for symptom management.

It's quick, detailed and pertinent. If I have any other questions I'll ask.

bbcewalters, NP · Sep 26, 2016

Always positives before pertinent negatives!
This is how I would expect my students to report to me:
"Jess" is a 26yo previously healthy woman with a complaint of acute onset of sore throat three days ago with sneezing and rhinorrhea, history of seasonal allergies without fever, chills, known sick contacts, dysphagia. On exam she has scant white patchy cryptic tonsils, 2+, worse on the R, slight serrous effusion bilaterally without erythema, shotty tender anterocervical lyhphadenopathy bilaterally. Chest and lungs are otherwise normal. Concern would be strep pharyngitis vs viral/allergic pharyngitis; would plan a rapid strep and throat culture and pend treatment on results. In any case she's likely need some APAP for symptom management.
It's quick, detailed and pertinent. If I have any other questions I'll ask.

Thanks for the Tips BostonFNP.... I knew that....just didn't write it correctly.... :bluecry1:

allnurses Guide · Sep 26, 2016

I remember being a student and having my mentor yell at me about positives and negatives and I never thought it was a big deal. Now its one of my biggest pet peeves with students.

Courtney, FNP-BC · Oct 5, 2016

I remember feeling so out of it in the beginning of NP clinical! Just remember to ask questions and always volunteer to help with procedures, paps, etc. I felt out of my comfort zone but pushed myself to break through that! One thing I did was make a clinical resource binder, I had JNC 8 info, ABX charts, derm charts, DM info, etc. It was a comfort knowing I had all of my resources in one binder! It will get better, just keep your head up! â˜ºï¸

kprn889 · Oct 6, 2016

I am almost finished with my program as I am in my last semester. You will learn that "common diseases occur commonly". Learn the symptoms and treatment plan of the disease processes you will see frequently. For example if you are in family practice, I am seeing a lot of sinusitis, upper respiratory infections, and gastroenteritis so know your common symptoms and treatment plans.

Also, having developing differential diagnosis can help you to learn differences in common symptoms of disease processes. I also think you should invest in a NP live or recorded review for your specialty and also a review book. I have learned that I wished I would have bought my review sooner. Do not be afraid to ask your preceptor anything whereas, they may have some pneumonics that can help you with your studies. Hope this helps, good luck.

TexasNP14 · Oct 8, 2016

Don't stress, everyone feels this way! You are there to learn. It took me the first 2 weeks or so of every semester to feel more comfortable and get my footing right.