I feel a bit incompetent during clinicals

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Specializes in FNP-C.

I guess I just had a bad day or something. :uhoh3: Well first of all, I'm on a US army base in the outpatient deployment health clinic doing clinical rotations. Preceptor doesn't talk much unless I talk to him. I'm a male just so you know because many people think i'm a female on these forums. Well anyway, though I did ask to do the H&P, it seems I'm not that trusted...yet? I did see a patient on my own today and charted in the EMR though :yeah:.

I feel like I do well in class and reading up on stuff, but when it comes to clinical, I sometimes forget to do a certain exam for a specific problem. Sometimes I'm not sure if he wants me to just go on with the H&P while we're in the room. Many of these patients already have a diagnosis so I did not get to make much new diagnoses so far. However, I did get to change a previous med to a new one. :D

But sometimes for like procedures, it seems he wants to do it for his own assessment and thats understandable, but I wish he'd just let me do it. For example, a DRE, I've done 4 so far in my clinical rotations since Summer 2010 and though I told him I'm comfortable and the patient was comfortable, he just wanted to do it. I was nonetheless professional about things and told him before I left today that I learned a lot and I hope to do more the next time. :)

I graduate in August 2011 and I finished one year of FNP school (i'm full-time) and a summer semester of clinical and this Fall 2010 is my second clinical semester. Maybe it's because I still need to adjust to the APRN role as well as working to know pretty much everything a provider needs to know? Does anyone in their 2nd year of APRN school and who just recently started clinical rotations feel the same as I do?

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Specializes in General.
I guess I just had a bad day or something. :uhoh3: Well first of all, I'm on a US army base in the outpatient deployment health clinic doing clinical rotations. Preceptor doesn't talk much unless I talk to him. I'm a male just so you know because many people think i'm a female on these forums. Well anyway, though I did ask to do the H&P, it seems I'm not that trusted...yet? I did see a patient on my own today and charted in the EMR though :yeah:.

I feel like I do well in class and reading up on stuff, but when it comes to clinical, I sometimes forget to do a certain exam for a specific problem. Sometimes I'm not sure if he wants me to just go on with the H&P while we're in the room. Many of these patients already have a diagnosis so I did not get to make much new diagnoses so far. However, I did get to change a previous med to a new one. :D

But sometimes for like procedures, it seems he wants to do it for his own assessment and thats understandable, but I wish he'd just let me do it. For example, a DRE, I've done 4 so far in my clinical rotations since Summer 2010 and though I told him I'm comfortable and the patient was comfortable, he just wanted to do it. I was nonetheless professional about things and told him before I left today that I learned a lot and I hope to do more the next time. :)

I graduate in August 2011 and I finished one year of FNP school (i'm full-time) and a summer semester of clinical and this Fall 2010 is my second clinical semester. Maybe it's because I still need to adjust to the APRN role as well as working to know pretty much everything a provider needs to know? Does anyone in their 2nd year of APRN school and who just recently started clinical rotations feel the same as I do?

i would bring up my concerns to him. How many days have you been with him in clinical I can tell you from past experieince that some NP's are very possesive of thier pt's. Sometimes it is just a matter of comfort level all around, and dont worry relax you are a student are not expected to know everything trust me I have been there and felt the same way you will be fine
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Specializes in FNP-C.

I guess I'm the type where I feel I gotta "know everything" sometimes and I do realize that it's just not practical to try to "remember every single thing", but the most critical points of care for certain issues. It's my second day with him and I guess I'm just too anxious about "getting there". I did one day last week, another this week and starting from next week on, I'm doing tuesdays and wednesdays every week so I guess that'll get me more comfortable then. Plus, I'm not sure if being on a military base has to do with anything? Lots of acronyms to remember for the Army, forms they use, and also their EMR is different from what I used in Epic in hospitals....

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Specializes in General.
I guess I'm the type where I feel I gotta "know everything" sometimes and I do realize that it's just not practical to try to "remember every single thing", but the most critical points of care for certain issues. It's my second day with him and I guess I'm just too anxious about "getting there". I did one day last week, another this week and starting from next week on, I'm doing tuesdays and wednesdays every week so I guess that'll get me more comfortable then. Plus, I'm not sure if being on a military base has to do with anything? Lots of acronyms to remember for the Army, forms they use, and also their EMR is different from what I used in Epic in hospitals....
the army acronyms alone are a learning curve and i too am the type who needed to know everything and i too was anxious to get there, I graduated one year ago and still am learning everyday and wondering when I am going to get there. google army acronyms and print them out, what post are you at by the way
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Specializes in FNP-C.

Schofield Barracks in Hawaii, a satellite of Tripler Army Medical Command. Where are you working? I guess as a student, I won't be able to see patients yet at a speed such as my preceptor does. However, I love doing procedures. At least the PA at the clinic said he'll let me do orthopedic procedures. I guess in the military, NPs and PAs get to do a lot more than civilian sector.

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Specializes in General.
Schofield Barracks in Hawaii, a satellite of Tripler Army Medical Command. Where are you working? I guess as a student, I won't be able to see patients yet at a speed such as my preceptor does. However, I love doing procedures. At least the PA at the clinic said he'll let me do orthopedic procedures. I guess in the military, NPs and PAs get to do a lot more than civilian sector.
i work rural health in Illinois, no you wont see pts at the same speed, not even as a new graduate, as a new grad I am seeing a pt every 20 - 30 minutes depending if they are a new pt in for a physical or something acute. keep in mind I only se peds so it is a different curve some days they come in with just a cc but by the time i am done i have covered behavior problems the cc and a few added in,where my supervising md see's pt' every 15 minutes but she has been doing this for 25 years
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Specializes in FNP-C.

Thanks for you insight on your experience! Im also joining the air force so I guess they'll train me more? I just passed my MEPs physical last week and going to get the Health Profession's scholarship! i'm so happy about this but i know i need to brush up on my skills and critical thinking...I guess its also because I feel the military has even higher standards for APRNs...

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Your awareness of what you don't know in clinical at this point is what will make you a great NP in the years to come. You no doubt have classmates bragging about their clinical prowess (insert eyerolls here). The harsh reality is that being aware of your limits and what you still need to learn makes you insightful AND smart and will keep you from harming yourself or your patient.

In my graduating class, we had one smart@zz who bragged all the time about what he knew, etc. From his comments and presentations one would think he was already intubating in the ER and placing miraculous chest tubes to save the day. Hmmm...well, rumor is that he has failed the boards THREE times so I wonder what he really does know ?

I digress, but my point is that you know a LOT more than you think you know. Just because it doesn't come to you instantaneously doesn't mean you don't know it...it just means you haven't had the chance yet to implement it so frequently that it becomes second nature. I am about 6 months into my first NP job and I STILL have moments when I am charting after clinic hours and think "ackkkk...I meant to check for _______" It gets better and better though and the more you see something, the quicker and more thorough you cover it the next time.

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Specializes in FNP-C.

carachel2,

Thank you for those encouraging words. :) I guess its just like how Pat Benner said in her novel from beginner to expert. More exposure over the years in working in the clinical setting will help solidify my skills. I will always be insightful of what I know and what I need to research further on. I wonder how that guy in your class failed three times!

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:)

carachel2,

Thank you for those encouraging words. :) I guess its just like how Pat Benner said in her novel from beginner to expert. More exposure over the years in working in the clinical setting will help solidify my skills. I will always be insightful of what I know and what I need to research further on. I wonder how that guy in your class failed three times!

He failed because is and was cocky as @#$@ and thought he knew it all. Seriously, the best NPs I know are always learning, very humble and readily admit when they don't know something. At least twice a week now I have to find some way to tell patients "I've never seen this before, but I know it is NOT X X or X....let me get another provider and we'll both think and look at this together. "

When I was first starting clinicals, I would see patients by myself and then present to my preceptor. At the end of the presentation I would say "...I also should have checked for X and X and these other diagnoses are on my differential list."

I would HIGHLY encourage you also (if you haven't made the leap yet) to purchase either Pepid or Epocrates Deluxe. They are wonderful in helping you briefly review a condition before you walk in the patients room so you'll remember to do some rarely done neuro check or to ask for something really specific and remote in the H&P. Of course, you have to pull the patients chart somehow and then duck into a quiet hallway where no one can see you pecking away at your PDA BUT still...very helpful!

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After almost a year in practice, I will leave the pt and think ackkk,,, I should have asked about x + z too. I still give myself a pretty good load of homework. I am a total fan of epocrates delux and their differentials. But I also like a series of book designed for midlevels called soap for general medicaine, soap for cardiology soap for pediatrics etc. These got me in the habit of 'covering all my bases'. I may not ask about everything a more experienced clinician would, but I do ask about things that will help guide differentials, treatment and exclude the nasties.

Also, I can not count how many DRE's I have done, but maybe a better question to ask is how many dre's does a clinician have to do before they can with certainty identify normal vs. abnormal. Not every pt is ok with having dre performed 2x to verify findings ;) and not every clinician will rely on anyone else -student or fellow clinician when it is your license on the line.

I was fortunate enough to do some of my clinicals in the jail, so the np's I worked with were not very concerned if someone had 1 dre or 2 done to verify if I thought a prostate was boggy.

My advice is get what you can from every clinician and however much you can, your desire to learn will become your backbone for solid clinnnical practice.

I also agree w/ Daisy, when I have something that I don't know what it is, or the best course of treatment I am honest with the pt. and it is appreciated. I have a loyal patient following that respects this.

Keep up the good work! learn what you can when you can.:twocents:

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