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New NP - Balancing What I Know and What I Don't Know

NP   (1,243 Views 9 Comments)

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I'm about to start my first job as a NP and I feel a little nervous.  I was wondering how you handle situations with patients where you don't know something or have to look it up?  I'm not sure that I want to do it in front of the patient because I don't want them to lack confidence in me, but I am curious what others do or say to leave the room to research what they don't know?  As a new NP, I know there are things I will have to look up and was wondering the best way to handle those situations.

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1,032 Posts; 10,903 Profile Views

I would never research an unknown in front of a patient. Most of the things that you may question you should be able to identify something that may be causing the symptoms and likely know that some tests will be necessary such as a CBC cmp etc. excuse yourself to let them know that you will be ordering some tests and that will provide time to do some research. If you know you’ll be prescribing but unsure of exactly which agent or dose then inform them that you’ll either be sending the medication to their preferred pharmacy or will be bringing their written prescription back shortly.  That buys time to look up meds and doses when necessary. 

Remember no one expects you to know everything as a new practitioner so don’t hesitate to ask your colleagues when unsure. 

Best of luck. 

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MikeFNPC is a MSN and specializes in FNP.

213 Posts; 5,785 Profile Views

I try and research the problem before walking in the room.  But that would depend on how well the person scheduling the appt words the chief complaint.  Of course you're going to be blind-sided by the "list" people.  And, then it depends on the patient.  You're going to find that there are pt's who won't be satisfied with whatever you do. 

 

Sometimes I try and wing it, or keep asking questions while trying to quickly look it up.  Don't be afraid to say something like, "let me grab something off the printer" related to another problem the pt has.  Then, saying something like, "sorry about that, someone asked me a question when I was out there", to explain a delay.  

 

You'll find your rhythm after a while.  Good luck.  

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djmatte has 7 years experience as a ADN, MSN, RN, NP.

2 Followers; 842 Posts; 7,376 Profile Views

If the diagnosis is clear and they’re in for something they’ve been in for a million times, then I make sure I look things that are foreign to me up before I enter the room. Sometimes I have a list of differentials where I’m not sure where it’s going without labs or imaging. I’m up front with that, why we need further testing, and the types of things we want to evaluate for. If there’s something I’m unsure of (don’t always know exact or min max doses of some meds), I’ll be up front, tell the patient I’m not quite sure but any changes I’ll be sure to tell them before they check out. I don’t lie and I don’t make up reasons to leave the room. Most appear appreciative of that candor. Was a skill I learned briefing generals as an Intel analyst. 

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traumaRUs has 27 years experience as a MSN, APRN, CNS and specializes in Nephrology, Cardiology, ER, ICU.

166 Articles; 21,045 Posts; 191,244 Profile Views

Hmmm...I'm the outlier here: I do look up things in front of the patient. I simply say that isn't part of what I deal with on a daily basis and I want to check the doseage. 

The caveat to this is that I do know the common complaints that my pts have and those of course I deal with in a very straight forward manner - no need to look up things. 

What's wrong with being honest with a pt and saying, "I need to look up something real quick?" 

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Penguins10 is a MSN, RN, NP and specializes in Primary care.

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15 hours ago, traumaRUs said:

Hmmm...I'm the outlier here: I do look up things in front of the patient. I simply say that isn't part of what I deal with on a daily basis and I want to check the doseage. 

The caveat to this is that I do know the common complaints that my pts have and those of course I deal with in a very straight forward manner - no need to look up things. 

What's wrong with being honest with a pt and saying, "I need to look up something real quick?" 

Same here. I don’t have to look up as many things now as my first year, but I frequently look stuff up in the room or tell people I am going to go look something up if I want to check a book. Especially if we’re talking drug doses. If anything I think people appreciate being taken seriously and getting cautious/thoughtful care. 

Edited by Penguins10

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Dembitz has 7 years experience as a APRN.

65 Posts; 3,972 Profile Views

I look things up all the time. And if a patient has an unusual set of symptoms, I talk them through my diagnosis. "Well, I'm sure it's not <XYZ emergency> because <ABC>, but I'm not really sure what this is. I'm going to do some research and follow up with you in a few weeks. In the meantime, keep me posted if <PDQ bad thing> happens." Patients seem to appreciate the honesty.

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AnnieNP has 20 years experience as a MSN, NP and specializes in Adult Primary Care.

1 Follower; 508 Posts; 3,686 Profile Views

I look things up in front of patients too!  My patients trust me to know what I don't know and they appreciate it if I tell them I'm not sure about something. 

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verene specializes in mental health / psychiatic nursing.

1,528 Posts; 9,777 Profile Views

I look stuff up with patients - most appreciate the candidness and the sharing of information! Sometimes even if I know the information well I'll still pull up a resource to share with the patient as this can be very helpful for visual learners;  being look at a diagram or chart or read the information for themselves can help them process and understand the explanation I've provided verbally.

I've had my own providers, MDs and NPs, alike stop to look something up or consult a more experienced or more specialized colleague and as a patient I appreciated their willingness to own what they did and did not know and seek out resources when they were unsure. It made me feel like they really wanted to provide high quality care and get to the bottom of my complaint rather than just send me out the door.

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