New NP practice advice

I'd like to hear suggestions too! Thank u.

I don't have a cheat sheet. I have a cheat NOTEBOOK hehe. I keep it in the pocket of my lab coat.

Lol I hear ya! What all do you put in it? I've considered doing the same! Lol

A few tips (I still do these and I have been practicing for 10 years)

Your exam: do it in the same order EVERY TIME. I start at the head and work my way down. You also can assess while you watch them. Watch their gait when they walk in the room, their speech when they talk, their extra ocular movements when they talk etc. Will save you time.

Take your history the same way. First thing I review is allergies/meds every time.

In time it becomes a habit and you do not have to think about it.

If you have EMR make a template for the common things you see and document while in the room. If you do not have EMR, make a checklist/cheat sheet that you bring in with you.

We use outlook as our email system at work and it has a wonderful thing called "sticky notes". In the beginning, every phone # I had to hunt for, clinical pearls I learned, my NPI/DEA #, insurance #'s, pharmacies I needed....I made a sticky note for each one. 10 years later I STILL use them. Could also do it on your smart phone. I made over a hundred little notes, they are color coded and all in one place.

Trust your gut. If you are getting a bad feeling, pay attention to it (just like you did as a nurse). That sixth sense I developed as nurse still saves me from missing a subtle exam finding, writing a script wrong etc.

TEACH your patients their meds. When you are writing a script, your last check is to READ it to your patient so they KNOW what they are getting. Caught mistakes I have made this way too (so easy to make a typo with electronically sending scripts).

As a patient is giving your their history, start forming your differential diagnoses in the back of your mind. If they are rambling and you are worried you are going to forget to order a test, etc, subtly jot yourself a quick note as they are talking (I do this a lot to make sure I remember laterality (left arm, right foot etc) so when they are done talking I do not start examining the wrong thing!

At the start of the visit, sit down, make eye contact and let them talk about 30-40 seconds without interrupting, using the computer, writing anything....makes. Big difference on how patients perceive they are being listened to.

At the end, ask if they have any questions and keep asking until they tell you they have no more questions. A lot patients will never ask unless we ask them first.

Ask if they are comfortable with the plan....if they are not ask why (sometimes you can fix it or you can use it as a teaching moment).

Never be afraid to ask questions. I work with people who have been practicing for 20 years and they STILL ask each other questions.

Know where your resources are, social work, your insurance/referral people, your IT people, your schedulers

Give yourself time and patience. It is going to be at least a year before you feel comfortable!

Nice tips

rnsrgr8t...thank you for the WONDERFUL tidbits. I see myself utilizing SEVERAL of your suggestions...Thanks again!

You are very welcome!

I'm still an NP student but worked as a D.C. for years. My P.A. preceptor with many years experience offers great advice to even the Doc's. 1) Don't try to fix all their problems in the first visit. That's what follow ups are for so just pick their top 2-3 (you choose) 2) If the lab test doesn't change your treatment plan then rethink why you need to order it anyway 3) Just take care of the patients first, paperwork (charting) second and then your boss. It may not pertain to your situation but it did straighten things out a little for me and some others. I would reiterate what's already been said here...get your own routine down so you won't get sidetracked by patients or staff who inadvertently trip you up.

I like 5 minute clinical consult. or at least i did in clinicals, I havent worked in a clinic since clinicals. But its really nice if you have a computer handy. I use epocrates, uptodate, 5mcc in the hospital setting though too.

5mcc is very useful for quick look ups. medscape great for drugs. uptodate great for home reading.

thank God for smartphones.

I am a new NP working in internal medicine and feel a lot like you, thinking I forget a lot of things. It's really hard when some of these patients have a million things wrong with them and want a lot of things done to remember everything. However I feel like I'm moving into a comfort zone doing the following:

1) I focus on what my patients came in for and work my way out from there. Some of these patients could take up your entire day if you let them, keep it focused and to the point.

2) I am completely unashamed to use my Uptodate and epocrates apps basically all day long. Most of the time I know what I want to do and use them as a security blanket for meds and dosages, but they really help build confidence and give you a feeling of security knowing your referencing current disease, diagnosis, and data.

3) I am not ashamed to ask for help from other providers. Some patients can be so overwhelming that I try and do as much as I can, but I'm not above grabbing the physician I work with and bringing him in the room. There's another NP in our office and I like to pick her brain as much as possible. The other providers you work with should understand that you're still learning, and if you're in a good place, should be more than happy to help you.

4) Project yourself confidently and have a plan. The owner of my practice told me this when I was a student and I still use this advice everyday. Regardless of how lost or clueless you may be, be confident. If you seem lost or unsure your patients will know it and be timid to seek your care in the future. Similarly, even if you think your plan is terrible, make a plan. I come up with something each time and when I'm unsure, I go noodle it over with the other providers.

Basically, be confident, don't be afraid to look up info in resources, and don't be afraid to ask for help. If you ever get the feeling that asking questions or seeking advice is a burden to other providers, you might be in a bad environment.