NPs: What Clinical Rotations Did You LEARN the MOST?

[the VEGAN Professor]

Licensed Nurse Practitioners & current Nurse Practitioner STUDENTS:

What CLINICAL ROTATIONS (sites) did you personally feel taught you to the MOST?

Which clinical rotation (SITES) did you feel felt like more of a waste of TIME? or simply taught you the least?

*I do understand the learning curve will differ greatly based on the individual PRECEPTOR you select, or have been selected for---but DID ANY clinic or hospital setting allow you to grow the most as a Nurse Practitioner student?

(personal issue--decided to switch universities and the FORMER university allowed and ENCOURAGED hospital preceptor rotations...TODAY I discovered that with the new university hospital settings are only discouraged, but are NOT ALLOWED) This was a huge BLOW to all previous plans and not quite sure where to start

(also was told there is NO MASTER LIST, whereas the previous school disseminated a master list before the 1st day of school)

[ICU2NP]

Are you a primary care focused cohort? That’s probably why they are discouraging inpatient rotations? We weren’t really supposed to do inpatient rotations either, as we are primary care (AGNP).

I learned the most in TCUs that had high acuity (not just elders needing rehab post-knee replacement). It felt very acute care-ish at times, with multiple comorbidities to manage. Some of those people who are getting discharged from the hospitals are SICK.

[the VEGAN Professor]

On 5/7/2019 at 3:24 PM, ICU2NP said:

Are you a primary care focused cohort? That’s probably why they are discouraging inpatient rotations? We weren’t really supposed to do inpatient rotations either, as we are primary care (AGNP).

I learned the most in TCUs that had high acuity (not just elders needing rehab post-knee replacement). It felt very acute care-ish at times, with multiple comorbidities to manage. Some of those people who are getting discharged from the hospitals are SICK.

(thank you so much for your response)

yes, actually switching from a Post-Master's FNP at one university to a DNP -FNP at a different university (they literally told me because of my MSN I had to to the DNP option)

PROBLEM... the 1st school ENCOURAGES ICU and ER rotations within the hospital setting current school says NO HOSPITALS

I'm wondering would I learn a lot more if training in an inpatient setting, and was the SWITCH not worth it (haven't started at the new school yet-- reconsidering based on training areas allowed)

my goal --> to work as a hospitalist upon graduation

[203bravo, MSN, APRN]

If you wish to be a hospitalist you should be in an acute care program not FNP

[Dodongo, APRN, NP]

22 hours ago, 203bravo said:

If you wish to be a hospitalist you should be in an acute care program not FNP

^^ Why do students have such a hard time with this concept. FNPs are trained in primary care. Why would you choose to train in primary care but then expect to work in acute care?

[fsuao2006]

I was under the impression that a FNP in some states or hospitals are NOT ALLOWED to care for acute patients... yet I have a handful of friends who graduated with their FNP who now work in the ER... ?‍♀️

[nursecatraxa]

Depends on the area you are concentrating on, and your interests. I am an FNP so I focused in primary care offices and places. The most learning (and currently working at) is definitely a FQHC. You see the weirdest, rarest, complex, interesting cases there because: 1) pts belong to many categories and combination of being uninsured, homeless, foreign born, poor and very sick, severe mental health and addiction. 2) You see a variety a procedures, and specialties because they cannot reach an specialist so you are the mental health, derm, ortho, endo, rheum, neurologist du jour for many patients on waiting lists for donation and pro bono specialists. 3)you get to manage time real fast because you are given 15-20 mins for 20-22 pts a day no admin time, many times no prior medical records with them or of them anywhere and said pts need medications to be given to them for free since they cant pay for them, all while taking care of them and making sure there is a f/u appt set so they are not lost, with forms to be filled all in the allotted time. You don't typically see this in private offices. 4) you a have a great team of assistants, MDs, PA, and NP ready to mentor you, and DM educators and Mental health team to refer to within. I am still a new NP, and believe me no NP school could have taught me all the skills I have acquired since I was student doing rotations there. The patients let you do procedures while the MD or another experienced provider literally holds your hand to do it, and they are grateful and Ok with that while you learn. is a win-win situation. I am confident I can be "thrown" into any situations and not be afraid. However, this is not for everyone, but it will be toughest job you will ever love. I digress, I feel FNP practice for FNPs, and acute care NP if you want to be hospitalist and or ER. I did rotations in those as well and I would have been totally inadequate as an FNP or the learning curve would have been tremendous that I would have been in a psych unit or dead from stress, and feelings of inadequacy, burn to a crisp etc. but I saw the signs before and I stayed within my scope. I am happy.

[FullGlass, BSN, MSN, NP]

To the OP: As an FNP student, you will only do primary care rotations. If you want to work in a hospital, then you need to earn an Acute Care NP. This should be clearly spelled out in your school's curriculum.

As for most educational clinical rotations: busy inner city Urgent Care, legitimate interventional pain management, long term care with a fantastic preceptor.

[the VEGAN Professor]

Attached is the email message from my PRIMARY CARE NP PROGRAM

[the VEGAN Professor]

On 5/12/2019 at 1:47 PM, nursecatraxa said:

Depends on the area you are concentrating on, and your interests. I am an FNP so I focused in primary care offices and places. The most learning (and currently working at) is definitely a FQHC. You see the weirdest, rarest, complex, interesting cases there because: 1) pts belong to many categories and combination of being uninsured, homeless, foreign born, poor and very sick, severe mental health and addiction. 2) You see a variety a procedures, and specialties because they cannot reach an specialist so you are the mental health, derm, ortho, endo, rheum, neurologist du jour for many patients on waiting lists for donation and pro bono specialists. 3)you get to manage time real fast because you are given 15-20 mins for 20-22 pts a day no admin time, many times no prior medical records with them or of them anywhere and said pts need medications to be given to them for free since they cant pay for them, all while taking care of them and making sure there is a f/u appt set so they are not lost, with forms to be filled all in the allotted time. You don't typically see this in private offices. 4) you a have a great team of assistants, MDs, PA, and NP ready to mentor you, and DM educators and Mental health team to refer to within. I am still a new NP, and believe me no NP school could have taught me all the skills I have acquired since I was student doing rotations there. The patients let you do procedures while the MD or another experienced provider literally holds your hand to do it, and they are grateful and Ok with that while you learn. is a win-win situation. I am confident I can be "thrown" into any situations and not be afraid. However, this is not for everyone, but it will be toughest job you will ever love. I digress, I feel FNP practice for FNPs, and acute care NP if you want to be hospitalist and or ER. I did rotations in those as well and I would have been totally inadequate as an FNP or the learning curve would have been tremendous that I would have been in a psych unit or dead from stress, and feelings of inadequacy, burn to a crisp etc. but I saw the signs before and I stayed within my scope. I am happy.

I can not THANK YOU ENOUGH for your well thought and and informative response! Any response is greatly appreciated, however you went above and beyond!

[203bravo, MSN, APRN]

I’m sorry but you may have misunderstood the spirit of my comment. I wasn’t implying that FNP students should never do any hospital rotations, rather that following the APRN consensus model and your desire to be a hospitalist you would be better served with an acute care program rather than FNP.

[umbdude, MSN, APRN]

You don't get primary care (FNP) experience in an acute-care inpatient unit within a hospital. Some hospitals have outpatient specialty clinics and those might make sense for FNP/AGNP, but surely not floors like med-surg, tele, and step downs. To work on these units for critically unstable patients, ACNP is the way to go.

The program is doing FNP students a disservice by telling them they could get hours from anywhere in the hospital. My guess is that this NP program makes students find their own sites and could care less where these sites are as long as students get the hours.