lying about clinical hours

Specialties NP

Published

I have an issue and maybe some of you can make light of it for me. I am a practicing FNP and have been asked to be a preceptor for someone whom I work with. He is in FNP school and thankfully I am not his preceptor at this time. When I ask how his hours are coming along he says just fine. He is in his 2nd clinical rotation and is working full time. All of the NP programs I know of require 16 hours of clinical hours per week. He takes one day off his full time job weekly to complete an 8 hour clinical rotation. He states he can see 16 patients a day and count each patient as 1 hour of clinical since it takes him 1 hour to work up the patient, which is complete BS. I know he cannot take off work to have a second day of clinical so he just reports the fake hours. So basically will have half of the clinical hours needed. He just finished his first rotation a few weeks ago and I thought he would have been caught but wasn't. He also says that other people in the program are doing the same thing, only 1 day a week and counting it as 2.

I and everyone I know that has completed a NP program has worked their butt off to complete their program and it just really irritates me that others just mend the program to their liking. Has anyone else experienced this?? It is really cheating in my opinion and I feel it takes integrity away from the profession and people are taking short cuts.

Specializes in Family Practice, ER, Tele, ICU.

Ditto here. Direct patient care time only. We even had to deduct time for taken for lunch. We also had to separate direct patient interaction time from consultation time with our preceptor.

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Ditto here. Direct patient care time only. We even had to deduct time for taken for lunch. We also had to separate direct patient interaction time from consultation time with our preceptor.

That's applicable for a tracking system, but definitely not reality. Not even for medical school. You should always be learning throughout your clinical day, not just when you're in front of a patient. The consultation time is extremely important, because as a student, you know nothing and need to be taught. Practicing on a patient, while having no knowledge, is not time well spent. Of course, lunch may sustain you, but should not count:no:

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Specializes in Family Practice, ER, Tele, ICU.

I wasn't arguing that lunch should count as clinical time. I also greatly value consult time with my preceptor. I was only making the point that it is a lot harder to "cheat" on clinical hours when your preceptor has to sign off on all hours, you have to essentially clock in and clock out for lunch, you have to enter direct patient, and you have to entrer preceptor consultation time.

I don't know if the person mentioned in OP's original comment has to document as described above. If he did, it would make it a lot harder to "lie about clinical hours".

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Why isn't the program using something like Typhon? It not only counts the encounters but basic demographics, CPT and ICD-10. This allows programs to compare students.

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Specializes in Internal Medicine.
Why isn't the program using something like Typhon? It not only counts the encounters but basic demographics, CPT and ICD-10. This allows programs to compare students.

My thoughts exactly. It's what my school used. It's still possible to fudge numbers but it's likely more obvious something fishy is going on when you're comparing it to the entire class in terms of their volume.

Most of my preceptors would also keep track of what days we were there in case they were ever asked by a school to verify, on top of each preceptor having to sign a statement and evaluation of the student. The instructors also showed up for evaluations while we were in our clinical sites, to see how our interactions went with patients (talk about intimidating).

I'll be honest, when I'm precepting a student at the end of the day when I'm just wrapping things up and they're just sitting there, I'll let them leave early (30 mins to and hour), and will still count it when I sign off on their time sheets or evaluation forms. The time students have to take reviewing all the stuff they just did during the day, entering Typhon logs, and preparing H&P's on those patients is going to take much longer than the 30 mins I give them off, and be much more instructional.

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Specializes in FNP.

"I'll be honest, when I'm precepting a student at the end of the day when I'm just wrapping things up and they're just sitting there, I'll let them leave early (30 mins to and hour), and will still count it when I sign off on their time sheets or evaluation forms. The time students have to take reviewing all the stuff they just did during the day, entering Typhon logs, and preparing H&P's on those patients is going to take much longer than the 30 mins I give them off, and be much more instructional."

Not sure if I'd admit that. Probably never happen in a million years but I've seen nurses loose their license for less. I'd worry about it being interpreted as a crime of moral turpitude.

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Specializes in Internal Medicine.

not really sure how when clinical hours is very poorly defined in the first place at the state level. Is it total patient care hours? Total hours onsite? Total hours spent doing all of the above including case reviews and charting after the fact? The state of Texas says 500 hours of practice in your advanced practice role. Some states are starting to count on campus skills sessions as part of this requirement.

Providers bill for acuity often based on total time spent reviewing the chart, notes, labs, and physical time at the bedside. A huge chunk of that can be done while in bed and they might be in the patient room for 10 minutes. As a student reviewing clinical logs and entering them into Typhon is arguably more time consuming and tedious than actual patient charting and requires in some cases a lot more detailed patient info. (Can't remember the last time I check what type of insurance a patient had in my hospital job)

I wish NP programs would make a shift similar to what CRNA programs do requiring a total case load in addition to hours, versus just counting clinical hours. The NP student seeing 10 patients in an 8 hour day isn't getting the same experience as the NP student seeing 20 patients in that same time frame.

Im wrapping up my ACNP right now and it scares me when I hear about some students seeing 7 or 8 patients in a 12 hour day.

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Specializes in Hospital medicine; NP precepting; staff education.

Indeed. On days I saw 20 as a student you bet I had to keep moving and it helped me streamline my process. I am infinitely grateful for one provider who encouraged me to organize my presentation in the medical model. Not only did it make my work efficient, I am recalling that uniform approach now daily at work, unlike the long drawn out care plans in nursing school. ( which are important in developing critical thinking but I think are moot after years of practice).

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Indeed. On days I saw 20 as a student you bet I had to keep moving and it helped me streamline my process. I am infinitely grateful for one provider who encouraged me to organize my presentation in the medical model. Not only did it make my work efficient, I am recalling that uniform approach now daily at work, unlike the long drawn out care plans in nursing school. ( which are important in developing critical thinking but I think are moot after years of practice).

As an NP what other model would there be, except the medical model? I haven't seen any other. Please enlighten. Also the type of patient is as important as the volume. I've seen many diseases go undiagnosed because of the quickness of the visit. There are some people that are just slow even when evaluating a grain of rice, and others very quick and thorough with the most complicated patient. It all depends on the situation. I for one, believe that students should see limited patients on their own at the beginning of each rotation and study up on anything new or unfamiliar, then increase number of patients for efficiency training. Just a thought.

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I'm not sure that its 'scary". I often only had 7-11 pts at my clinical rotations. I think the slower pace actually allowed me to spend time with patients and allow for actual mentoring from my preceptor.

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Specializes in Hospital medicine; NP precepting; staff education.
As an NP what other model would there be, except the medical model? I haven't seen any other. Please enlighten. Also the type of patient is as important as the volume. I've seen many diseases go undiagnosed because of the quickness of the visit. There are some people that are just slow even when evaluating a grain of rice, and others very quick and thorough with the most complicated patient. It all depends on the situation. I for one, believe that students should see limited patients on their own at the beginning of each rotation and study up on anything new or unfamiliar, then increase number of patients for efficiency training. Just a thought.

Gradually increasing patient load as a student is preferred and was my pleasant experience. I was vocal on what I felt comfortable doing as I wanted to be thorough and learn, which was the point. As to other approaches, I've heard reports or cases presented from other NPs that meandered and was inconcise so as to not really paint an accurate picture of the patient. Heck, I've received better RN shift reports. What I find those do not offer is the assessment and plan and until this simple but valuable skill is learned, progressing as a provider is hindered.

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Gradually increasing patient load as a student is preferred and was my pleasant experience. I was vocal on what I felt comfortable doing as I wanted to be thorough and learn, which was the point. As to other approaches, I've heard reports or cases presented from other NPs that meandered and was inconcise so as to not really paint an accurate picture of the patient. Heck, I've received better RN shift reports. What I find those do not offer is the assessment and plan and until this simple but valuable skill is learned, progressing as a provider is hindered.

I agree. The lack of good preceptors sometimes puts students in the position of being additional staff, without any sort of structured learning. I have had great preceptors who wanted to teach and did not see you as part of the practice. You were a student and the purpose for your presence was to learn.

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