Presenting to the attending physician

[kathrn99]

I am very close to completion of my AGACNP program. I'm doing clinicals with a hospitalist group. They have offered me a job after obtaining my license. I'm scared of looking stupid in front of them. I don't want them to think they've hired a complete idiot. But I am having difficulty presenting my admissions to the attending. My preceptor says I say too much and should only include pertinent details. Well I am scared of leaving something out. Is there a template or something to help me with this ? I appreciate any advice.

[NPmimzy75]

I had the same problem, I was worried that something might be important but I just couldn't see that yet, so wouldn't want to leave anything out! I didn't know yet, what was important and what wasn't. I'm 2 years into practice and just now starting to get comfortable with a quick presentation. When you're getting together what you're going to say, try working backwards from your diagnoses or conclusions and think about what supports them- those will be the important things. The first sentence should give you a clear picture of what kind of patient it is- "a 57 year old uncontrolled diabetic smoker presenting with exertional chest pain" gets their attention right from the beginning.

[Corey Narry, MSN, RN, NP]

I could tell you how we do our presentations where I work. It's basically a SOAP note that you are presenting:

In the case of a newly admitted patient, start with SO by giving a short recap of the HPI (i.e., 57/F came in with sub-sternal chest pain brought on by activity...), give past medical histories, home meds and allergies, social history. Then you can proceed with the physical exam with pertinent labs as you go along.

If this is not an ICU patient, you could omit systems that have normal findings or just say no Neuro, Renal, Heme, or ID issues and focus your exam on the pertinent findings. When presenting cardiovascular system, give your physical exam with pertinent labs and diagnostics (i.e., HR 70's regular rate and rhythm with EKG showing no acute ST changes but with an elevated troponin of 0.1, BP is...).

At the end of your system review, start the AP by summarizing your presentation by saying something like...Mrs. S here is a 57/F who presented with sub-sternal chest pain concerning for a NSTEMI given her risk factors of HTN, hyperlipidemia. I would like to admit her to telemetry and do serial cardiac enzymes. I would start her on Morphine IV for chest pain, daily ASA, nitrate prn, and supplemental oxygen...