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Topics About 'Student Obstacle'.

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  1. I have a psychotic disorder. I am in a BSN program. I managed to pass my first semester of an accelerated program with 4 Bs and a C. Yet I wonder if it is responsible of me to become a nurse given my history of psychoses. I consider giving up on this career choice despite shelling out 20k in loans. I have not had psychoses in two years, but its only a matter of time before it returns. I wonder If I am being responsible pursing this career. I desperately want to not be disabled by this condition and pursue a normal career path. I desperately want to reclaim my life from the ruinations psychoses caused, but perhaps I am not being realistic. The doctors state my goals are attainable, and my progneses very good perhaps I should believe them I just don't. I view this diagnoses as the end of my life. I repeatedly get told I can do this, but I don't believe it. I have been an inpatient in a psychiatric ward . I suppose I should listen to the doctors when they tell me there is no reason to give up on my dreams that I am capable of this they would know, but it is difficult. I wonder if I can give the proper care given my condition. Of course when I am stable I have no doubt, but when I am unstable I wonder if I might endanger the patient unintentionally, but none the less whether or not I have any business doing this career path. Its probably irrelevant as I have my doubts I will pass through nursing school despite passing my first semester. Call me cynical, but my life experiences have made me so. I wonder if pursuing this career is even responsible of me given my history. I might be able to pass, and I might even be able to give adequate care for a time, but given my history I wonder if I might not end up endangering a patient at a certain point. Perhaps I should cease my pursuit of this.
  2. Welcome student NPs and prospective student NPs! Starting your journey towards advanced practice and the provider role is a stressful time (we all know, we have been there) but also is a time to really embrace your transition and have the freedom to be an active learner. This time will be the foundation your career and your practice is built on. Unfortunately, this is a stage that is often mired by anxiety related to clinical placements. I wanted to take some time and share my personal opinions on some frequently asked questions and frequently discussed topics. I would like to offer some guidance in a two-part post on this topic, this is part one of two. First off, a little about me. I am a board-certified Family Nurse Practitioner and I work in a mixture of both inpatient and clinic settings with a small independent adult internal medicine practice. I live in a state that requires a collaboration agreement but I practice almost fully independently (as fully as I am comfortable with, see below). I have been on the clinical and didactic faculty at a local NP program as well as a lecturer and clinical preceptor for a local medical school. I have been an active preceptor for most of my NP career. I am active in the local and national NP association. I am not, however, the be-all-end-all of NP advice, so take everything as the opinion of one person with some experience. 5 Questions I Frequently Hear From Students: How do I find a clinical placement? How much RN experience do I need before I start clinicals? How do I prepare for my first clinical? What is expected of me at my first clinical? Do students really fail clinical? And here are my thoughts on each, perhaps other experienced members will add theirs as well. In part one I will take the first 5 questions as I see them. I will add a second installment with the later five out of ten. How do I find a clinical placement? Hopefully you are going to a program that helps you secure quality preceptor spots, this is my personal/professional bias, but your clinical experience is critical to your success as an NP and programs that leave that up to a student are not doing their students any favors. That being said I realize it is a trend for programs to not secure clinical sites and that there are good programs that no longer offer this. Remember there are a surplus of NP students and a relative lack of preceptors, and preceptors are (most often) not paid and often take on extra work and/or lost productivity earnings to take a student while many more are prohibited from taking students by their employer. Just like finding the right job, finding the right clinical site depends on using your existing network contacts, your school's network contacts, and making a personal effort. Talk to your family, your friends, your coworkers, your classmates, your alumni/ae, and your personal providers to see if anyone can help you get a "foot in the door" with anyone. Getting that initial contact is important. Join both the AANP and your local state NP association; they often have resources to help students find preceptors, it helps you network, and the dues are often very cheap/free for students. Make a professional and succinct resume and cover letter and hand deliver it to local practice managers; focus on small practices where you can get a face to face with the manager but also understand that many offices are very busy and won't have time to sit down with you. Cast a wide net. Don't expect to have much luck posting on message boards for preceptors. Lastly, try and avoid any paid services. They are often not helpful and offer limited guarantees and return on your investment. How much RN experience do I need before I start clinicals? This is a hotly debated topic and you can do a search on this website for a myriad of opinions. Most importantly is you need to have your RN before you can start APN clinicals. From my experience, there is no universal answer to this question. There are students with no experience that perform very well and there are nurses with ages of experience that struggle. They are, for the most part, the outliers. It is true that the RN role and the NP role are very different, but there are also important aspects they both share. I normally answer this question with a question: how much experience do you think you need? Self-reflection is very important at the provider level. The first step is to evaluate yourself and understand what you need; shadows some NPs and see if you are totally lost or ready to jump in. The second step is to figure out what your school requires. The third step is to discuss with prospective preceptors what they feel is appropriate. While RN experience may not be required of everyone there is very little argument that some RN experience won't benefit just about everyone. I don't love that some student NPs are also trying to work their first RN job, learn that role, go to school, and also do NP clinicals. There is, for me, too much confusion there. How do I prepare for my first clinical? This is one of the most stressful things for students along with the "what is expected of me" question below, and they are intimately related. The first step is to do some research on the type of practice you will be joining for your semester. You can search the internet to find the most common reasons for visits to that speciality and the most common diagnoses. You can find through your school resources the guidelines for treating common diseases in that setting. The second step is to reach out to your preceptor ahead of time and convey that you have done step 1 and ask if there is anything specific that you could do to prepare. The third step is to assemble an acceptable wardrobe to wear for your clinical rotation: it's ok to find something professional but inexpensive and wear the same thing each day (often once a week) if you don't have the money to buy a whole new wardrobe. Don't show up looking unprofessional. The fourth step is make sure you can get there on time! What is expected of me at my first clinical? As state above, this is intimately related to how you prepare. You will be expected to show up on-time and as scheduled, in appropriate attire, with a basic understanding of the type of patient you are expected to see and some general idea of the type of practice. This is pretty universal. I expect my first semester students to #1 be safe and #2 to be open to learn and active in the process. I also expect them to communicate with me openly, as I consider that part of #1 (safety). I also expect my first-time students to be able to have a general idea of how to obtain a basic comprehensive history and do a basic comprehensive physical exam. That's all I ask at the start of the first semester. On the first day I expect students to just get acclimated to the environment; meet the staff, navigate the EMR, shadow me through the day on acute and chronic visits or rounds. I welcome students to be involved with me in discussion between patients and get involved in physical findings I will identify; as above be honest if they can't see/hear/feel them. From that point on my expectations are dictated by the student: I first challenged to identify normal from abnormal as this is required for safe practice. Next I have students begin to focus their history and exam and to begin to formulate crude differentials with a focus on ruling out the most dangerous possibilities. Next I have students start thinking about potential treatment plans followed by what their actions would be on the next visit if unsuccessful. That is as far as most students will get in their first rotation. It may be basic for some, a challenge for others, but if a student can focus on those things they have a good foundation to build on. Do students really fail clinical? Yes. Students fail clinical; when it happens it is (almost) always the fault of the student for breaking very clear and simple rules. For me there are only three ways you can fail your first clinical semester. The first is that you don't show up or you show up late. There are always situations that can be excused but if you are either chronically late or unreliable you have failed yourself and thus your clinical rotation. This is the worst type of failure because t shows you are not invested in your career. The second (and most important) is that you are clinically unsafe; this changes every semester with your expectations. For a first semester student being clinically unsafe (to me) is giving medical advice your are not qualified to give, not being able to identify normal from abnormal by the end of the semester, or being unable to consider crude differentials and/or doing what I call "pigeonholing" repeatedly. This is the best type of failure because it protects your career from a lawsuit. Repeat your semester and improve. The third is not being honest with me. Your job is to be a student and it is ok to make mistakes and it is your time to see and hear and feel and learn. If I ask you to look in an ear and tell me what you think and you say "I don't know what I am looking at" or "I can see" that's fine because it's honest. If you look in the ear and say "the membrane is pearly gray and the landmarks are visible" when there is a full cerumen impaction then you are both unsafe (see the second reason) and dishonest; if you can't see and don't tell me than I don't know you can't see and you will never learn normal and abnormal (see the second reason). It's rare I fail a student but it is always in that student's control and that student's best interest. I have also had a student I failed come back and be one of the best NP's I know. It's not the end of your career it's the start of it. Read the 2nd part to this article at
  3. Brenda F. Johnson

    Get Your Foot Off My Self Esteem!

    She slapped my right hand just as I was about to inject the medicine. Startled, I looked back at her to see angry green eyes and thin lips pursed in disapproval. Knowing that the patient could see us, I kept my face unemotional."Aspirate," she hissed, giving me sharp hand signals that looked somewhat epileptic. After I aspirated and injected the shot we went out of the room into the hallway. In a high pitched thin voice she said, "You are an unsafe nurse, you forgot to aspirate! You are being put on probation." Stunned, I walked away frustrated, scared and angry. I was ready to give up. For the entire semester she had found one thing or another to yell at me or put me down about. It had been my first injection. My first ever. I was frightened to begin with, now I felt like a failure. I had looked up the medication my patient was to receive, wrote down all the information on the medication and the reason my patient needed it, and finally had drawn it up in the syringe with painstaking care. Then I had talked myself into getting the nerve up to give the injection, only to be traumatized to paralysis. After clinical that day, I sat in post conference trying not to cry. Short blonde hair that stood up in most places framed her petite face. Behind her silver framed glasses eyes clouded with prejudice, hate, and some other things I couldn't put my finger on. Trying not to make eye contact I pretended to read my paper. Afterwards I ran to my car, tears chasing me the entire way. I could hardly open the car door because my vision was blurred, once inside I let myself cry. I felt some relief but the nagging sense of self doubt hovered low over my head. I began to question myself, just like my instructor had. Is this the path God really wants me on? Had I gotten it wrong? Was I not smart enough? The questions rolled around my head until a migraine began creeping up my neck, cradling my head. On my way home I passed my church. Pulling into the parking lot, I parked facing the steeple that held a cross. Praying and crying out to God, I asked Him all the questions I had asked myself. When the questions finally ceased, I was still. Wiping the tears from my face I took a deep breath in and slowly let it out. I felt at peace. I knew in my heart that God had directed me onto this path. That night I told my husband about what had happened, I cried and reverted back to feeling sorry for myself. I even voiced that I was going to quit nursing school. He only said one sentence, but that is all I needed. "You are better than that, stop feeling sorry for yourself. You are not a quitter, show her how wrong she is." I was shocked at his bluntness, but it was exactly what I needed. I had run out of excuses. I gleaned strength from my faith and family support that coupled with my inner resolve to finish what I had started. I became even more determined to be the best nurse I could be, in spite of an instructor who didn't like me. A few clinicals passed and I worked hard and kept to myself. Then one day in the middle of a clinical, I was at a desk doing my careplan for my patient and the instructor came up to me. "I've noticed something different about you." "Thank you. I decided I wasn't going to let anything you said or did discourage me." Her face got that familiar cloudy look and she stomped off and out of my self esteem. As I watched her walk away I felt a thrill start at my toes and make it's way to my head. I smiled to myself and knew in my heart I had done the right thing. My experience with this instructor forced me to evaluate and question myself. Self reflection is a great tool in evaluating life choices and deciding the right path. In life we can grow from difficult experiences and I did in this one. I became stronger. Nursing school is extremely hard all by itself, excluding life challenges that come along trying to knock us out of the game. With the exception of this one instructor, I respected my nursing instructors. They often worked two jobs, and they always pushed us to learn and be better. Allow me to encourage nursing students who may be having a conflict with an instructor to prove them wrong. Be quietly strong, be fantastic and finish strong.