Tips for NP/PA 1st job?

core0 · Mar 16, 2008

OKay so all of you out there already practicing, what do you wish you had known?
What reference books do you HAVE to have?
Do you use a PDA?
Recommended programs a newbie should have?
Tips/tricks that would help a newbie?
One specific question I have, since I will have to look many things up, (although I am hoping to have a few PDA programs before I start, just not sure which one's to buy from skyscape, besides epocrotes)
What do you personally tell the patient when you need to go look something up and need to leave the room?
Do you just say, "I need to look something up?" Or just, "I'll be right back?"
Any mistakes you made as a newbie that we could benefit by?
Do you wear a lab coat?
Thanks:D

I had a treo and now a blackberry that both run Epocrates. Probably an I phone in the future. When I started out I carried a lot of stuff in my Palm but found out I really didn't use it. When I moved I threw away about 3/4 of my medical books. What I keep is 3-4 general references from my specialty. The latest currents. A derm book with pictures. Some subspecialty texts.

I found that its kind of like when I was a Paramedic. When I started out I had a belt with all sorts of gadgets on it. Probably weighed 20 lbs. After six months I had a pen light, a pen, and a stethoscope that I "acquired" from an ER somewhere. Less is usually better.

As far as looking something up, I usually either tell them that I need to look up some labs or tell them I want to run something by the physician. Realistically you won't need to look much up after a few months on the basics. Also if you can look at their history before you go in, you can look things up real quick. It makes you look like some kind of genius "so Mr. Smith, you have Blatsky-Kromsky symdrome type II. I find that interesting since its usually associated with Mongolian dwarves and is principally spread by squirrels".

I wear scrubs so a lab coat is necessary for the pockets. I have everything that goes in a certain pocket. That way I know where everything is. My current iteration has a pen and penlight in the top pocket. Card case with business cards and name stamp in the right pocket and stethoscope and dictation card in the left.

Final hints that I learned from a very smart doc. In the hospital especially but even in the office give your patients a busineess card. Get a card case and carry them with you. Especially in the hospital where there are 10 or so people a day trouping through the room you look like a start because the only one that the patient remembers is you - because you gave them a card to help them remember. Also get a stamp from staples. Mine has my name, the practice and my phone number. I stamp it everywhere that I sign my name. That way people can actually figure out who was there.

Good luck,

David Carpenter, PA-C

Trauma Columnist · Mar 16, 2008

1. I wear business casual and a long blue pin-striped lab coat with my practice's log on one side and my name, credentials on the other side. I carry my old-lady glasses and a pen in the top pocket.

2. I have a Smartphone and use it daily. Programs I have: epocratesPro, Renal Dosing, Antibiotics for Renal Patients, and two other programs for nephrology. I use my smartphone all day long. I don't have a problem telling pts I want to check a doseage/indication. I always say that I have a general idea of what I want to prescribe but want to be totally SURE. No one ever takes offense that I want to give the right med, right dose to THEM.

3. Gotta endorse David's business card advice. All of my new hospitalized pts get my business card. I have received nothing but positive comments about it. I have a really long unusual name so it makes it easier for folks to remember who was who and with what specialty. (My practice furnishes my business cards).

4. I write very neat so I don't have a stamp. However, again I think David has a great idea. I do always write traumarus, APN, Nephrology, beeper XXX-XXXX so that no one has to hunt for me to clarify an order. I am a fovorite of the ward clerks - lol!

5. I would not invest in too much till you get a job and see what is provided and what exactly you will need. I do like to check more than one drug reference though so having 2-3 of these is invaluable for me. Also, my client base is chronic hemodialysis patients as well as acutely ill patients.

DaisyRN, ACNP · Mar 18, 2008

tips for np/pa 1st job?

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okay so all of you out there already practicing, what do you wish you had known?

what reference books do you have to have?

i use my maxwell guide all the time... that is, until i lost it a couple weeks ago. i had all of my own notes in there and found it to be the most helpful resource during my clinical rotations and even on the job. i minimized the dubin "notes" pages at the back of the book and stapled them in my maxwell's back cover, then i had murmur notes, codes for the dictation system minimized, door codes/passwords, etc. not including the information that's already in it. you can check it out at http://www.maxwellbook.com/

if you count the dubin notes pages at the back of the text (which you can download at http://www.emergencyekg.com, then dubin's ekg book is a must have if you are in critical care or cardiology).

i have a book called "clinical practice guidelines for the acute care nurse practitioner" by thomas barkley. it breaks everything down by disease or problem and how to treat, based on the most current guidelines.

do you use a pda?

yes, i use a palm treo 755 from sprint. the program i use most frequently is the clinical rotation companion by pepid (http://www.pepid.com). i have used epocrates in the past and find pepid to be superior, although epocrates allows you to search by symptom(s). what i like most about pepid is that everything is integrated. you don't have to go from interface to interface... its all right there. i just found it much more user friendly.

recommended programs a newbie should have?

i didn't catch what kind of mlp you are going to be... but i think this is dependent upon the specialty you will be working with. i am working in cardiology and use my pepid program, and have downloaded many guidelines from the american college of cardiology site and have them on hand on my pda. i find a drug reference that interrelates to the disease process most helpful. sanford guide is a good one for abx, but i find it very difficult to utilize. it may just be that i haven't spent enough time with it... but overall, i can find whatever i need in pepid.

tips/tricks that would help a newbie?

what a great idea, david! i'll have to do that when my cards get here next week... and i still am a newbie. so i'm picking up on all the pointers i can.

one specific question i have, since i will have to look many things up, (although i am hoping to have a few pda programs before i start, just not sure which one's to buy from skyscape, besides epocrotes)

what do you personally tell the patient when you need to go look something up and need to leave the room?

do you just say, "i need to look something up?" or just, "i'll be right back?"

i think david's suggestion is a great one... and you will seem more in tune to that patient and their problems. that way they don't have to explain a ton of things over and over. but as for me, i carry my pda in the room and if i need to look something up that is in my program, i'll do it in the room and tell them what i'm looking up. if its not in there, then i will just tell them i'm going to double check something and be right back. most of the time, i do not hesitate to tell them i am a newbie. i just make up for the "newbieness" by being upfront, acknowledging my weaker areas, building rapport, and making seemingly intelligent decisions. i don't know about you, but i can tell when someone isn't sure of him or herself... so why try to put up that front? i just tell them how it is. most of them appreciate that. kinda like going to a restaurant and having a seemingly horrible waiter... then they come up to you and say, "i'm sorry... i'm new here and have been so busy... what can i get you guys?" i know that once i know someone's new... i'm a lot easier on them. oh... but i also make sure the patient knows i will talk with the doc to verify my recommendations and let them know if there are any discrepancies.

any mistakes you made as a newbie that we could benefit by?

hmm... not yet, but i'll keep ya posted. well... i did take a bad job for a newbie, but it's not anything that i could have learned without being in this position. i'm giving the ceo 30 days to make it right and then i'll be going to our sister office if it isn't better.

do you wear a lab coat?

i do not wear a lab coat... i wear hospital issued scrubs that the docs of the group wear and the cath lab wears. in the office, i don't really have a need for it... but in the hospital, i will probably wear mine. i'm still trying to figure out what works best for me. the pockets (and maybe easy recognition) would be the only reason i'd probably wear one. but... i don't like to get hot. *haha* so we'll see...

and good luck!

thanks

rnsrgr8t · Mar 19, 2008

Let's see...

I wear business casual and I do wear a labcoat that my division gives us. It has our hospital logo on one side and my name, credentials and division on the other.

I echo David on the business cards. One of my friends gave me a swanky card holder (It is silver and has my name on it) for Christmas last year (I used to just keep them in the lab pockets) and I get complements from families all the time. It helps establish your relationship with your patients because they will learn your name, role and how to contact you.

I use a palm treo and I love it. I use Epocrates almost every time I write a script (except for the ones I know by heart now). I also have the Sanford Guide for antimicrobials, a Red Book and a couple of other pediatric references that I love. Except for Epocrates, you may need to work for awhile to see what you actually will need in practice.

I look up things in front of patients all the time, I often tell them to bear with me b/c I am doing math (figuring out drug dose on calculator), double checking med dosing/interactions etc. I have no problem telling them if I need to step out to look up a reference or run something by a colleague. Patients appreciate your being thorough. I have been doing this for 3 years and regularly tell families that I have to double check something.... my colleagues have been doing Urology for 15-20 years, no way I have that knowledge base yet.

As far as tips...read everything you can get your hands on, go to conferences when you can, be a sponge :) (like you were when you were a new nurse). Be patient, it will be a year before you are comfortable. Triple check when you write scripts, I have caught myself a few times writing the wrong dose. Just like when you started dispensing meds as a new grad, double/triple check until you know in your head just by looking at it that it is correct. My mentor, who has been doing this for 10 + years, still will have me calculate a med dose for her to double check when it just does not look right too her.

Use this board as a resource...it is excellant and wish I had found it sooner!

Godd Luck!