Typical clinical days as a NP student

allnurses Guide · Jan 21, 2020

8 hours ago, allaboutfun said:
I am wondering if anyone can share a typical clinical day with a preceptor. I am going to start clinicals with a doctor in adult health and I want to be prepared.
I am going to carry textbooks for assessment and labs, I have apps downloaded on my phone such as uptodate.
I will need to gather 3-4 cases to do my assignment. Do you write down all the information you need before leaving the office? or can I ask for copies? Of course, I will delete all confidential info. I think this can depend on the preceptor, but if it is too much to ask for copies, I do not want to ask in the first place.
Any tips are appreciated!

Here what a student's first day with me might look like (adult internal medicine practice):

1. Meet and greet if we haven't already met and discussed the semester. I'll outline what I expect from the student and try to nail down what the student expects of me. I like to hear what they feel like their strengths and weaknesses are (keeping in my if this is their first clinical rotation they are expected to be completely green). I go over my "rules". And I give them a tour of the clinic.

2. First half of the day I just have the student be my shadow: come into each visit with me, listen to the history, follow along on the physical, and have a dialogue with me about the assessment and plan. In the beginning students won't know the "right" answers but I want them to get used to applying what they know to new experiences and also get comfortable not always knowing the answer. During this time I am assessing the student and figuring out what their strengths and weaknesses are and if they need more shadow time.

3. Second half of the day I will either have the student continue to shadow or I will let them start to conduct some of the history while I am in the room with them and can help guide them. We'll still do the exam together. I'll start having the students give me a 2-4 line report before we discussed the A&P. During this time, depending on the student, when we are discussing the A&P if the student doesn't know the answer I will start having them look it up and then come back and tell me (using POC tools or texts).

Every preceptor is different, but I am willing to bet that most will follow a similar pattern.

SopranoKris, MSN, RN, NP · Jan 21, 2020

Due to HIPAA, most practices are not going to let you print out a chart for your assignment. You're going to have to write down everything as you go. Depending on the practice, you could be seeing patients every 15 to 20 minutes for episodic visits and 30 min to an hour for comprehensive. I found it useful to make a grid of all the info I was required to gather for charting my SOAP notes for my clinical course. I'd write them down on the grid and input them into my school's system at home. My OB/Gyn clinicals weren't such a frantic pace as family med and I actually had time between patients to enter everything on my laptop. It really depends on the practice and the pace of your preceptor's patient load.

I found I used UpToDate the most during clinicals. I downloaded the app on my phone and had access via my school (it's expensive on its own). Bring a good diagnostics book and a clinical procedures book so you can quickly look up what to do.

I would also suggest making a "cheat sheet" of commonly treated illnesses with common drug dosages: DM2, HTN, asthma, depression, anxiety, sinus infection, URI, UTI, etc. Make sure to have treatments for both adults & children. Very useful when you're under a time crunch.

Your preceptor will start giving you more autonomy as you demonstrate knowledge & skill with assessment & diagnosis. I started off shadowing, then doing assessments with preceptor in the room, then finally doing the entire visit on my own and presenting to the preceptor when I was done. She would ask the patient follow-up questions if she had doubts about my diagnosis. It was a GREAT way to learn.

I was very surprised at how often you have to treat depression & anxiety in a family practice setting. I wasn't as well-versed in the meds for treatment before I started clinicals. I learned a LOT last semester. The toughest was learning to dose peds patients. Totally not in my wheelhouse as I am used to working critical care with adults. That was the biggest learning curve.

I definitely ended clinicals with a new found respect for family practice medicine. You really have to be a "jack of all trades" expert in such diverse diseases, and have to switch quickly from one disease to the next. Definitely different than a specialty, where you see pretty much the same thing over & over (like OB/Gyn).

allaboutfun · Jan 22, 2020

Thank you for sharing Boston FNP! I am already worried about not having the right answer. Your comment is encouraging and I feel better now knowing how the flow will be!

allaboutfun · Jan 22, 2020

Thank you SopranoKris for sharing. I think it is a great idea to make a grid for all my information. I will work on it and also cheat sheets for common meds!

LadyT618, MSN, APRN, NP · Jan 22, 2020

Congratulations on starting clinicals!! Try to savor every moment and take in as much as you can. I loved every minute of mine.

I bought a few of these books to keep track of my patient information for Typhon: https://www.amazon.com/gp/product/B078QD1LFR/ref=ppx_yo_dt_b_asin_title_o06_s00?ie=UTF8&psc=1

But cheap steno notebooks will do the job as well.

And don't forget to keep copies of all your notes in Typhon (or similar software of choice by your university) as the end of the semester to keep for reference/posterity.

Go out there and shine! ?

allaboutfun · Jan 22, 2020

Thank you LadyT618, I love the book and bought one! I didn’t know there is such a book like that?

LadyT618, MSN, APRN, NP · Jan 22, 2020

10 minutes ago, allaboutfun said:
Thank you LadyT618, I love the book and bought one! I didn’t know there is such a book like that?

I saw it while shopping for textbooks and bought a few of them because they fill up fast. And they fit so nicely in your labcoat pocket ?. Good Luck!!

verene, MSN · Jan 22, 2020

From a PMHNP student perspective clinicals started with meet&greet with preceptor and discussing expectations/goals (assuming this wasn't done before clinicals started). Usually the first day or two was primarily shadowing, then being allowed to document interviews done by preceptor, then interjecting commentary during preceptor assessment and being responsible for documentation, then interviewing with preceptor in room and finally interviewing independent of preceptor and providing a brief assessment summary and treatment recommendations to preceptor and having them sign off on treatment decisions & orders. Each preceptor I worked with had a slightly different time frame for this based on their & my comfort level with the patient population and setting. My adult outpatient clinical had a SLOW ramp up ( I think 3 or 4 weeks before I could complete full interview and treatment plan with preceptor in room), my adult inpatient clinical had me seeing people independently by day 4 and carrying a full daily-panel with in just a few weeks.

In one of my rotations I used a cheat-sheet to make notes to then document later for school. For the others I would log data into our school's online tracker at the same time as I logged into organization EHR that way everything was done quickly and I wouldn't forget information (e.g. was that 99214 or a 99215 CPT code? What non-psychotropic medications was that patient taking? etc).

In terms of references/resources I found asking what the organization offered to providers to be really useful - it got me using a variety of different resources (both those I'd been exposed to in school and those I hadn't) and was also "real world" to what might be offered by a future employer in terms of resources. I did bring a couple of references with me to clinicals (DSM5, Stahl's Drug Guide, and MGH's psychiatric resident pocket book were the most useful) but generally limited extra stuff I brought with me.