What was your clinical experience like?

[MarBug7]

Hi All,

I am looking to hear about experiences during your clinical hours/preceptorship during NP school. I just started my first round of clinical hours in my FNP program. I worry that I am not "doing enough" but, its only my first clinical. How much did you do in terms of patient management, physical assessment, etc? My preceptor is pretty much always with me and I think she accidentally just jumps in and takes over. She says just tell her if I want to do something, but sometimes I feel like some of these patients are just beyond my level of knowledge at this point. At the end of the quarter I have a faculty come to do my eval, so I want to be prepared.

What were your NP clinical rotations like?

[spacegal52]

I found it depending a lot on the preceptor. In my last clinical experience before graduation, I had an NP and MD preceptor that pretty much left most of the exam to me. If a patient came in for sore throat, they would look at the throat too but I went in alone first and did my own assessment, then presented to them, and they would ask "ok, so what would you do/prescribe?" The NP actually let me do all of the total health exams (yearly physicals, etc) and would just listen to heart and lungs and trust me on everything else. I also had a DO preceptor that semester who wanted to do her own assessments, so we would do physical exams as a team but she let me do the paps. She also let me do procedures under her supervision, such as an IUD removal, cryotherapy, etc, whereas some preceptors don't let you do any procedures.

For my first clinical experience, I precepted with about 5 different NPs at a clinic, but spent the majority of my time with 3 of them. The first day with each of them I basically just observed and got the feel of things. After that they were all good about having me go in first and do assessments and letting me do all of the physical exams. I worked with a midwife my first clinical experience who let me do all of the pelvics/pap smears, so I got a lot of great experience with this common procedure! I actually felt pretty confident and had a lot of procedural experience after my first clinical.

I actually got very lucky with most of my preceptors in the sense that they actually allowed me to participate. I did have one doctor I followed for a couple of half days who pretty much told me he was busy and didn't want to get behind schedule, so I would just be observing him. This doesn't really do us much good when we are trying to learn! It is stressful to get "put on the hot seat" as a student, but I learned and got so much more out of the clinical experiences where I was allowed to be an active participant in the patients' care rather than just an observer. I totally understand not wanting to "put out" your preceptor by asking to be given some opportunities; but remember, they did agree to precept you, and that is part of it.

[lhflanurseNP, APRN]

I think it depends on what your first clinical is. Mine has been history and physical assessment. My preceptor came in the room with me initially, then allowed me to go in and get started while she would finish up or get caught up with chart reviews. The last several weeks, she encouraged me to start "diagnosing" and "treating". It was really good. She really helped me stretch my critical skills out from nursing to practitioner.

[jessica.lanelle]

My clinicals have been awesome (except for the first couple of days when I was stuck with a complete quack that didn't see any patients and just had me sit there and told me weird stories all day, but that story is for another time).

My preceptor, a DO, lets me go into the pt's room by myself, collect the info, present to him, give him a few possible dx's and treatment options, and then he would talk to me about what he thought, then we would go see the pt together. It was much like what the medical students do at the university I work at, and I found it to be very effective, even if I was wrong most of the time starting out.

If we get really busy, he will see some pts really quick, and then he will catch up with me and check my patient when I am done, since I am sooooo much slower at this point. Anyway, he really focuses on making sure that I am actually getting something out of my time there, and not just standing around, or not learning anything/not having any pt interaction.

[BostonFNP, APRN]

sometimes I feel like some of these patients are just beyond my level of knowledge at this point.

Actually that's one of the most important things you can learn! Most patients, during your first clinical round, are far beyond your level. I think that's an important skill to learn: identifying what's beyond you.

I normally expect my first semester students to be able to identify normal from abnormal, both in history and physical. If they can do this effectively, and communicate effectively, I consider that a good base to work from.