Starting NP clinical rotations is an exciting milestone in your education. It means you’re nearing the end of your program and will soon be on your way to starting your first job. Most of us put a lot of pressure on ourselves to do well in clinical rotations. We want to learn as much as possible while impressing our preceptor and faculty. Today I want to share 5 mistakes you may be making in clinical plus how to avoid them.
Every hour in clinical rotations is gold. With a limited number of clinical hours plus a huge amount to learn, every hour and patient visit while you’re an NP student is so valuable! NP clinical rotations are very different from your nursing school rotations. You’re now in the provider role and have to make complicated decisions around patient care. In addition, the role demands a deeper understanding of anatomy, physiology, pathophysiology, and pharmacology all while considering the best evidence-based guidelines. It’s a LOT!
In order to take full advantage of your time as an NP student, make sure you don’t make these 5 mistakes.
Are you making these 5 mistakes in clinical?
- Showing up unprepared or last minute
- Not reviewing the chart before seeing your patient
- Not asking your preceptor or faculty questions
- Skipping an open discussion with your preceptor about your limits, what you want to work on, etc.
- Not looking things up after clinical
Mistake #1 Showing up unprepared or last minute
Imagine this: traffic is bad, you’re now late, you rush into the office and find your preceptor and first patient ready. Oh, and you forgot your stethoscope. This stressful start does not set you up for success.
Showing up ready to go and on time shows that you’re serious. Being prepared and timely sets you and your preceptor up for a good day. It also makes a good first impression on your preceptor and the clinic staff. If you can arrive a few minutes before you’re supposed to be there, you can get yourself logged into the computer, get your resources ready to go and make sure you have the right equipment. Once your first patient is ready to be seen, you’ll feel more confident knowing you started the day not rushed or stressed. Read more about 11 items you should always bring to clinical.
Mistake #2 Not reviewing the chart before seeing your patient
Reviewing your patient’s chart before the visit sets you up for success. It’s important to know your patient’s past medical history before seeing them. Doing a brief chart review before seeing the patient will help you ask the right questions, formulate your differential diagnosis, and come up with an appropriate plan.
Typically, before going into the room, you should review:
- Intake note for today’s visit
- Problem list
- Current medications
- Allergies
- Recent lab results
- The note from the patient’s last visit, especially if this is a follow-up or chronic disease visit. Even if today’s visit is unrelated to their past history, it’s helpful to still review the last provider’s note to get a sense of what’s going on for this patient and see if there is anything that needs to be followed up on today.
- Preventative care: are their screenings and immunizations up to date? This is often a provider preference. Many will choose not to address these if the patient is coming in for a problem-focused visit.
Unlike nursing school, most of us don’t have the opportunity to prep the night before. You may not have the chance to know who you’re going to be seeing that day ahead of time. I recommend spending a few minutes, even just 5 minutes, to review your patient’s chart. You’ll be much more comprehensive knowing your patient’s past medical history rather than walking in blindly.
Mistake #3 Not asking your preceptor or faculty questions
Your preceptor and faculty are there to help you! They are “experts” on being Nurse Practitioners and are a wonderful resource you have access to as a student. Hopefully, they even remember what it’s like to be a student. Don’t be shy to reach out if you have questions or if you’re struggling in any way.
A lot of questions that come up in clinical rotations can be easily looked up. However, there are some things you cannot look up as easily.
These kinds of questions are great to ask your preceptor or faculty:
- Clinical decision making. For example, why did they choose treatment A over treatment B? Or, what points in the history or physical exam led them to this diagnosis over another?
- How to write prescriptions correctly because the details really matter. Also, consider all the little things like how many grams are in tubes of cream, when to write for a bottle instead of milliliters.
- Most students aren’t able to actually write the prescriptions in the EHR. If this is the case for you, I highly recommend practicing writing it out on a piece of paper so you get familiar with all the little details.
Mistake #4 Skipping an open discussion with your preceptor about your limits, what you want to work on, etc.
Sometime before or during the first day with your new preceptor, I recommend sitting down for 10 minutes to have a discussion about both of your expectations for your time together. Having a discussion about expectations sets the foundation for your relationship with your new preceptor. It can also help avoid problems down the road. Sharing your needs helps your preceptor help you so you can get the most out of the time you’ll spend together.
Here are some topics to discuss and questions you may want to ask:
- Share briefly what your clinical experiences have been so far. What type of visits or age groups do you need more practice with? Are there procedures you’d like to practice?
- What areas of improvement are you focusing on? What skill or knowledge gap would you like to improve upon?
- What is your workflow when working with a student?
- Should I see the patient, take a history, do my physical exam, and then come out to discuss my diagnosis and plan with you? This is the most common way of doing things, but make sure to check because each preceptor may do things a little differently.
- Will you tell me which patients you would like me to see or can I choose who I see?
- If I have a question, should I ask as I go or wait until the end of the day?
- Can I order labs, diagnostic imaging, medications, etc, and have you sign off, or do you need to do any and all ordering?
Mistake #5 Not looking things up after clinical
There’s not enough time in your clinical day to look everything up. When you’re in clinical, your priority is seeing patients and getting as much hands-on experience as possible. This does not leave enough time to look up unfamiliar medications and diseases during the day. I recommend jotting down anything you want to look up later. Doing so will reinforce your learning from the day and help you learn new information for the next time you encounter a similar situation.
There’s so much to learn. If you leave clinical and don’t think twice about what you did and what you have questions about, you’re missing a huge opportunity. Clinical rotations highlight your knowledge gaps. Use this to your advantage and make sure to look up things you’re unsure of later.
Some things you may need to look-up:
- Medications – new medications, ones you’re not very familiar with, or rationale for choosing one drug class or medication over another
- Conditions you’re not familiar with
- Appropriate workup for a new clinical problem
- When to refer to a specialist versus continuing to manage the problem in primary care
- Lab interpretation
Summary – Are you making these 5 mistakes in clinical?
Clinical rotations are a stressful and exciting time in NP school. Every day is a new learning opportunity! Most days you’ll come home exhausted from all the mental and emotional effort of being a novice and learning a new role. Now is the time to lean into being a student and novice so take advantage of every clinical opportunity. Are you making any of these 5 mistakes in clinical? By avoiding these 5 mistakes, you’ll be able to maximize your learning in clinical rotations and set yourself up for success in your first job.
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