Before starting clinical rotations as a Nurse Practitioner (NP) student, I always wondered what a typical day looked like so I wanted to share that with you today. I also wondered what the interaction and workflow would be like when working with a preceptor. Towards the end of the post, I’ll write out how the workflow generally looks working with a preceptor.
Stick around as we run through what a typical day of clinical rotations looks like for a NP student.
Location: a town of over 50,000 located about 1 hour driving from Seattle, WA
Type of Practice: Urgent Care in a Community Health Center
Preceptor: A Physician’s Assistant
Other details: 2 days per week following my preceptor’s schedule (9am-8pm)
A Day in the Life: Urgent Care Clinical Rotation
Morning Session
Getting ready
9:00-9:30am – Arrive at the clinic and get settled for the day. The urgent care opens its doors right at 9am. This gives me some time to get ready while all of the patients get checked in and roomed. I make sure to say hi to the front desk staff and all of the back office staff. Once at my station, I pull out my laptop and all of the other resources I might use during the day. I get my notepad, a pen, my stethoscope and lab coat out and ready to go (see this post for what to bring to clinical).
As soon as the first patient gets scheduled, I open his chart and review the reason for today’s visit, his past medical history, and medication list. Being in an urgent care with walk-in patients only, I cannot do chart reviews ahead of time. While this has its challenges, it forces me to be efficient and really look for exactly what I need in order to provide appropriate care that day.
See patients
9:30am-2:00pm – For the next several hours, I see patients. This is my final clinical rotation of Nurse Practitioner school. I typically see 2 patients per hour at this site. My preceptor allows me to see whichever patients I like. I try to choose patients that come in with complaints I need more practice with (right now this tends to be any neuro complaint, headaches and abdominal pain). I also make an effort to see any pediatric patients as I can always benefit from more exposure to this age group. Depending on the flow of the day, I usually see several patients in a row completing minimal charting right after the visit and then chart during little breaks that pop up throughout the day.
This morning session really flies by and is always very busy. Everyone seems to come in first thing in the morning!
This session I see a lot of coughs and rashes. Exciting stuff!
Break time
2:00-3:00pm – Lunchtime! My favorite time of day. I’m very ready for a break. My brain is working hard. The clinic closed during lunch hour. With my preceptor’s encouragement, I really try to take the full hour to rest my brain and take a break. I find this really helps me learn better. In some clinics, it isn’t the norm to take a lunch break so I try to take advantage when I can. After I eat my lunch, I go for a walk and buy a coffee.
Afternoon Session
Seeing patients part 2
3:00-7:00pm – More patients. Again, everyone seems to show up today right when the clinic re-opens right after lunch. After spending some time in this urgent care, there seem to be themes in the most common visits. I see a lot of colds and influenza cases, rashes, ear pain, UTIs, and shoulder, knee and ankle complaints. Despite these more simple complaints, a lot of the patients I see have been out of care for a while or take several medications which adds complexity to the visit.
This evening session I saw an interesting case, one that challenged me which is always a fun surprise. A woman in her late 40s came in with symptoms of a UTI and uterine cramping. Long story short – when I did her abdominal exam, I felt a large lumpy mass in her pelvic area. She had never noticed this mass before. My preceptor and I suspected multiple fibroids, but we needed further work-up (aka investigation) to determine the diagnosis and plan. We proceeded with treating her UTI and cramping. We also had to address and figure out a plan for the irregular mass we felt in her pelvis. This was a great learning experience. It’s not too often you find abnormal findings on an abdominal exam!
Finishing up the day
7:00-8:00pm – Time to close out all of the charts. My preceptor usually has me stop seeing patients in the last hour so I can finish all of my charting and ask any lingering questions. After I finish all of my charts, my preceptor reviews them with me and provides feedback. We talk about what I can document differently to be more clear or comprehensive.
Well, it was another busy day full of learning. I’m officially tired so I sign out and start my drive home.
What does it look like working with a preceptor as a student?
These are the general steps that I follow working with most preceptors:
- Monitor the schedule and identify the next patient I want to see based on age and the reason for visit. Confirm with my preceptor that I can see this patient.
- Review the chart while the patient gets checked in at the front desk and then roomed by the Medical Assistant (MA).
- Confirm that the MA has roomed the patient and review the MA’s intake note. I focus on the reason for visit, any changes to past medical history or the medication list, and vital signs).
- See the patient on my own completing a history and physical exam.
- Step out of the room and organize my thoughts. I then determine a preliminary diagnosis, a list of differential diagnoses, and my treatment plan.
- Do a brief case presentation to my preceptor. Basically present important points from the history, any important findings from my physical exam, my presumptive diagnosis, other diagnoses I considered, and my proposed treatment plan.
- Discuss the case and plan with my preceptor based on whether he agrees with the diagnosis and plan I proposed.
- Finish the visit – my preceptor returns to room, sometimes with me and other times without me, to confirm important findings, review the plan, and answer questions.
Summary – A day in the life of a NP student in clinical rotations
Starting clinical rotations is a scary and exciting part of NP school. Each day is going to look a little bit different, but once you start, you’ll find a flow and begin to develop your own style. Every clinical site and working with different preceptors will bring unique challenges and learning opportunities. Being prepared and flexible will help you get the most out of your clinical experiences. If you’d like, see this post for more information about what I wish I knew in NP school.
I’d love to hear from you – comment below to let me know what some of your challenges are in your NP student clinical rotations. What do you struggle with? What has been your favorite rotation so far? If you haven’t started yet, what makes you nervous about clinical rotations?
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