What Is the Role of the Nurse Practitioner Student in Clinical Rotations?
Simply put, the objective of a nurse practitioner (NP) student is to become a competent clinician. Through clinical rotations, he/she will need to develop and implement foundational skills and knowledge for their future clinical practice. To accomplish this, the NP student should be actively and enthusiastically involved in patient care as a member of the diagnosing and treating team—not a scribe or errand-runner. However, the NP student is not an independent practitioner just yet. Therefore, they can only participate in patient care under the guidance and supervision of the authorized preceptor. The NP student should have a clear understanding of their roles and responsibilities to maximize their time during clinical rotations.
There are several key hands-on duties that NP students are responsible for during their preceptorship.
Depending on the clinical setting, a new patient's history may be collected in one visit (such as in urgent care, the emergency room, and the hospital) or over two or three visits (as done in family or internal medicine, pediatrics, and outpatient clinics). Regardless of the setting, the NP student should begin the visit by introducing themselves and asking the patient what they would like to address.
If the patient has one pressing concern, the NP student should address that acute issue without neglecting other chronic conditions and perform the physical exam that's appropriate for the problem at hand. For example, if the patient presents an aching leg, the exam should be focused on the lower extremities. An exam for the eyes may not be needed, unless there is another reason. Based on the clinical findings, the NP student should learn to formulate three to five differential diagnoses and an appropriate treatment plan.
During the first initial meeting with their preceptor, the NP student should ask about any format preferences for the presentation. Some preceptors prefer abbreviated versions, while others prefer comprehensive formats for teaching purposes. The purpose of the verbal presentation for the preceptor is to convey the problem-oriented essentials of the patient case. This requires more than just a simple reiteration of what the patient and the labs show. A good patient presentation demonstrates the patient's most concerning issues and includes the NP student's clear plan of treatment and critical analysis.
After seeing the patient, the NP student should spend at least a few minutes organizing their thoughts before presenting the case. They should also aim to keep the presentation concise (about three to five minutes for new complex cases), organized (with history in chronological order, pertinent findings, and labs), and well thought-out (three to five differential diagnoses and rationales for each, as well as recommended treatment and follow up). If the NP student is unable to formulate a diagnosis or plan, they should ask for the preceptor's help. This offers an opportunity to conduct further research online or through textbooks, which demonstrates strong enthusiasm and a "self-starter" attitude.
The note that comes from the NP student should demonstrate a comprehensive grasp on the patient's presenting case. It should follow the SOAP format (Subjective, Objective, Assessment, Plan) as learned in NP programs. Since the preceptor is ultimately the person who is legally responsible for the patient's care, the NP student should review the plan with the preceptor first before discussing with the patient. The ‘plan' includes ordering further screening or diagnostic tests, writing prescriptions, and providing patient education. It is important the NP student learns how to write the prescriptions appropriately under the preceptor's guidance. All notes, orders, and prescriptions need to be reviewed and co-signed by the preceptors.
After presenting the case to the preceptor, the NP student may directly request for any suggested improvements to the presentations or write-ups. If the NP student has a specific need for further instructions, they should ask the preceptor if they can go over a certain physical examination such as a cardiac or ankle exam. Additionally, the student should schedule a mid-term evaluation with the preceptor to gauge how they are doing and where they can improve.
Reading is a great way to expand your understanding of diseases and different patient cases. Before each visit, it's helpful for the NP student to read the patient's charts and pertinent scientific literature to formulate an approach ahead of time. By understanding the patient's primary concern, the student can determine appropriate questions to ask during the history-taking and establish a physical exam to focus on. Proper preparation before seeing the patient will save time during the interaction.
Before the physical exam, an NP student may briefly read over the patient's chart again or their own notes to ensure that the proposed approaches are correct.
In advance of each case presentation, NP students should review their findings to solidify the rationale and clarify any aspects they are unsure about.
Between patient visits, reading critical medical literature that relates to patient cases can improve overall understanding.
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