A reader recently asked if I would write a post about my first day as a nurse practitioner clinical student. Surely I had already covered this topic, I thought. But, looking back I realized had only discussed NP clinical placements in general, never in a more personalized sense. As I sit here at my kitchen table with my coffee this morning I remember why-because I am still trying to forget that first day.
Nothing like this happened during my first clinical rotation or I my have quit my NP program completely, but the first day, and I’m sorry to say, weeks and months of my clinical rotation were pretty tough.
As a family nurse practitioner student, my first clinical assignment was a family practice clinic about 30 minutes away from my home. The practice included three physicians each with an assigned medical assistant. It was the kind of place your grandparents want to go to the doctor. The physicians for the most part had been around for years. They were especially adept at treating the chronically ill bringing type II diabetics, heart disease patients and the elderly streaming through the doors. Not many children to be found. This was the kind of clinic where the patients come baring brownies and cakes and the staff actually eat them (In contrast to where I work now- bring us cookies and we suspect foul play).
My first clinical preceptor was a slightly rotund Filipino physician named Dr. Lim. He was fabulous. His gentle demeanor drew the sickest patients and most complex internal medicine cases. And he could deal with them all. Thankfully, Dr. Lim had precepted a number of nurse practitioner students before and knew not to expect much from my first day. Still, he asked me plenty of questions grilling me in a compassionate fashion. Growing tired of responding “I don’t know”, I revised my standard response to “I’ll look it up”. Eventually, each day I would arrive at the clinic, pull a fresh sheet of paper out of the printer and jot my questions down throughout the day leaving with a few hours of Googling to do over a glass of wine in the evening.
The first day of my clinical experience I arrived at the clinic early having accounted for traffic that didn’t exist. I was nervous. I mean, pee your pants nervous. Palm pilot (Remember those? I was so professional) in hand I was ready to learn how to become an NP. The clinic’s receptionist led me back to the office where the physicians worked and I figited as I anticipated Dr. Lim’s arrival. When he arrived he quickly greeted me and immediately got down to business. He already had two patients waiting. “Follow me” he instructed.
I shadowed Dr. Lim the first half of the clinical day taking in his style, watching how he interacted with patients and observing the inner workings of the clinic. After the lunch hour he decided I was ready to go solo. When the next patient arrived and was placed in the exam room, Dr. Lim instructed that I was to see them first. He asked that I get their reason for the visit, a brief history of the problem and complete the physical exam. When I exited the room I was to give a brief summary and my treatment recommendations.
I don’t remember the very first patient I saw as an NP student but I’m pretty sure I botched the interaction completely. My first days in clinical I never knew which antibiotic to prescribe or which blood pressure medication to add. I couldn’t diagnose shingles from the doorway and certainly hadn’t learned my most important skill to date- politely ending a conversation with a chatty patient. The first few weeks of my clinical experience I felt overwhelmed and awkward. There was simply too much information to learn in such a short amount of time. I wasn’t confident in my clinical skills and I knew this was evident to patients.
Like most people, I don’t enjoy being in situations that make me look stupid and the first day of my clinical placement did just that. While the clinic staff and Dr. Lim were very understanding of my shortcomings, I didn’t enjoy being a rookie. After my first day I knew I had two options. I could shrink back and treat my clinical placement as more of a job shadowing experience, or I could take the risk of messing up and embracing my inexperience in order to learn. I chose option number two.
While I never felt comfortable treating patients on my own during my first clinical placement, I slowly became more adept in my practice. I gradually mastered the skills I would eventually need to work as a nurse practitioner. I studied during my lunch hour and asked questions of my preceptor. My extra research at home, note taking throughout the day and commitment to improve paid off.
Even though I still had a long way to go, one of the other physicians in the clinic complimented me on the last day of my clinical rotation. He said I knew more and had learned more than most other NP students they precept. Beaming, I left my first clinical rotation ready to take on the next. I still had a lot to learn but it was nice to know I was getting somewhere.
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