The Perfect NP Student
If you are a student reading this, you are already in the top 5% my friend. How am I so omniscient you ask? Well, after serving as a preceptor for the last five years or so I’ve seen all sorts of students. We all are unique and bring different skills, backgrounds, and personalities to the learning space. This should be celebrated, the world would be awfully boring if we all were the same. Having said that, there are trends I see amongst nurse practitioner students, and some of them are not so great. I’m going to tell you what IMO I believe makes for a fabulous student in clinical rotations; one we want to hire. Arguably one of the best qualities is beginning with the end in mind. Those who prepare in advance are not amongst the majority, so congratulations for being an elite! Clinicals are your #1 source for job acquisition, so you want to show up with your A game!
This may be hard to read. Some of these recommendations are going to come across as picky or unrealistic. I know that; I also know your plight. You are pulled in a million directions with a million deadlines and tasks right now, clinicals are just one part. And that is why some students approach clinical rotations as a checkbox to complete. But I argue that with only a small shift in your priorities, focus, and engagement level you can make a huge difference in your future. We almost always hire NPs from within our realm. People we had as students or have heard great things about. Clinical rotations should be viewed as a working interview, and you would always show up strong for a potential job right? I say this stuff with love, respect, and kindness and a genuine desire to see YOU succeed. Tough love is still love my friends. Most all of the do not do this examples below are referring to exhibiting these traits in excess. Preceptors aren’t (or at least shouldn’t) be slave drivers with impossible expectations.
Communication
Expectations on both sides may be way out of alignment which leads to frustrations and stunted learning opportunities. As master’s and doctoral students you are not quite as green as you were in your undergrad clinical rotations. The assumption is that you are more responsible, motivated, and involved in your own learning experience. Therefore the interaction you will receive from your clinical adjunct faculty will be limited, at best. Most students have never meet their faculty in person and as a preceptor I only communicate with them once (maybe) during the rotation for an evaluation. So it’s just you and me friend. We are working together to create the best rotation possible for you and to make this as easy on me as possible we gotta talk. What I have learned is that the best students know themself very well and are able to verbalize to me their needs. I love when students come in ready to discuss with me where they are in their training and what their expectations for the rotation include.
Learning style. The best student I ever had told me “I ensure that I am receiving the information you share by repeating it back to you. If that ever becomes annoying please let me know.” My jaw about hit the floor. It’s the first time a student started the rotation off by letting me know her method of learning. Ultimately, I am pretty adaptable and to give you the best use of your time we should approach things in a way that make sense to you. Take some time before you start your rotation to reflect on your ideal learning style and what would best serve you at this point. Writing more notes? Seeing more patients? Focusing harder on fewer patients? Would it help you to focus on one diagnosis per day and really drill down, including allotting time for you to watch some videos on it during the shift? Great.
Feedback. No one in the history of humankind has ever relished hearing how they suck at something. Emotional maturity means you are able to receive criticism for the benefit it offers. An opportunity to learn and grow - before you get out into the real world. Yes, its hard. I trained at Emory and I adored that the providers all took an interest in my learning. So much so that they sought out many opportunities to pimp me out. To push me publicly to think through, present patients, and answer questions in front of the whole unit (at least it felt that way). It was incredibly stressful, and humiliating when I got things wrong followed by an attending lecture. But honestly, I took those experiences and ran with them. I then spent hours/days learning everything I could about whatever it was. I used the feedback to level up my game.
Put the ego aside. Following the heels of the above point, let’s discuss ego. I find students come in two forms: nervous and hesitant or overly defensive/egotistical. I know its hard being in a place of knowledge deficit and high expectations. You may have been top dawg nurse on the unit, but you’re essentially starting over here. Get comfortable with the discomfort. You’re going to be in this head space far beyond your preceptorship and going into your first year or more as a new NP. If you can’t approach new learning opportunies for the boon they are, it’s going to be a long painful course for you.
Professionalism
Be on time. Goes without saying, but you can infer what happens in reality by the fact that it is, in fact, not going without saying. You know what I’m saying? I’m not talking the occasional running late student. I’m talking the rarely on time student. Now, depending on the specialty and location there may not be as tight a window. But in most inpatient settings, especially the ones where you have to take report from a previous shift, it is crucial that you are present to hear the relevant events of the night. If you are the person consistently late, it is noticed. And while it’s not detrimental as a student, it sets the message for what you will be like as a team member. Who wants to hire the colleague that’s never on time?
Try to avoid excessive schedule switches or call outs. Obviously, I’m there regardless so it’s not crucial, but there are some behind the curtain factors you may not be aware of in regards to constantly changing your schedule. Your preceptor likely has more than one student. Many of us do, and we intentionally schedule you separately so you do not have to share your experience. Secondly, many NPs cover big territories, like bouncing between clinics, hospitals etc. If I am curating my assignment like electing to go to certain locations on days you are with me, it could create more hardship for me if you cancel.
Don’t “preceptor shop.” Specifically I am referring to the period of time after we have come to an agreement. If we are working together and your dates don’t align with mine, please let me know. We can work together to find a back up preceptor or shift things around for you. But if you are asking everyone you know on my team if they will take you for a shift or two that is outside your scope as a student. As the person who knows you and your learning trajectory, please allow me to be the person to find the right fit for you. There may be factors you aren’t aware of in regards to why a certain person shouldn’t precept.
Scope. Always bear in mind the role that you are acting in for this shift. You are not the bedside nurse, you are not the staff member, you are not the acting NP. You are a NP trainee. That means your job is to approach the patient as if you were the NP - focusing on making diagnoses and assessment/treatment plans. Don’t go beyond that scope and give verbal orders to staff that we haven’t previously agreed upon. Don’t approach consultants and ask for things if we haven’t previously discussed this approach. I find nurses who are completing clinicals at their place of employment are the ones who struggle with this the most. They are used to being industrious and have connections. The other side to this is the failure to rise up to scope. This is the student who is super nervous or overwhelmed. They can be found stalling by performing nurse tasks. The default when you are unsure of yourself is to do what you are sure of. The problem with this is you are allowing your fear to take control. Instead, let your preceptor know what your fears are. They should be able to identify if the fear is normal and need to be pushed past or if the task assigned to you is truly outside your capabilities.
Engagement
Illustrate passion. Even if critical care isn’t your jam and your life’s dream is to be a trauma provider, you still want to parlay interest in critical care. No teacher enjoys teaching someone who could care less, is checked out emotionally, minimally interactive, turns down learning opportunities, asks to shadow only, or puts in minimal effort. That teacher, when asked to provide a reference for you or asked how you were as a student and whether or not the trauma team should hire you is not going to speak favorably. That preceptor is assuming a lot of work and hassle to train you. For you it’s just jumping through a hoop to graduation, but be respectful of their engagement and give back that same level if not more. If you are coming across shy, not talking much, or balking at tasks because you are nervous - please, please communicate this with your preceptor. If we don’t know this factor we may assume it is lack of interest on your part.
Focus on clinicals. I know you have so much to do in so many aspects of your life. But while you are in clinicals focus on clinicals. The best students I have ever had spend down time during the shift (and sometimes after the shift) extending their learning of the topics we are facing that day. They can be found reading up to date guidelines, watching videos, reading others’ notes on subjects they are struggling to get down. They are the ones who when asked to learn about a subject and come back the next day to teach/talk about it have actually done so. It indirectly show me you have a high level of expectation for yourself - you don’t just anticipate being spoon fed information and want to learn outside of our teaching moments. It shows me you are actually interested in our patient population and may have a desire to enter this particular field. I was offered a job once because while I had zero experience in oncology, I showed up to clinicals with notes on research I had done in advance of my rotation. While I knew almost nothing about the recommendations for colon cancer I knew that FOLFOX was a common regimen and a tiny bit about each drug. I was told no student had ever done that level of preparation before. It took me maybe an hour the day before I started. It’s not herculean efforts or time preceptors are expecting form you.
Above and beyond. The student who offers to do hard things, who asks to be assigned harder patients, who adapts their schedule to prioritize clinicals, who offers to present to the difficult attending. Those are all examples of bravery, extending beyond comfort knowing growth starts from a place of deep discomfort. Those are rare and unique qualities, and this is the student I have in mind when looking for a future co-worker.
Never, never ask to just shadow. You do not learn effectively while watching someone else work. You need to get in there and do it.
The Best NP Student I Ever Had
She brought a wealth of experience as an ICU nurse with her, which while it isn’t critical to making a great NP, certainly helps. She also clearly communicated her best learning style, her level of experience as an NP student, her goals, and her passions. She never balked when things got busy, she rose above her fears and got in there. She was comfortable being uncomfortable and didn’t fight so hard against it. She showed up reliably on time every time and clearly put her clinical rotation experience high on her list of priorities. She was always reading, learning about what we were talking about, and exhibited a passion for the work we were doing. She held herself to a high expectation of performing well. It was never just checking off a box of required hours for her. She, in part because of her excellent reputation both as a nurse and an NP student got a job offer over several experienced NPs in the field of her dreams. It is absolutely possible friends!
Be sure to join us this Thursday 3/30/23 at 3pm EST/2pm CST/1pm MST/12pm PST for a Youtube Livestream where we talk about this as well as other topics for providers.
Click the image above to watch this video where I chat with my friend Mitzi who has been teaching new NP’s since the dawn of time.