Ep #89: Tips for Navigating Clinicals with Anna

Welcome to Becoming a Stress-Free Nurse Practitioner, a show for new NPs and students that want to pass their board exam the first time and make that transition from RN to NP as seamless as possible. I’m your host Sarah Michelle. Now, let’s dive into today’s episode.

Sarah: Hey, everyone, it’s Sarah Michelle here. And today with me, I have Anna again. And the last time that we were on this podcast together, which was a couple of episodes ago now, we were talking about things that we wish we had known before we graduated nurse practitioner school, before we started looking for those first jobs.

And so this time, we’re going to take a little bit of a jump back in time and we’re going to be talking about some things that we wish we had known before starting our clinicals. Because that is a huge pivotal point in your inflection as a student and you becoming a true real deal nurse practitioner.

And so there are so many things that we wish we had had the heads up on. But I didn’t have any nurse practitioners in my family. I didn’t go to school or I didn’t work with a lot of people who were becoming nurse practitioners alongside me, and so I didn’t have the magic in. What about you, Anna? Did you have anyone to give you insider tips?

Anna: I did not. So I do have one sister-in-law who is a nurse practitioner. But other than that, I didn’t really know a whole lot of nurse practitioners except for some of the ones that rounded at the hospital. And even though networking with them was a key moment in some of my clinical sites, it wasn’t something that I did before I started clinicals.

Like I wasn’t really asking these questions. I didn’t even know what to ask, really, to these people that I had or these resources that I had. And I wish I had known what to ask, what timeline I should be looking at with these types of things. Because that would have saved me a lot of headache in the end.

Sarah: A lot of grief, yeah. I had no clue what to ask either. Looking back on that time I was just like, I’m going to go into clinicals and see what happens. It was very much a go with the flow moment for me, which is not my personality. But to your point, I didn’t even know what to ask.

And so I think the very first thing that I wish I had known before I’d ever applied for school and gotten into nurse practitioner school is that most of the time your school is not responsible for finding you a preceptor. And so it is excruciatingly important that right from the jump, like as soon as you decide that you want to go to nurse practitioner school, if you go to one of these schools that does not find you a preceptor, that you go ahead and already start that hunt.

Because what I found was that literally all of these preceptors and clinical sites were booked up for years in advance. So I would call a clinical site, I would be so excited, I would be like, “Hey, I’m Sarah,” you know, pitching myself. And they’re like, well, are you going to be here in three years or four? Because we’re already booked up to that point.

And so that was something that was really difficult for me to overcome in the beginning because, like we were just talking about, I didn’t know a whole lot of nurse practitioners in the first place. And the few I did were all psych nurse practitioners and so I didn’t really have that in. And finding clinical sites was very, very painful for me. I finally did it, but it was always like almost right to the minute.

Anna: Yeah, it was excruciating, as you said. That’s the perfect word to detail it. And I didn’t know, like I knew my school didn’t find preceptors and that we were responsible for that. But I was like, oh, no big deal, that’s going to be easy. And I was in a completely different state than you were in and I had the exact same struggle. Places were booked out two to three years in advance.

And my program was two years. I mean, I did it full time, I did school through the summer, but still I didn’t have three years notice. And I didn’t even start looking when I first started school because I didn’t know to. And so I’m starting to look six months, nine months before my clinical rotations, and good luck because it was painful. I did find them, but it was very, very difficult.

And then you have the times where sometimes that timeline is inevitable. I had a preceptor, there were three nurse practitioners in the office and a physician. And all four of them were completely fine with me coming and doing clinicals there. They were all willing to work with me a little bit. And when it came time to finally fill out the paperwork, the office manager said no. And this was like a couple of months.

Sarah: What in the world? That’s so weird.

Anna: So weird. They were like, “No, we can’t handle students right now.” I’m like, all of you providers in the office said that they can, but okay. So this is like two months before it’s about to start and I have nobody. And so find your clinical sites as soon as possible. Get that paperwork in as soon as possible. And network, network, network because you never know when you’re going to need to use those networks, especially last minute.

Sarah: Yeah, and I know it’s hard to do, but I feel like there’s a lot of value in going in-person, especially we’re kind of out of the pandemic now. I don’t know if we’ll ever fully be out, but we’re mostly out of the pandemic at this point. And I think because I was doing so much cold calling because I’d never had an experience like this before, that really hurt me because that first clinical site was definitely by far the hardest to find.

I was like begging people on the phone. I called over 100 different places. And if I could go back in time, I would have just started showing up. Because I felt like if I had shown up and I had even been able to hand them a resume or put a name to a face, it would have been a lot less chaotic.

And I kind of was at a disadvantage too, I did an expedited nurse practitioner program because I already had a master’s in nursing education. So any of you that do that, your timeline of getting into clinicals is going to happen so much faster because you’re essentially skipping a bunch of classes you’ve already done. And so when I first saw it I was like, oh, okay, I’ve got like six months upon a clinical site. I thought that would be plenty of time. And it definitely was not plenty of time, it was always down to the wire for me.

The school that I went to, basically they were like if you don’t find a clinical site, you’ll just sit out a semester. And so there was one time I was very, very dangerously close to sitting out a semester because I found a preceptor, I was very excited about this preceptor. I was very excited about the site, it was going to be super cool.

And then the week before I was supposed to start with her, she was an acute care nurse practitioner and a family nurse practitioner and she let her license lapse for her family nurse practitioner.

Anna: Oh no.

Sarah: So I couldn’t be with her. And it was so painful trying to find somebody in seven days. So that’s where networking can really come into play, because if it had not been for my mother and the connections that she had as a school teacher, I would have never found a clinical site in time.

Anna: Yeah, I had an opposite experience. At my first clinical site, and this probably harmed me for my next couple semesters. My very first clinical site was the easiest one to find.

Sarah: Lucky duck.

Anna: It was at a community health center. Yeah, I was so lucky. It was a community health center. I literally filled out a form online. I didn’t call. I didn’t go in person. I filled out a form online and a couple of months later they emailed me and were like, “Hey, we found you a preceptor.” I’m like what? Y’all, that is unheard of, do not expect that.

So I got in, that was my very first clinical site. It was a disaster of a clinical site, but it was a clinical site. I got my hours in. But after that, I literally had the hardest time finding one. The only one I could find was women’s health because I was working as a women’s health nurse at the time. And so I had an in in these offices, I could network with these nurse practitioners. These nurse practitioners would come round at the hospital I was working at and I could track them down to sign my paperwork.

But my peds clinical, it took me months and months of people backing out, and people saying no, people just not responding. I lived in Colorado at the time, I had to travel back to Kentucky to complete this clinical site because there was no one.

I mean, I even tried to use one of those preceptor finding services where you pay because I was desperate. Like I was not delaying my graduation. They couldn’t find anybody in the state of Colorado at the time. So I literally traveled to where I used to live in Kentucky to do my clinical sites.

Sarah: Yeah, I was about to ask you. I’m like, did you use any of those services? I didn’t, but I keep seeing those pop up more and more, especially post pandemic life because clinical sites were so hard to find during the pandemic.

So if anyone out there listening has a great resource of one of those find you a preceptor websites, definitely let us know because we’re not necessarily in the know on that. But we would love to be able to share that with other students too.

Anna: Yeah, and I hate that sometimes it comes down to that, having to pay, because we’re already paying for school and all this stuff is not cheap. But I was desperate at that moment of just trying not to delay my graduation, not having another semester. It was starting to become my only option. And so they’re out there. And so yeah, we’d love to hear of any good resources.

Sarah: Absolutely. I think the next big thing for me was just like what in the world to even bring. Like I said earlier, I was going with the flow. I just kind of, like the first one I showed up with my stethoscope and a notepad. I was like, oh, what do you all bring when you come into work? But I think those are definitely the two biggies.

I think a lot of people like to bring electronics into the office, and I did have my little mini laptop that I brought too. But I never took it in patient’s rooms. I don’t know, I think being an oncology nurse, that just felt gross to me. And I’m like, I want to be able to be in the moment with the patient too, that’s always super important to me.

And so I would scribble a couple of notes down on my notepad, but then like really write down things outside the room. What about you, Anna? Did you kind of bring the same things?

Anna: Yeah, so I brought my stethoscope. I always had a notepad and a pen and I would write things down while I’m doing my history and all of that. And then I’d finished my notes when I exited the room. But I did try to write stuff down as I was talking to them just so I wouldn’t forget it.

I always brought my iPad, not into the room, but I always kept it in the office or where we would chart because I had all my resources there. So like Up To Date, Epocrates, anything that I wanted to look up. And then I also liked to bring my little pocket guide physical assessment book. And so that I used a lot, especially just starting out.

Let’s say someone had a musculoskeletal concern. Well, okay, I’d break out my book, kind of look through that section and be like, okay, that’s how I remember to do this test, or just refresh on some of the pictures. So I found that really helpful for me.

When I was later in clinicals, my preceptor, if they had a computer they charted on, this was like my last semester when I was actually getting into the, okay, I can chart while I’m talking with the patient and getting this. I would bring their computer with the charting in and try to do a few of the things while talking to the patient. But I was definitely not well versed at that, so I tried to be present with the patient too, because when I started focusing on the charting, I just could not coordinate the two.

Sarah: You’d get lost. Yeah, it’s so funny, thinking back on my clinical experiences now being in Kentucky, because there was one clinical experience where they didn’t always have functioning internet, number one. So I did a lot of things like scribbling down notes. But number two, one of the doctors in the practice would verbally transcribe his notes on an old school recorder. And then one of the administrative assistants or the CNAs would take the nose off of that recorder and put them into an electronic chart.

I mean, it’s just mind blowing for me to think about like we’re in 2023 right now, and in the last five years I’ve done a clinical where somebody was using a tape recorder. You’ve kind of just got to lean into what’s going on in the scenario too.

Anna: Yeah, you’ve got to lean into what resources you have available, what type of clinic you’re at. And it’s really valuable, I think, to get a wide variety of clinical sites if you can. So I did a couple of community health centers and private practices. Apparently I did clinicals in two different states, which I do not expect you all to do.

But I got such a wide range of patients and experiences and charting systems and resources. And getting all of that experience was so, so helpful, especially to see what you really like before you start that job hunt. And so I recommend getting as wide of an experience as you can when you’re doing these clinical sites.

Sarah: And be open minded too. I know everybody thinks if you’re doing nurse practitioner clinicals, they have to be with a nurse practitioner. A lot of schools will have a little bit of flexibility, like you can do one semester or so many hours with a physician or a physician’s associate. And so I ended up doing one clinical semester with a PA, and I found that to be really eye opening and it was a really great experience for me.

And I was a little bit anxious about it because she’s not a nurse practitioner, like how comparable will it be? And I think having that experience allows me to work out in the real world with a different view set of the people that I’m working with.

Anna: Yeah, absolutely. And look into if your school will allow you to do hours in a specialty area too. I could do up to so many hours in a specialty, even though I was going for my family nurse practitioner. So I did a whole rotation in an asthma and allergy clinic, and it was one of my best experiences.

It was amazing. I learned so much. And so much of that I can apply to primary care because you see patients in primary care with asthma and allergies and these ENT concerns all the time. So that was a really awesome experience.

Sarah: And if you can ever do a home health rotation, that was one, by far, that I was so nervous about because we literally just went into people’s homes. And I can only think of like one time that it felt really kind of sketchy and off. And there was one particular time that there may or may not have been roaches.

But for the most part, it was super cool to be like, “Hey, are you taking your blood pressure medicines?” And they’d be like, “Yeah, of course.” And then you can literally open up their cabinet with them and see like a full pill bottle and know they’re not taking their medications. And just being able to give people access to care that they wouldn’t otherwise have, because predominantly what’s going to happen when you do home health is a lot of elderly people.

So was I nervous about that experience? Yes. But was it the best one I did? By far because there’s definitely a lot of critical thinking and thinking on your feet that goes into being in someone’s home.

And so just kind of be open, not only to working with different providers, but doing something totally off the cuff. Because I remember some of my classmates were like, “You’re going to go into people’s homes?” And I was like, “Yeah, I’m just going to see what it’s like.” And it was really fun.

Anna: Yeah, and what better way to see what it’s like, than when you have a preceptor with you? Especially a preceptor that you can trust and that you can really learn from. What I found from, again, a wide variety of experiences, is that preceptors really do make or break your experience in your clinical rotations.

Sarah: Sadly. So sadly.

Anna: Yeah, my very first preceptor, so when I said it was a little bit of a mess, she didn’t even know my name, you all. Like we were halfway through the rotation, and granted I was a little shy, introverted, in my very first clinical site and she had multiple students, which is already kind of a red flag. So it’d be me and another student there on the same day. But we are halfway through rotation and she called me by some other random student’s name. And I was like, oh my gosh.

Sarah: That’s not me, thanks.

Anna: Okay. Like, do I correct her? Do I not correct her? What do I do? And, y’all, I thought she hated me. She was like getting on retirement. She was a very, very strict preceptor. But then on the very, very last day of my very first clinical experience, she goes, “You did a great job, Anna. It was so nice having you as a student.” I was like, “What?”

Sarah: Like, are you sure?

Anna: Are you sure you’re talking about me, Anna?

Sarah: That’s wild.

Anna: Yeah, but she had a lot of students on different days.

Sarah: Yeah, my very first preceptor was the same way. She must have had five students rotating in and out when I was doing my clinicals. And she was also super strict. But it was strange because she was super strict, but she wanted to push you very hard to be independent. And I think where me and her got into trouble the most was the majority of the students that were with her that semester were final semester students and I was a first semester student.

And so kind of like your preceptor was forgetting your name, my preceptor was forgetting where I was skill wise and just clinical knowledge wise. You know, I’m still learning. I’m just trying to pick things up as I go. And so she was super intimidating for me and that was really hard because I didn’t feel like I could ask all the questions or do all the things that I wanted to do in that site because I just felt like we were on totally different pages all the time.

But luckily, past that point I had a lot of really great preceptors. Like the one I had for my home health rotation, that was my very last rotation, and she very much let me do it all. Like if I wanted to chart. If I wanted to put the prescriptions in. If I wanted to do that stuff, of course, with her oversight, she gave me the ability to do so. And what a confidence boost that was right before graduation because I was like, okay, she has faith in me that I can do this. I’m starting to have faith in myself that I can do this.

But it also is interesting too, now that I look back, when I was with the PA, it was right in the middle of all of my clinical rotations. And she hadn’t had a student in a long time. So that’s something to take into consideration when you’re looking at different preceptors if you have a couple options. I know we don’t always have options, as we were just talking about. But it was really hard for me, or it was really hard for her to give me independence because she hadn’t had a student in a long time.

And so I went from a preceptor where I had full independence to her, where I had no independence. Like she wasn’t even going to let me even go in the rooms by myself, to then go into a home health rotation where I had full independence again. And so that was just a lot of chaos for my own brain to try to filter through.

Anna: Yeah, that is really difficult. And it’s so wild to think about too, like how you feel walking into your very first day of your first clinical, really the whole semester of your first semester of clinicals, versus your last.

Sarah: Yeah.

Anna: Because it is a very big difference. So if you are walking in on your first day or you are finishing, you’re on your last day of your first clinical rotation, and you still semi have a deer in the headlights look, I promise you it gets better. And you just need a really supportive preceptor who is going to push you in the right ways.

And my very last preceptor, I would say, is the one who pushed me the most. And she multiple times would say, “Anna, you are about to graduate. You are about to do this by yourself. Act as if you are going in there and this is your patient.” So she would, she would have me go in, she would have me do everything from start to finish, go back out. And then tell her like, this is what I saw. This is what I think. This is what I would do.

And then she would go in, verify, do her own findings because she is signing off on this. And then we’d kind of talk through it together. And that was so, so helpful for me. And it just gave me that last semester push that I needed. And I will say that’s also when I was starting to study for boards and so it was all coming together in that last semester.

Sarah: Yeah.

Anna: In my first two semesters before that, I did not feel that way. And I look back now and I definitely was improving. I definitely was learning things. I wasn’t giving myself enough credit at the time. And I want to remind everybody too, you’re not expected to know it all. Your preceptors, no matter how intimidating they are, they don’t expect you to know it all.

My preceptors wanted me to be looking stuff up. They did not want me just trying to remember and guess at what prescription I would order. They’d be like, well, how do you know that? Can you confirm that? And then they would take me on Up To Date and be like, yep, you’re right because here’s where it says it. They wanted me to confirm with the most up to date guidelines, like they expected me to use my resources. And that was really reassuring.

Sarah: Yeah, every preceptor I had used their resources. I mean, there were some that even had old board review books from when they had done their own board reviews and they were flipping through things, looking things up. The majority of them used Medscape, Up To Date, like that was very common practice everywhere I went.

Anna: Yeah. And that was so, so helpful for me. So take a deep breath if that is you walking into your first clinical. They do not expect you to know at all. I mean, yes, you have to have your baseline knowledge level, you have to be able to go in and do your physical assessment. But you are learning, you are a student, and that’s okay.

Sarah: Yeah, you have to remember you’re a student. And leaning into remembering that you’re a student and you don’t want to overdo it, I think the biggest thing I wish I had known in advance, or wish I had done differently maybe might be a better way to phrase it, is to not jam pack all of my clinicals back to back to back to back to back to get them done as soon as possible.

There were reasons I did that, I had a lot going on in my personal life. I was getting married, we were moving, all this stuff, working different jobs. But God bless, it was so difficult to be ripping and running seven days a week. And I feel like I would have been a better student and I would have probably had better experiences had I not jam packed literally every single clinical rotation I did.

Anna: Yeah, I 100% agree. I mean, my school did have a max of how many I could do each semester. But within that max, especially in my last semester, I kind of crammed it all in out of necessity. But I wish I hadn’t had to. I wish I could have spaced it out. But I mean, I was doing the max I could. I was doing 40 hours a week because I was pregnant, I was about to move. I had to get this done before I was having a baby, before I was moving across the country and losing my clinical site back in Colorado.

And so I literally worked and did clinicals 40 hours a week. I mean, Monday through Friday if my preceptor was at the clinic, I was at the clinic. And so I really got a real life experience of what it was like. And thank goodness that was my last semester because I felt at least a little more prepared. It was a really good experience of what working full time as a nurse practitioner would be like. But trying to finish out school and work and moving on top of that was really, really difficult to get any of those aspects your best self.

Sarah: Yeah, for perspective, the year that I was about to graduate nurse practitioner school was when COVID hit. And so COVID, you know, March 13th everything shuts down. And so they shut down all of our clinicals the next week. I only had one day of clinical left when they shut down all the clinicals because I had done so many hours and so many days in my final semester. Because essentially with COVID they cut everybody a break.

At my school you had to have 750 hours of clinical time, I think, to graduate. But the board exam only required you to have 500. Well, everybody had 500 before that semester even started, so wherever you were in March when the world shut down, that was how many hours you were at, and I was already done.

Anna: Yeah, I was the same way because I crammed it all in to be done.

Sarah: So I could study for boards, that was my plan.

Anna: Yeah, I was done by midterms because, again, I was moving the next week. I was losing my clinical site, like I had to get these hours in. But I think it was like March 7th I finished clinicals. And the next week, all the clinical sites shut down. And I was like, oh, okay, thank goodness.

But my school also required almost 800 and so they had things in place. As long as you had that minimum of 500 and you could do a board review course or something to make up those hours. I mean, everybody was scrambling to try to figure out what to do in this uncharted territory of clinical sites shutting down and the pandemic and whatnot.

But I was just so thankful I didn’t have to worry about that. Again, I do not recommend packing your schedule like that. But out of necessity it very luckily worked out for me at the time.

Sarah: Yeah, so to kind of like briefly recap what we’ve talked about in this episode, if your schools are not responsible for finding preceptors, which is the majority of nurse practitioner schools, definitely like the day you enroll go ahead and just be thinking about clinical sites. Putting some feelers out, starting to network, make sure you’re at a really good spot for when that time comes to set that up.

Be thinking about what you want to bring when you’re going into these clinical sites, what’s going to make the most sense for you. What I took into an office was a lot different than what I took into people’s homes. And so just kind of like being cognizant of that along the way.

And if you do have some choice in preceptor, try to find one that can really make that experience for you and let you do a lot of things and learn a lot of things without that intimidating pressure. Because there are a lot of students that end up leaving nurse practitioner school or don’t finish because they have a really make or break clinical experience. So it’s just something to keep in the back of your mind.

And always, always, always, you’re never expected to know it all. I feel like I say that every day, but I’m going to say it one more time just to make sure everyone hears it. And please try not to jam pack your clinicals so that you are awake and aware and you are ready to really learn in those environments that you have found to do clinicals.

Anna, would you have anything to add?

Anna: I think my only thing I want to say as we finish out is just to go in with an open mind and be open to every single experience you can be. Like admit what you don’t know, but also jump at every single opportunity you can.

So if another provider in the office has a unique situation going on, a unique procedure, or even just a unique diagnosis that you haven’t seen before, maybe it’s a skin condition or something. Ask to go in there. Ask every provider in there, hey, if you have anything that you think would be helpful to see, can you come find me and let me know so I can go experience that?

Anything that you can do within these rotations and anything you can see is so, so helpful. And if you’re not comfortable with something, just tell your preceptor like, hey, I’ve never done a joint injection before. Could I watch you on this one? Could you talk me through it and then the next one I could try? And you will be amazed just by you taking the initiative and being open and saying that, how much more you will experience.

So just go in and be open minded and take every single experience that you can.

Sarah: And it doesn’t mean it won’t be scary. The very first time I ever did stitches, I’ll never forget, it was with my very intimidating preceptor. And it was on a wound care physician in this urgent care I was doing clinicals in. And I was like, I don’t know if I can do this. I don’t know if I can do this. And I was like, but I’ve just got to try because I don’t know when these opportunities are going to pop up again. This is going to be really important for, you know, the way my brain works is like I have to be able to like tactile, like do it myself.

But just lean into all the opportunities because there will be plenty of opportunities, especially if you’re in a bigger office with a lot of providers. And making sure everyone knows that there’s a student around is super, super helpful.

All right, guys, that is it for this week. Join in with us next time and we might be doing yet another of these episodes of things we wish we had known before starting nurse practitioner school. But if you like this episode series, please let us know and reach out to us on Instagram, Facebook, all the different places and we’ll talk to you soon.

As an extra bonus, friends, if you’re looking for support no matter what phase of your nurse practitioner journey you’re currently in, I have communities available for both students and new nurse practitioners. In these communities, we work to uplift one another and grow this profession together every single day. Links to join will be included for you in the show notes.

Thanks for listening to Becoming a Stress-Free Nurse Practitioner. If you want more information about the different types of support we offer to students and new NPs, visit https://www.npreviews.com/resources. See you next week.