A Key Perspective for NP Students in Clinicals

Last week one of the speakers at our MMU kickoff made an interesting point as part of her presentation. She mentioned that a professor in nurse practitioner school told her that “clinicals are as much about learning what not to do as they are about learning what to do“. This stuck with me as it was a perspective I hadn’t previously considered. 

Ideally, as nurse practitioner students, each of our preceptors teaches us to practice in the most evidence-based, up-to-date manner possible. But, as we’re all aware, this doesn’t always happen. Pressures of employers and real world practice get in the way. Not everything is done according to the book in healthcare facilities. This can look different depending on the provider and specific facility. Some providers may not use the latest treatment guidelines. Others prescribe more controlled substances than we might agree with.

Most often, our preceptors don’t practice with misguided intent. Rather, there is a lot of gray area when it comes to healthcare. You might have a different vision for the way you want to practice medicine than your preceptor. Or, you may have a different perspective on what it means to provide quality customer service to your patients. So, what should you do as a nurse practitioner student if you feel like your clinical site is more of an education in how not to practice than the ideal education experience you were hoping for?

Define the problem

If your nurse practitioner clinical placement isn’t going as you imagined it would, pinpoint the reason why. Examples might include your preceptor’s personality, prescribing philosophy, clinical skill set, or lack of time to teach. 

If your clinical preceptor is providing unethical care, working outside of his/her scope of practice or breaking the law, you will need to contact your school to be reassigned and advised as to what next steps you should take. 

Decide what you can learn from shortcomings

There’s probably a lot you can learn by observing your less than ideal NP clinical situation. If your preceptor seems too busy to provide as much guidance as you anticipated, watch how he/she manages the pressures of working in a busy practice. You can take away from the experience practical tips for working efficiently and balancing a heavy patient load. If you disagree with your preceptor’s prescribing practices, use this as motivation to keep up to date with evidence-based guidelines, hone a speech you can give to patients about the dangers of unnecessary antibiotics, or motivation to educate yourself about your state’s guidelines for opioid prescribing, to name a few.

Reframe your perspective

Once you’ve decided that there is ultimately something you can learn from your clinical placement, you’ll need to reframe your perspective to maintain a positive attitude. Continue focusing on what you can learn rather than what you can’t – even if it’s not quite what you anticipated. You get out what you put in to your education so use the clinical placement to its full potential no matter the situation. 

Have you had a disappointing clinical placement? What did you do about it?

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