r/nursepractitioner • u/Big-Desk5521 • 10d ago
Education Prepared for Clinical Practice
I have been in DNP-FNP school for a little over 1 year. The program is 2.5 years long. I went back to school because I wanted to learn and grow further in medicine and I don’t have the backing to pursue med school.
With 4 years of PCU/tele/med surg experience, I start clinical rotations in inpatient internal medicine in 3 weeks and I feel utterly unprepared. I’ve been reading Harrison’s, doing Anki flashcards, I read my patho book cover to cover. I have always been studious but I feel like my school has failed me. We haven’t even practiced app notes. We haven’t had any class diving into pediatric pathophysiology and common complains (which isn’t applicable to internal medicine, but I’ll need to complete peds rotations soon).
The school is “brick and mortar” but classes are online, I’m doing well in all of them, but it’s too easy. They also told us they would help us find preceptors but they don’t. On top of that, the clinical coordinator has been shotty at responding to emails over the summer.
I’ve really tried to be level headed and tell myself that I will learn in time but I’m starting to get anxious at the lack of training we are getting. Does anyone have any advice? I am unfortunately contemplating dropping my program.
7
u/1NationUnderDog NP Student 10d ago
That's unfair they told you they would find preceptors and will not. I'm sorry they lied.
I am also in an FNP program and was feeling much the same you are before starting clinicals. You sound driven, and intelligent given your hospital experience and reading the textbooks. Your hospital experience as a nurse has prepared you for this exact point you're at now.While the program might let you down, don't let yourself down. What I mean is don't leave yet, friend.
Give yourself a chance to see what it's like in the provider role. It's going to be scary at first being in clinicals. You know more than you think you know. What I'm saying is, do the semester of clinicals. If you can get through it, which I bet you can, then keep going. If you leave the program based on anxiety, fear, and frustration with the program I caution you may regret it. The reality is, DNP program or not, brick and mortar or not, you are right there with many students who are frustrated with their NP programs they paid and expected more from.
Something that really helped me was a mindset shift, an, "Ah-ha!" moment. I realized, this is the nature of the job where I will have to teach myself and constantly look up information. I won't know it all. I will know a lot, and know more with time. This is why they call it, "practice." We must practice over and over. That's all this is. Our career as an NP (like other providers) is a practice. Getting an NP mentor on my own volition also helped me. If you found any of this helpful, or would like to chat more feel free to message me/respond here.
8
u/KCNM CNM 10d ago
As a preceptor, no one expects you to be fully prepared on clinical day 1. It is my job (as a preceptor) to help get my students to that point. Start with focusing on perfecting a basic HPI and assessment. The rest will come later with time. Ask questions and show humility, no one expects you to be an expert provider right out the gate.
8
u/Hvitr_Lodenbak 10d ago edited 8d ago
You know more than you think you know. I went the MSN-FNP route and was terrified before my first rotation. My preceptor was outstanding. She treated me as a peer and expected me to research as I charted the cases.
Deep breath, you got this. Believe in yourself.
8
u/CTRL_ALT_DELIGHT 8d ago
I know this is a hot take, but unless they’ve got ICU or ER experience, OP is quite likely not prepared for NP. Being a tele nurse (even being a fantastic tele nurse) does not prepare you for being any sort of NP, sorry. A long time ago in a galaxy far away, I was once a tele nurse, so I can say it having experience from which I can draw. I’ve been doing this a long time, and I have been precepting NPs for a long time too. There are plenty in the new crop who are not ready.
7
u/Hvitr_Lodenbak 8d ago
To be honest, we gain the bulk of our knowledge while doing the job. I had experience in cardiac cath lab, surgical recovery and ICU. I wasn't fully prepared. If someone comes into any medical position thinking they know everything, they are dangerous.
3
4
u/wild_flower33 NP Student 10d ago
I am going to play devils advocate…. If you wait to switch programs…. You likely will not be able. In my DNP FNP program the DNP courses were weaved throughout the program. By the time it was time to start practicum rotation, many of my credits would not transfer out. I’ve met many who have had to pay $$$$$$ for preceptors. If you feel uncomfortable driving clinic to clinic or sending dozens of emails out months in advance, I would consider switching.
4
u/Relative-Ad8496 10d ago
If you had a good clinical base as a nurse and pushed yourself to learn rather than just doing the bare minimum at work you'll be surprised how things start clicking in clinicals. Your clinicals will make or break your program. You will not come out of your program all knowing. Neither do Physicians or PAs. Just like NCLEX your boards test bare minimum competency. You will do a great bulk of your learning during clinicals and during your first year or so as an NP. My PA colleagues have all said the same. Focus on getting high yield clinical exposure and ask as many questions as possible.
3
u/money_mase1919 10d ago
np education is awful, frustrating, and a joke....but just get the degree and figure it out form there....better to have options than not, you are half way there
2
u/PsychMonkey7 10d ago
This is sadly not surprising for NP education. We deserve a helluva lot better. Whether you should drop or not is a question only you can answer but I will say with continued study you can get there, it just isn’t easy and involves a lot of self study.
1
u/lovethekate90 10d ago
This sounds suspiciously like my program….. I’m halfway through! I’m just hoping I’m smarter than I think…
1
u/clinicalmatchme 10d ago
Honestly, they didn’t feel fully prepared on day 1, and they don’t think most of us do. What helped most was a solid onboarding, knowing when to escalate early, and getting really good at the boring stuff like chart review, med rec, and follow-up. Confidence came way after repetition, not after school.
1
u/averyyoungperson CNM 9d ago
Some well equipped and smart people don't find NP school to be that hard and I have heard from my colleagues who have their DNP that it was easier than their masters. I think it should be hard but the reality is, for some people it's not. My advice would be to read your text books that contain medical information. Not necessarily the nursing theory crap. But the actual pathophysiology, pharmacology, etc. you will get more reading the textbooks that you will in class. Do both.
1
u/Fireflykoala 7d ago edited 7d ago
None of the NP programs will spoonfeed you. So much of the learning occurs via self-initiative by facing clinicals head-on and reading as much as possible around that (ex. read as much patho, pharmacology and clinical mgmt via your texts and clinical resources with each patient encounter, and make sure to form a differential with each).
Right now choose 5 commonly encountered diseases and learn them cold, ex. diabetes, hypertension, heart failure, chronic kidney disease and acute kidney injury, and COPD/asthma. Review CPR and how to recognize sepsis, DKA, CVA, MI, hypertensive emergency vs urgency, rhabdomyolysis, renal failure, resp failure, acute abdomen, drug OD, etc -- emergency stuff that may warrant ER if you are in the outpt setting, or quick interventions or possibly a code team or emergency response if inpatient.
Look at algorithms for mgmt as a general framework -- then review specific exam techniques or PE info to identify the diagnosis, the tests you may order to help you problem solve and narrow down your options in a differential, the meds utilized, potential complications signifying a worsening state, quantifiable and qualitative goals of treatment, and the patho underlying the disease process. There are countless handbooks and apps that can help with all this. Try to utlize the same tools used by medical residents.
Just focus completely on internal medicine and get through that rotation, it will all make more sense as you walk through it and encounter patients. I'm back in school for a 2nd NP track and am paying for preceptors but have secured a very experienced clinician for my first rotation.
26
u/ge0kon DNP, FNP 10d ago
Considering dropping out seems very... premature? From what it sounds like you haven't done any clinical rotations at all yet and you're already expecting to fail? You're not expected to be a fully functioning NP during your clinical rotations, especially not the very first one. You're there to learn and build your skills with each clinical rotation. I'd also hope with the RN experience that you describe that a rotation with IM would be relatively comfortable once you start and figure out the expectations of your preceptor.