discussion board
Note to writer: Please read student posts below, pick 2 out of the 4 posts and respond individually in 1 page each providing 2 peer reviewed articles for references for each post. Articles must be less than 5 years old. No cover pages required, thanks. Please use APA 7th edition referencing style.
Renay’s Post
Reflect on your past experiences in nursing and consider how the role change to NP may challenge your knowledge and skills.
Reflecting on my previous experience with becoming a registered nurse I feel I know what aspects of role change that will most challenge my knowledge and skills. According to Stewart and DeNisco (2019) the most common issues may include “understanding the role of the NP, the expanded level of autonomy, leadership, clinical skills, and decision making†(p. 153). Knowing my personality and previous experience I feel I will be challenged by many of these issues. I tend to be quieter and like to observe individuals rather than speak up to give my opinion. I know as a nurse practitioner I will need to speak up and offer my opinion as to what I feel is the best treatment approach. I also like to collaborate with a treatment team and bounce ideas off one another. Depending on my clinical setting I know as a NP I will be challenged to become more autonomous regarding patient care. When I began working on my current psychiatric unit, I struggled with becoming a leader and making decisions because I was a brand-new registered nurse. Compared to the rest of the treatment team I did not feel knowledgeable enough to be confident in my skills. I know when my role changes to NP I will struggle with this also due to feeling inept, however, just like my past experience as I have more patient interaction and experience I will feel more confident in my abilities to make decisions, delegate, resolve conflict, and act with integrity (Melnic Team, 2016, Four Areas for Leadership section).
Do you feel role change from an RN to NP will be a greater identity crisis than when you first became a licensed RN?
What strategies for using support in the clinical experiences are available?
The clinical education is arguably one of the most exciting yet overwhelming experiences a NP student has. The American Association of Colleges of Nursing defines clinical practice experiences as “planned learning activities in nursing practice that allow students to understand, perform, and refine professional competencies at the appropriate program level†(2016, para. 1). An NP student enters their first clinical experience as a novice with their previous nursing knowledge and information related to their new NP student role. “Overtime, the NP student’s thought processes mature, and their clinical reasoning expands to incorporate complex or vague information into their approach to patient care†(Pearson & Hensley, 2018, Clinical Learning section).
Throughout a NP student’s educational experience there are a few people who they can lean on for support including themselves. These individuals would include NP faculty, the preceptor, and the student themself. A goal of the NP faculty is to be sure the NP student’s didactic knowledge is adequate. Some programs have clinical coordinators who can match students with the best suited clinical experience to meet their personality and needs. Another faculty member may include a clinical advisor. According to Stewart and DeNisco (2019) this individual “is the link for the student and preceptor†and may visit the student at the clinical site to be sure the student is progressing and gaining the knowledge they should (p. 151-152). These individuals can evaluate the students progress by direct observation either during a real patient discussion or using a simulation which may use actors as patients. During the visits, the faculty and student can have an open dialogue for any questions or concerns the student may be feeling (Stewart & DeNisco, 2019, p. 152).
The next vital person in an NP students’ journey to becoming licensed is the preceptor during the clinical experience. “Preceptors must keep in mind that every NP student presents with theoretical understanding of subjects taught in didactic classes, their own unique history of clinical experiences, and an individual learning style†(Pearson & Hensley, 2018, Student-led methods section). The preceptor should be able to distinguish where a NP student is in their clinical education and assist and push them accordingly. Two of the most valuable things a preceptor can do for their student is to be an outstanding role model and demonstrate the use of evidence-based practice. A good preceptor should possess the knowledge of how to teach student through formal and informal methods. Most importantly the preceptor should have great communication skills, be empathetic, and consistent for the student to feel comfortable asking questions and voicing concerns (Stewart & DeNisco, 2019, p. 157).
In addition to the NP faculty and preceptor the student also has immense responsibilities during the clinical experience. The student should always be professional and ask the appropriate questions to further their knowledge. The student should seek out learning opportunities and receive feedback graciously. Along with a licensed preceptor who enhances the students critical thinking abilities the student should utilize reflective journalism . This is a way the student can help facilitate role integration (Stewart & DeNisco, 2019, p. 156).
Who do you feel will be your biggest support through the clinical practice portion of this program and why?
References
American Association of Colleges of Nursing. (2016). CCNE Accreditation. https://www.aacnnursing.org/CCNE-Accreditation/Resources/FAQs/Clinical-Practice
Melnic Team. (2016). Think You Have What it Takes to Be a Great NP Leader? https://www.melnic.com/job-seekers/learning-center/well-being/leadership/np-leadership-skills/
Pearson, T., & Hensley, T. (2018). CEArticlePrint. Positive precepting: Identifying NP student learning levels and needs. https://www.nursingcenter.com/ce_articleprint?an=01741002-201902000-00009
Stewart, J. G., & DeNisco, S. M. (2019). Role development for the nurse practitioner (2nd ed.). Jones & Bartlett Learning.
Informational Form
Renay M. BSN, RN
Area of Concentration:
Aspiring psychiatric mental health nurse practitioner
Previous Work Experience:
Regarding my previous nursing experiences, I have held one job since obtaining my RN license. For the past four years I have worked as a charge nurse on a 10-bed inpatient adolescent psychiatric unit at Cincinnati Children’s Hospital & Medical Center. I have become comfortable with dealing with the care of adolescents who suffer from a variety of mental health illnesses. Some diagnosis that we deal with frequently are depression, borderline personality disorder, ADHD, disruptive mood dysregulation disorder, and psychosis. I am certified in TCI (Therapeutic Crisis Intervention) which means I have the knowledge on how to prevent and safely manage patients when they are escalating or in crisis. I feel I have grown to be calm in crisis situations, can correctly assess the situation, and perform the correct interventions needed in a timely manner. I have also worked in collaboration with the treatment team so each patient has a well-rounded team of individuals working to provide the best care possible so they can return to their daily routines as quick as possible.
Concerns Regarding Clinical:
I have a few concerns regarding my clinical experience. Due to the vast responsibility of a nurse practitioner I fear I will not be able to experience all the duties of a NP in a clinical setting due to time constraints which could lead to feeling ill prepared when I begin working autonomously. I also fear that I will not remember all the information taught didactically and I will become hard on myself for not being able to which will lead to anxiety and stress. I want to learn as much as possible without feeling too overwhelmed. Another concern I have is I will not be knowledgeable of all the uses, functions, and side effects of all the psychiatric drugs and will feel incompetent during my clinical experience. I tend to work best with individuals that have clear communication, makes expectations clear, and is approachable and not intimidating. I hope to enjoy my clinical experience at a facility that is open to students with many questions and be given the constructive feedback I need to be a successful NP. Although I do have some concerns regarding my clinical experience I am excited to start this part of my journey to becoming a psychiatric mental health nurse practitioner.
Rishi’s Post
Seminar Discussion Questions 1 & 2,
Question # 1- Reflecting on my past experiences in nursing and consider the changes to NP may challenge my knowledge and skills. One of the challenges that I will be facing as a new NP student is knowing how to make the right diagnosis with the right proper treatment. In my past nursing experiences working on the floor, I have worked with so many NP when I had to make a phone call to them for medical orders and treatment for my patients. Over time, I was familiar with what the NP would order for each and every disease process or prognosis. As an NP, my biggest fear is knowing how to make the right referral, consultations to another specialist, or transcribing a transfer order.
Question # 2- That strategies for using support in the clinical experiences which are available to me are asking my preceptor for guidance and help. Asking another staff on board what is their input regarding this situation and looking at the policy and protocol for the procedure. “Providing students with early and extensive clinical experiences during their training is crucial.†(Alhaqwi, 2015). According to Ali, his theory points out that every clinical student should put forth the time and effort to gain the experience they need as an NP.
References
Alhaqwi, A. L. (2015, March 01). Promoting excellence in teaching and learning in clinical education. Retrieved from Science Direct: https://www.sciencedirect.com/science/article/pii/S165836121500027X (Links to an external site.)
One Page Requirement
Rishi S
Northern Kentucky University
MSN- Psych Practitioner Program
Information Form for Nursing Preceptor
To Whom It May Concern,
I want to introduce myself, I am Rishi Sharma, I been a nurse for the past four years and I am currently working on my MSN- Psych NP at Northern Kentucky University, located in Highland Heights, in Kentucky. I began my nursing career in 2013 at Galen College of Nursing, in Louisville, KY. I started off with my LPN, then went back for my RN and BSN Bridge Program at Galen. I been blessed though out my nursing career by working as a Float Nurse working almost all specialty units. The units I currently work on is; Float and Admission Nurse, Med Surge, Psychiatric, Long Term Rehab, ICU, Step Down, Orth-Surgery, Cardiac Step Down, Telemetry Unit, PCU and ER.
Though my nursing career, I have been blessed to take care varieties of patients with many medical complication, not limited to; cardiac patients, Stepdown surgery patients, Patients who are intubated, and drips. I have worked with patient’s with 6-7 drips running at the same time and reason why I am writing this letter is to ask since I have worked in Psych settings before, I am hereby requesting to find a preceptor which I can work aside with for my clinical hours requirements. I am willing to share my information with you and I can be reached at …..
Thank you for taking your time to read this letter, I look forward hearing back from you soon.
Leandra,s post
1. Reflect on your past experiences in nursing, and consider how the role change to NP may challenge your knowledge and skills.
Stewart and DeNisco (2019) discuss how difficult and uncomfortable it can be for one to go from an experienced registered nurse (RN) to a novice nurse practitioner (NP). One may experience loss of confidence and professional identify (Barnes, 2015). I believe the role change to a NP will challenge how I assess and evaluate patient situations. For example, as an acute care RN, I am responsible for completing admission information and assessments on new patients. I then will report abnormal or concerning information to the doctor or NP. As the NP, however, I will need to use my medical knowledge to develop a care plan of action most appropriate for the patient. I will need to utilize additional knowledge learned to provide optimal care. This will involve critically thinking of how each potential intervention will impact the overall patient outcome. I will also be challenged by developing a different skill set. There are skills and training that are within the scope of practice of a NP that are not for a RN. For example, I will be able to order additional diagnostic tools that a RN would not be able to. I will need to understand and practice delegating certain tasks that I would normally complete as a RN, such as foley catheter placement or obtaining lab work. It will be challenging to transition my thinking from RN to NP, until I gain experience and build confidence in doing so (Stewart & DeNisco, 2019).
2. What strategies for using support in the clinical experiences are available?
There are many ways of obtaining support during the clinical experience. Prior to clinical placement, the facility takes steps to ensure the student will be successful (Stewart & DeNisco, 2019). These steps include clinical advisors and coordinators that can be used as resources. Obtaining their names and contact information (i.e. phone numbers, emails) would be important to ensure ability to utilize such resource. As the student, it would be beneficial to write down notes about each clinical experience. If a day was more challenging, exploring the events of that day with the preceptor or clinical instructor may provide insight into the given situation. The preceptor will be an ongoing resource during the clinical experience. One could establish time toward the end of each clinical day to debrief and discuss the day. Another going source of support will be the clinical instructor. The clinical instructor will not always be at the clinical site but will come to observe at different times (Stewart & DeNisco, 2019). Honest feedback and discussion during this time may provide additional support during the clinical experience. Farzi et al. (2018) describe how clinical experience helps guide the link between theory and practice. Utilizing my resources for support will aid in providing the most beneficial clinical experience possible.
Do you have any fears when it comes to starting clinicals?
References
Barnes H. (2015). Exploring the factors that influence nurse practitioner role transition. The
journal for nurse practitioners: JNP, 11(2), 178–183. https://doi.org/10.1016 (Links to an external site.)
/j.nurpra.2014.11.004 (Links to an external site.)
Farzi, S., Shahriari, M., & Farzi, S. (2018). Exploring the challenges of clinical education in nursing
and strategies to improve it: A qualitative study. Journal of education and health promotion, 7,
115. https://doi.org/10.4103/jehp.jehp_169_17
Stewart, J. G., & DeNisco, S. M. (2019). Role Development for the Nurse Practitioner, 2nd ed.
Jones & Bartlett Learning.
One page letter to clinical faculty and preceptor:
Dear Clinical Faculty and Preceptor,
I appreciate your willingness to precept a Psychiatric Mental Health Nurse Practitioner student from Northern Kentucky University. The guidance and knowledge displayed by you will provide me with essential components to aid in my transition from a Registered Nurse to an Advanced Practice Nurse. I value your time and expertise knowing this will only help in my growth as a future health care provider. I eagerly await our time together.
I have worked as a registered nurse for two years. I currently work within a rural hospital on the acute care floor. I have work with medical-surgical, telemetry, intensive care, and pediatric patients. I have also worked in a long-term care facility as an agency nurse. This included working with rehab and dementia patients, with and without behaviors. My experience with patients ranges. I have worked with intubated patients on multiple intravenous medication drips, restraints, arterial/central lines, bladder thermometer etc. I have worked with patients recovering from a total joint replacements and other surgeries. I have also worked with patients experiencing acute illnesses and withdraw/detox, depression, anxiety, suicidal ideation, bipolar, schizophrenia, obsessive compulsive disorder, anorexia, attention deficit disorder, and post-traumatic stress disorder. I feel comfortable with all the different patient populations and situations I have worked in.
My biggest concern with beginning clinical is how to know what interventions or medications to start with for a patient. I believe there are so many options of where to begin treatment for someone. I fear not knowing where to begin. I am worried my treatment recommendations will not be effective and the patient will lose confidence in my medical knowledge. Another concern I have is not recognizing signs and symptoms due to not having a lot of psychiatric experience as a nurse. I have taken care of patients and family members with mental health diagnoses. However, I have not experienced an extreme of any mental health diagnoses. Those I have helped have been milder in severity.
I am excited to expand my knowledge and build upon my experience within the clinical setting. I know the textbook can only teach so much. I am eager to apply learned theories into the clinical setting. I am grateful to have your support and assistance during this time. If you have any advice or recommendations before beginning clinicals, please contact me by information provided below. Again, I want to thank you for the opportunity. I look forward to working with you.
Sincerely,
…. BSN, RN
PMHNP Concentration NKU
Jennifer,s Post
Reflect on your past experiences in nursing and consider how the role change to NP may challenge your knowledge and skills.
Reflecting on my past experiences in nursing, I am rather proud of how much I have grown and how many fields I have been exposed too. In the last ten years, I went from my Associates Degree in Nursing (ADN), to my bachelor’s degree (BSN). When I first started, a Nurse Practitioner (NP) was never on my radar or in my bucket list of career goals. I started on a Neuro floor and then went to Labor and Delivery where a huge part of my passion will always be. My husband went from a volunteer to a career fire fighter which lead me to home health for the flexibility. I did a short stent on a Cardiac floor before returning to Labor and Delivery. My knowledge and skill set are the strongest in labor and delivery. Labor and Delivery may be my closet experience to mental health other than my own personal experiences. Unfortunately, in Labor and Delivery we deal with fetal demise or the loss of an infant too often. However, I feel working in so many fields, I have gained a bit of insight from relating to patients from long term hospital admissions, to a few hours to bonding with them in their home. I have a broad scope of practice from the different fields. Reflecting on these past experiences, and considering my role change to NP, will certainly challenge my knowledge and skill set. As Stewart and DeNisco (2019), highlights the NP student has tremendous responsibilities with upcoming clinical experiences, and the RN to NP transition is often an uncomfortable one. As NP we are expected to correlate the medical knowledge we have acquired and apply it direct patient care. My ability to collaborate and often consultation and referrals will be taken to the next level.
What strategies for using support in the clinical experiences are available?
Anyone who has been through a nursing program can attest to the stress of the program, with clinicals being no different. As students navigate through clinicals, peer support and personal mentoring have been noted as effective strategies to reduce stress and anxiety (George et al., 2020). With the support of senior nursing students in the role of mentors, beginning junior nursing students can be guided in patient care assignments within the clinical setting. This relationship fosters confidence as students communicate freely and ask questions without fear of reprisals from nursing instructors. Nursing students support each other in a student centered, non-threatening learning environment that minimizes the student’s anxieties when first entering unfamiliar clinical settings (George et al., 2020). The use of caring, competent clinical instructors, orientation to clinical sites, laboratory and simulation days, self-reflection, peer-support, and debriefing have also been beneficial strategies of support for clinical experiences (Roling et al., 2020).
References
George, T. P., DeCristofaro, C., & Murphy, P. F. (2020). Self-efficacy and concerns of nursing students regarding clinical experiences. Nurse Education Today, 90. https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.1016/j.nedt.2020.104401
Roling, G., Lutz, G., Edelhäuser, F., Hofmann, M., Valk-Draad, M. P., Wack, C., Haramati, A., Tauschel, D., & Scheffer, C. (2020). Empathy, well-being and stressful experiences in the clinical learning environment. Patient Education and Counseling. https://doi.org/10.1016/j.pec.2020.04.025 (Links to an external site.)
Stewart, J. G., & DeNisco, S. M. (2019). Role Development for the Nurse Practitioner (2nd ed.). Burlington: Jones and Bartlett Learning.
Information Form
Jennifer H
(859) ……..
Email:…..
PMHNP
I have worked in various fields from Neuro, Home Health, Cardiac and primary Labor and Delivery. Labor and Delivery is my passion, where I interact with patients generally over a short time frame, but mainly in the most memorable times in their lives. My skill set and knowledge are strongest in this field. On the other end, Cardiac remains a great weakness. That is a specialty I have no strong desire to learn and therefore have never fully embraced or grasp the needed concepts. Neuro was of great interest and long-term care of patient allowed me to bond unlike any other specialty I have been in. My Neuro assessments remain strong and I still have great interest in that specialty. My greatest concern beginning clinical is first the unknown of many factors. The uncertainly of finding an amazing passionate preceptor. The unknown of where I will be and heading into the mental health field with no prior clinical experience, I feel I am possibly at a disadvantage.