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• W2985169508 abstract "I wonder if it’s time to reconsider the way we educate nurse practitioner (NP) students in primary care. Most programs today intersperse didactic content with skills practice and precepted clinical experiences. Students are not always able to practice what they’ve just learned in class. Competition for clinical sites for NP students makes it difficult for faculty to find sites appropriate to the student’s level in the program. Beginning students benefit most from starting in primary care. They learn how primary care works, the types of patients seen and the workflow. Unfortunately, due to competition for clinical placements in most areas, students may not be able to get into a primary care site for several months, well into their program. They may be placed in specialty sites. When this happens, students don’t get the necessary foundation they require to appreciate specialty practice. I’ve worked with students nearing the end of their program who had not yet honed their history taking and physical exam skills because they had spent most of their practice time in specialty sites. In these instances, they might learn how to do a one system history or assessment very well. This will serve them in the future. However, students should learn the basics first. The Commission on Collegiate Nursing Education and other accrediting bodies require that nursing courses build on previous knowledge. Specialty clinical practice prior to a solid foundation in primary care does not meet this standard. In addition, many specialty clinical sites claim they are too busy to permit faculty to observe patient visits. When they are not permitted to be present in the exam room with the student and patient, faculty frequently substitute virtual visits for in-person visits. However, this may be insufficient to fully assess whether the student has acquired fundamental skills. Clinical preceptors work with students and provide recommendations to faculty regarding the student’s acumen, but faculty are responsible for evaluating and grading the student. Faculty work very hard to find sites and preceptors for students appropriate to their learning needs. In addition to competition for sites, physician assistant (PA) and medical school programs frequently pay for clinical placements. Nursing programs typically can’t afford to pay, don’t want to shift the tuition burden to students or are in solidarity with other schools of nursing to avoid paying for placements. A few NP programs have already adopted a model that front loads theory or didactic education followed by clinical experiences in the form of intensive and lengthy rotations. Students may return to campus for selected classroom days, but the latter portion of the program is primarily spent immersed in clinical experiences. Students get in-depth time in generalist and specialty areas. There are practical reasons why changing to this type of structure is warranted. Anecdotally (after spending 20 years educating NP students), clinical sites tend to prefer longer intensive periods with students than 1 or 2 days per week. From an andragogical perspective, this makes sense because students tend to learn better when they are immersed. It is more likely they will learn about the practice, such as operations and reimbursement and see patients in follow up. This also serves the practice because the student becomes knowledgeable more quickly and learns to see more patients in less time. The student becomes an asset to the practice which may increase their chances of being hired after graduation. There is also the not insignificant benefit of allowing true interprofessional experiences for students. It is easier to develop team cohesion and collaboration when people are seeing each other every day and working through issues and problems together. PA and medical school curricula are similarly structured allowing for sharing of classes, lab experiences and simulations. This may also reduce the need for additional nursing faculty by permitting more interdisciplinary team teaching. This will not solve the problem of nursing programs being unable to pay for clinical rotations but may make clinical sites more likely to accept NP students and hire new graduates." @default.
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• W2985169508 date "2019-11-01" @default.
• W2985169508 modified "2023-09-25" @default.
• W2985169508 title "Immersion Clinical Experience for NP Students?" @default.
• W2985169508 doi "https://doi.org/10.1016/j.nurpra.2019.10.019" @default.
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