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This guest post is written by Nick Angelis, CRNA MSN. 

Let’s start out on a positive note, which is rare for me because my sense of humor is dark and drier than the saltines locked up by Dietary because the nurses were eating too many.  I love nurse practitioners.  They are adaptable, dependable, and their education opens up a world of possibilities and knowledge that doesn’t exist at the BSN level.  Like CRNAs, the skill and finesse they learn in school elevates caring to an art form.  Sometimes it’s a lot of fun! But, on the healthcare hierarchy totem pole, graduate students are still a bug trapped underneath the pole.  Clinical sites evaluate them much more closely and lord more power over them than in nursing school.  When it came to the hands-on, manage-the-patient-as-if-you-were-a-nurse part of nursing clinicals, I was about as skilled as this guy.

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It took a long time for anyone to notice because I had a 4.0 and could answer any question thrown at me.  With an MSN, the bar is much higher.  You need to start performing on Day One rather than blunder through a three month orientation trying not to kill anyone at your first job.  The closer scrutiny on clinical results is necessary and rewarding, but there are two major ironies for CRNA and NP students to accept.  There are a lot of fabulous things too, but those aren’t as interesting to write about.  The first irony is that you are paying money to make other people money–sometimes while being treated poorly.  An example is the anesthesiologist resident being supervised remotely while sedating for colonoscopies, except that he makes enough to buy Ramen while the nurse anesthesia student does not.  The second is that although you occasionally generate the same level of notice and respect that Housekeeping does, whether your clinicals are at a small office or a large hospital, some of your preceptors will be intensively interested in your personal life.

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Watch out for bullying

Identifying psychotic preceptors is an invaluable tool as a graduate student.  My site on bullying and corporate wellness can help with some of this.  Who can you trust?  Programs with multiple clinical sites have a liaison between the school and the program, although that doesn’t automatically mean anything.  Find out from students who have been to that clinical site before, although they may be more loyal to advance practice nurses at an institution than they will be to you.  Seniors may be after a job or desperately want to please someone at the site with juicy information about a new student.  At this point, you may suspect I’m a suspicious sourpuss.  I’m actually embarrassingly gullible and tend to see the best in people rather than their glaring faults, which is why advice like this was so helpful for me.  And really, you should be treating everyone as well as you can.  Not two-faced or disingenuous, but the way you want to be treated.  The simpler you can keep your clinical relationships, the more you can concentrate on doing well clinically instead of the petty drama that some people live for.  I know it doesn’t sound like it, but I found clinicals tremendously more fun and interesting the second time around.

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Trying to understand expectations between preceptors

Once you do find trustworthy preceptors that have your best, long-term interests in mind and really want to help, try new things and work on your clinical weaknesses with them.  As a new student, skills like arterial and central line placement or intubating with a new type of blade or equipment are good examples.  Even discovering your deficits may seem bewildering.  One preceptor will compliment you on your critical thinking and the next may berate you for the exact same thought process.  Understand that many of the brilliant preceptors who ask you highly specialized and difficult questions only have a handful of them that are meant to stump you, unless they’ve been reading textbooks between patients.  Often there’s a strong correlation between a fixation with antibiotics or airway or amiodarone dosing and a terrible mistake they once made.  Even if an outcome is one in a million, if it happens to your patient, you’ll pay special attention to it in every subsequent case until you retire (or receive adequate therapy).

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Prioritize your emotional wellbeing

As a last side note, would extensive counseling help you survive and perhaps even thrive in graduate school?  The answer is yes.  Of course, if you had the time and money for counseling during school, you probably wouldn’t really need it.  Similar to training your brain how to study, resilience is one of the most important skills you should master.  This is quite different than stubbornness, which can be evidenced clinically as trying that spinal for a sixth time instead of just changing your inflexible plan.  In the future, we will talk much more about emotional help on FreshNP.com and how to build a healthy, balanced support system that doesn’t suck or suck your loved ones dry.  Although it helps to stay close to home instead of leaving everyone you know for that perfect school hundreds of miles away, I’ve been asked if it’s better to be a nurse at a facility before becoming a nurse practitioner or anesthesia student.  Can you step out of the shadow of your old job?  An incompetent student will still have major problems six months into a program, even if everyone loves her.  

What do you think? How do your NP clinicals compare to nursing school, or how do you expect them to differ?

Nick Angelis, CRNA, MSN, is the author of How to Succeed in Anesthesia School (And Nursing, PA, or Med School) and regularly writes or presents continuing education articles on a variety of dry and dreary topics, unlike this one. He also has a thing for fiction, non-fiction guides for students and clinicians, and satire closely resembling non-fiction. Nick works as a nurse anesthetist in Ohio and the Florida Panhandle and enjoys playing several sports poorly. You can connect with him on Twitter or Instagram.