How Do You Deal With a Bad Clinical Placement?

I quickly became frustrated with one of my first nurse practitioner program clinical placements. Working alongside a physician in his solo, small town family practice clinic seemed like the ideal place to learn. But, then, I realized he accepted nurse practitioner students as a way to get more help running his clinic- and I don't mean when it came to diagnosing and treating patients. This particular physician would ask me to get on the phone with Blue Cross regarding collections that hadn't come through or claims that had been denied. I drew blood to help his overwhelmed LPN rather than ordering labs myself. With my education on the line, I was concerned.

Your NP program clinical hours are the pinnacle of your nurse practitioner education. With all the time, energy, and dollars you are putting into your schooling you expect the experience to be top notch. Unfortunately, NP program clinical placements aren't as structured as the rest of your courses. Individual placements vary depending on the preceptor. Some preceptors are more in tune to the needs of NP students than others. Some preceptors view hosting a student as a way to have a 'free' employee. Others throw themselves into the mentor-mentee relationship.

If your clinical placement isn't meeting your expectations, there are a few steps you can take to remedy the situation.

1. Pinpoint why you are unhappy

Think through the reasons you are dissatisfied with your clinical placement before taking action. Are you bummed because you were placed in a urology clinic when your sights were really set on ER? Does your preceptor have the personality of a brick wall? Or, perhaps the clinic in which you are placed is a two hour commute each way leaving you constantly in the car. Pinpointing the root of the problem helps guide your next steps.

2. Decide if the problem is something you can work through

Clinical placements are temporary and you will have many in your life as a nurse practitioner student, If you are only working along the lines of 60 or 90 hours in a particular practice, you can likely deal with any inconveniences or keep personality conflicts on the down-low for a few weeks. You will learn something from each and every situation, even if it ends up being different information than you expected. Sacrifices like a long commute for the perfect learning environment will be worth working through in the end. If the placement is a more significant part of your clinical experience, or the problem is too big to overcome, you may need to take more drastic action.

3. Talk to your preceptor about the problem

If your dissatisfaction is with an aspect of your learning experience, chat about it with your preceptor. Ask if they have a few minutes to talk after the work day, or the following morning before you start seeing patients. This isn't a conversation to bring up in the middle of a busy work day. Respectfully state what you had hoped you would learn, or how you had hoped the clinical experience would work. Make a few suggestions as to how you can modify your current learning experience to match your expectations. Just remember, your preceptor is not getting paid to train you- they are doing so as a favor to you. Don't be too demanding.

4. Discuss the problem with your NP program director

Your NP program directors want feedback as to how preceptors are performing, especially if clinical placements are set up by your school. Most likely, you aren't the first student to be unhappy in this placement. Your program director may be able to do a little switch-a-roo and match you with a placement that better meets your learning expectations, or is more suited to your career goals. Ask your program director to change up your placement. If this is not a possibility, make specific requests in regards to future clinical sites.

5. Decide to make the most of the situation

Whatever happens in regards to your disappointing clinical placement, make the most of the outcome. If you get re-matched to a more satisfactory preceptor, count your blessings and work your behind off to learn as much as possible from this individual. If you aren't able to be moved to another clinic or hospital, you have an opportunity to learn regardless. There are lessons to be taken from each and every situation, learn them even if it isn't easy.

While my small town clinical experience had me doing more billing and coding than diagnosis and treatment, and often left me as the one giving the injections rather than ordering the medication, I was able to take something away from the experience. My added knowledge of how insurance claims are processed gives me insight into healthcare economics and insurance jargon. I feel that I have a more well-rounded knowledge when it comes to the inner workings of how a medical practice operates.

Some clinical placement woes can be remedied, others cannot. The good news? There's always the next one!

 

You Might Also Like: 5 Ways to Excel in Your NP Program Clinical Placement

 

Comments

Maryanne: You are right. It is so important to recognize and appreciate your clinical placement. Preceptors are generally not compensated or rewarded at all. I've known several who were not even given a note of thanks from the student. A real concern for preceptors is the feeling of "being used" constantly and having no "break" from students. There is often conflict, too, that precepting slows down productivity within the office setting. This can create its own set of issues.

PPC

Hi Erin,
Thanks for the advice! I checked out that post on how to find a preceptor and it had many great tips. I also did post on the message board, which was new to me! So, fingers crossed!

Linda Poteau

This post really caught my attention. I, too am in an adult/Gero Online program at University of Cincinatti. I live in a rural area in NC and placements have been hard to find. I am working with a private practice in which the doctor is very moody. He will often not tell me what or why he is doing anything and will run into the rooms and see the patient after Ive done my assessment so i never see the follow through, nor does it always make much sense to me. However, I am thankful and realize I'm fortunate to have this placement despite the many issues I'm facing. I keep hearing how hard it is for others to find any placement at all and since this is a requirement for our schooling I feel I need to be quiet and get through it. I do really wish there was a more structured way this could be done with the schools.

Maryann

Hi Linda,

Check out this post for help: How to Find a Clinical Preceptor for Your Nurse Practitioner Program. Also, try posting on the MidlevelU message board to see if any NPs out there are willing to precept you as well as get advice from other NP students.

Hope this helps, let me know if you have any further questions!

Erin Tolbert

Hi,
I am currently in an Adult/Gero NP program in Massachusetts and have to find my own clinical placements for the spring. This is the first time I have ever had to do so. Next semester is right around the corner and I still have not found any placement. Any tips on how to go about this?

Linda