Pass the Granola Bars, Please- Becoming Proficient with Procedures

During my nurse practitioner clinical hours and first year of practice I ate a granola bar before each time I sutured a laceration. It made my hands shake less. Fortunately, I wasn't working in the emergency department at the time where I may suture five or more times a day, or I would have had to increase the size of my scrubs as well. Now, more seasoned in my practice my hands are surer than ever, low blood sugar or not. How do you make the transition from becoming a ball of nerves every time a procedure is in order to practicing with confidence?

Here are a few tips that served me well in increasing my procedural proficiency. 

1. See a Few, Do a Few, Teach a Few

The "See One, Do One, Teach One" mantra is popular among medical schools across the country. The idea behind the trend being that after observing a procedure, you should be prepared to perform it yourself, and that teaching your newfound skills to another reinforces your learning. This model has been heavily criticized in the name of patient safety, but following these steps can prove to be an effective learning process.

After you have observed a procedure once or twice, seek assistance in performing it on your own a few times. Initially, attempt simple procedures such as suturing short, linear lacerations, before you move onto those that are more complex. 

2. Practice, Practice, Practice On Your Own

Practicing procedures on your own isn't as helpful as performing them in real life, but regardless it can improve your skills and confidence. Purchase a suture practice kit online and throw in a few knots to hone your skills. Consider attending a skills workshop geared towards nurse practitioners and physician assistants. There are a few conferences every year that focus on improving procedural know how. 

3. Actively Seek Out Opportunities for Improvement

Standing back and simply observing as you complete your clinical hours or during your first months of practice can be tempting. Taking the initiative to use your newfound suturing or I&D skills on a real live patient is anxiety provoking but essential. But, you've got to learn sometime. 

Your clinical hours are the ideal time to practice procedures. You are practicing under supervision and are expected to be a novice. Once you get a job, it may be more difficult to find help and support as you continue to learn. Take advantage of this time in your education asking preceptors to let you in on as much procedural action as possible.

4. Solicit the Help of a Colleague

Each and every nurse practitioner has been a newbie at some point. We all remember how it feels. Identify a mentor in your practice, be it an NP, PA, or MD who is willing to help you continue your learning. Ask to observe when they find themselves performing procedures. Ask your mentor to observe you as you work on your skills, stepping in to give advice as needed. While this may seem like a big favor, ultimately your practice as a whole will be better off with a group of consistently strong providers. 

5. When in Doubt, Ask- Even if it's Just for Reassurance

If you have a question, always, always, always ask. Procedures inherently incur some risk to the patient. You don't want to make a mistake. If you aren't sure which suture technique is appropriate for a certain wound, or if a laceration can be glued, seek assistance. Even though I have practiced for nearly five years in the emergency department, I occasionally have a physician look at complex wounds before I close them just to be sure we are on the same page as to how to achieve the best outcome. 

 

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Comments

These comments are all extremely helpful as a prospective NP applicant. I thought it might have been the magic bullet for my career in nursing, but now have a more grounded perspective. Same struggle, different level.

Jordan