Nurse Practitioner interns

We have had the pleasure recently of having two NP interns (NPi) at the practice in their final year(s) of study. The theory is that the best way to learn is to teach, I find the best way to learn is from those who are in training. Both nurses come from different backgrounds and bring different expertise to the role. We are fortunate to have this opportunity to help ‘grow our own’ but also learn from their wealth of experience.

So it works like this… initially, I will sit in on the consultation and observe the process from subjective history taking, objective assessment, analysis of the information and then a plan for treatment going forward. Once I am satisfied that the NPi is comfortable with this process in our practice setting the format morphs into more autonomous practice. I will come into the consultation only at the point of analysis of the presenting complaint, when the NPi will present the case to me and we discuss the plan for treatment etc. This allows the patient and NPi the chance to develop a relationship and then as the case is reiterated to me, the patient hears what the NPi has understood of the complaint. From here there is discussion about treatment considerations driven by the NPi and as appropriate initiated. If there is a need for changes to the treatment plan I am able to do this in conjunction with the NPi and patient. Autonomous and supported practice allows for growth in the NPi role, but also provides safety and reassurance for the patient.

I have found that when I am in the room the patient tends to talk to me, or try and engage with me and I am known to answer, where we are wanting the NPi to be in dialogue with the patient!!! We will tell the patient ‘pretend I’m invisible’, so they direct their discussion to the NPi.

After a consultation the NPi and I will discuss details in a more robust sense. How did we feel the patient interacted, did they seem comfortable with sharing in a three way conversation etc? We will cover examination techniques, medications, referral to other providers, investigations, all the while looking at this from the pending independent NP role. We also review patients from the previous week and any blood test results, investigation results etc that may have come through. This gives the NPi the opportunity to follow through with processes, and also make further decisions about how to interpret results and further plan from these. This involves informing the patient, maybe changes medications and/or referring on to other providers. It completes the episode of care.

Formative and summative assessments of the NPi practice is a requirement of the universities and gives us the opportunity to critique their practice in the clinical setting. Set against the New Zealand Nursing Council Competencies, this is very detailed and specific to the NP role. It is also an opportunity to identify areas for further development and focus for the NPi.