WEBVTT 00:00:00.000 --> 00:00:02.120 there is a fine line between just charging somebody 00:00:02.120 --> 00:00:04.730 to shadow you. and charging somebody because 00:00:04.730 --> 00:00:06.690 you're going to take the time out of your scheduled 00:00:06.690 --> 00:00:08.849 patient day to ensure that they're learning we 00:00:08.849 --> 00:00:11.250 give our students progressive expectations so 00:00:11.250 --> 00:00:13.369 you should know what you should be working on 00:00:13.369 --> 00:00:16.230 semester one semester two semester three how 00:00:16.230 --> 00:00:18.489 we do our clinicals is different than what i 00:00:18.489 --> 00:00:20.510 was used to in our program so ours was everybody 00:00:20.510 --> 00:00:22.489 does this many hours this many hours this many 00:00:22.489 --> 00:00:24.929 hours nursing is intriguing to a lot of people 00:00:24.929 --> 00:00:26.829 we see people at the best and the worst moments 00:00:26.829 --> 00:00:29.550 of their life bedside nursing provider it doesn't 00:00:29.550 --> 00:00:32.890 matter your job is an entire picture and so You 00:00:32.890 --> 00:00:35.429 just have to talk to somebody, like ask them 00:00:35.429 --> 00:00:37.130 questions that you would want to be asked. If 00:00:37.130 --> 00:00:39.229 you have somebody who is a working mother who 00:00:39.229 --> 00:00:41.750 works two jobs, has three children, giving her 00:00:41.750 --> 00:00:43.369 meds that need to be taken three times a day 00:00:43.369 --> 00:00:45.609 is probably not going to work well for her. Preceptors 00:00:45.609 --> 00:00:48.469 don't expect you to know everything. We expect 00:00:48.469 --> 00:00:50.850 you to be teachable and I expect you to be engaged. 00:00:51.390 --> 00:00:55.130 I want you to be with me. If I get up and walk 00:00:55.130 --> 00:00:57.619 out of my office, you should follow me. Welcome 00:00:57.619 --> 00:01:00.500 to another episode of No Prior Auth. Today we 00:01:00.500 --> 00:01:04.700 have Andrea Kemp back for part two, and we are 00:01:04.700 --> 00:01:07.420 super excited to talk about some really practical 00:01:07.420 --> 00:01:12.739 things for you Psych NP students, such as preceptorship, 00:01:13.060 --> 00:01:16.180 how to find preceptors, how to prepare for clinical, 00:01:16.500 --> 00:01:20.540 how to navigate, you know, tricky patient situations, 00:01:20.799 --> 00:01:25.000 what to look for in that first role. Andrea has 00:01:25.000 --> 00:01:26.959 a lot of real -world experience because she's 00:01:26.959 --> 00:01:29.620 been doing this for 11 years. She's a sun devil 00:01:29.620 --> 00:01:31.859 like I am. We went to the same school, so we've 00:01:31.859 --> 00:01:35.060 known each other for a while. And she runs a 00:01:35.060 --> 00:01:39.180 community for providers who are navigating the 00:01:39.180 --> 00:01:41.900 inpatient psych world. So welcome, Andrea. Thanks 00:01:41.900 --> 00:01:44.140 for coming back. Really excited about this episode. 00:01:44.260 --> 00:01:49.579 And kick us off with just kind of as a psych 00:01:49.579 --> 00:01:53.329 NP student. Where where should they start when 00:01:53.329 --> 00:01:56.329 it comes to, you know, finding clinicals and 00:01:56.329 --> 00:01:58.390 vetting those two? Because some of the rotations 00:01:58.390 --> 00:02:02.870 I'm hearing about are not to quality. Yes. So 00:02:02.870 --> 00:02:05.769 it is hard if you are in a program that does 00:02:05.769 --> 00:02:08.110 not find you preceptors. OK, I know Lindsay and 00:02:08.110 --> 00:02:09.729 I didn't have to worry about that. We could find 00:02:09.729 --> 00:02:11.750 our own if we wanted to. But we were basically 00:02:11.750 --> 00:02:13.949 told this is where you're going. These are your 00:02:13.949 --> 00:02:15.990 hours. This is what you're going to see. If you 00:02:15.990 --> 00:02:18.090 needed to adjust it, you could. But we just went. 00:02:18.250 --> 00:02:21.340 There was no. bartering or anything that happened. 00:02:21.460 --> 00:02:24.020 Looking back, it was great because I had a great 00:02:24.020 --> 00:02:26.699 clinical experiences in school. I got a different 00:02:26.699 --> 00:02:30.099 array all the time. And I felt very prepared 00:02:30.099 --> 00:02:34.340 when it came to work. So my current program does 00:02:34.340 --> 00:02:38.780 not provide preceptors. And that is honestly 00:02:38.780 --> 00:02:42.180 because it has become so hard to find them. It 00:02:42.180 --> 00:02:44.860 has become so hard even for universities to come 00:02:44.860 --> 00:02:46.620 up with those relationships because a lot of 00:02:46.620 --> 00:02:50.150 people are wanting to be paid. for being preceptors. 00:02:50.349 --> 00:02:53.370 That's a pretty big thing. And so I think you 00:02:53.370 --> 00:02:55.930 should take to LinkedIn. I have people send me 00:02:55.930 --> 00:02:59.270 messages on TikTok, on Instagram all the time, 00:02:59.270 --> 00:03:00.830 and a lot of stuff on LinkedIn. A lot of people 00:03:00.830 --> 00:03:03.490 reach out on LinkedIn and you should call big 00:03:03.490 --> 00:03:06.030 clinic areas like in your area. If you know there's 00:03:06.030 --> 00:03:08.569 a big mental health clinic that has multiple 00:03:08.569 --> 00:03:12.189 locations, call hospitals and just ask. It's 00:03:12.189 --> 00:03:14.210 really the only thing you can do and it won't 00:03:14.210 --> 00:03:16.930 hurt. And sometimes you might be like, oh, you 00:03:16.930 --> 00:03:19.449 need to email this person. There might be a clinical 00:03:19.449 --> 00:03:22.689 placement person in human resources. Who should 00:03:22.689 --> 00:03:26.210 students talk to? Call, ask them that. That's 00:03:26.210 --> 00:03:28.150 a big thing. And a lot of times once you get 00:03:28.150 --> 00:03:31.810 in with one, then a preceptor might be like, 00:03:31.889 --> 00:03:34.530 oh, I have a friend who sees all peds, or I have 00:03:34.530 --> 00:03:37.009 a friend that works inpatient. Let me see if 00:03:37.009 --> 00:03:38.770 you can go with them for a little bit of time 00:03:38.770 --> 00:03:41.710 next semester. And I do that with my students. 00:03:42.400 --> 00:03:44.759 precept at least a handful of students every 00:03:44.759 --> 00:03:47.539 semester and then I will reach out to people 00:03:47.539 --> 00:03:50.560 that I know and tell them like hey this person 00:03:50.560 --> 00:03:52.500 needs this type of hours this person needs that 00:03:52.500 --> 00:03:54.719 can they come with you for a little bit and we 00:03:54.719 --> 00:03:58.020 see if we can just make it happen yeah okay gotcha 00:03:58.020 --> 00:04:02.560 so have you ever accepted a student from one 00:04:02.560 --> 00:04:04.879 of these like cold dms or like how do you go 00:04:04.879 --> 00:04:09.099 about choosing what students that you're that 00:04:09.099 --> 00:04:11.930 you would take So right now it's a little bit 00:04:11.930 --> 00:04:14.810 different since I do teach in a program. I take 00:04:14.810 --> 00:04:18.829 my students first. I have taken a couple students 00:04:18.829 --> 00:04:21.629 at other Arizona universities. Also, usually 00:04:21.629 --> 00:04:23.629 that's from a reach out. That's from like a provider 00:04:23.629 --> 00:04:26.209 to provider reach out. And then I will flip it. 00:04:26.269 --> 00:04:28.110 I'll take a student from your program. You take 00:04:28.110 --> 00:04:30.290 a student from my program and we'll do it that 00:04:30.290 --> 00:04:33.209 way. I have not really had the availability to 00:04:33.209 --> 00:04:35.290 take anybody that reaches out. I do explain that 00:04:35.290 --> 00:04:38.970 to them just because I can only take so many. 00:04:39.899 --> 00:04:43.959 To make it worthwhile. Right. Yeah. What do you 00:04:43.959 --> 00:04:48.000 think about charging for clinicals? I don't enjoy 00:04:48.000 --> 00:04:53.259 it at all. I understand why private practice 00:04:53.259 --> 00:04:55.939 people want to do it, but I think that there 00:04:55.939 --> 00:04:57.980 is a fine line between just charging somebody 00:04:57.980 --> 00:05:00.819 to shadow you and charging somebody because you're 00:05:00.819 --> 00:05:02.560 going to take the time out of your scheduled 00:05:02.560 --> 00:05:04.259 patient day to ensure that they're learning. 00:05:04.720 --> 00:05:07.569 And that I think is one of the... biggest issues 00:05:07.569 --> 00:05:10.889 that I see is and students feeling uncomfortable, 00:05:10.949 --> 00:05:12.910 like it's not set up in the beginning what they're 00:05:12.910 --> 00:05:14.910 going to be doing, how they're going to be seeing 00:05:14.910 --> 00:05:17.170 patients. And then a lot of times they're just 00:05:17.170 --> 00:05:20.250 sitting there watching somebody else do the job 00:05:20.250 --> 00:05:22.769 and they're not really learning the job. Is that 00:05:22.769 --> 00:05:25.350 a big stress that you see for the students in 00:05:25.350 --> 00:05:28.069 the program you teach in, like finding their 00:05:28.069 --> 00:05:31.180 rotations? Yeah, and I ask them, like, is this 00:05:31.180 --> 00:05:33.560 what you're doing? And we give our students progressive 00:05:33.560 --> 00:05:36.300 expectations. So you should know what you should 00:05:36.300 --> 00:05:38.699 be working on semester one, semester two, semester 00:05:38.699 --> 00:05:42.279 three. Our clinicals, how we do our clinicals 00:05:42.279 --> 00:05:44.680 is different than what I was used to in our program. 00:05:44.779 --> 00:05:46.819 So ours was everybody does this many hours, this 00:05:46.819 --> 00:05:51.089 many hours, this many hours. How we do it. Everybody 00:05:51.089 --> 00:05:53.470 has a different credit hour. And so some might 00:05:53.470 --> 00:05:55.930 be a first credit hour, but they're all in the 00:05:55.930 --> 00:05:57.829 same clinical cohort. And so they're only doing 00:05:57.829 --> 00:05:59.910 a certain number of hours. Then the next group 00:05:59.910 --> 00:06:02.069 of credits is taking more. And then the final 00:06:02.069 --> 00:06:03.750 group of credits is like getting ready to graduate. 00:06:04.029 --> 00:06:06.610 So they just increase every semester instead 00:06:06.610 --> 00:06:08.949 of having the same set amount of hours every 00:06:08.949 --> 00:06:14.029 semester. And so a lot of times I will check 00:06:14.029 --> 00:06:18.069 in midterm and I'll ask because we do a tele 00:06:18.069 --> 00:06:21.300 -meeting for midterm check -in. Are you guys 00:06:21.300 --> 00:06:23.540 meeting your progressive expectations? Because 00:06:23.540 --> 00:06:26.660 by the end of the semester, we do a sim day where 00:06:26.660 --> 00:06:28.579 they get a simulated patient and they have to 00:06:28.579 --> 00:06:31.680 do a full psyche bell. And so you need to be 00:06:31.680 --> 00:06:33.759 practicing that. I need to make sure that you 00:06:33.759 --> 00:06:39.000 are getting that exposure. And the only way I 00:06:39.000 --> 00:06:42.560 can do that is if I ask you directly. But a lot 00:06:42.560 --> 00:06:45.199 of times, my preceptor doesn't really know how 00:06:45.199 --> 00:06:48.980 to use me. Okay. Well, let's talk about that. 00:06:49.139 --> 00:06:51.120 Is that they don't know how to work you into 00:06:51.120 --> 00:06:53.319 their day? Are they at a big clinic and they 00:06:53.319 --> 00:06:54.980 don't have time built in for students? Can they 00:06:54.980 --> 00:06:57.040 ask for an additional 40 minutes of administration 00:06:57.040 --> 00:06:59.459 time because they are taking a student? Like 00:06:59.459 --> 00:07:02.319 we need to figure out where you can learn because 00:07:02.319 --> 00:07:04.300 sitting there just watching somebody or being 00:07:04.300 --> 00:07:07.000 put in your own office and then just doing like 00:07:07.000 --> 00:07:09.579 easy refills that your preceptor has deemed appropriate 00:07:09.579 --> 00:07:12.360 for a student isn't going to get you where you 00:07:12.360 --> 00:07:17.579 need to be at the end of your program. So what 00:07:17.579 --> 00:07:22.560 do you recommend that psych NP students, like, 00:07:22.560 --> 00:07:26.060 what conversation should they have with their 00:07:26.060 --> 00:07:28.720 preceptors on the front end to kind of get the 00:07:28.720 --> 00:07:32.800 most out of it, hopefully? So I think, and especially 00:07:32.800 --> 00:07:36.060 if you're paying. You cannot be passive. You 00:07:36.060 --> 00:07:38.060 need to ask, what am I going to get out of this 00:07:38.060 --> 00:07:40.620 rotation? What population are you seeing? Can 00:07:40.620 --> 00:07:43.060 you send me before my first day? Do you have 00:07:43.060 --> 00:07:45.180 a note template that you follow that I can learn 00:07:45.180 --> 00:07:47.879 so that I can help you document from day one? 00:07:48.040 --> 00:07:50.519 Like make yourself available, make yourself a 00:07:50.519 --> 00:07:53.980 asset, not a liability. So whatever you can show 00:07:53.980 --> 00:07:56.959 up and do, I'll go get that patient for you. 00:07:57.000 --> 00:07:58.860 I'll take their vitals. I'll bring them into 00:07:58.860 --> 00:08:01.199 the room. I'll walk them out. I'll make sure 00:08:01.199 --> 00:08:03.769 they got that thing you printed. What can you 00:08:03.769 --> 00:08:05.589 take off their plate so maybe they do have a 00:08:05.589 --> 00:08:09.230 little bit of time to walk you through their 00:08:09.230 --> 00:08:12.509 thought process in the moment? And I think that 00:08:12.509 --> 00:08:15.110 that's kind of where students fall short is they 00:08:15.110 --> 00:08:17.209 just kind of show up and they expect their preceptor 00:08:17.209 --> 00:08:19.509 to be like, here's your outline. I have an outline 00:08:19.509 --> 00:08:21.990 for my students. When you show up every day, 00:08:22.149 --> 00:08:24.410 this is what you do. The first day I have them, 00:08:24.509 --> 00:08:26.689 they watch me chart. They're supposed to take 00:08:26.689 --> 00:08:29.410 notes and see where everything is. I give them 00:08:29.410 --> 00:08:33.080 my templates and then we go from there. I don't 00:08:33.080 --> 00:08:35.500 have appointments, so it is easier to build in 00:08:35.500 --> 00:08:38.460 my teaching during the day because I'm in a hospital 00:08:38.460 --> 00:08:41.820 setting. But there are things that you can ask 00:08:41.820 --> 00:08:44.620 for ahead of time to prep. And then you should 00:08:44.620 --> 00:08:47.080 be asking during the day. Like you need to show 00:08:47.080 --> 00:08:49.360 up with a notebook. Don't show up with your iPad. 00:08:49.840 --> 00:08:51.980 Throw that thing out the window. Show up with 00:08:51.980 --> 00:08:54.240 a notebook so you can take notes. Write down 00:08:54.240 --> 00:08:56.139 your questions. And at the end of the day, ask 00:08:56.139 --> 00:08:58.899 three of them. Ask three of those questions. 00:08:59.000 --> 00:09:00.919 The rest of them, look them up before your next 00:09:00.919 --> 00:09:03.990 clinical day. That's what I want you to do. I 00:09:03.990 --> 00:09:07.629 want curiosity. Curiosity over confidence every 00:09:07.629 --> 00:09:11.970 single day as a student. So do you think Psych 00:09:11.970 --> 00:09:16.990 NP students should be on social media platforms, 00:09:17.450 --> 00:09:22.049 on LinkedIn? And if so, how do you think that 00:09:22.049 --> 00:09:25.769 they should leverage those to network or connect 00:09:25.769 --> 00:09:29.049 with potential preceptors? Any guidance on what 00:09:29.049 --> 00:09:32.289 message to send? If they're going to cold DM 00:09:32.289 --> 00:09:35.009 somebody. Yeah. So LinkedIn, I think for sure. 00:09:35.090 --> 00:09:38.950 I think you can build your LinkedIn network whenever 00:09:38.950 --> 00:09:40.950 you want in your career. I think that that's 00:09:40.950 --> 00:09:43.909 important. Or at least know where to look or 00:09:43.909 --> 00:09:47.409 what you're watching for. Social media, I think, 00:09:47.409 --> 00:09:51.299 can be difficult. Because it depends on what, 00:09:51.340 --> 00:09:54.799 if you are posting, you know, big companies are 00:09:54.799 --> 00:09:57.000 going to look at that. Individual preceptors 00:09:57.000 --> 00:09:58.320 might look at that. There might be a little bit 00:09:58.320 --> 00:10:00.179 of a concern. Are you going to show too much? 00:10:00.179 --> 00:10:03.379 Are you going to be responsible? And so I would 00:10:03.379 --> 00:10:07.980 just remember that we are a profession. tend 00:10:07.980 --> 00:10:10.240 to forget it. Nursing is intriguing to a lot 00:10:10.240 --> 00:10:11.899 of people. We see people at the best and the 00:10:11.899 --> 00:10:13.759 worst moments of their life, bedside nursing 00:10:13.759 --> 00:10:16.419 provider, it doesn't matter. And so I think a 00:10:16.419 --> 00:10:18.139 lot of people, there's interest in seeing it 00:10:18.139 --> 00:10:20.320 and people want to show it, but we are still 00:10:20.320 --> 00:10:23.379 a profession no matter what anybody wants to 00:10:23.379 --> 00:10:25.919 talk about. nowadays. But we are a profession. 00:10:26.100 --> 00:10:28.179 You need to be professional. And you are a student. 00:10:28.240 --> 00:10:30.139 You are representing your university. And most 00:10:30.139 --> 00:10:32.080 of all, you're representing yourself. However 00:10:32.080 --> 00:10:34.059 you put yourself out there now is how people 00:10:34.059 --> 00:10:36.799 are going to remember you. And if you can make 00:10:36.799 --> 00:10:39.960 yourself a valuable student to your preceptor, 00:10:40.019 --> 00:10:42.259 those are the preceptors who are going to reach 00:10:42.259 --> 00:10:44.720 out to you when their clinic is hiring and say, 00:10:44.820 --> 00:10:47.159 hey, you're getting ready to graduate. We're 00:10:47.159 --> 00:10:49.460 hiring. They're also the ones that write letters 00:10:49.460 --> 00:10:52.179 of recommendation and keep you in mind. And so 00:10:52.179 --> 00:10:57.720 you want to be A shining star. Yeah, 100%, 100%. 00:10:57.720 --> 00:11:00.500 So what should somebody say if they're going 00:11:00.500 --> 00:11:03.500 to DM somebody on LinkedIn, let's say? I think 00:11:03.500 --> 00:11:05.360 you should start with who you are, where you 00:11:05.360 --> 00:11:08.340 go to school. and what exactly you're looking 00:11:08.340 --> 00:11:11.139 for so that that person knows if they can even 00:11:11.139 --> 00:11:13.139 not, do I have the availability? Do I actually 00:11:13.139 --> 00:11:15.820 have the hours that this person needs? Because 00:11:15.820 --> 00:11:18.539 if you're, if they're like, I need 250 clinical 00:11:18.539 --> 00:11:20.960 hours and that person might see peds, but if 00:11:20.960 --> 00:11:23.120 they're like, I have a lot of, you know, vacation 00:11:23.120 --> 00:11:24.740 this semester, I'm going to some conferences. 00:11:25.100 --> 00:11:26.539 I don't think I'm going to be able to get you 00:11:26.539 --> 00:11:28.360 all those peds hours so that you're just not 00:11:28.360 --> 00:11:30.740 wasting a back and forth time. I think you should 00:11:30.740 --> 00:11:32.620 be upfront with what you need, your availability. 00:11:33.610 --> 00:11:36.370 All that stuff. Just so that it's the easiest 00:11:36.370 --> 00:11:38.149 for a person to look at it and just respond, 00:11:38.389 --> 00:11:41.169 yes, I'll take more information. No, I won't. 00:11:41.190 --> 00:11:44.409 I won't have the time to do that. And I just 00:11:44.409 --> 00:11:46.470 think that gets you everything right up front. 00:11:46.570 --> 00:11:48.570 As much information as you can provide without 00:11:48.570 --> 00:11:52.649 being redundant. Yeah, right. What should Psych 00:11:52.649 --> 00:11:54.950 NP students bring to like day one of clinical 00:11:54.950 --> 00:11:59.629 or any tips for how they should prepare or like 00:11:59.629 --> 00:12:02.730 stuff they should brush up on before they? So 00:12:02.730 --> 00:12:05.330 I think you should be able to do a mental status 00:12:05.330 --> 00:12:08.370 exam cold. Like you need to know every part of 00:12:08.370 --> 00:12:10.169 a mental status exam and be able to do a good 00:12:10.169 --> 00:12:12.909 safety risk assessment. OK, everything else you 00:12:12.909 --> 00:12:15.169 can talk through. Everything else is a general 00:12:15.169 --> 00:12:17.990 nursing knowledge at that point. You're not prescribing 00:12:17.990 --> 00:12:20.679 your first day. at clinicals, you are talking 00:12:20.679 --> 00:12:23.600 to somebody, okay? Your didactic courses teach 00:12:23.600 --> 00:12:26.460 you how to be a provider, how to prescribe meds. 00:12:26.460 --> 00:12:28.139 Your clinicals teach you how to be in a room 00:12:28.139 --> 00:12:30.879 with a human. And those skills are very different. 00:12:30.940 --> 00:12:32.820 And that's where people lose it. They get so 00:12:32.820 --> 00:12:36.080 focused on, I need the correct diagnosis right 00:12:36.080 --> 00:12:38.539 this moment and pick the exact perfect medication. 00:12:38.799 --> 00:12:42.200 And that is not how this career goes. It just 00:12:42.200 --> 00:12:45.350 isn't. be able to do a good mental status exam, 00:12:45.429 --> 00:12:49.490 practice. In our clinicals, we have three times 00:12:49.490 --> 00:12:51.669 a semester where students write them up on a 00:12:51.669 --> 00:12:54.649 TV or a movie character. So we give a list of 00:12:54.649 --> 00:12:57.049 movies or television shows. They write it. They 00:12:57.049 --> 00:12:59.070 pick a character, you know, A Beautiful Mind, 00:12:59.330 --> 00:13:01.590 What About Bob, all those movies that are like 00:13:01.590 --> 00:13:05.720 hallmarks. Practice writing and dictating a mental 00:13:05.720 --> 00:13:08.600 status exam. It's important. It's also how you're 00:13:08.600 --> 00:13:11.240 going to like show your preceptor that you understand 00:13:11.240 --> 00:13:15.559 how that patient is presenting. And then top 00:13:15.559 --> 00:13:18.700 10 to 15 meds, starting dose, scary side effect, 00:13:18.820 --> 00:13:21.679 patient education. You don't need to know 200 00:13:21.679 --> 00:13:25.000 medications immediately. And like I said, safety 00:13:25.000 --> 00:13:27.460 screening. If you can get a note template or 00:13:27.460 --> 00:13:31.039 at least know how the notes are written. I don't 00:13:31.039 --> 00:13:33.259 think it's super important to be able to tell 00:13:33.259 --> 00:13:35.279 me at the beginning of your clinical rotation 00:13:35.279 --> 00:13:39.419 every single symptom of every single disorder. 00:13:40.580 --> 00:13:42.919 To me, those students are just trying to look 00:13:42.919 --> 00:13:45.179 really impressive, but it doesn't show me that 00:13:45.179 --> 00:13:47.860 you can take the information and learn. I want 00:13:47.860 --> 00:13:49.779 to know that you're teachable and that you're 00:13:49.779 --> 00:13:52.960 there to learn at the moment. I don't need you 00:13:52.960 --> 00:13:55.740 to know everything. And I think it's also important 00:13:55.740 --> 00:13:59.639 to know that you're not pretending to be a provider. 00:14:00.240 --> 00:14:03.700 you are a learner with rn knowledge and insights 00:14:03.700 --> 00:14:07.700 and so you need to know what can transfer what 00:14:07.700 --> 00:14:09.700 do i already know what am i already good at as 00:14:09.700 --> 00:14:13.039 a nurse that are assets to being in a provider 00:14:13.039 --> 00:14:15.799 role and then you start filling in the rest as 00:14:15.799 --> 00:14:20.259 you learn so i think that that's kind of the 00:14:20.259 --> 00:14:22.139 biggest thing and i think people forget you're 00:14:22.139 --> 00:14:27.009 just talking yeah i forgot I'll never forget 00:14:27.009 --> 00:14:30.570 being with the SMI population and my preceptor. 00:14:30.570 --> 00:14:33.490 Like I was so worried about asking the right 00:14:33.490 --> 00:14:36.830 questions and gleaning the right clinical information 00:14:36.830 --> 00:14:40.830 that like I was making it awkward. And I literally 00:14:40.830 --> 00:14:42.850 remember my preceptor being like, in this next 00:14:42.850 --> 00:14:45.230 appointment, can you just try to make conversation 00:14:45.230 --> 00:14:48.970 with the client? Like just try to make the client 00:14:48.970 --> 00:14:51.210 feel comfortable and just make conversation. 00:14:52.039 --> 00:14:54.220 And I was like, yes, sure. And it's the biggest 00:14:54.220 --> 00:14:55.759 thing that I see with students because I said 00:14:55.759 --> 00:14:59.139 they do simulated psyche vows on actors at the 00:14:59.139 --> 00:15:01.340 end of every semester. And we either sit in the 00:15:01.340 --> 00:15:03.740 room or we watch them later on. And sometimes 00:15:03.740 --> 00:15:09.120 I'm like, just talk like just ask a normal question. 00:15:09.399 --> 00:15:11.960 I tell my students, I want you to act like you're 00:15:11.960 --> 00:15:15.240 at brunch with your bestie who's got good stuff 00:15:15.240 --> 00:15:18.000 to tell you. And you want to know every detail 00:15:18.000 --> 00:15:21.470 about that stuff like. Just ask the question. 00:15:21.850 --> 00:15:23.970 And I think sometimes students get uncomfortable. 00:15:24.529 --> 00:15:28.190 And I'm like, I don't think you get more uncomfortable 00:15:28.190 --> 00:15:29.850 than asking someone if they want to end their 00:15:29.850 --> 00:15:32.389 life. And so if you can ask somebody, do you 00:15:32.389 --> 00:15:35.289 want to die? Do you want to harm yourself? You 00:15:35.289 --> 00:15:37.350 should be able to ask any other question. There's 00:15:37.350 --> 00:15:39.809 really nothing more personal than asking somebody 00:15:39.809 --> 00:15:42.730 if they no longer want to be here. And so once 00:15:42.730 --> 00:15:45.149 you can ask that question from an empathetic 00:15:45.149 --> 00:15:47.980 perspective, you can ask. How many sexual partners 00:15:47.980 --> 00:15:51.019 do you have? OK, because a big part of our life 00:15:51.019 --> 00:15:53.340 of our job is health promotion. As much as I'm 00:15:53.340 --> 00:15:55.259 going to prescribe meds, I need to educate you 00:15:55.259 --> 00:15:58.600 on things. Are you sexually active? How old is 00:15:58.600 --> 00:16:00.100 this patient? Do we need to be talking about 00:16:00.100 --> 00:16:02.940 pregnancy prevention, STD prevention, all of 00:16:02.940 --> 00:16:05.659 these things? And students like to skip those 00:16:05.659 --> 00:16:08.460 questions because they don't think it's going 00:16:08.460 --> 00:16:10.259 to give them the clinical information they need 00:16:10.259 --> 00:16:12.000 to get to that diagnosis or to pick the right 00:16:12.000 --> 00:16:16.259 med. And that's inappropriate. Your job is an 00:16:16.259 --> 00:16:18.899 entire picture. And so you just have to talk 00:16:18.899 --> 00:16:21.419 to somebody, like ask them questions that you 00:16:21.419 --> 00:16:23.340 would want to be asked. If I was sitting here 00:16:23.340 --> 00:16:26.460 and I was depressed, I was feeling very uncomfortable. 00:16:26.500 --> 00:16:28.399 I was feeling very sad and very anxious. I have 00:16:28.399 --> 00:16:30.200 these like things going on. What would I want 00:16:30.200 --> 00:16:32.960 somebody to ask me? And then ask them, is there 00:16:32.960 --> 00:16:35.720 anything that I haven't asked you that you think 00:16:35.720 --> 00:16:38.220 is important that you were thinking I was going 00:16:38.220 --> 00:16:40.580 to ask you? Because patients play these appointments 00:16:40.580 --> 00:16:43.480 in their heads. They are wondering what they're 00:16:43.480 --> 00:16:45.080 going to be asked or how it's going to go, especially 00:16:45.080 --> 00:16:47.259 if they've never done one before. So is there 00:16:47.259 --> 00:16:49.360 something that you thought I was going to ask 00:16:49.360 --> 00:16:51.759 you that I haven't asked will sometimes get you 00:16:51.759 --> 00:16:55.200 really good information? Yeah, that's a great 00:16:55.200 --> 00:16:58.559 point. That's a question that I think more psych 00:16:58.559 --> 00:17:06.339 NPs need to start asking for sure. Yeah. What 00:17:06.339 --> 00:17:10.019 do you recommend as far as psych NPs trying to 00:17:10.019 --> 00:17:14.049 learn? how to provide like psychoeducation and 00:17:14.049 --> 00:17:18.789 like any tips on how they should practice that 00:17:18.789 --> 00:17:20.650 or learn that skill? Because I think that that 00:17:20.650 --> 00:17:23.049 one is kind of ambiguous. It feels ambiguous. 00:17:23.589 --> 00:17:25.769 It is. And I think that if there are certain 00:17:25.769 --> 00:17:29.839 things that you want to explain. I think it's 00:17:29.839 --> 00:17:31.559 easiest to explain things like you're trying 00:17:31.559 --> 00:17:34.099 to explain them to somebody in just layman's 00:17:34.099 --> 00:17:38.539 terms. You don't want to use huge words. It just 00:17:38.539 --> 00:17:40.480 doesn't work. And a lot of times patients will 00:17:40.480 --> 00:17:42.440 feel like they're being spoken down to if you 00:17:42.440 --> 00:17:45.180 start using big medical terms. I talk to people, 00:17:45.319 --> 00:17:47.299 like I said, like I'm talking to my best friend 00:17:47.299 --> 00:17:49.980 or like I'm talking to my child. How would I 00:17:49.980 --> 00:17:52.799 get my child, who's even my adult children, how 00:17:52.799 --> 00:17:59.319 would I get them to listen to me? doesn't feel 00:17:59.319 --> 00:18:03.279 demeaning or like I'm putting myself above them? 00:18:03.759 --> 00:18:07.200 And what do they really need to know? And that 00:18:07.200 --> 00:18:09.380 goes also along with like when you're choosing 00:18:09.380 --> 00:18:13.980 medications. I'm a big person on structure, okay? 00:18:14.720 --> 00:18:17.539 Even if you get stuck with like a hard patient, 00:18:17.700 --> 00:18:21.799 you go with what brought you in, how long, what 00:18:21.799 --> 00:18:24.920 changed, what has helped before, and are you 00:18:24.920 --> 00:18:27.720 safe? If you get those five questions answered, 00:18:28.440 --> 00:18:30.299 you can just talk for the rest of the appointment 00:18:30.299 --> 00:18:33.960 okay silence is a tool a lot of people freak 00:18:33.960 --> 00:18:37.359 out about it all right just count before you 00:18:37.359 --> 00:18:39.440 rescue because right before you get ready to 00:18:39.440 --> 00:18:41.079 talk again that patient's probably going to say 00:18:41.079 --> 00:18:44.680 something because they just need a moment you're 00:18:44.680 --> 00:18:46.819 asking them so many questions in a psyche valve 00:18:46.819 --> 00:18:50.150 right about everything medical family Have you 00:18:50.150 --> 00:18:51.890 wanted to kill yourself? How are you sleeping? 00:18:52.190 --> 00:18:55.109 Are you using drugs? All of these things. And 00:18:55.109 --> 00:18:56.950 then you're just bombarding them with stuff. 00:18:57.049 --> 00:18:58.730 And our brains just need a moment to catch up 00:18:58.730 --> 00:19:02.890 sometimes. And your job is to make somebody feel 00:19:02.890 --> 00:19:05.630 safe, feel heard, and to not make it worse. So 00:19:05.630 --> 00:19:07.430 if you can answer those questions and get through 00:19:07.430 --> 00:19:10.829 that, you'll be good. Slow your pace. Slow. Narrate 00:19:10.829 --> 00:19:12.349 what you're doing. I'm going to ask you these 00:19:12.349 --> 00:19:14.670 questions now. This is why I'm asking, especially 00:19:14.670 --> 00:19:17.130 about trauma. If you're asking about trauma, 00:19:17.309 --> 00:19:20.019 sexual abuse, anything like that, This is why 00:19:20.019 --> 00:19:23.480 I'm asking it. There's a big thing right now 00:19:23.480 --> 00:19:28.839 where sometimes we tell people, if you don't 00:19:28.839 --> 00:19:30.420 feel comfortable answering this question, it's 00:19:30.420 --> 00:19:32.839 okay to not answer it. I don't tell patients 00:19:32.839 --> 00:19:35.619 that. I wait until I pick up on them feeling 00:19:35.619 --> 00:19:38.079 uncomfortable and then I'll ask, seems like you're 00:19:38.079 --> 00:19:39.619 uncomfortable with this line of questions. Could 00:19:39.619 --> 00:19:43.180 you tell me why? Because I feel like you're shutting 00:19:43.180 --> 00:19:44.940 down. You're almost kind of telling them like, 00:19:45.000 --> 00:19:48.160 I don't want to hear that. Like if you don't 00:19:48.160 --> 00:19:50.500 feel comfortable saying it, It can be taken in 00:19:50.500 --> 00:19:52.799 a different way, especially if they have a significant 00:19:52.799 --> 00:19:54.619 thing that they maybe have never told anybody 00:19:54.619 --> 00:19:56.960 and you're telling them it's okay to still not 00:19:56.960 --> 00:20:00.680 tell somebody, but it's not. If it's a big issue 00:20:00.680 --> 00:20:04.000 is why you're here, I need you to tell me. And 00:20:04.000 --> 00:20:06.119 so I would rather start asking questions and 00:20:06.119 --> 00:20:08.480 I trust my instincts to pick up on that they're 00:20:08.480 --> 00:20:11.720 either hesitating to answer or now their answers 00:20:11.720 --> 00:20:15.720 are very short and they're not elaborating like 00:20:15.720 --> 00:20:17.700 they were on other questions for me to be able 00:20:17.700 --> 00:20:22.690 to probe. And then when it comes to meds, you 00:20:22.690 --> 00:20:25.609 don't need to panic. Okay. There are a lot of 00:20:25.609 --> 00:20:28.609 psychiatric meds. Okay. And everyone's like freaks 00:20:28.609 --> 00:20:31.470 out. But you need to know like a few things. 00:20:31.569 --> 00:20:33.549 So you need to know what your target symptom 00:20:33.549 --> 00:20:35.930 is. Number one, that gets you to the book. That 00:20:35.930 --> 00:20:37.450 gets you to the chapter of the book with your 00:20:37.450 --> 00:20:41.269 meds. Right. And then you need to know, am I 00:20:41.269 --> 00:20:43.190 going to prescribe this in a way like what has 00:20:43.190 --> 00:20:46.289 worked or failed? Okay. So this is my target 00:20:46.289 --> 00:20:48.049 system. What has worked or failed already? You're 00:20:48.049 --> 00:20:50.789 going to weed some out. OK, what can this patient 00:20:50.789 --> 00:20:53.849 tolerate? Not only what can their body tolerate, 00:20:54.009 --> 00:20:57.009 kidney, liver dysfunction, stuff like that. What 00:20:57.009 --> 00:20:58.670 can they financially tolerate? What is their 00:20:58.670 --> 00:21:01.269 insurance going to cover? OK, and then what can 00:21:01.269 --> 00:21:03.549 their schedule tolerate? If you have somebody 00:21:03.549 --> 00:21:06.150 who is a working mother who works two jobs, has 00:21:06.150 --> 00:21:08.289 three children, giving her meds that need to 00:21:08.289 --> 00:21:09.990 be taken three times a day is probably not going 00:21:09.990 --> 00:21:13.299 to work well for her. Okay. If you have somebody 00:21:13.299 --> 00:21:15.160 who's at home all day, sure. Why not? I mean, 00:21:15.180 --> 00:21:17.319 it might be better, but you need to know what 00:21:17.319 --> 00:21:19.220 can this person tolerate. And that's going to 00:21:19.220 --> 00:21:22.200 take your group of 200 meds down to like five. 00:21:22.640 --> 00:21:25.240 And then you can offer, you know, this one might 00:21:25.240 --> 00:21:26.880 have more weight gain. Patient's very worried 00:21:26.880 --> 00:21:28.160 about that. We're not going to do that. This 00:21:28.160 --> 00:21:30.359 one could stunt appetite. They already don't 00:21:30.359 --> 00:21:33.039 eat a lot. We don't want to do that. So that 00:21:33.039 --> 00:21:34.720 gets you where you need to be, but people freak 00:21:34.720 --> 00:21:38.759 out. About mix. Yeah, for sure. That reminds 00:21:38.759 --> 00:21:41.380 me of kind of like I'm hearing, of course, there's 00:21:41.380 --> 00:21:43.000 just polarization everywhere on the Internet. 00:21:43.160 --> 00:21:47.279 But I hear about like on one end of the spectrum, 00:21:47.440 --> 00:21:50.259 like you really kind of need to like use your 00:21:50.259 --> 00:21:53.799 used car salesman techniques to like. get people 00:21:53.799 --> 00:21:56.119 on these meds to the other end of the spectrum 00:21:56.119 --> 00:21:59.740 where it's like, you know, it's their choice 00:21:59.740 --> 00:22:02.579 and just be, don't be too whatever about it. 00:22:02.640 --> 00:22:04.259 Like, what's your approach and line of thinking 00:22:04.259 --> 00:22:07.299 in that when you are presenting medication options? 00:22:08.720 --> 00:22:10.859 So I think I had a different approach depending 00:22:10.859 --> 00:22:13.799 on inpatient versus outpatient. Outpatient, if 00:22:13.799 --> 00:22:15.940 you're not an acute safety risk, it is obviously 00:22:15.940 --> 00:22:18.759 100 % your choice most of the time, whether you 00:22:18.759 --> 00:22:22.259 take psychiatric medications. So I was more of 00:22:22.259 --> 00:22:24.720 a proponent when I, I think the biggest issue 00:22:24.720 --> 00:22:27.220 for me is when I saw kids whose parents did not 00:22:27.220 --> 00:22:29.019 want to medicate for things that could have made 00:22:29.019 --> 00:22:32.380 their children's lives a lot easier. And then 00:22:32.380 --> 00:22:35.180 we're waiting and waiting and waiting. And there's 00:22:35.180 --> 00:22:36.680 behavior issues. Kids are getting suspended. 00:22:36.859 --> 00:22:39.619 They're failing. They're being held back. And 00:22:39.619 --> 00:22:41.920 I'm like, let's talk about this a little more 00:22:41.920 --> 00:22:45.539 upfront now, because what we're doing is not 00:22:45.539 --> 00:22:48.809 working. I'm not going to trick anybody into 00:22:48.809 --> 00:22:50.470 taking meds. I'm not going to make a med sound 00:22:50.470 --> 00:22:52.450 better than it is. I'm not going to hide a side 00:22:52.450 --> 00:22:54.349 effect that I know you're potentially going to 00:22:54.349 --> 00:22:59.150 get. I think that you have to go in 100 % willingly 00:22:59.150 --> 00:23:02.170 because the second that I give you a med that 00:23:02.170 --> 00:23:03.730 gives you a horrible side effect that I didn't 00:23:03.730 --> 00:23:07.210 tell you about, you don't trust me anymore. And 00:23:07.210 --> 00:23:10.089 as much as I want to make you feel better, I 00:23:10.089 --> 00:23:12.529 want to help you feel better, I need you to come 00:23:12.529 --> 00:23:15.279 back to me. And I think that that's where you 00:23:15.279 --> 00:23:16.980 get a lot of people who start and stop psychiatric 00:23:16.980 --> 00:23:20.960 treatment because they start. It's going well. 00:23:21.059 --> 00:23:23.400 They take a med. It doesn't help them. They don't 00:23:23.400 --> 00:23:25.299 know why. No one's told them why it's not helping. 00:23:25.539 --> 00:23:27.160 Sometimes we don't know, but they've been given 00:23:27.160 --> 00:23:30.359 no education on it. They've had bad side effects. 00:23:30.440 --> 00:23:32.059 No one's listening. They're just increasing doses. 00:23:32.299 --> 00:23:34.420 So they stop. And then a couple of years later, 00:23:34.539 --> 00:23:37.019 it's bad again. They find another provider. The 00:23:37.019 --> 00:23:40.640 same thing happens. So I don't promise anything 00:23:40.640 --> 00:23:42.849 that I don't know is going to happen. I tell 00:23:42.849 --> 00:23:45.329 you what could potentially happen. And then I 00:23:45.329 --> 00:23:47.710 offer, this is what we're going to do about those 00:23:47.710 --> 00:23:51.470 things if they occur. And then give me time to 00:23:51.470 --> 00:23:53.910 fix it. Because there are things that I don't 00:23:53.910 --> 00:23:56.869 know. Everybody is different. Prescribing in 00:23:56.869 --> 00:24:00.069 psychiatry is an art. It is not always a science. 00:24:00.250 --> 00:24:02.369 While, like I said, target symptoms get us to 00:24:02.369 --> 00:24:05.210 certain meds, everybody's body is different. 00:24:05.470 --> 00:24:08.390 And so you have to wait and you have to see what's 00:24:08.390 --> 00:24:10.630 still going to be there and what's not. And I 00:24:10.630 --> 00:24:13.630 just don't. ever want to have a patient feel 00:24:13.630 --> 00:24:17.130 like I tricked them into taking something. Yeah, 00:24:17.210 --> 00:24:20.890 no, 100%, 100%. I think another like good angle 00:24:20.890 --> 00:24:26.269 is telling somebody, you know, if this was my 00:24:26.269 --> 00:24:30.269 family or best friend, this is the treatment 00:24:30.269 --> 00:24:32.029 I would want them to have. And this is why. And 00:24:32.029 --> 00:24:33.670 being able to kind of explain that objectively, 00:24:33.809 --> 00:24:36.910 I think can, you know, they can hear that conviction 00:24:36.910 --> 00:24:41.119 in your voice. Yes. Yes. And I think it's important 00:24:41.119 --> 00:24:43.220 to show people sometimes, especially if they 00:24:43.220 --> 00:24:45.539 are patients who come on and off meds a lot, 00:24:45.619 --> 00:24:48.279 or they want to lower doses too quickly after 00:24:48.279 --> 00:24:50.859 they've stabilized, it's good to show them a 00:24:50.859 --> 00:24:53.359 before and after. Like, we're going to go back. 00:24:53.359 --> 00:24:55.140 I'm going to read you my note from a year ago, 00:24:55.299 --> 00:24:57.539 okay? And I'm going to tell you how you presented 00:24:57.539 --> 00:24:59.299 to me a year ago, and I'm going to read what 00:24:59.299 --> 00:25:01.920 I wrote today. And you're telling me you don't 00:25:01.920 --> 00:25:04.130 want to be on meds anymore, but... Let's just 00:25:04.130 --> 00:25:06.769 look at what we could potentially lose. You've 00:25:06.769 --> 00:25:09.250 had a job promotion since then. Your marriage 00:25:09.250 --> 00:25:10.829 is in the best spot it's been. You're getting 00:25:10.829 --> 00:25:13.990 along with your children. Same thing with kids 00:25:13.990 --> 00:25:15.869 who decide that if they get to high school, they 00:25:15.869 --> 00:25:18.309 don't want to take meds anymore. They don't want 00:25:18.309 --> 00:25:20.990 to take ADHD meds anymore. And I'm like, we can 00:25:20.990 --> 00:25:22.849 do it for a very short amount of time, but I 00:25:22.849 --> 00:25:25.369 want to see you in a month because a month behind 00:25:25.369 --> 00:25:29.589 in school is hard to make up. So I'm a big proponent 00:25:29.589 --> 00:25:33.289 of you can try. It's your life. But I also want 00:25:33.289 --> 00:25:35.029 you to know these are the things that if they 00:25:35.029 --> 00:25:37.250 come up, I need you back. I need you back here. 00:25:37.849 --> 00:25:42.130 Yeah. Yeah. Do that kind of like. Yeah, that's 00:25:42.130 --> 00:25:45.410 that's really important. What else? It just saves 00:25:45.410 --> 00:25:47.170 you from a follow up. It saves you from three 00:25:47.170 --> 00:25:48.390 months down the line where they're like, well, 00:25:48.450 --> 00:25:51.390 my life's been going horribly. Yeah. I'm like, 00:25:51.410 --> 00:25:53.569 well, remember we talked about those things that 00:25:53.569 --> 00:25:54.990 you were supposed to if they occurred, you were 00:25:54.990 --> 00:25:58.059 supposed to come back. Yeah. Yeah, I know that 00:25:58.059 --> 00:25:59.539 some of those things I had to learn the hard 00:25:59.539 --> 00:26:01.660 way with like getting the phone calls and getting 00:26:01.660 --> 00:26:03.740 the follow up appointments and then being like, 00:26:03.839 --> 00:26:07.460 oh, I need to like really kind of reiterate and 00:26:07.460 --> 00:26:10.440 be more clear with this person. Yeah. And those 00:26:10.440 --> 00:26:12.980 are things that you learn with practice. Yeah. 00:26:13.079 --> 00:26:17.119 About the risk benefit. What else that I haven't 00:26:17.119 --> 00:26:21.380 asked you, would you want to tell psych NPE students? 00:26:21.900 --> 00:26:27.680 So I think it's important to remember that. Preceptors 00:26:27.680 --> 00:26:30.579 don't expect you to know everything. Like I said 00:26:30.579 --> 00:26:33.339 before, we expect you to be teachable and I expect 00:26:33.339 --> 00:26:37.299 you to be engaged. I want you to be with me. 00:26:37.380 --> 00:26:39.819 If I get up and walk out of my office, you should 00:26:39.819 --> 00:26:41.740 follow me, whether I tell you to follow me or 00:26:41.740 --> 00:26:45.700 not. Don't sit there and just expect. And I want 00:26:45.700 --> 00:26:47.779 you to ask questions that show me that you're 00:26:47.779 --> 00:26:49.700 trying to learn when you're not even with me. 00:26:50.039 --> 00:26:51.940 So if you're going to be with your preceptor 00:26:51.940 --> 00:26:54.819 on like Tuesday and Thursday. You're there Tuesday. 00:26:55.220 --> 00:26:57.500 You've seen some hard patients, things that you 00:26:57.500 --> 00:26:59.779 wanted to look up. When you come back on Thursday, 00:27:00.000 --> 00:27:03.099 I realize you did this for this reason or ask 00:27:03.099 --> 00:27:04.940 questions. Or I'm thinking with that patient 00:27:04.940 --> 00:27:08.200 we saw earlier, I'm thinking A, because of B, 00:27:08.339 --> 00:27:10.960 am I on the right track? Not just how am I doing? 00:27:11.680 --> 00:27:14.460 You're going to get a very perfunctory answer. 00:27:14.900 --> 00:27:18.279 So I would ask specific questions. Like I said, 00:27:18.299 --> 00:27:20.380 try to make yourself valuable. Clinicals are 00:27:20.380 --> 00:27:24.660 stressful. And depending on where you are, they 00:27:24.660 --> 00:27:27.839 could be good and they could be bad. But they 00:27:27.839 --> 00:27:29.180 will teach you something. They're either going 00:27:29.180 --> 00:27:31.380 to teach you what to do or what not to do. And 00:27:31.380 --> 00:27:34.099 that's okay. All of it's a learning experience. 00:27:34.339 --> 00:27:36.740 And I think it's important depending on the type 00:27:36.740 --> 00:27:39.500 of state. So we obviously are in a full practice 00:27:39.500 --> 00:27:42.900 state. And that is why in clinicals, they had 00:27:42.900 --> 00:27:48.019 us do everything, right? Peds, adults, and inpatient 00:27:48.019 --> 00:27:51.079 and outpatient. Really, you need to do anything 00:27:51.079 --> 00:27:52.380 that you're going to want to do in practice. 00:27:52.599 --> 00:27:54.200 If it's already something that's in practice, 00:27:54.319 --> 00:27:56.519 you need to do it in school. If new technology 00:27:56.519 --> 00:27:58.519 and new treatments come out while you're already 00:27:58.519 --> 00:28:00.519 a nurse practitioner, there is more on -the -job 00:28:00.519 --> 00:28:02.859 training or CMEs that you can do. But if there 00:28:02.859 --> 00:28:06.619 is something that you want to do or an area that 00:28:06.619 --> 00:28:08.500 you want to work in, you have got to do it in 00:28:08.500 --> 00:28:10.400 school because you need didactic and you need 00:28:10.400 --> 00:28:12.220 clinical hours. Because if you were to ever get 00:28:12.220 --> 00:28:14.099 called in front of the board, that's what they're 00:28:14.099 --> 00:28:15.500 going to ask you. They're going to ask you how 00:28:15.500 --> 00:28:19.889 you learned to manage that type of patient. and 00:28:19.889 --> 00:28:23.529 I got a job is not a reason. That's not how you 00:28:23.529 --> 00:28:26.730 learn. So you need to be able to look at all 00:28:26.730 --> 00:28:28.549 of the, all the potential clinical sites that 00:28:28.549 --> 00:28:31.410 you can go to and you need to find every different 00:28:31.410 --> 00:28:34.150 one that you think will help you. Yeah. Yeah. 00:28:34.690 --> 00:28:38.049 And, and you have a friend who works at the state 00:28:38.049 --> 00:28:42.769 board, right? Yes. And you also let you do some 00:28:42.769 --> 00:28:46.380 like work, right? For the board. I have written 00:28:46.380 --> 00:28:51.440 scope of practice statements on certain board 00:28:51.440 --> 00:28:54.960 complaints. So the board will reach out. If there 00:28:54.960 --> 00:28:56.759 is a significant complaint, the board will reach 00:28:56.759 --> 00:28:59.299 out. And this is for any specialty. They'll reach 00:28:59.299 --> 00:29:01.319 out to somebody in that specialty working in 00:29:01.319 --> 00:29:04.019 the same similar setting, and they will ask, 00:29:04.119 --> 00:29:07.170 is this reasonable? It is what this provider 00:29:07.170 --> 00:29:09.410 did because not everybody is a psych MP. Not 00:29:09.410 --> 00:29:11.490 everybody has the same. So they reach out without 00:29:11.490 --> 00:29:14.009 making just a blanket assumption that it's wrong. 00:29:15.009 --> 00:29:17.170 They will reach out and say, hey, is this OK 00:29:17.170 --> 00:29:21.049 or was this not? And then they will get an opinion 00:29:21.049 --> 00:29:23.289 on it that goes through the whole process of 00:29:23.289 --> 00:29:25.130 it. There's a board complaint and then any type 00:29:25.130 --> 00:29:29.329 of remediation that goes with that. Yeah, because 00:29:29.329 --> 00:29:32.529 I know that as nurses and nurse practitioners, 00:29:32.650 --> 00:29:36.839 there's a lot of just like fear. about safety 00:29:36.839 --> 00:29:41.359 and losing our license, you know? I think that 00:29:41.359 --> 00:29:44.700 that's because nurse practitioner, like I do 00:29:44.700 --> 00:29:47.779 think it's easier for NPs and maybe PAs, I'm 00:29:47.779 --> 00:29:49.819 not sure, to lose their license above a physician. 00:29:51.339 --> 00:29:53.400 Physicians are given a significant amount of 00:29:53.400 --> 00:29:54.859 leeway and everybody will say that's because 00:29:54.859 --> 00:29:57.059 they have more education. Well, it doesn't really 00:29:57.059 --> 00:29:59.720 matter if you're unsafe, how much education that 00:29:59.720 --> 00:30:04.039 you have. And they just are. And I've had... 00:30:04.240 --> 00:30:05.980 multiple physicians that I've worked with that 00:30:05.980 --> 00:30:09.299 have had horrible outcomes in their career and 00:30:09.299 --> 00:30:11.680 they get like a little slap on the wrist. And 00:30:11.680 --> 00:30:14.039 then I've had nurse practitioners I know who 00:30:14.039 --> 00:30:16.599 have had their license halted for what I would 00:30:16.599 --> 00:30:18.359 consider to be very small things that could be 00:30:18.359 --> 00:30:22.430 easily explained. And so I think that if you 00:30:22.430 --> 00:30:24.069 have any questions about whether or not you're 00:30:24.069 --> 00:30:25.650 being asked to do something that is outside of 00:30:25.650 --> 00:30:28.109 your scope or how the state board feels about 00:30:28.109 --> 00:30:30.490 it, you should go online. Your state board will 00:30:30.490 --> 00:30:33.150 have an advanced practice representative who 00:30:33.150 --> 00:30:35.289 you can either email or ask questions to directly. 00:30:36.009 --> 00:30:37.650 Calling and getting somebody on the phone is 00:30:37.650 --> 00:30:40.049 sometimes hard. So you might want to call and 00:30:40.049 --> 00:30:42.609 ask who is the email where I can send advanced 00:30:42.609 --> 00:30:44.890 practice questions to. And there are usually 00:30:44.890 --> 00:30:49.089 advisory opinions on all sorts of topics. that 00:30:49.089 --> 00:30:51.130 the state boards have just readily available. 00:30:52.069 --> 00:30:54.970 And sometimes you'll call and ask a question. 00:30:55.029 --> 00:30:56.430 They'll be like, we're getting ready to write 00:30:56.430 --> 00:31:00.230 an opinion on that. And you can ask kind of which 00:31:00.230 --> 00:31:02.130 way they're leaning and what information they 00:31:02.130 --> 00:31:05.130 can give you. Because there's just a lot of things 00:31:05.130 --> 00:31:08.710 like IV hydration, TMS clinics, ketamine, everything. 00:31:08.789 --> 00:31:11.089 There's an advisory opinion on probably anything 00:31:11.089 --> 00:31:13.289 you're wondering about, but they do get updated. 00:31:13.569 --> 00:31:15.609 And so that's why sometimes it's important just 00:31:15.609 --> 00:31:17.369 to reach out to whoever your advanced practice 00:31:17.369 --> 00:31:20.309 representative is at your respective state board 00:31:20.309 --> 00:31:23.720 and ask them. And then ask them, well, what can 00:31:23.720 --> 00:31:25.839 I do? Like I've been I want to transition into 00:31:25.839 --> 00:31:28.119 this role or I've been asked to do this. And 00:31:28.119 --> 00:31:30.759 they're saying it's part of the job. And sometimes 00:31:30.759 --> 00:31:32.740 they'll be able to provide you either our statute 00:31:32.740 --> 00:31:35.059 or within our nurse practice app where it says 00:31:35.059 --> 00:31:36.960 that that's actually not something that a nurse 00:31:36.960 --> 00:31:39.440 practitioner can do. And I would assume that 00:31:39.440 --> 00:31:41.720 if you're in a more restricted state, they have 00:31:41.720 --> 00:31:44.180 all sorts of things to give you so that you're 00:31:44.180 --> 00:31:46.420 not practicing outside of your scope without 00:31:46.420 --> 00:31:48.740 even knowing it sometimes. Yes, that's a great 00:31:48.740 --> 00:31:52.559 point. That's a really good point. What about 00:31:52.559 --> 00:31:56.259 like dealing with like a tricky patient situation 00:31:56.259 --> 00:32:00.299 or, yeah, a patient who maybe is being quote 00:32:00.299 --> 00:32:05.420 unquote difficult? As a student? Yeah. Okay. 00:32:06.420 --> 00:32:10.019 So I think sometimes you're going to get a patient 00:32:10.019 --> 00:32:12.039 who doesn't want to be there, right? They are 00:32:12.039 --> 00:32:14.200 there because their significant other wants them 00:32:14.200 --> 00:32:15.640 there. They're there because their parents want 00:32:15.640 --> 00:32:17.480 them there. Their employer wants them there. 00:32:17.819 --> 00:32:22.160 And that's when you're like skeleton. which is 00:32:22.160 --> 00:32:24.960 like, this is what my evaluation is. This is 00:32:24.960 --> 00:32:27.140 what I need to get to. You just fall back on, 00:32:27.240 --> 00:32:30.779 I'm going to stick to my core. Okay. Again, what 00:32:30.779 --> 00:32:32.539 brought you in? How long? What changed? Are you 00:32:32.539 --> 00:32:35.480 safe? And even if they're butting heads the whole 00:32:35.480 --> 00:32:37.279 time and they're not really giving you answers, 00:32:37.599 --> 00:32:40.480 I would just continue working through your questions. 00:32:40.559 --> 00:32:43.940 And I'm sorry you don't want to be here. I just 00:32:43.940 --> 00:32:46.720 got to ask these questions to get to the end. 00:32:46.940 --> 00:32:48.859 And at the end of it, we're going to make a plan 00:32:48.859 --> 00:32:51.599 together. So then you tell them at the end, we're 00:32:51.599 --> 00:32:53.119 going to make a decision together. I'm not going 00:32:53.119 --> 00:32:55.099 to tell you what to do because sometimes they 00:32:55.099 --> 00:32:57.519 feel forced into that evaluation or that appointment. 00:32:57.740 --> 00:32:59.900 And so if you remind them that at the end, you 00:32:59.900 --> 00:33:01.799 still have the choice as to whether or not you 00:33:01.799 --> 00:33:05.279 seek treatment or you take medication, sometimes 00:33:05.279 --> 00:33:07.680 that will calm them down enough. Other times, 00:33:07.700 --> 00:33:10.619 patients just need to vent. People have a lot 00:33:10.619 --> 00:33:13.319 going on. Not everybody enjoys telling people 00:33:13.319 --> 00:33:15.980 all like the ins and outs of their life. And 00:33:15.980 --> 00:33:17.839 so sometimes they might just want to sit there 00:33:17.839 --> 00:33:19.619 and talk for a little bit. And I would let them. 00:33:19.680 --> 00:33:22.420 If you can give them five minutes to just get 00:33:22.420 --> 00:33:24.519 out whatever they need to, you'll probably get 00:33:24.519 --> 00:33:26.559 some good information. You'll be able to assess 00:33:26.559 --> 00:33:28.559 their thought process and their thought content 00:33:28.559 --> 00:33:31.059 and their mood. You'll get a bunch of mental 00:33:31.059 --> 00:33:33.119 status exam items checked off by just letting 00:33:33.119 --> 00:33:35.259 somebody rant. And they might say things that 00:33:35.259 --> 00:33:36.700 you know that you're going to need to build upon 00:33:36.700 --> 00:33:42.160 later and just take notes. I do not chart on 00:33:42.160 --> 00:33:45.410 a computer while I talk to people. I write everything 00:33:45.410 --> 00:33:48.029 by hand. I just take little notes. I think it 00:33:48.029 --> 00:33:51.329 pulled over from being in the ER. I just, it's 00:33:51.329 --> 00:33:53.869 easier for me to shorthand. It also makes me 00:33:53.869 --> 00:33:56.250 feel more personal and it makes, I think, my 00:33:56.250 --> 00:33:58.970 patients feel more personal when I'm staring 00:33:58.970 --> 00:34:00.970 at them and not at my computer. And I will tell 00:34:00.970 --> 00:34:02.690 them, hey, I need to add that in or I got to 00:34:02.690 --> 00:34:04.109 send your meds now. When I worked outpatient, 00:34:04.289 --> 00:34:07.029 like I would explain what I was doing. Inpatient, 00:34:07.190 --> 00:34:10.710 I have a lot. People are paranoid. They don't 00:34:10.710 --> 00:34:12.849 like technology. So I stay away from computers 00:34:12.849 --> 00:34:15.090 when I'm interacting with patients as much as 00:34:15.090 --> 00:34:18.369 I can. But I think it's just important to and 00:34:18.369 --> 00:34:21.010 if it's too much, I think you need to tell your 00:34:21.010 --> 00:34:23.349 preceptor like, hey, I'm trying, especially if 00:34:23.349 --> 00:34:25.349 your if your preceptor has set you up in a separate 00:34:25.349 --> 00:34:26.650 room, because sometimes they'll do that. You 00:34:26.650 --> 00:34:28.250 know, once you're like farther on in your program, 00:34:28.329 --> 00:34:30.329 you might have an office where you see patients 00:34:30.329 --> 00:34:33.969 and you're. time out. I got to go get my preceptor 00:34:33.969 --> 00:34:35.929 real quick and just explain to them, like, I'm 00:34:35.929 --> 00:34:37.769 trying, I've tried everything. I don't know what 00:34:37.769 --> 00:34:40.309 to do. Your preceptor should then come in and 00:34:40.309 --> 00:34:43.429 not say, hey, my student says you're being a 00:34:43.429 --> 00:34:47.570 pain in the ass, but like, I'm coming in now. 00:34:47.610 --> 00:34:50.030 I just want to see how it's going and what's 00:34:50.030 --> 00:34:51.829 going on so that they can assess. And then maybe 00:34:51.829 --> 00:34:56.210 you can see how that preceptor changes either 00:34:56.210 --> 00:34:59.949 their tone, how they're engaging. how they're 00:34:59.949 --> 00:35:02.250 interacting. And sometimes that starts with literally 00:35:02.250 --> 00:35:05.230 just asking, don't ask about politics, don't 00:35:05.230 --> 00:35:08.969 ask about politics, but sports or the weather, 00:35:09.010 --> 00:35:11.909 something ridiculously mundane that they might 00:35:11.909 --> 00:35:14.869 want to talk about. That's not going to get them 00:35:14.869 --> 00:35:17.909 really elevated in the moment. Yeah. Yeah. Right. 00:35:18.070 --> 00:35:20.650 Yeah. No, that's a great point. But I think that's 00:35:20.650 --> 00:35:22.530 where people struggle too, is like if patients 00:35:22.530 --> 00:35:27.289 are bringing up very pointed topics, especially 00:35:27.289 --> 00:35:30.460 political stuff. You know, the last few years, 00:35:30.480 --> 00:35:32.179 people want to talk about that. It causes people 00:35:32.179 --> 00:35:34.460 a lot of stress and they want they're trying 00:35:34.460 --> 00:35:36.460 to assess if like you're on the same side as 00:35:36.460 --> 00:35:39.440 them sometimes about those types of topics. And 00:35:39.440 --> 00:35:42.440 it's it's hard to not get drawn in or want to 00:35:42.440 --> 00:35:44.980 defend yourself. But then it goes back to being 00:35:44.980 --> 00:35:46.780 a professional. Right. They don't need to know 00:35:46.780 --> 00:35:51.559 my beliefs or anything like that. And so it just 00:35:51.559 --> 00:35:54.340 you have to learn how to redirect. conversations 00:35:54.340 --> 00:35:56.500 and that can be very difficult. But I also don't 00:35:56.500 --> 00:35:58.280 think you should shy away from big things that 00:35:58.280 --> 00:36:01.320 are happening out in the world that are going 00:36:01.320 --> 00:36:03.659 to cause people distress because you are a human. 00:36:03.739 --> 00:36:06.119 It's all human interaction. So they're looking 00:36:06.119 --> 00:36:08.659 for a little bit of a connection. You just don't 00:36:08.659 --> 00:36:10.980 have to connect in a way that either ramps them 00:36:10.980 --> 00:36:13.360 up or they're like, yeah, they're on my side 00:36:13.360 --> 00:36:15.539 because then it just can create other issues 00:36:15.539 --> 00:36:20.760 down the road. Right, right. Yeah. Okay, I know 00:36:20.760 --> 00:36:23.300 we're coming up on time. So anything else that 00:36:23.300 --> 00:36:28.480 you think psych NP students need to know in 2026? 00:36:30.019 --> 00:36:34.280 In 2026, I think you should just stay curious. 00:36:34.820 --> 00:36:38.320 I think it's easy to think that you know everything 00:36:38.320 --> 00:36:41.880 or to be like, I am so prepared for this rotation. 00:36:42.619 --> 00:36:45.039 But you need to ask questions and you need to 00:36:45.039 --> 00:36:47.449 stay focused on the fact that Your assessment 00:36:47.449 --> 00:36:50.829 is an intervention. Meds are not all the end 00:36:50.829 --> 00:36:54.389 -all and be -all of psychiatry. If you can't 00:36:54.389 --> 00:36:57.130 assess, you can't treat. So you need to make 00:36:57.130 --> 00:36:59.710 sure that you have a good structure, a good framework, 00:36:59.809 --> 00:37:02.449 and be able to just knock out a good psychiatric 00:37:02.449 --> 00:37:04.409 evaluation and then a follow -up assessment. 00:37:05.090 --> 00:37:08.989 And learn your documentation. Learn all your 00:37:08.989 --> 00:37:11.110 tips. Read how other people are documenting. 00:37:11.289 --> 00:37:13.309 I know there's a lot of AI documentation now. 00:37:13.929 --> 00:37:15.929 And I think that that can be kind of difficult 00:37:15.929 --> 00:37:18.730 to learn than how other people's thought process 00:37:18.730 --> 00:37:21.429 is. Because that was one thing I liked is being 00:37:21.429 --> 00:37:23.190 able to read how other providers write their 00:37:23.190 --> 00:37:24.949 notes. Be like, oh, I like how that's worded. 00:37:24.949 --> 00:37:27.949 That makes more sense. Like what I say in three 00:37:27.949 --> 00:37:30.730 sentences, they said in one. I like that flow. 00:37:31.230 --> 00:37:33.409 And so I think it's important to still learn 00:37:33.409 --> 00:37:36.030 or ask somebody how they would word it. And just 00:37:36.030 --> 00:37:38.070 make sure that you're continuing to learn even 00:37:38.070 --> 00:37:40.230 as a new NP. And even now, I mean, I learn things 00:37:40.230 --> 00:37:42.469 all the time. that I didn't even think about. 00:37:42.530 --> 00:37:44.050 Somebody said a word the other day and I was 00:37:44.050 --> 00:37:45.750 like, I don't know what that is. And I'm like, 00:37:45.789 --> 00:37:47.130 I do know what that is. I've just never heard 00:37:47.130 --> 00:37:50.230 anybody say this term before. And so I think 00:37:50.230 --> 00:37:52.550 you just need to stay curious and know that it's 00:37:52.550 --> 00:37:55.070 okay to not know it. Like this is the one time 00:37:55.070 --> 00:37:56.949 as a student, it's the one time in your career 00:37:56.949 --> 00:38:01.110 where you're allowed to not know it. It's the 00:38:01.110 --> 00:38:02.670 only time you're going to be allowed to know 00:38:02.670 --> 00:38:05.630 so little and no one's going to care at that 00:38:05.630 --> 00:38:10.179 time. So hone in. take that and then say, I'm 00:38:10.179 --> 00:38:12.079 just going to make this the best possible opportunity 00:38:12.079 --> 00:38:14.760 I can. Don't focus on the end result, which is 00:38:14.760 --> 00:38:18.300 a nice paycheck and easier schedule. Focus on 00:38:18.300 --> 00:38:20.659 learning so that you're doing what the job is 00:38:20.659 --> 00:38:22.460 and that you're going to do it safely in the 00:38:22.460 --> 00:38:25.769 end. Right. Yeah. No, those are great tips. Great 00:38:25.769 --> 00:38:28.329 suggestions. You guys, if you have additional 00:38:28.329 --> 00:38:31.289 questions that you want or topics that you want 00:38:31.289 --> 00:38:35.050 to hear about from Andrea, we can always do another 00:38:35.050 --> 00:38:38.389 episode. So definitely leave us comments on kind 00:38:38.389 --> 00:38:41.269 of what you want to hear from Andrea with her 00:38:41.269 --> 00:38:44.409 specific experience. So thank you for being on 00:38:44.409 --> 00:38:47.230 and we'll see you next time. Of course. Thank 00:38:47.230 --> 00:38:47.449 you.