there is a fine line between just charging somebody
to shadow you. and charging somebody because
you're going to take the time out of your scheduled
patient day to ensure that they're learning we
give our students progressive expectations so
you should know what you should be working on
semester one semester two semester three how
we do our clinicals is different than what i
was used to in our program so ours was everybody
does this many hours this many hours this many
hours nursing is intriguing to a lot of people
we see people at the best and the worst moments
of their life bedside nursing provider it doesn't
matter your job is an entire picture and so You
just have to talk to somebody, like ask them
questions that you would want to be asked. If
you have somebody who is a working mother who
works two jobs, has three children, giving her
meds that need to be taken three times a day
is probably not going to work well for her. Preceptors
don't expect you to know everything. We expect
you to be teachable and I expect you to be engaged.
I want you to be with me. If I get up and walk
out of my office, you should follow me. Welcome
to another episode of No Prior Auth. Today we
have Andrea Kemp back for part two, and we are
super excited to talk about some really practical
things for you Psych NP students, such as preceptorship,
how to find preceptors, how to prepare for clinical,
how to navigate, you know, tricky patient situations,
what to look for in that first role. Andrea has
a lot of real -world experience because she's
been doing this for 11 years. She's a sun devil
like I am. We went to the same school, so we've
known each other for a while. And she runs a
community for providers who are navigating the
inpatient psych world. So welcome, Andrea. Thanks
for coming back. Really excited about this episode.
And kick us off with just kind of as a psych
NP student. Where where should they start when
it comes to, you know, finding clinicals and
vetting those two? Because some of the rotations
I'm hearing about are not to quality. Yes. So
it is hard if you are in a program that does
not find you preceptors. OK, I know Lindsay and
I didn't have to worry about that. We could find
our own if we wanted to. But we were basically
told this is where you're going. These are your
hours. This is what you're going to see. If you
needed to adjust it, you could. But we just went.
There was no. bartering or anything that happened.
Looking back, it was great because I had a great
clinical experiences in school. I got a different
array all the time. And I felt very prepared
when it came to work. So my current program does
not provide preceptors. And that is honestly
because it has become so hard to find them. It
has become so hard even for universities to come
up with those relationships because a lot of
people are wanting to be paid. for being preceptors.
That's a pretty big thing. And so I think you
should take to LinkedIn. I have people send me
messages on TikTok, on Instagram all the time,
and a lot of stuff on LinkedIn. A lot of people
reach out on LinkedIn and you should call big
clinic areas like in your area. If you know there's
a big mental health clinic that has multiple
locations, call hospitals and just ask. It's
really the only thing you can do and it won't
hurt. And sometimes you might be like, oh, you
need to email this person. There might be a clinical
placement person in human resources. Who should
students talk to? Call, ask them that. That's
a big thing. And a lot of times once you get
in with one, then a preceptor might be like,
oh, I have a friend who sees all peds, or I have
a friend that works inpatient. Let me see if
you can go with them for a little bit of time
next semester. And I do that with my students.
precept at least a handful of students every
semester and then I will reach out to people
that I know and tell them like hey this person
needs this type of hours this person needs that
can they come with you for a little bit and we
see if we can just make it happen yeah okay gotcha
so have you ever accepted a student from one
of these like cold dms or like how do you go
about choosing what students that you're that
you would take So right now it's a little bit
different since I do teach in a program. I take
my students first. I have taken a couple students
at other Arizona universities. Also, usually
that's from a reach out. That's from like a provider
to provider reach out. And then I will flip it.
I'll take a student from your program. You take
a student from my program and we'll do it that
way. I have not really had the availability to
take anybody that reaches out. I do explain that
to them just because I can only take so many.
To make it worthwhile. Right. Yeah. What do you
think about charging for clinicals? I don't enjoy
it at all. I understand why private practice
people want to do it, but I think that there
is a fine line between just charging somebody
to shadow you and charging somebody because you're
going to take the time out of your scheduled
patient day to ensure that they're learning.
And that I think is one of the... biggest issues
that I see is and students feeling uncomfortable,
like it's not set up in the beginning what they're
going to be doing, how they're going to be seeing
patients. And then a lot of times they're just
sitting there watching somebody else do the job
and they're not really learning the job. Is that
a big stress that you see for the students in
the program you teach in, like finding their
rotations? Yeah, and I ask them, like, is this
what you're doing? And we give our students progressive
expectations. So you should know what you should
be working on semester one, semester two, semester
three. Our clinicals, how we do our clinicals
is different than what I was used to in our program.
So ours was everybody does this many hours, this
many hours, this many hours. How we do it. Everybody
has a different credit hour. And so some might
be a first credit hour, but they're all in the
same clinical cohort. And so they're only doing
a certain number of hours. Then the next group
of credits is taking more. And then the final
group of credits is like getting ready to graduate.
So they just increase every semester instead
of having the same set amount of hours every
semester. And so a lot of times I will check
in midterm and I'll ask because we do a tele
-meeting for midterm check -in. Are you guys
meeting your progressive expectations? Because
by the end of the semester, we do a sim day where
they get a simulated patient and they have to
do a full psyche bell. And so you need to be
practicing that. I need to make sure that you
are getting that exposure. And the only way I
can do that is if I ask you directly. But a lot
of times, my preceptor doesn't really know how
to use me. Okay. Well, let's talk about that.
Is that they don't know how to work you into
their day? Are they at a big clinic and they
don't have time built in for students? Can they
ask for an additional 40 minutes of administration
time because they are taking a student? Like
we need to figure out where you can learn because
sitting there just watching somebody or being
put in your own office and then just doing like
easy refills that your preceptor has deemed appropriate
for a student isn't going to get you where you
need to be at the end of your program. So what
do you recommend that psych NP students, like,
what conversation should they have with their
preceptors on the front end to kind of get the
most out of it, hopefully? So I think, and especially
if you're paying. You cannot be passive. You
need to ask, what am I going to get out of this
rotation? What population are you seeing? Can
you send me before my first day? Do you have
a note template that you follow that I can learn
so that I can help you document from day one?
Like make yourself available, make yourself a
asset, not a liability. So whatever you can show
up and do, I'll go get that patient for you.
I'll take their vitals. I'll bring them into
the room. I'll walk them out. I'll make sure
they got that thing you printed. What can you
take off their plate so maybe they do have a
little bit of time to walk you through their
thought process in the moment? And I think that
that's kind of where students fall short is they
just kind of show up and they expect their preceptor
to be like, here's your outline. I have an outline
for my students. When you show up every day,
this is what you do. The first day I have them,
they watch me chart. They're supposed to take
notes and see where everything is. I give them
my templates and then we go from there. I don't
have appointments, so it is easier to build in
my teaching during the day because I'm in a hospital
setting. But there are things that you can ask
for ahead of time to prep. And then you should
be asking during the day. Like you need to show
up with a notebook. Don't show up with your iPad.
Throw that thing out the window. Show up with
a notebook so you can take notes. Write down
your questions. And at the end of the day, ask
three of them. Ask three of those questions.
The rest of them, look them up before your next
clinical day. That's what I want you to do. I
want curiosity. Curiosity over confidence every
single day as a student. So do you think Psych
NP students should be on social media platforms,
on LinkedIn? And if so, how do you think that
they should leverage those to network or connect
with potential preceptors? Any guidance on what
message to send? If they're going to cold DM
somebody. Yeah. So LinkedIn, I think for sure.
I think you can build your LinkedIn network whenever
you want in your career. I think that that's
important. Or at least know where to look or
what you're watching for. Social media, I think,
can be difficult. Because it depends on what,
if you are posting, you know, big companies are
going to look at that. Individual preceptors
might look at that. There might be a little bit
of a concern. Are you going to show too much?
Are you going to be responsible? And so I would
just remember that we are a profession. tend
to forget it. Nursing is intriguing to a lot
of people. We see people at the best and the
worst moments of their life, bedside nursing
provider, it doesn't matter. And so I think a
lot of people, there's interest in seeing it
and people want to show it, but we are still
a profession no matter what anybody wants to
talk about. nowadays. But we are a profession.
You need to be professional. And you are a student.
You are representing your university. And most
of all, you're representing yourself. However
you put yourself out there now is how people
are going to remember you. And if you can make
yourself a valuable student to your preceptor,
those are the preceptors who are going to reach
out to you when their clinic is hiring and say,
hey, you're getting ready to graduate. We're
hiring. They're also the ones that write letters
of recommendation and keep you in mind. And so
you want to be A shining star. Yeah, 100%, 100%.
So what should somebody say if they're going
to DM somebody on LinkedIn, let's say? I think
you should start with who you are, where you
go to school. and what exactly you're looking
for so that that person knows if they can even
not, do I have the availability? Do I actually
have the hours that this person needs? Because
if you're, if they're like, I need 250 clinical
hours and that person might see peds, but if
they're like, I have a lot of, you know, vacation
this semester, I'm going to some conferences.
I don't think I'm going to be able to get you
all those peds hours so that you're just not
wasting a back and forth time. I think you should
be upfront with what you need, your availability.
All that stuff. Just so that it's the easiest
for a person to look at it and just respond,
yes, I'll take more information. No, I won't.
I won't have the time to do that. And I just
think that gets you everything right up front.
As much information as you can provide without
being redundant. Yeah, right. What should Psych
NP students bring to like day one of clinical
or any tips for how they should prepare or like
stuff they should brush up on before they? So
I think you should be able to do a mental status
exam cold. Like you need to know every part of
a mental status exam and be able to do a good
safety risk assessment. OK, everything else you
can talk through. Everything else is a general
nursing knowledge at that point. You're not prescribing
your first day. at clinicals, you are talking
to somebody, okay? Your didactic courses teach
you how to be a provider, how to prescribe meds.
Your clinicals teach you how to be in a room
with a human. And those skills are very different.
And that's where people lose it. They get so
focused on, I need the correct diagnosis right
this moment and pick the exact perfect medication.
And that is not how this career goes. It just
isn't. be able to do a good mental status exam,
practice. In our clinicals, we have three times
a semester where students write them up on a
TV or a movie character. So we give a list of
movies or television shows. They write it. They
pick a character, you know, A Beautiful Mind,
What About Bob, all those movies that are like
hallmarks. Practice writing and dictating a mental
status exam. It's important. It's also how you're
going to like show your preceptor that you understand
how that patient is presenting. And then top
10 to 15 meds, starting dose, scary side effect,
patient education. You don't need to know 200
medications immediately. And like I said, safety
screening. If you can get a note template or
at least know how the notes are written. I don't
think it's super important to be able to tell
me at the beginning of your clinical rotation
every single symptom of every single disorder.
To me, those students are just trying to look
really impressive, but it doesn't show me that
you can take the information and learn. I want
to know that you're teachable and that you're
there to learn at the moment. I don't need you
to know everything. And I think it's also important
to know that you're not pretending to be a provider.
you are a learner with rn knowledge and insights
and so you need to know what can transfer what
do i already know what am i already good at as
a nurse that are assets to being in a provider
role and then you start filling in the rest as
you learn so i think that that's kind of the
biggest thing and i think people forget you're
just talking yeah i forgot I'll never forget
being with the SMI population and my preceptor.
Like I was so worried about asking the right
questions and gleaning the right clinical information
that like I was making it awkward. And I literally
remember my preceptor being like, in this next
appointment, can you just try to make conversation
with the client? Like just try to make the client
feel comfortable and just make conversation.
And I was like, yes, sure. And it's the biggest
thing that I see with students because I said
they do simulated psyche vows on actors at the
end of every semester. And we either sit in the
room or we watch them later on. And sometimes
I'm like, just talk like just ask a normal question.
I tell my students, I want you to act like you're
at brunch with your bestie who's got good stuff
to tell you. And you want to know every detail
about that stuff like. Just ask the question.
And I think sometimes students get uncomfortable.
And I'm like, I don't think you get more uncomfortable
than asking someone if they want to end their
life. And so if you can ask somebody, do you
want to die? Do you want to harm yourself? You
should be able to ask any other question. There's
really nothing more personal than asking somebody
if they no longer want to be here. And so once
you can ask that question from an empathetic
perspective, you can ask. How many sexual partners
do you have? OK, because a big part of our life
of our job is health promotion. As much as I'm
going to prescribe meds, I need to educate you
on things. Are you sexually active? How old is
this patient? Do we need to be talking about
pregnancy prevention, STD prevention, all of
these things? And students like to skip those
questions because they don't think it's going
to give them the clinical information they need
to get to that diagnosis or to pick the right
med. And that's inappropriate. Your job is an
entire picture. And so you just have to talk
to somebody, like ask them questions that you
would want to be asked. If I was sitting here
and I was depressed, I was feeling very uncomfortable.
I was feeling very sad and very anxious. I have
these like things going on. What would I want
somebody to ask me? And then ask them, is there
anything that I haven't asked you that you think
is important that you were thinking I was going
to ask you? Because patients play these appointments
in their heads. They are wondering what they're
going to be asked or how it's going to go, especially
if they've never done one before. So is there
something that you thought I was going to ask
you that I haven't asked will sometimes get you
really good information? Yeah, that's a great
point. That's a question that I think more psych
NPs need to start asking for sure. Yeah. What
do you recommend as far as psych NPs trying to
learn? how to provide like psychoeducation and
like any tips on how they should practice that
or learn that skill? Because I think that that
one is kind of ambiguous. It feels ambiguous.
It is. And I think that if there are certain
things that you want to explain. I think it's
easiest to explain things like you're trying
to explain them to somebody in just layman's
terms. You don't want to use huge words. It just
doesn't work. And a lot of times patients will
feel like they're being spoken down to if you
start using big medical terms. I talk to people,
like I said, like I'm talking to my best friend
or like I'm talking to my child. How would I
get my child, who's even my adult children, how
would I get them to listen to me? doesn't feel
demeaning or like I'm putting myself above them?
And what do they really need to know? And that
goes also along with like when you're choosing
medications. I'm a big person on structure, okay?
Even if you get stuck with like a hard patient,
you go with what brought you in, how long, what
changed, what has helped before, and are you
safe? If you get those five questions answered,
you can just talk for the rest of the appointment
okay silence is a tool a lot of people freak
out about it all right just count before you
rescue because right before you get ready to
talk again that patient's probably going to say
something because they just need a moment you're
asking them so many questions in a psyche valve
right about everything medical family Have you
wanted to kill yourself? How are you sleeping?
Are you using drugs? All of these things. And
then you're just bombarding them with stuff.
And our brains just need a moment to catch up
sometimes. And your job is to make somebody feel
safe, feel heard, and to not make it worse. So
if you can answer those questions and get through
that, you'll be good. Slow your pace. Slow. Narrate
what you're doing. I'm going to ask you these
questions now. This is why I'm asking, especially
about trauma. If you're asking about trauma,
sexual abuse, anything like that, This is why
I'm asking it. There's a big thing right now
where sometimes we tell people, if you don't
feel comfortable answering this question, it's
okay to not answer it. I don't tell patients
that. I wait until I pick up on them feeling
uncomfortable and then I'll ask, seems like you're
uncomfortable with this line of questions. Could
you tell me why? Because I feel like you're shutting
down. You're almost kind of telling them like,
I don't want to hear that. Like if you don't
feel comfortable saying it, It can be taken in
a different way, especially if they have a significant
thing that they maybe have never told anybody
and you're telling them it's okay to still not
tell somebody, but it's not. If it's a big issue
is why you're here, I need you to tell me. And
so I would rather start asking questions and
I trust my instincts to pick up on that they're
either hesitating to answer or now their answers
are very short and they're not elaborating like
they were on other questions for me to be able
to probe. And then when it comes to meds, you
don't need to panic. Okay. There are a lot of
psychiatric meds. Okay. And everyone's like freaks
out. But you need to know like a few things.
So you need to know what your target symptom
is. Number one, that gets you to the book. That
gets you to the chapter of the book with your
meds. Right. And then you need to know, am I
going to prescribe this in a way like what has
worked or failed? Okay. So this is my target
system. What has worked or failed already? You're
going to weed some out. OK, what can this patient
tolerate? Not only what can their body tolerate,
kidney, liver dysfunction, stuff like that. What
can they financially tolerate? What is their
insurance going to cover? OK, and then what can
their schedule tolerate? If you have somebody
who is a working mother who works two jobs, has
three children, giving her meds that need to
be taken three times a day is probably not going
to work well for her. Okay. If you have somebody
who's at home all day, sure. Why not? I mean,
it might be better, but you need to know what
can this person tolerate. And that's going to
take your group of 200 meds down to like five.
And then you can offer, you know, this one might
have more weight gain. Patient's very worried
about that. We're not going to do that. This
one could stunt appetite. They already don't
eat a lot. We don't want to do that. So that
gets you where you need to be, but people freak
out. About mix. Yeah, for sure. That reminds
me of kind of like I'm hearing, of course, there's
just polarization everywhere on the Internet.
But I hear about like on one end of the spectrum,
like you really kind of need to like use your
used car salesman techniques to like. get people
on these meds to the other end of the spectrum
where it's like, you know, it's their choice
and just be, don't be too whatever about it.
Like, what's your approach and line of thinking
in that when you are presenting medication options?
So I think I had a different approach depending
on inpatient versus outpatient. Outpatient, if
you're not an acute safety risk, it is obviously
100 % your choice most of the time, whether you
take psychiatric medications. So I was more of
a proponent when I, I think the biggest issue
for me is when I saw kids whose parents did not
want to medicate for things that could have made
their children's lives a lot easier. And then
we're waiting and waiting and waiting. And there's
behavior issues. Kids are getting suspended.
They're failing. They're being held back. And
I'm like, let's talk about this a little more
upfront now, because what we're doing is not
working. I'm not going to trick anybody into
taking meds. I'm not going to make a med sound
better than it is. I'm not going to hide a side
effect that I know you're potentially going to
get. I think that you have to go in 100 % willingly
because the second that I give you a med that
gives you a horrible side effect that I didn't
tell you about, you don't trust me anymore. And
as much as I want to make you feel better, I
want to help you feel better, I need you to come
back to me. And I think that that's where you
get a lot of people who start and stop psychiatric
treatment because they start. It's going well.
They take a med. It doesn't help them. They don't
know why. No one's told them why it's not helping.
Sometimes we don't know, but they've been given
no education on it. They've had bad side effects.
No one's listening. They're just increasing doses.
So they stop. And then a couple of years later,
it's bad again. They find another provider. The
same thing happens. So I don't promise anything
that I don't know is going to happen. I tell
you what could potentially happen. And then I
offer, this is what we're going to do about those
things if they occur. And then give me time to
fix it. Because there are things that I don't
know. Everybody is different. Prescribing in
psychiatry is an art. It is not always a science.
While, like I said, target symptoms get us to
certain meds, everybody's body is different.
And so you have to wait and you have to see what's
still going to be there and what's not. And I
just don't. ever want to have a patient feel
like I tricked them into taking something. Yeah,
no, 100%, 100%. I think another like good angle
is telling somebody, you know, if this was my
family or best friend, this is the treatment
I would want them to have. And this is why. And
being able to kind of explain that objectively,
I think can, you know, they can hear that conviction
in your voice. Yes. Yes. And I think it's important
to show people sometimes, especially if they
are patients who come on and off meds a lot,
or they want to lower doses too quickly after
they've stabilized, it's good to show them a
before and after. Like, we're going to go back.
I'm going to read you my note from a year ago,
okay? And I'm going to tell you how you presented
to me a year ago, and I'm going to read what
I wrote today. And you're telling me you don't
want to be on meds anymore, but... Let's just
look at what we could potentially lose. You've
had a job promotion since then. Your marriage
is in the best spot it's been. You're getting
along with your children. Same thing with kids
who decide that if they get to high school, they
don't want to take meds anymore. They don't want
to take ADHD meds anymore. And I'm like, we can
do it for a very short amount of time, but I
want to see you in a month because a month behind
in school is hard to make up. So I'm a big proponent
of you can try. It's your life. But I also want
you to know these are the things that if they
come up, I need you back. I need you back here.
Yeah. Yeah. Do that kind of like. Yeah, that's
that's really important. What else? It just saves
you from a follow up. It saves you from three
months down the line where they're like, well,
my life's been going horribly. Yeah. I'm like,
well, remember we talked about those things that
you were supposed to if they occurred, you were
supposed to come back. Yeah. Yeah, I know that
some of those things I had to learn the hard
way with like getting the phone calls and getting
the follow up appointments and then being like,
oh, I need to like really kind of reiterate and
be more clear with this person. Yeah. And those
are things that you learn with practice. Yeah.
About the risk benefit. What else that I haven't
asked you, would you want to tell psych NPE students?
So I think it's important to remember that. Preceptors
don't expect you to know everything. Like I said
before, we expect you to be teachable and I expect
you to be engaged. I want you to be with me.
If I get up and walk out of my office, you should
follow me, whether I tell you to follow me or
not. Don't sit there and just expect. And I want
you to ask questions that show me that you're
trying to learn when you're not even with me.
So if you're going to be with your preceptor
on like Tuesday and Thursday. You're there Tuesday.
You've seen some hard patients, things that you
wanted to look up. When you come back on Thursday,
I realize you did this for this reason or ask
questions. Or I'm thinking with that patient
we saw earlier, I'm thinking A, because of B,
am I on the right track? Not just how am I doing?
You're going to get a very perfunctory answer.
So I would ask specific questions. Like I said,
try to make yourself valuable. Clinicals are
stressful. And depending on where you are, they
could be good and they could be bad. But they
will teach you something. They're either going
to teach you what to do or what not to do. And
that's okay. All of it's a learning experience.
And I think it's important depending on the type
of state. So we obviously are in a full practice
state. And that is why in clinicals, they had
us do everything, right? Peds, adults, and inpatient
and outpatient. Really, you need to do anything
that you're going to want to do in practice.
If it's already something that's in practice,
you need to do it in school. If new technology
and new treatments come out while you're already
a nurse practitioner, there is more on -the -job
training or CMEs that you can do. But if there
is something that you want to do or an area that
you want to work in, you have got to do it in
school because you need didactic and you need
clinical hours. Because if you were to ever get
called in front of the board, that's what they're
going to ask you. They're going to ask you how
you learned to manage that type of patient. and
I got a job is not a reason. That's not how you
learn. So you need to be able to look at all
of the, all the potential clinical sites that
you can go to and you need to find every different
one that you think will help you. Yeah. Yeah.
And, and you have a friend who works at the state
board, right? Yes. And you also let you do some
like work, right? For the board. I have written
scope of practice statements on certain board
complaints. So the board will reach out. If there
is a significant complaint, the board will reach
out. And this is for any specialty. They'll reach
out to somebody in that specialty working in
the same similar setting, and they will ask,
is this reasonable? It is what this provider
did because not everybody is a psych MP. Not
everybody has the same. So they reach out without
making just a blanket assumption that it's wrong.
They will reach out and say, hey, is this OK
or was this not? And then they will get an opinion
on it that goes through the whole process of
it. There's a board complaint and then any type
of remediation that goes with that. Yeah, because
I know that as nurses and nurse practitioners,
there's a lot of just like fear. about safety
and losing our license, you know? I think that
that's because nurse practitioner, like I do
think it's easier for NPs and maybe PAs, I'm
not sure, to lose their license above a physician.
Physicians are given a significant amount of
leeway and everybody will say that's because
they have more education. Well, it doesn't really
matter if you're unsafe, how much education that
you have. And they just are. And I've had...
multiple physicians that I've worked with that
have had horrible outcomes in their career and
they get like a little slap on the wrist. And
then I've had nurse practitioners I know who
have had their license halted for what I would
consider to be very small things that could be
easily explained. And so I think that if you
have any questions about whether or not you're
being asked to do something that is outside of
your scope or how the state board feels about
it, you should go online. Your state board will
have an advanced practice representative who
you can either email or ask questions to directly.
Calling and getting somebody on the phone is
sometimes hard. So you might want to call and
ask who is the email where I can send advanced
practice questions to. And there are usually
advisory opinions on all sorts of topics. that
the state boards have just readily available.
And sometimes you'll call and ask a question.
They'll be like, we're getting ready to write
an opinion on that. And you can ask kind of which
way they're leaning and what information they
can give you. Because there's just a lot of things
like IV hydration, TMS clinics, ketamine, everything.
There's an advisory opinion on probably anything
you're wondering about, but they do get updated.
And so that's why sometimes it's important just
to reach out to whoever your advanced practice
representative is at your respective state board
and ask them. And then ask them, well, what can
I do? Like I've been I want to transition into
this role or I've been asked to do this. And
they're saying it's part of the job. And sometimes
they'll be able to provide you either our statute
or within our nurse practice app where it says
that that's actually not something that a nurse
practitioner can do. And I would assume that
if you're in a more restricted state, they have
all sorts of things to give you so that you're
not practicing outside of your scope without
even knowing it sometimes. Yes, that's a great
point. That's a really good point. What about
like dealing with like a tricky patient situation
or, yeah, a patient who maybe is being quote
unquote difficult? As a student? Yeah. Okay.
So I think sometimes you're going to get a patient
who doesn't want to be there, right? They are
there because their significant other wants them
there. They're there because their parents want
them there. Their employer wants them there.
And that's when you're like skeleton. which is
like, this is what my evaluation is. This is
what I need to get to. You just fall back on,
I'm going to stick to my core. Okay. Again, what
brought you in? How long? What changed? Are you
safe? And even if they're butting heads the whole
time and they're not really giving you answers,
I would just continue working through your questions.
And I'm sorry you don't want to be here. I just
got to ask these questions to get to the end.
And at the end of it, we're going to make a plan
together. So then you tell them at the end, we're
going to make a decision together. I'm not going
to tell you what to do because sometimes they
feel forced into that evaluation or that appointment.
And so if you remind them that at the end, you
still have the choice as to whether or not you
seek treatment or you take medication, sometimes
that will calm them down enough. Other times,
patients just need to vent. People have a lot
going on. Not everybody enjoys telling people
all like the ins and outs of their life. And
so sometimes they might just want to sit there
and talk for a little bit. And I would let them.
If you can give them five minutes to just get
out whatever they need to, you'll probably get
some good information. You'll be able to assess
their thought process and their thought content
and their mood. You'll get a bunch of mental
status exam items checked off by just letting
somebody rant. And they might say things that
you know that you're going to need to build upon
later and just take notes. I do not chart on
a computer while I talk to people. I write everything
by hand. I just take little notes. I think it
pulled over from being in the ER. I just, it's
easier for me to shorthand. It also makes me
feel more personal and it makes, I think, my
patients feel more personal when I'm staring
at them and not at my computer. And I will tell
them, hey, I need to add that in or I got to
send your meds now. When I worked outpatient,
like I would explain what I was doing. Inpatient,
I have a lot. People are paranoid. They don't
like technology. So I stay away from computers
when I'm interacting with patients as much as
I can. But I think it's just important to and
if it's too much, I think you need to tell your
preceptor like, hey, I'm trying, especially if
your if your preceptor has set you up in a separate
room, because sometimes they'll do that. You
know, once you're like farther on in your program,
you might have an office where you see patients
and you're. time out. I got to go get my preceptor
real quick and just explain to them, like, I'm
trying, I've tried everything. I don't know what
to do. Your preceptor should then come in and
not say, hey, my student says you're being a
pain in the ass, but like, I'm coming in now.
I just want to see how it's going and what's
going on so that they can assess. And then maybe
you can see how that preceptor changes either
their tone, how they're engaging. how they're
interacting. And sometimes that starts with literally
just asking, don't ask about politics, don't
ask about politics, but sports or the weather,
something ridiculously mundane that they might
want to talk about. That's not going to get them
really elevated in the moment. Yeah. Yeah. Right.
Yeah. No, that's a great point. But I think that's
where people struggle too, is like if patients
are bringing up very pointed topics, especially
political stuff. You know, the last few years,
people want to talk about that. It causes people
a lot of stress and they want they're trying
to assess if like you're on the same side as
them sometimes about those types of topics. And
it's it's hard to not get drawn in or want to
defend yourself. But then it goes back to being
a professional. Right. They don't need to know
my beliefs or anything like that. And so it just
you have to learn how to redirect. conversations
and that can be very difficult. But I also don't
think you should shy away from big things that
are happening out in the world that are going
to cause people distress because you are a human.
It's all human interaction. So they're looking
for a little bit of a connection. You just don't
have to connect in a way that either ramps them
up or they're like, yeah, they're on my side
because then it just can create other issues
down the road. Right, right. Yeah. Okay, I know
we're coming up on time. So anything else that
you think psych NP students need to know in 2026?
In 2026, I think you should just stay curious.
I think it's easy to think that you know everything
or to be like, I am so prepared for this rotation.
But you need to ask questions and you need to
stay focused on the fact that Your assessment
is an intervention. Meds are not all the end
-all and be -all of psychiatry. If you can't
assess, you can't treat. So you need to make
sure that you have a good structure, a good framework,
and be able to just knock out a good psychiatric
evaluation and then a follow -up assessment.
And learn your documentation. Learn all your
tips. Read how other people are documenting.
I know there's a lot of AI documentation now.
And I think that that can be kind of difficult
to learn than how other people's thought process
is. Because that was one thing I liked is being
able to read how other providers write their
notes. Be like, oh, I like how that's worded.
That makes more sense. Like what I say in three
sentences, they said in one. I like that flow.
And so I think it's important to still learn
or ask somebody how they would word it. And just
make sure that you're continuing to learn even
as a new NP. And even now, I mean, I learn things
all the time. that I didn't even think about.
Somebody said a word the other day and I was
like, I don't know what that is. And I'm like,
I do know what that is. I've just never heard
anybody say this term before. And so I think
you just need to stay curious and know that it's
okay to not know it. Like this is the one time
as a student, it's the one time in your career
where you're allowed to not know it. It's the
only time you're going to be allowed to know
so little and no one's going to care at that
time. So hone in. take that and then say, I'm
just going to make this the best possible opportunity
I can. Don't focus on the end result, which is
a nice paycheck and easier schedule. Focus on
learning so that you're doing what the job is
and that you're going to do it safely in the
end. Right. Yeah. No, those are great tips. Great
suggestions. You guys, if you have additional
questions that you want or topics that you want
to hear about from Andrea, we can always do another
episode. So definitely leave us comments on kind
of what you want to hear from Andrea with her
specific experience. So thank you for being on
and we'll see you next time. Of course. Thank
you.