Advanced Practice Nursing: Preparing Yourself
This blog post was written by Nick Angelis, MSN CRNA
In my last post, I mentioned that clinicals are very different at the master’s level. There is very little watching “The Price is Right” while learning to make a bed or fold a washcloth properly.
Similar prioritization exists in the classroom, where case studies revolve around what the clinician should do to fix real problem themselves. Of course, get an interdisciplinary team involved and call all the right people, but whether you are a psychiatric nurse practitioner or a nurse anesthetist, you need to have and be the solution. Because of this, in some ways the culture is less academic and more practical–hopefully, in an evidence-based way that makes a real difference in patient health. I felt I needed an exponential increase in knowledge and fine motor skills during my MSN. The technical skills of a baccalaureate nurse are often limited to the catheterization of various veins and orifices. However, career advancement requires expertise in a new array of procedural abilities, not just the learning of more in-depth pharmacology and physiology. It’s ironic, and of course the new hands-on skills must be used appropriately. I was always told by my grumpier preceptors, “We could teach a monkey how to intubate.” I’m not sure that’s true. At least, not for a banana. Maybe if I were a monkey and Jane Goodall offered me a banana tree–no, a banana orchard, then I’d settle down and learn how to pass an endotracheal tube between another monkey’s vocal cords, but it would still take a lot of effort not to jack up their teeth, and if I did mess up and summon the monkey tooth fairy, I’d probably be thrown out of the monkey club or whatever they call a group of monkeys because now the intubated monkey could only gum mangos instead of bite them, once they took the tube out, I mean.
One Thing at a Time (or, Gum One Mango at a Time)
Sorry about that. Take steps today to avoid feeling stressed and overwhelmed like a gummed mango. It certainly is difficult to transition from knowing the right answers on a test to making the right decisions in practice. Sean wrote an excellent post the other day about preparing for the next step while still in nursing school.
Remember that paper you’re supposed to be writing about NP school but instead you’re reading this blog? Getting into school is a similar process in that there’s more work and time involved than you’d suppose. The worst thing you can do is procrastinate because of some vague requirement or elusive document that the school demands. No, you don’t want to look needy and helpless (that secretary you keep calling is an important gatekeeper), but you certainly can’t afford to miss deadlines and be pleading with professors who barely remember your name for effusive reference letters at the last minute.
Do the legwork or move on to a school that doesn’t require you to retake Geography of Middle Earth (yes, I have taken that class) before applying. It may be difficult not to let all of the requirements to hang over your head. Different schools have tasks to complete in order to grant an interview that vary in difficulty, from faxing a resume to destroying a golden ring with addictive and invisible properties.
That said, don’t let preparation for the next phase in your life cause you to miss the present. The worst attitude is “I can’t learn anything from where I am right now, I can’t wait until I have my MSN.” Do you really want to be the hapless nurse well-versed in Orem’s theories but not any practical help on a hospital unit? Learn as much as you can every step of the way and make your brain adaptable. Saving patient’s lives often requires quick, irreversible decisions. First impressions in a health care environment can be similar. We’re wired to make snap judgments. That’s why I gave my patient with the Sponge Bob tattoos (as in like, every character on the show) more propofol on induction than the one without.
Balance
Preparing mentally means you first concentrate on being the best nurse aid or tech possible. Figure out the basics before trying to become the best nurse or nurse practitioner possible. I get emails all the time from STNAs wanting to become CRNAs. I actually answer them all and give clear directions so that worry of the unknown won’t impair their education, but I realize that much of my effort is wasted because it’s much too soon. The process of setting goals naturally gives us tunnel vision. There’s nice scenery from various vantage points of the Himalayas, not just Everest’s summit. See, I was going to talk about bananas and mangoes and toothless monkeys again, but as my earlier .gif demonstrated, I know when to stop.
Balance adaptability with consistency
You can pick out the right attitude years ahead of time. I could write a whole post about honing initiative by finding the sweet spot between humility and confidence. Flexibility from floating to other units or specialties trains your brain to learn new information–it’s good to feel uncomfortable sometimes. Excellence every time allows coworkers, preceptors, and patients to trust you with the routine. I can adapt easily, partly because of my alternative medicine experience of random miracle cures to some patients that were worthless potions to the next. In contrast to my style, some students soon perform consistently, but what happens when they meet a patient who doesn’t fit neatly in the middle of a bell curve? The latest research, protocols and algorithms work so well on standard patients, but I assume all of us would also like to impact the outliers skewed on the edges of normal, rather than, uh, mid-level. What frame of mind do you think would work best to pursue your MSN? How will you make it sustainable? Remember, there are no weird answers, just outliers skewed on the edges of normal.
Written by Nick, author of How to Succeed in Anesthesia School (And RN, PA, or Med School)
