Self-Evaluation Practicum II

I mentioned in my previous self-evaluation that the two most attractive perks that enticed me to become a nurse practitioner were the right of prescriptive autonomy and the ability to manage my patients’ entire plan of care independently. After a second semester of clinicals in various practice settings, I can state that I still stand by my initial statements. The only difference, though, is that I was able to size up the responsibility that comes attached to these privileges.This second round of clinicals was a startling eye-opener in relation to my understanding of the process of diagnosing. The more hours I ended up spending in my clinical settings, the clearer it became to me that the skill of narrowing down on a pathological complain is not an exact science, but rather an elegant dance of science and art. In a primary care setting, where the more convenient cutting-edge diagnosing resources are scarce, providers need to use a bush-clinic approach in their diagnosing process. Too many times, the final diagnosis was not a clear-cut answer to my patients’ problems, but rather a more-or-less educated guess, or an ambiguous solution in the game of diagnosis elimination. Several times I wondered if my and my preceptor’s diagnosis were accurate enough to allow us to sleep good at night. What if, because of my decision, my patient’s condition would aggravate overnight? But, whatever the final outcome, we had to stand by and to account for our decisions; the good, as well as the bad ones.

       This time around I had the opportunity to only work with nurse practitioners and midwifes. My experience during my first semester of practicum while under the supervision of an MD, allowed me to notice a difference in an MD’s verus an NP’s approach while tending to our patients. For instance, my MD preceptor focused more on finding a pathological diagnosis and treatment, while advance nurse practitioners concentrated on connecting with their patients and to addressing the entirety of their patients. Even if painful, I have to mention that my MD preceptor had a deeper knowledge of the pathophysiological and pharmacological leitmotifs, which were grander than the knowledge displayed by my NP and midwife preceptors.  The MD had simply more knowledge and more depth in the fields of anatomy, pathophysiology and pharmacology. The nurses, on the other side, came through as more human, more approachable and maybe a bit more effective in convincing their patients to comply with their plan of care. But, there is plenty to learn from both worlds.

     Consequently, my goal for my next semester of clinicals is to absorb and to immerse myself as much as I can in both philosophies of care; to become an outstanding diagnostician and professor, on one side, and a practitioner with a reputation for professional integrity, benevolence and amenability, on the other.  

Thank you,
David Muscan