Many times, nurse practitioners (NPs) are trained in outpatient settings and have limited exposure to the NP role in a hospital, aside from prior bedside nursing experience. Entering the NP workforce as a hospital-based provider has its challenges and can be intimidating. But, by knowing how a hospital NP approaches their day and what to expect, you can feel empowered while safely and successfully taking care of your patients.
Hospital based NPs typically have responsibilities of both rounding and completing admissions for patients that need to be placed in the hospital. State practice laws determine the amount of physician oversight and procedures that you will be doing. Be sure that you have a good understanding of your scope of practice prior to beginning this role.
Pre-rounds are a priority in the morning (while drinking your coffee!). During pre-rounds, you look up your patient’s charts, familiarize yourself with their stories, diagnostic procedures performed, morning labs, overnight vital signs, plans of care, read specialist notes, etc. If you see something that needs to be addressed, you can start treatments for the day. For example, low potassium levels resulting from overnight labs may need to be immediately addressed, or any other issues that you may notice.
Sometimes it is appropriate to consult specialists while doing your pre-rounds. If there is something that you know needs a consult (example: a dialysis patient needs a nephrology consult), it's best to alert the consulting services about these patients early in the day so they can better plan their patient flow. On the other hand, sometimes you need to see the patients and complete a physical exam before consulting with specialists. When you become more accustomed to the facility, you will learn what different consulting services prefer.
After fueling up on your 'morning sunshine in a mug' during pre-rounds, you head outside of your office/provider’s lounge and into the nursing units. Prioritization here is key. You have to decide where to go first… should you see your sickest patients in the ICU first, the patient that may need a cardiology consult, or the patient with questions that has a procedure planned later? Deciding which patient to see first can be the hardest part of organizing your day and the answer will change daily.
Remember to round with your bedside nurses! We all know that nurses are the heartbeat of the hospital. It is so important to round with them so they can update you on events and you can make sure that you are on the same page with the plan of care. Rounding with the nurse is absolutely crucial to the care of the patient.
Some providers take computers with them to each room to round and put in orders while they are with the patient. Others choose to sit down at the nurses station and put in orders after they round. This is a personal preference and you will figure out what you like once you ‘get in your groove.’
After you see all of your patients, put in orders, consult specialists, and sometimes update family members, it's time to document everything you have done. Writing progress notes on every patient can be tedious, but it is extremely important. Your daily notes provide many people with so much information: nurses, case managers, other providers, another NP that may take care of this patient when you go home, and the list goes on. A key aspect of success in this role is making sure that your charting is correct and complete.
It Will Be Worth It
Every day working in the hospital setting will be different. You will take care of a variety of diagnoses, be immersed in so many different types of situations, meet a variety of people (both coworkers and patients), and constantly be thrown off of your plan for the day. At the end of the day, it is important to remember that a hospitalized patient is likely experiencing the scariest day of their life. Although this situation is routine for you, they are terrified. When you are going through your day, take the time to talk with the patient and make them feel as comfortable as you can that you are taking the best care of them. You will be able to walk away from your day knowing that you took the best care of your patients, and that you will be ready and prepared for all that you are faced with your during your next shift.
Sara L Piercy, DNP, FNP-C
Sara is a nurse practitioner in a hospital setting in rural North Carolina. She enjoys taking care of the geriatric population and has a particular interest in cardiac and neuro patients.