Whether handing-off patient care to another provider or communicating patient advocacy to an overseeing physician, this skill is essential for ensuring safe and effective continuity of care. Many new nurse practitioners are anxious about this task, but a few TiPPs may alleviate some anxiety surrounding this important duty.
1. Build self-confidence.
You should practice confidence building throughout nursing school, especially during preceptorships. One way to do this is to treat every patient encounter as though you are the sole decision maker for their care and avoid depending too heavily on the knowledge and experience of instructors or preceptors. Only after determining diagnoses and a plan of care, seek affirmation or correction for your decision making and learn from the mistakes.
After graduation and landing your dream job, follow the same process, but get that affirmation from a co-practitioner or supervising physician.
2. Look it up.
You are not going to “know it all”. That is a true statement even after years of experience. But you do have many resources at your disposal-use them. Never approach another medical professional with a question without a potential diagnosis and plan in place.
3. Be clinical.
This is difficult for nurses, maybe due to the holistic patient care model of nursing rather than the disease process model used by many practitioners. Regardless, you need to adapt to giving precise clinical data in a fast-paced environment. Do not be conversational. Remember, you are encroaching on a valuable commodity (time) when you ask others for input. Which means you need to become well versed in delivering the most pertinent information at a quick pace. Give them only the information they need to evaluate your clinical judgement.
4. Start with “the ask”.
Again, your peers and overseeing physicians are extremely busy, so make clear your request for input at the beginning. Start with a statement or question like: “I wanted to make sure my differential diagnoses are accurate.” or “What other tests would you recommend?” This way they know what information is valuable and the type of response you are requesting. Remember, saving time with concise questions will be greatly appreciated by your overseeing physician and co-practitioners.
5. Anticipate questions.
You will not have the time to read the chart to the provider, but you need to know the pertinent information required for advisement. For example, if a patient presents with symptoms of heart disease, you need to know their smoking history, family history, date of last stress test, and medication status (are they taking a statin and if not, why?). You may not have mentioned these things in the verbal report, but you should be able to answer these questions on the spot.
And even if you forget a detail, the experienced practitioner will ask the right questions and it is up to you to know your patient well enough to answer competently.
I know it is not going to be easy in the beginning. But if you are as prepared as possible to answer questions, you will get a boost in confidence and build trust between you and fellow practitioners.
6. Master a quick chart review.
Fear not, you will become proficient at this. However, in the beginning it can be quite overwhelming especially if a patient has an extensive medical history. It may be helpful for you to start performing mostly physical exams in the beginning of your career if that is allowed by your employer. These types of exams are often tedious for other practitioners, but it can be a great learning experience for you because it requires you to absorb a lot of information about the patient in a short time frame.
Of note: Theoretically when a patient comes in for a well visit, it should not be combined with an E/M (Evaluation and Management) visit. You need to devote that time to a thorough chart review and physical exam. Doing both may sacrifice the purpose of the physical.
Finally, these are not an exhaustive list of tips for improving your Provider-to-Provider reporting skills. Still, they are a good place to start on your journey to becoming the best Nurse Practitioner that you can be. Be well and good luck!
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