Transcript: The Right (and Wrong) Way to Ask Questions as a New Nurse Practitioner

​Liz Rohr:
Hey there, it's Liz Rohr from Real World NP. You're watching NP Practice Made Simple, the weekly videos to help save you time, frustration, and help you learn more faster, so you can take better care of your patients. Today, I want to talk to you about the right way and the wrong way to ask questions as a new grad.

I'm going to tell you about some of the mistakes that I made and then three steps to make it really easy for you to avoid the mistakes that I made. I had an amazing grad experience in my NP program. I worked with a clinician who, unfortunately, because of both her personal style and the clientele that she worked with, I did a lot of shadowing instead of seeing patients on my own. I learned a ton just by absorbing passively, but I didn't really have that skill down of seeing patients on my own.

When I graduated, I pretty much adopted one of my colleagues as my adopted preceptor. That's not necessarily what she had signed up for, because she was my colleague, she wasn't my supervisor, she wasn't my preceptor, I wasn't a student. What I would do is, I would go into a room, I'd see a patient, I'd just blurt out whatever was happening, just in the middle of the story, without any context. I'd just be like, what should I do? Thank you so much, Christina, for your patience with me.

That's an example of the wrong way to ask questions. Our colleagues are there to help us, and they've been there too. It's okay to ask questions, but there's definitely a better way to ask, so that you get the answers that you're looking for, and also, you build and maintain your colleague relationships. That's a lot to ask of one of your colleagues, to just do what I did.

Step one, the first thing is really presenting a case. When I was in school, I found this to be a little bit old school. Maybe it's not, maybe I'm just stubborn. But, in terms of those classic case presentations of, I have a 33-year-old woman with abdominal pain and blah, blah, blah, I was very lackadaisical about it and I don't think that that helped me. I don't think you necessarily have to be very rigid, but if you can work on presenting a case in an organized way, so that you give all of the relevant, pertinent information to the person you're asking the question of, that's really, really helpful.

For example, I've got a 33-year-old woman with new onset abdominal pain, right upper quadrant, started last night. It was 10 out of 10, now it's about eight out of 10. She has no nausea, vomiting, diarrhea, dysuria, hematuria, vaginal discharge, et cetera, et cetera. And no past medical history, no past surgical history, anything relevant, no family history.

If you start with step one by presenting your case, when you go to step two, the next step, instead of saying, what should I do, you just have to do as much of the legwork as you can. Luckily for me, when I first started, and this ties into my first video which I can link to in the comments below, is that you need to have enough time in your schedule to be able to do all of that learning and all that legwork, so that you know what you're doing and you're not relying on your colleagues to give you all the answer. Stabbing at the differentials, the possible treatment options and taking it from there.

For this particular patient, she took Tylenol a couple of times, maybe 500 milligrams, and didn't really help her. It seems to be slightly improving, but it seems like it's also radiating down to her left lower quadrant. I'm really worried that it's something... She has no fever.
You can tell that I'm still a little bit lackadaisical about my presentations and I have to write them down, but I left out that she had no fever or chills. Your right upper quadrant has your spleen, your left lower quadrant has your intestines, and I'm thinking about your ovaries are there. Is this something ovarian? It doesn't really seem like it's intestinal. Spleen is a pretty rare differential. So, starting there with the discussion.

Step number three is to ask as specific a question as possible. What I would used to do, even if I got the first two steps right, I'd still be like, do you agree with that? I got feedback from somebody that said to me, and I agree with this, that the practice of medicine is an art. Even though we have guidelines and we have recommendations, and usually getting from A to B, you'll get there, but people will do it a little bit differently stylistically. So, I changed my phrasing to either, what do you think about that, or, what other tests would you order? Something a little bit more specific.

Those are the three steps. Number one, presenting your case a little bit more concisely than I am. I write mine down. When I write it down and I'm reading it off, it's more concise. I do take my own advice. Number two is, doing as much of the legwork as possible, coming up with differentials, and a stab at a plan. Hopefully the full plan, if you can have that full hour to look at your patient's chart and your resources. And then number three is, just asking those specific questions so they can guide you the best that they can.

I'd love to hear from you. Are there any strategies that you use to build those relationships, ask the questions to get the right answers? Leave me a comment below. It helps me and it helps our other colleagues learn and do better. 

Don't forget to go to realworldnp.com and sign up for the email list. You'll get these videos by email every week, including a note from me and some bonus content that I just don't share anywhere else. That's it for today. Thank you so much for watching. Hang in there and I'll see you next time.