Post nurse practitioner school: Did you feel prepared?

There is absolutely no way to feel 100% prepared coming out of nurse practitioner school. Health care is a vast and ever changing field. It is impossible to know everything. Many experienced and new grad nurse practitioners feel a sense of imposter syndrome. This is very common and to be expected. As nurse practitioners, we are never expected to know it all. We should have resources and collaboration with our colleagues. 

Having said that, in terms of charting, most nurse practitioners are not prepared for real world practice. 

Nurse practitioners are taught very little when it comes to charting. And yet, charting is such an important part of our practice. As nurse practitioners we essentially chart for three reasons. 

1.Continuation of care

2.Billing and coding 

3.Legal purposes

Our visit with the patient does not mean anything if we do not document our findings. 

However, nurse practitioner schools do not teach enough about charting. I don’t know about you, but when I was in nurse practitioner school, I had like one lesson on how to chart that barely scraped the surface of how to code a visit. 

I was lost as to what I should be doing, what should go in a chart note, how to properly choose the correct evaluation and management code, and how to protect myself legally. I did not feel prepared coming out of his practitioner school. 

Fortunately, I was able to document during my clinical experiences. I know how many of my fellow nurse practitioner students did not have this privilege. It takes a lot of action and practice to create a chart now and ensure you have the necessary information. I started out dictating notes, which was very helpful.  Reiterating a history of present illness,  a review of systems, physical exam, and plan of care taught me the components of a chart note. But that is about all I learned in regards to charting during nurse practitioner school.

I know it is extremely difficult for instructors to have the time and resources to teach on charting, so that is part of the reason why I created The Nurse Practitioner Charting School. The NP Charting School is the one stop for all documentation resources. I wanted to provide the education to fill the information gap in nurse practitioner schools. That is why I created free and paid resources to provide nurse practitioners the education to improve their charting. 

Nurse practitioner schools fail at charting education.

Here are a few of the reasons why nurse practitioner schools fail at educating APRNs about charting. 

Evolving curriculum.

Nurse practitioner schools often prioritize clinical skills, advanced diagnostics, and evidence-based practice. These areas are vital (pun intended) for nurse practitioners to provide high-quality care. However, due to the limited time and extensive curriculum, charting might take a back seat, leading to a lack of comprehensive training in this essential aspect.

Time constraints.

The rigorous nature of nurse practitioner programs leaves little room for in-depth training on all aspects of nursing practice. Students are required to absorb a wide range of medical knowledge and clinical skills, which can lead to less emphasis on practical skills like charting.

Varied clinical placements.

Nurse practitioner schools often have diverse clinical placements in various specialties and healthcare settings (that NP students have to find themselves). While this provides nurse practitioners with a well-rounded clinical experience, it might not allow for consistent exposure to charting practices specific to a particular unit or department.

Limited faculty resources.

Educational institutions may have limited faculty resources to provide individualized training on charting. Clinical instructors may prioritize other critical skills, leaving charting education to be acquired through self-study or on-the-job learning.

Assumption of prior knowledge.

Some nurse practitioner schools might assume that students possess basic charting skills from their previous nursing education. As a result, they may not include comprehensive charting instruction, assuming that students will refine these skills during clinical rotations. There are also several differences in charting as a RN vs. a NP that do not get discussed in nurse practitioner school.

Focus on technological proficiency.

Modern healthcare is increasingly reliant on electronic health records (EHRs) and digital charting systems. Nurse practitioners might be taught how to navigate these systems rather than focusing on the foundational principles of actual charting itself.

Legal considerations of charting. 

Charting is not just about documenting patient care; it also has legal and ethical considerations. Many nurse practitioner schools do not educate nurse practitioner students how to protect themselves legally. Teaching these intricate aspects requires dedicated time and expertise, which may not be fully integrated into nurse practitioner school curriculum.

To learn more about legal considerations, check out Legal Issues with Charting

Lack of standardization.

Charting practices can vary widely across healthcare facilities and specialties. The lack of standardization makes it challenging for nurse practitioner schools to provide a one-size-fits-all charting curriculum.

Practical vs. theoretical learning.

Nursing education often balances between theoretical knowledge and practical skills. Charting falls into the latter category, which can sometimes receive less attention in favor of theoretical concepts. I don’t know about you, but I wish I could have learned more about charting and less about nursing theory…..

Emphasis on critical thinking.

Nurse Practitioner school focuses on developing critical thinking skills, which are essential for complex decision-making. While charting requires critical thinking, the emphasis might be on clinical practice rather than documenting it.

As mentioned, there are many challenges instructors face when it comes to education on documentation. However, I believe there should be more of an emphasis on charting during nurse practitioner school. There are several negatives that can result from a lack of this education.

Negatives of lack of charting education.

The lack of comprehensive charting education for nurse practitioners can have significant implications.

Increase time and frustrations. 

When nurse practitioners are not properly taught how to chart in nurse practitioner school, they often struggle when it comes to real world practice. When nurse practitioners are not properly educated about charting, it can increase time and efforts from the nurse practitioner. It can leave the nurse practitioner feeling frustrated and overwhelmed.

Risk for nurse practitioner burnout. 

As The Burned-out Nurse Practitioner, I have discovered the #1 cause of nurse practitioner burnout is a lack of work-life balance. So many APRNs are staying late at the office or bringing charts home, just trying to catch up. This can ultimately cause nurse practitioner burnout. If NPs were taught how to chart in nurse practitioner school, they may have been able to prevent their nurse practitioner burnout. 

Loss of revenue. 

We have to remember that healthcare is a business and and businesses have to generate income in order to continue to run. As a nurse practitioner, it is our duty to assess, diagnose, and treat patients. We then document our findings. This documentation is used to choose the correct evaluation and management code which will then be used to bill the patient’s health insurance for services rendered.

In order to generate income, nurse practitioners should choose the accurate evaluation and management code. Nurse practitioner schools should do their part to educate NP students on the process of billing and coding patient encounters. This will ensure accuracy and avoid any lost revenue. 

Inaccurate documentation. 

Incomplete or inaccurate charting can lead to misunderstandings, potentially compromising patient safety and continuity of patient care. Nurse practitioners should be educated on the importance of documentation and taught how to properly chart. 

Legal and regulatory risks.

Inadequate charting can expose nurse practitioners and their institutions to legal and regulatory challenges, as proper documentation is essential for evidence-based practice and risk management. Nurse practitioner schools should educate NP students on ways to decrease their chances of legal actions to be taken.

Communication breakdown.

Effective charting enhances communication among healthcare providers, ensuring a seamless flow of information. Poor charting can hinder effective communication, leading to misunderstandings and mismanagement of patient care.

Summary

Charting is an integral part of nursing practice that holds immense importance for patient care, legal compliance, and communication among healthcare providers. The reasons why nurse practitioners often don’t receive comprehensive charting education during their schooling are multifaceted and interconnected.

As the healthcare landscape continues to evolve, it becomes increasingly crucial for nursing education programs to strike a balance between theoretical knowledge and practical skills, ensuring that future nurse practitioners are well-equipped to document patient care accurately and effectively. 

Additional charting resources for nurse practitioners. 

For any nurse practitioners who did not feel prepared from their nurse practitioner school (myself included), The Nurse Practitioner Charting School has some amazing resources. 

Time Management and Charting Tips Course​: Learn the tips and tools to chart accurately and efficiently so you can run on time during your workday, eliminate the overwhelm, leave work on time, and STOP charting at home!

​​Basics of Billing and Coding Course​: Feel confident choosing the correct Evaluation and Management CPT® code for an outpatient, inpatient/obs, ER, and nursing facility patient visits, so you can avoid over coding (and under coding!) ensuring you receive proper insurance reimbursement!

​​Legal Issues with Charting Course​: Learn how to prevent a malpractice suit and put your mind at ease regarding legal issues of charting.

The Comprehensive List of Smart Phrases​: Get access to over 125 smart/dot phrases you can easily implement into your charting system and immediately save time charting!​

​How to Chart as a New Grad Nurse Practitioner Course will help you overcome the overwhelm and learn to chart as a new grad nurse practitioner!