About Adam Greenberg, MSN, ACNP-BC: Adam Greenberg is a Nurse Practitioner at The Children’s Hospital of Philadelphia, where he works with patients ages 18 and older, providing medical consultation and care coordination services. He also serves as an Advanced Cardiac Life Support instructor for clinical staff at the Hospital. Prior to his current role, Mr. Greenberg was a Heart Failure Nurse Practitioner at the Einstein Medical Center Philadelphia, where he developed clinical care plans for patients suffering from heart failure.
Prior to becoming a nurse practitioner, Mr. Greenberg worked as the Heart Failure Nurse Coordinator for The University of Pennsylvania Medical Center, and as a Critical Care Unit RN at Hahnemann University Hospital. He earned his BSN from Drexel University in 2004, and his MSN with a concentration in Acute Care Nurse Practitioner from The University of Pennsylvania in 2011.
[OnlineFNPPrograms.com] May we please have a brief description of your educational and professional background?
[Adam Greenberg, MSN, CRNP] I earned my BSN from Drexel University and MSN from the University of Pennsylvania, both located in Philadelphia; I am a certified as an Acute Care Nurse Practitioner (ACNP) by the ANCC. I am also a certified BLS and ACLS instructor. Of note, my BSN is actually my second bachelor’s degree–the first was a BA in anthropology from Drew University in Madison, NJ.
I am currently a nurse practitioner at the Children’s Hospital of Philadelphia, providing general clinical management of inpatients that are greater than 18 years old (Children’s Hospital of Philadelphia has a substantial patient population > 18 yoa: ~ 10%). I was actually hired to start this consult service. In addition to inpatient management, I work with a multidisciplinary team that develops comprehensive transition plans for patients with complex medical needs and/or intellectual and/or developmental disabilities that are transitioning to adult medical providers.
Prior to this, all of my nursing experience (both RN and NP) was with patients with heart failure. At Einstein Medical Center, functioning as an NP, I managed patients with heart failure in both the ambulatory and acute settings, including the ICU. I also ran my own clinic two days per week, seeing patients independently. Most often, I was performing heart failure symptom assessments and titrating medicine accordingly–trying to make patients feel better and keep them out of the hospital. Prior to that I worked as a heart failure nurse coordinator in a busy ambulatory clinic and in a cardiac ICU, both in urban academic centers.
[OnlineFNPPrograms.com] Could you please describe your past and current responsibilities as a preceptor? How do you collaborate with your students to set learning objectives for the academic term, what kinds of tasks/responsibilities are your students expected to take on, and what kinds of guidance do you provide them with?
[Adam Greenberg, MSN, CRNP] My responsibility as a preceptor has been two-fold: to ensure that the student meets all of their clinical milestones (performing appropriate histories and physical examinations (H&Ps), developing appropriate plans of care, and writing succinct progress notes, etc.) but also ensuring that they begin to build confidence as independent decision makers in patient care. I also found it important that NP students maintain professional standards when interacting with patients, other providers, and clinical staff in general.
Most clinical rotations lasted about twelve weeks and during that time, my goal was to move the student from observer to seeing two to three patients independently. Initially, I would have them follow me for a day or two in order to increase their awareness of the clinical presentation and needs of the patient population and to understand how clinics flow. After that, it would be a series of escalating tasks: obtaining histories then performing H&Ps and then writing notes. Primarily this would be for one patient, and then two, and possibly three. I would have them present the patient to me before I saw the patient and then ask them to present to other providers towards the end of their rotation.
[OnlineFNPPrograms.com] For graduate nursing students, clinical placements are an opportunity to apply what they have learned in their classes to actual patient scenarios, and to gradually step into the role of a provider. Could you explain what goes into this transition from registered nurse to provider?
[Adam Greenberg, MSN, CRNP] From my perspective, one of the biggest transitions for graduate nursing students is moving into the role of clinical decision maker. Graduate students are typically very good at obtaining complete H&Ps and physical examinations–it’s the assessment and plan that seems to cause the most apprehension. I’ve seen a lot of graduate nursing students and new-to-practice NPs hesitant to tell me what they think next steps for the patient should be. I think it’s a fear of not only being wrong but also potentially injuring a patient. However, clinical rotations should be safe environments for graduate nursing students to further develop their assessment and reasoning skills. More importantly, graduate nursing students need to be able to verbalize their reasoning for their clinical decision making. Finally, inasmuch as possible, it’s important for students to expect questions–and that’s not a bad thing! It’s our job as preceptors to ensure that students are headed down the right clinical path. We ask questions to make sure they’ve thought about all of the important things along the way and/or to help us understand how they’ve come to their decisions on patient care. When they are done with school, their real life experience should very much mimic this experience. You have to be ok being visible and accountable and those aren’t bad things.
[OnlineFNPPrograms.com] For current and prospective MSN students, what advice do you have for them in terms of making the most of their clinical placements? What are the challenges that students encounter when trying to obtain clinical placements, and how do you recommend they address these challenges?
[Adam Greenberg, MSN, CRNP] The clinical placement process can be tough. First, they are not always easy to get. I was fortunate enough to attend a school that had a coordinator to assist with placements but I know that’s not the case for everyone. If you are tasked with finding your own placements and aren’t having success, perhaps try to focus on sites that have a large nurse practitioner presence rather than on a specific clinical discipline. These practices may be able to accommodate you by having you work with different nurse practitioners for a given clinical rotation. To that end, always try to do a clinical rotation at a site that has previously accommodated graduate nursing students. This helps to ensure that structures to meet your education needs already exist. If you are reaching out to a practice, I would try to find how they utilize nurse practitioners (e.g. do they have an NP-run service?). Moreover, you may need to consider off-shifts like evenings, nights, and weekends, and travel. I negotiated a schedule with my preceptor to be there two to three consecutive days per week so that I could stay at a motel and not have to drive every morning. You have to be flexible at every turn.
In terms of discipline, I would encourage students to start more broadly and then narrow their focus, even if they know in which direction they would like to go. For example, I think an internal medicine rotation is a great place for every student to start. It provides exposure to common clinical conditions that present themselves across the adult life span, like asthma, diabetes, pneumonia (and other infections), hypertension, chest pain, etc. Students will be able to call on this knowledge for the entirety of their careers. Not to mention, if you are not sure what you want to do next, you get exposure to many different diseases and patient populations. The drugs that treat these conditions are common and you will see them throughout your career. It’s always nice not to have to look something up in order to understand how a situation might impact clinical decision making and impact a patient’s overall health. In my case, I started with an internal medicine rotation, did heart failure, and then specialized even more and did a rotation in pulmonary hypertension.
[OnlineFNPPrograms.com] In your opinion, what is the ideal working relationship between preceptor and student? Is it more collegial or is it structured more like a mentor-mentee relationship? How frequently do you typically interact with your students on a daily and weekly basis, and for what span of time during students’ clinical placements?
[Adam Greenberg, MSN, CRNP] In my opinion, the ideal relationship between a preceptor and student should span the spectrum from formal (mentor-mentee) to collegial, and, over time it may shift either way, usually depending on the student’s performance. I think it’s important for students to appreciate that, while a clinical rotation should be enjoyable, my priority is developing their clinical competence and ensuring patient safety. If, over time, a student exhibits diligence, respect, and humility, the less formal the relationship can be. I’ve also had to shift approaches in the past. When I first started precepting, I took the collegial path. I had a smart student and was confident in their abilities. From a clinical perspective they were outstanding but professionally, there was room to mature. Thus, I had to shift back to a mentor-mentee relationship, which allowed me to reestablish clinical and professional expectations.
In general too, I believe that all nurse practitioners are de-facto leaders, so I try to enhance leadership and communication skills during their rotation, if possible. For example, if a difficult conversation needed to occur (i.e., patient and provider, provider to provider), we would discuss not only the information that needs to be communicated, but also how to communicate it, how to manage misunderstandings and potentially negative interactions, while maintaining the respect and dignity of all involved parties.
[OnlineFNPPrograms.com] What are some of the primary questions and concerns your students have when preparing for and completing their clinical placements? How do you help your students address these concerns?
[Adam Greenberg, MSN, CRNP] The two most common types of questions are about schedules and expectations: how long does a typical day last, including when to arrive and leave. These are all fair questions, especially when students have competing needs like family, work, and other classes. I try to be as flexible as I can be and find days that meet their academic and personal needs and also work with my schedule. The first set of expectations is typically dictated by their university (e.g., how many notes they need to write and or submit, how many patients they need to see by the end of the rotation, etc.). I do also review my expectations for them: I want them to learn, ask questions, take it seriously, and hopefully enjoy themselves.
[OnlineFNPPrograms.com] What advice do you have for nurse practitioners who would like to become preceptors, in terms of preparing for this role? Why did you decide to become a clinical preceptor, and what steps did you have to take to become a preceptor?
[Adam Greenberg, MSN, CRNP] Advice for new nurse practitioners that would like to be preceptors is to first ensure–for as silly as it might sound–is to be sure that they would truly like to take on this additional responsibility. Being a preceptor means being present and that takes energy. It’s not always easy having a graduate student–the expectation is rightfully high, so the timing should be such that there aren’t too many competing demands on you (e.g., new position or clinical or new administrative responsibilities.) To that end, in terms of preparation, have a clear understanding of the clinical milestones that the student is expected to achieve, what are the expectations of the student’s academic institution for you (e.g., what and how often do you need communicated with them–face-to-face meeting, calls, etc.). When you have that information you can start to organize your student’s time with you. An additional consideration, in order to increase your student’s exposure to other clinical areas, is to reach out to colleagues beforehand to determine if additional opportunities might be available (e.g., a day with infectious disease, or in the OR, depending on the student’s interest).
Thank you Mr. Greenberg for participating in our Nursing Preceptor interview series!