About Cortney Mazur, MSN, PACNP-BC: Cortney Mazur is a Pediatric Nurse Practitioner at Children’s Hospital of Michigan, where she works in the Hospitalist Division managing the care of acutely and chronically ill children. She has also served as a clinical preceptor for Wayne State University for over six years. Prior to becoming a nurse practitioner, Ms. Mazur was a Pediatric RN at the Children’s Hospital of Michigan, where she treated patients in the Burn, Trauma, and Rehab Inpatient Unit. She received her Bachelor’s of Science in Nursing at Oakland University in 2005, and her Master’s of Science in Nursing from Wayne State University in 2009.
[OnlineFNPPrograms.com] May we please have an overview of your academic and professional background in pediatric nursing and precepting?
[Cortney Mazur, MSN, PACNP-BC] I graduated with my BSN from Oakland University in Rochester, MI in 2005. I completed my MSN in Acute Care Pediatrics from Wayne State University in 2009. I worked as a registered nurse on the burn/trauma/rehab unit at Children’s Hospital of Michigan from 2005-2010. In 2010, I transitioned my role as a bedside/charge nurse to the role of a Pediatric NP in the hospitalist division at Children’s Hospital of Michigan (CHM). In April 2014, CHM transitioned its NPs to work for University Pediatricians, however my job has changed very little in this process. I continue to work in the same role at CHM despite this change in employer. I have been a clinical preceptor for Wayne State University since 2011. My students are primarily in the acute care PNP students, however I have also taken a few FNP students as well. I have also taken students from University of Detroit Mercy as well as Duke University.
[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?
[Cortney Mazur, MSN, PACNP-BC] My expectations of students vary greatly depending on their prior clinical experience, experience in the acute care pediatric setting, and if they are near the beginning or end of their master’s program.
In general, I like to sit down informally with my students either on their first day of clinical or prior to starting clinical and discuss general expectations. Personally, I am not as concerned with a student’s ability to document as much as I am concerned with their clinical competence. I am fairly certain that if given enough time, most students can write a thorough and accurate History and Physical Examination (H&P) or progress note. I want my students to get as much experience with patients and families as possible.
Typically the first day of clinical, I ask my student to simply shadow me to see what a typical day is like for me and to get acclimated to the workflow. Day two I will give them one or two patients to follow and I will observe them as they perform an H&P and assist them in presenting the patient in a concise and logical manner. Day 3 they will take 2-3 patients and depending on the medical complexity of those patients I will expect them to continue to take admissions throughout the day as they are able. By the end of the semester, I expect them to comfortably handle 3-4 patients to start the day and admit 2-3 new patients per day.
I don’t like my students to feel overwhelmed. I don’t feel the object of clinical is to “sink or swim.” I want my students to get enough clinical experience and have time to think about each case and actually learn something they can utilize in their future practice. I am personally not a big fan of objective evaluations (although most schools require them) where I rate my students’ abilities on a sliding 1-5 scale. I really want their clinical experience to be about soaking up anything that they can learn while they are here and repeating/reinforcing the process of gathering data/history, performing a complete and thorough physical assessment, forming an accurate impression with differential diagnoses, and formulating a cost-effective and sensible plan for the patient. These are the basics of any NP job and they need practice, practice, and more practice.
[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 health care provider?
[Cortney Mazur, MSN, PACNP-BC] The transition from RN to NP, for me, was a not an easy one. I enjoyed my job as a burn nurse immensely and I initially had a moment of regret when I became an NP. I loved being at the bedside and having so much one-on-one time with my patients and their families. I enjoyed doing blood draws, passing medications, performing dressing changes, etc. The role of the NP involves a lot of delegating and as a new NP I was initially uncomfortable delegating tasks to people with whom I used to work alongside as an RN. I found myself performing a lot of the tasks myself (placing NG tubes, drawing blood, etc) because I can do it, so why not do it? There comes a point where you will become comfortable and be able to let go of these things (largely because you won’t have time to do two jobs).
As the NP becomes more confident in her skills, the more she is willing to let go of the bedside tasks and find her place as a provider. Nursing is a very task-oriented profession… not that bedside nurses don’t use their brains, we all know that’s not true, but the role of the NP is to gather information, analyze that information, and formulate a plan. The NP role is more of a clinician and less of a caretaker. Any nurse can take a history. The NP’s role is to create an impression from the information gathered and come up with a plan. The NP’s job is to make the best decisions possible given a patient’s particular presentation and unique set of circumstances. This is much easier said than done and takes lots of time and practice, even after the student completes his or her schooling and clinical. Much of what there is to learn will be learned in the field with lots of time, experience, guidance, and practice.
[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?
[Cortney Mazur, MSN, PACNP-BC] My advice for any clinical placement would be to learn as much as possible and not be afraid to break outside of your comfort zone. I am grateful that I had the opportunity to rotate through a few subspecialties like GI and Pulmonology. In those placements, one will learn “a lot about a little” and there are valuable clinical pearls that come with such a specialized learning experience that one can only learn from a subspecialist. In rotations like ER, a clinic, or hospitalist team, you learn “a little about a lot” which is equally beneficial to have experience in a broad range of diagnoses. I encourage students to seek out clinical opportunities that are out of their comfort zone. That is where optimal growth and learning take place. Take advantage of the opportunity to polish the areas that need polishing. It will make the student a more confident practitioner in the long run.
[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?
[Cortney Mazur, MSN, PACNP-BC] I prefer to have a more collegial relationship with my students. I don’t want them to be intimidated or nervous. I want them to learn, ask questions, and absorb as much as they can during their clinical placement. I want us to get to know each other personally because more often than not, these students will become my professional NP colleagues at the hospital. That being said, there is an element of respect that must be present. I expect a student to be eager and not lazy. I expect them to challenge themselves and seek out opportunities to learn. I expect them to conduct themselves professionally with patients, families, and my colleagues. Sometimes when a relationship becomes too friendly, it is easy to lose that necessary respect and for the student to lose drive and focus. My students typically have to complete 200-300 hours of clinical in a semester, so they generally work 2-3 days out of the week with me (12 hour shifts). We work in a relatively small environment on a small team, so we have the opportunity to interact quite frequently throughout the day.
[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?
[Cortney Mazur, MSN, PACNP-BC] My students generally ask:
Q: What are the most common diagnoses seen in this rotation and how can I prepare myself?
A: I do feel like most of my students have the basic knowledge and are adequately prepared to see most patients assigned to my team. As a provider on the hospitalist team, we see a very broad variety of diagnoses and interact with subspecialists frequently, so it is difficult to narrow down one element to brush up on before starting clinical. This may be different with a subspecialty rotation. I prefer my students to actively learn and ask questions throughout their rotation as opposed to doing too much reading and research. It can be overwhelming especially working for a team with such diverse diagnoses.
Q: What are your expectations of me during this clinical?
A: I expect my students to be on time or communicate with me if they will not be on time. I expect them to take initiative without being asked… reassessment of the patient is huge for me. I find that many students will round in the morning and then get stuck staring at a computer to write notes. I, personally, am not worried about documentation. I am certain any graduate student can compile a thoughtful and thorough H&P or progress note if given enough time. I want my students to spend as much time at the bedside and with myself as possible. They should talk to families, reassess after interventions without being asked to do so, and modify the plan accordingly based on patient responses. I expect a complete and thorough physical exam on every single patient… that includes ears, eyes, nose, and throat. The more normal ears a student looks at, the more likely they are to be able to identify otitis media or other abnormality. It is certainly not easy to wrangle a 2-year old to look in their ears and throat, but it is necessary.
Q: What should I wear to clinical?
A: I personally wear scrubs to clinical on occasion and business clothes on most days. I feel I have the luxury of wearing scrubs because I have been doing this job for a long long time and I earned it! But my advice to students is to always dress in business clothes and lab coat. They need practice dressing and acting as a professional and it leaves an overall positive impression with patients, families, and colleagues.
[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?
[Cortney Mazur, MSN, PACNP-BC] I actually became a preceptor within one year out of graduate school (there were not enough acute care PNPs in the workforce to take on the number of students) and I am glad for it. I did warn my students that I am actively learning along with them. This approach really worked out well for me and (I hope) for my students. It was beneficial to learn together. I did not have all of the answers but we would figure things out together. I do feel one should be relatively confident in their skills as an NP before taking on students; however, I don’t think anyone is ever 100% confident in their skills and there is always room for improvement. One of my favorite sayings is “know what you don’t know.” You will never know everything about pediatric medicine. That is the beauty of this job. We are always learning and always developing ourselves as clinicians. The scariest person is the one who thinks they know it all. That is the practitioner that will potentially harm someone.
I try to only take students two semesters out of the year. As much as I love to teach, I feel it’s important to take a break to avoid getting burned out.
[OnlineFNPPrograms.com] What have been some of your most educational and/or rewarding experiences thus far as a preceptor? On the other hand, what challenges have you encountered as a preceptor, and how have you managed these challenges?
[Cortney Mazur, MSN, PACNP-BC] I have had a few NP students who went on to work for my team as NPs and they are now my colleagues. It is rewarding to me that they felt adequately prepared and enjoyed their rotation enough to want to make it their career. I have had one student that I had to fail half-way through the semester which was challenging. She wasn’t the worst student I have had in terms of clinical preparedness. I am certain she would pass her boards if she took them today, however I could not tolerate unprofessional behavior towards myself and my colleagues and that was a deal-breaker. I spoke with her personally at the mid-term evaluation and some of her behaviors changed but many did not. I felt it best to end our relationship as I did not feel she would be successful in this clinical. This is why attitude, professionalism, accountability, and respect are so important (and so easy to do, in my opinion).
Thank you Ms. Mazur for participating in our preceptor interview series!