About Jodie Marcantoni, MSN, DNP, FNP-BC, ANP-BC: Jodie Marcantoni is a Family Nurse Practitioner and Adult Nurse Practitioner who specializes in Infectious Diseases at Washington University in St. Louis/Barnes Jewish Hospital, where she provides intensive care to adolescent and adult patients suffering from complex and/or serious infections. She also works as an Instructor for Inpatient Medical/Surgical Nursing at Barnes Jewish Hospital, where she lectures on medication safety, critical care, and infectious diseases. Prior to her current roles, Dr. Marcantoni was a Family Nurse Practitioner at East Boston Neighborhood Health Center, and delivered primary care to adult and pediatric patients. She also worked for several years as a Registered Nurse in the General Medicine and Emergency Departments at Massachusetts General Hospital, and as a Certified Nursing Assistant at Brigham and Women’s Hospital.
Dr. Marcantoni earned her Bachelor’s of Science in Nursing and her Master of Science in Nursing from Simmons College in 2005 and 2007, respectively. She earned her DNP from the University of Massachusetts Boston in 2012.
[OnlineFNPPrograms.com] May we please have an overview of your academic and professional background in nursing?
[Jodie Marcantoni, MSN, DNP, FNP-BC, ANP-BC] I am certified as both a Family and Adult Nurse Practitioner, and currently practice at Washington University in St. Louis/Barnes Jewish Hospital in the specialty of Infectious Diseases. I work on an inpatient consult team, and provide specialized care to adolescent and adult patients with severe infections. Infections and antibiotics require a thorough approach to all body systems and medications; therefore a large part of my practice also involves General Medicine. I am also an adjunct faculty member for Grand Canyon University’s Acute Care NP program. Before I specialized in Infectious Diseases, I worked as a Nurse Practitioner in Family Practice at East Boston Neighborhood Health Center and provided primary care services to obstetric, pediatric and adult patients. My RN experience is in both general and emergency medicine at Massachusetts General Hospital in Boston. I received both my BSN and MSN degrees from Simmons College in 2005 and 2007, respectively. I received the Doctor of Nursing Practice degree from the University of Massachusetts in 2012. As a doctoral student and professional, I have been able to enjoy opportunities such as speaking, clinical research, staff education and training, and leading evidence-based clinical quality improvement efforts.
[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?
[Jodie Marcantoni, MSN, DNP, FNP-BC, ANP-BC] For the past several years I have worked with students in both Acute Care and Primary Care NP masters programs. For my current specialty, I created an orientation manual that explains the duties and expectations of my position, and includes resources and tools I have found useful in the clinical setting. Before the start of the practicum, I send this manual along with several articles to the student so they can familiarize themselves with the role, terminology, commonly used resources, etc. I also include learning objectives for them, which we review and edit as needed once they start their practicum.
The first day or two of our time together involves them shadowing and writing down any questions they may have. Based on their experience and comfort level, I have them see 1-2 patients on their own and gradually add more patients based on their preference and performance. They generally start with reviewing the patient’s chart (history, lab results, medications, imaging, etc.) and simultaneously looking up clinical information as needed. After this, they meet the patient and perform a history and physical exam. Based on these findings, we review the literature and any necessary clinical tools, and assess whether the patient requires any new diagnoses, and what kind of clinical plan they require (diagnostics such as imaging or labs, medication changes or additions, consultation with a specialist, etc.). We then discuss any collaboration and patient education that may be necessary.
I always emphasize to my students that I want them to walk away with the knowledge of appropriate collaboration and consultation, as well as knowing how to obtain evidence-based information for clinical diagnosis and management. I also encourage a systematic approach to each patient encounter, as this helps minimize the risk of overlooking information and potential errors. One example is to always start with the patient’s chart review and obtain as much history and clinical knowledge (i.e. medication review) as possible before the actual patient interaction. Clinical care is always changing and it is impossible to know everything about everything. Therefore knowing where to find reliable and scientific information is key to delivering safe care to patients.
There are several things a NP student must consider and discuss with me during a clinical day. Before each patient interaction, the student and I go over the information obtained from the chart, as well as any necessary reviews of the literature or clinical tools. After the patient interaction, where a history and physical exam are performed, we also touch base to review all of the data gathered. At this point, we can work together to formulate an assessment, plan and educational/teaching plan for the patient. So there are many points at which we get together and discuss key information, which helps the student know what to expect as well as emphasizes the systematic approach discussed earlier.
[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?
[Jodie Marcantoni, MSN, DNP, FNP-BC, ANP-BC] Transitioning from the RN to the NP/Advanced Practice Nurse role is certainly challenging, both from a clinical standpoint as well as an emotional/holistic standpoint. In many settings, RNs are able to spend more time with patients and this can be quite a change once becoming a NP and acquiring greater clinical and coordination responsibilities for an often larger number of patients.
A day in the life of a RN in the acute care/hospital setting typically starts with a shift report, prioritizing which patients to assess first, and identifying acute versus non-acute needs. The tasks of administering medications and treatments, monitoring for clinical responses and/or changes, utilizing clinical tools and policies/procedures literature, documenting clinical information, and teaching patients and families are constantly in motion throughout the day. NPs in the hospital setting utilize many of these same skills, for instance prioritizing the patients on their list, and identifying acute versus non-acute needs. The overarching goal of the NP does differ in regard to formulating a plan of care, consulting with other providers as needed, considering insurance coverage for medications and treatments, and moving closer (as appropriate) toward discharge planning and preparation.
In the outpatient/clinic setting, RNs and NPs also have quite a bit of overlap in regard to responsibilities and daily tasks. Although patients are booked into appointment slots, overbooking needs and emergencies require prioritizing of patient needs. Patient assessment and teaching are also important for both roles. The RN role in this setting requires patient assessment, medication and treatment administration, and patient teaching in regard to care plan changes, lab results, etc. The NP role focuses on more in depth chart reviews, advanced examination/assessment techniques, consideration of insurance coverage for diagnostics and medications, coordination and communication regarding consultations, and follow-up regarding results.
One of the biggest changes when stepping into the role of provider is the amount of time spent reviewing information, both from the chart as well as literature and clinical resources. Medicine is increasingly becoming more evidence-based, and knowing what to do as well as why is of the utmost importance when formulating a plan of care as a NP. Another challenge I remember, and that my students notice once they start practicing, is that of collaboration and consultation. There are so many specialties in nursing and medicine, and it can often be overwhelming when determining which individual to contact for questions and/or referrals. Creating a foolproof follow-up system is also a new responsibility for NPs, including ensuring patients received an appointment within the appropriate timeframe, and that you receive all necessary information from specialist visits.
It is important to remember that although the role may change, the basics of nursing care do not change. There are many responsibilities of a RN and NP that overlap, for example patient assessments, medication safety monitoring and patient/family teaching. NPs will always be nurses and must still remember to address all aspects of the patient’s human needs, include family/friends in patient education, and remain compassionate despite the increased responsibility of managing the patient’s health.
[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?
[Jodie Marcantoni, MSN, DNP, FNP-BC, ANP-BC] The biggest challenge that students encounter when trying to secure clinical placements is that of busy providers. I have often heard colleagues mention that while they are willing to teach students, they are just too busy with patient care and its associated administrative work.
In my experience, students are often looking for a semester long clinical opportunity, which typically requires 1-2 days per week of working with a preceptor, and can be daunting to those with a full time clinical role. My suggestion would be to offer several options in their request to a preceptor, perhaps a 3-4 week experience, or one day every other week for a semester. This may require more juggling on the part of the student, but may result in finding more willing preceptors.
[OnlineFNPPrograms.com] Do you mean that some students have multiple preceptors and medical settings that they go to for a given term to fulfill those hours?
[Jodie Marcantoni, MSN, DNP, FNP-BC, ANP-BC] Exactly. Some programs allow students to obtain approval for several preceptors for a given term. Multiple preceptors and medical settings can lead to more juggling work on the student’s part, but results in teaching from multiple providers with a range of experience and teaching styles. This also results in a more varied clinical experience, which I strongly suggest. This would expose the student to more styles of care management, a wider range of resources, and different clinical practice cultures. This was the approach I took while working on my Masters degree, in order to get some exposure to various specialties. Some of the tidbits of information I learned during a one day per week/4 weeks total Dermatology clinical I have used for the past 10 years!
I also strongly suggest that students pick a realistic number of articles to read during their time in clinical in order to supplement the lessons learned. This will solidify a habit of applying evidence to practice as well as expand their knowledge base.
[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?
[Jodie Marcantoni, MSN, DNP, FNP-BC, ANP-BC] I think at first, relationships between preceptor and student start out structured more like a mentor-mentee relationship. This relationship can certainly vary based on the knowledge base and career experience of the student and the responsibilities of the preceptor. If there is more time allowed in the daily schedule, the relationship as colleagues can have a chance to grow. In situations where the clinical experience spans several months, I have certainly seen a mentor-mentee relationship move into more of a collegial relationship. Many times students possess a very strong knowledge base in a particular area in which their preceptor is not familiar. We can learn a great deal from each other, and appreciate this opportunity for professional growth. I work with many NPs that joined me on a clinical several years prior, and I think our current collegial relationship is stronger because of that experience.
[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?
[Jodie Marcantoni, MSN, DNP, FNP-BC, ANP-BC] The primary concern tends to be that of seeing enough clinical variety so that they can apply these experiences to their course discussions, assignments and exams. There are also many questions regarding where to look up information, and what clinical resources are reliable and valid. I will often help students see a wider variety of cases by collaborating with colleagues regarding shadowing or additional clinical opportunities, or showing the student how to look up case reports on rare or challenging cases. A big part of my teaching is to show students how to access clinical resources, and how to appraise clinical research in terms of its applicability to practice.
[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?
[Jodie Marcantoni, MSN, DNP, FNP-BC, ANP-BC] When I started to specialize in Infectious Diseases, I started receiving a lot of emails from students who wanted a short-term clinical experience in Infectious Diseases. I work in an academic setting where there are a lot of resources like literature databases, conferences, and seminars, and wanted to be able to share these opportunities with students. I also believe that we can learn the most when we teach others, as it forces us to master knowledge in particular areas and then provide further explanation and examples.
There is no additional certification required to work as a preceptor, however some schools do require a short orientation (often online) that familiarizes preceptors with the school philosophy, course expectations and resources. There is usually an evaluation to complete on the student at the end of the course, and some schools also schedule a phone call or site visit.
A potential preceptor should closely evaluate their clinical setting to determine whether the time, space and resources for student teaching are available. An evaluation of the culture and environment of one’s clinical practice setting is also vital, as the student will be utilizing the common areas and interacting with other staff and providers. They should also evaluate their time commitments, as precepting students does require additional time to answer questions, look up information, review and evaluate documentation, and meet with school faculty as needed.
Thank you Dr. Marcantoni for participating in our preceptor interview series!