About Laura Smith Dziama, MSN, WHNP-BC: Laura Smith Dziama is a Women’s Health Nurse Practitioner at Boston University, where she provides primary care and gynecological care to female patients from adolescence to post-menopausal age. Prior to her current role at Boston University, Ms. Dziama worked at Phuli Cohan, MD’s private practice and at the University of Massachusetts Correctional Institution for Women. She has also been an Advanced Practice Clinical Preceptor for over 10 years at Boston College.
[OnlineFNPPrograms.com] May we please have an overview of your academic and professional background in nursing?
[Laura Smith Dziama, MSN, WHNP-BC] I earned both my BSN and my MSN at Boston College (BC). I decided to go right from undergrad to graduate school because I still had eligibility to compete as a track and cross country athlete for BC and get most of my graduate degree classes covered by my athletic scholarship. I am a member of the Sigma Theta Tau National Honor Society, Alpha Chi Chapter. I am nationally certified through NCC as a Women’s Health Nurse Practitioner. Since graduating I have been previously employed as a Registered Nurse and Women’s Health Nurse Practitioner at a private integrative medicine practice (Phuli Cohan MD), Worcester Polytechnic Institute Health Center and the University of Massachusetts Correctional Institution for Women in Framingham. I am currently employed at Boston University’s Student Health Center where I have been practicing for the past 6 years. A year after graduating from Boston College’s Connell Graduate School of Nursing I started precepting nurse practitioner students and have continued to do so for the past 10 years.
[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?
[Laura Smith Dziama, MSN, WHNP-BC] All preceptors are different but my style is to gradually expose my students to my work environment at Boston University. I make sure they are first comfortable with the electronic medical record, visit templates and also the types of visits we see on a daily basis. I think it’s important for them to feel comfortable before allowing them to see patients on their own. My goal in working with each and every student is that by the end of the semester they are comfortable seeing most patients on their own, presenting cases to me, asking questions and feeling confident in their clinical decision making. This takes time, patience and a lot of work on behalf of the student and myself as a preceptor. The first few weeks of having a student involves a lot of talking and time on my part which can be frustrating at first because I usually run behind schedule. But the reward typically comes at the end of the semester when I start to see my students becoming more independent and confident in their ability to give good care. Often times they make my job easier because they are able to do certain visits completely on their own with minimal consultation. I think that reaching this mutual goal is what keeps me wanting to precept and giving back to my profession in this way.
[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 staff nurse to advanced practice provider?
[Laura Smith Dziama, MSN, WHNP-BC] I worked part time as an RN about 16 hours a week for UMass Correctional Health in their trauma room and infirmary units while I was in graduate school. The biggest change I noticed going from RN to NP was being in a position where I was taking a lot of orders to immediately being in a role where I was completely independent and giving a lot of orders. Although I was always under the supervision of a physician I was primarily on my own and was making a lot of clinical decisions about the care of my patients. I think being able to make this transition successfully takes a lot of practice and repetition.
In the college health setting, there tends to be a lot of similar types of appointments such as contraceptive visits, visits for respiratory symptoms etc. I tell my students that repetition is good, you are never an expert the first time you are seeing a patient for a specific problem but the more you encounter that patient problem you become more confident asking the right questions, knowing what to look for clinically and then formulating the correct plan of care. Most importantly through repetition and experience you become effective at communicating the plan of care to patients in an empathetic and informative manner.
When I was a student and RN I gained lot of confidence from my clinical rotations, especially those where I was given a lot of autonomy and freedom to see patients on my own, as well as the freedom to ask questions and get feedback from my preceptors. I always keep that in mind when working with students. I want them to feel like they can ask me a lot of questions and alternatively I like to give feedback on what they could work on and also what they are doing well. The biggest challenge I see with students is their ability to feel confident communicating a specific and detailed plan of care to patients. I tell them that with time and experience this will come and to most of all be patient and kind to themselves while they are going through the process.
[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?
[Laura Smith Dziama, MSN, WHNP-BC] I think students should know that they actually do have a say in the types of clinical placements they will have and if they are not happy or not meshing well with their preceptor there is usually another option. The job of their clinical faculty member is partially to make sure they are happy and thriving in their clinical setting, so the first step would be to talk with them and look into all possible options that are specifically tailored to each student. In my opinion, NP students are paying good money to attend school and they should not but subjected to finding their own placements. But it is up to the student to be vocal with their clinical placement advisors and let them know if they have a strong clinical interest in a certain specialty.
For me, I was always interested in College Health, even back when I was in undergrad. Eventually I ended up in that clinical setting, actually for the longest stretch of my Women’s Health Nurse Practitioner career. If I hadn’t spoken up for what I wanted out of my clinical placements I may never have ended up where I am today, happy with my professional career! If students are unsure what they want to do in the long run they should be exposed to as much diversity as possible with their clinical placements and then usually from there they start to develop their own niche.
I do recommend that if there are certain skills or topics NP students are interested in while in their clinical setting they should look into conferences or workshops that help strengthen their knowledge; this will only make them more attractive to employers. One example in my line of work would be IUD insertion, as it is a very specific skill that Nurse Practitioners can perform independently and might make one person a stronger candidate over another when interviewing for positions. There are plenty of conferences such as Contraceptive Technology with intensive training on this particular skill. I’ve recommended them to many of my students in the past. Overall, they have had such great a experience learning, networking with other colleagues that have similar interests, and then being able to apply their knowledge in the professional world. Many conferences offer discounts to students, which is a nice perk!
[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?
[Laura Smith Dziama, MSN, WHNP-BC] The best scenario is to have a preceptor who can take a student for the entire year, especially if the student is particularly interested in that specific setting. Again, repetition is key in building skills, confidence and knowledge so the more a student is engaged and present the stronger they will be in that setting once they enter the professional world. Sometimes students will have to change settings due to the preceptor having to take another student, vacations or taking a medical leave which is something that is out of the student’s control. Variety is good, especially if the student is gaining valuable clinical knowledge and they are overall happy with the setting they are in. I personally have made a point to bond with my students personally, not that we are hanging out socially but I like to get to know them and vice versa so that they feel comfortable with me and we have a good rapport. I have kept in touch with many of my students through the years. A few have felt comfortable asking me for recommendations, which is always such a great feeling as a preceptor. Helping students enter the professional NP world is another level of reward that makes me happy my time with them was well spent!
[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?
[Laura Smith Dziama, MSN, WHNP-BC] Students always want to know if they are doing a good job and not all of them are open enough to share this with me so I try to make sure I am always giving them constructive criticism. If I am noticing a specific weakness with one of my students I try to let them know in a positive helpful way and will give them a few suggestions on how to correct the issue. I haven’t had much push back when approaching teaching students this way and have actually had mostly favorable responses and results!
[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?
[Laura Smith Dziama, MSN, WHNP-BC] I always recommend completing a full year or two of professional practice before precepting. There is so much growth and learning that takes place during that first year. Rookie NPs are busy enough learning how to be independent in their role that they should focus on becoming experts and then when they feel 100% confident in their role they should consider precepting. I started precepting after my first full year of practice, to be honest I did not take any classes or workshops; I just thought back to the best experiences I had as a student and tried to mirror those preceptors methods of teaching. I decided to be a preceptor because I was precepted and I felt the desire to give back to my alma mater and to my profession as both had already given so much to me.
[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?
[Laura Smith Dziama, MSN, WHNP-BC] NP students always keep me on my toes and help me stay current and up to date with what is going on in my profession so I can pass the most accurate evidence based clinical information on to them. The most rewarding thing to me as a preceptor is when I hear from my students that I have affected their professional practice in a positive way or better yet have helped them get hired! The biggest challenge is helping students gain confidence in their clinical skills and accepting failure…I think that being patient and open with your students helps them be patient with themselves in the long repetitive and sometimes confusing learning process!
Thank you Ms. Dziama for participating in our Nursing Preceptor interview series!