Psych NP Clinicals: Things I Wish Someone Had Told Me Before I Started - Part 2
There are some things about psych NP clinicals that you simply don’t understand until you’re actually doing them.
You can study the DSM. You can review medications. You can prepare for your first day.
And then you walk into clinical and realize there’s a whole other layer to becoming a PMHNP that no textbook really prepares you for.
Check out Part 1 of tips for the transition from RN to Psych NP student if you missed it..
Start Asking Why Your Preceptor Is Making Clinical Decisions
One of the best ways to learn during psych NP clinicals is to stop focusing only on what your preceptor is doing and start paying attention to why they are doing it.
Your preceptor might choose one medication over another, ask a question you didn't think was important, order labs, change a dose, hold off on starting a medication, or decide that a patient needs a higher level of care.
It's easy to watch those decisions and think:
Okay, that's what we do in this situation.
But there's a much more valuable question to ask:
Why did you make that decision?
That's where clinical reasoning starts to develop.
You could leave clinical knowing that your preceptor likes a particular medication for a particular diagnosis.
But that doesn't necessarily help you when you encounter a patient who doesn't fit the exact same scenario.
Instead, try to understand the reasoning behind the decision.
For example, instead of thinking:
My preceptor started sertraline for this patient.
Ask yourself:
Why was an SSRI chosen?
Why sertraline specifically?
What symptoms were they trying to target?
What patient factors influenced the choice?
What alternatives were considered?
Were there reasons to avoid other medications?
What side effects or risks were they thinking about?
What would make them change the plan later?
Now you're not just memorizing a medication choice.You're learning how to think through a medication choice.
Don't Pretend You Understand Something When You Don't
This might be one of the hardest lessons to learn as a student:
You don't have to pretend you understand everything. There will be moments during clinical when your preceptor starts talking about a medication, diagnosis, treatment strategy, or clinical decision and you realize you don't completely understand what they're saying.
And your first instinct might be to nod.
Smile.
Maybe say, "Right."
And hope the conversation moves on.
Don't.
It's Okay Not to Know
You're a student.
You're there to learn.
You are not expected to walk into clinical knowing everything your preceptor knows.
In fact, one of the best things you can do during clinical is become comfortable saying:
"I'm not sure I understand that. Can you explain it?"
Or:
"I'm familiar with the medication, but I don't think I understand why you chose it in this situation."
Or:
"I don't know the answer to that. Can I look it up?"
Those aren't signs that you're unprepared.
They're signs that you recognize a knowledge gap and are willing to close it.
Don't Confuse Looking Confident With Being Competent
There can be a lot of pressure in NP school to look like you know what you're doing.
You want your preceptor to think you're prepared.
You want to answer questions correctly.
You don't want to be the student who constantly says, "I don't know."
But there's an important difference between confidence and pretending.
A student who confidently gives an incorrect answer because they're afraid to admit they don't know something is much more concerning than a student who says:
"I don't know, but I'll find out."
The second student is demonstrating something much more important: intellectual honesty.
And that's a quality you want to carry into practice.
Your Preceptor Can't Teach You What You Don't Tell Them You Don't Know
Think about it this way.
If your preceptor explains something and you nod even though you don't understand it, they have no reason to explain it differently.
They may assume:
"She's got it."
So you move on.
Then a week later, the same concept comes up and you're still confused.
If instead you say:
"I'm sorry, can you back up for a second? I don't think I fully understand that."
your preceptor now knows where the gap is.
They can explain it another way.
They can give you an example.
They can point you toward a resource.
They may even realize that other students have struggled with the same concept.
Ask the "Dumb" Question
You will probably have moments when you think:
"This is probably something I should already know."
Ask anyway.
Maybe you're unsure about a medication interaction.
Maybe you don't understand why one diagnosis is being favored over another.
Maybe you aren't sure what your preceptor means by a particular term.
Maybe you don't understand why they're asking the patient a seemingly unrelated question.
Maybe everyone else in the room seems to understand something that completely went over your head.
Ask.
There is almost always someone in the room who has had the same question at some point.
And if you truly missed something foundational, that's okay too.
Now you know what you need to review.
But Learn How to Ask Without Derailing the Encounter
There is a difference between asking questions and interrupting every 30 seconds with a question.
You don't necessarily need to stop your preceptor in the middle of every patient encounter.
Sometimes it's better to make a quick note and ask afterward.
For example:
"I wrote down that you considered bipolar disorder but didn't think the patient met criteria. Can we talk about what you were looking for after we're finished?"
This allows the clinical encounter to continue while making sure you don't lose the opportunity to learn from it.
You'll eventually develop a sense for which questions need to be asked immediately and which can wait.
Let yourself be a student while you're still a student.
Get Comfortable With Silence
One of the hardest things to get used to during psychiatric interviews is silence. Especially when you're a student.
You ask a patient a question.They don't answer immediately. Three seconds pass. Five seconds. Ten seconds.
And suddenly your brain starts screaming:
"This is awkward. Say something!"
So you jump in with another question.
Don't be so quick to fill the silence.
Silence Isn't Necessarily a Problem
In everyday conversation, silence can feel uncomfortable.
In a psychiatric interview, it can be useful information. Patients may need time to think about what you've asked. They may be trying to figure out how much they're comfortable sharing. They may be emotional. They may not know how to put what they're experiencing into words.
They may be deciding whether they trust you enough to tell you something difficult.
And sometimes they're simply thinking.
If you immediately fill every pause, you may accidentally interrupt that process.
Give the Patient a Chance to Answer
As a student, you may be tempted to ask another question because you think the patient didn't understand the first one.
Sometimes they didn't.
But sometimes they just need a little more time.
Try waiting.
Maintain appropriate eye contact and an attentive posture.
Don't start frantically looking through your notes.
Don't immediately rephrase the question three different ways.
Just give them a moment.
You may be surprised by what comes next.
A patient who initially sits silently may suddenly say:
"I don't know why, but I haven't told anyone this before."
Or they may simply give you a much more thoughtful answer than they would have given if you'd rushed them.
Silence Can Tell You Something
Pay attention to when the patient becomes quiet.
Did they hesitate when you asked about suicidal thoughts?
Did they become tearful after you asked about their relationship?
Did they pause when you asked about substance use?
Did they suddenly become guarded when you asked about trauma?
You don't want to automatically interpret silence as evidence of anything specific.
But it can be a cue to slow down and explore further.
You might say:
"I noticed you got quiet when I asked about that. What are you thinking?"
Or:
"Take your time. There's no rush."
Sometimes the most clinically useful information comes after the question—not immediately after it.
