Sending MGH Institute graduates into MGB system after “exposure, reps, and autonomy”

 

Matthew Lawrence loves what he does. A clinical preceptor at Cooley Dickinson Hospital for more than a decade, the critical care nurse practitioner has a direct role in molding the next generation of nurse practitioners. 

“I really I love the teaching part, going through and showing students how to do bedside procedures and taking care of critically ill patients,” said Lawrence, a critical care nurse practitioner for the past 17 years. “Being a preceptor is a key role in the Mass General Brigham healthcare system. I feel passionate about it because I’m giving future nurse practitioners the kind of exposure that they need to hit the ground running.”

It’s fair to say that most nurse practitioner students interested in acute care may have their hopes set on a clinical rotation at one of the big academic medical centers within MGB, and when they’re placed instead at Cooley Dickinson, aren’t sure what to expect. Little do they know it’s a blessing in disguise. 

“I think when people get placed here, they're kind of surprised by how much hands-on they get,” said Lawrence.

It’s the hands-on experience at Cooley Dickinson, a small community hospital in Northampton, that makes this clinical rotation a unique one. 

“You’ll get some opportunities at the big hospitals, but you certainly don't get the volume of experience that you would here,” noted Lawrence. “For example, in our ICU, there's a pulmonary critical care physician, and a physician assistant or nurse practitioner, and that’s it. Each of us is handling a lot, so there’s a lot of opportunity.”

Because Cooley is not a teaching hospital, there are no medical students or residents, and that means exponentially more exposure for nurse practitioners in training. 

“Students get a lot of dedicated time, and they get a certain amount of autonomy to do their own thing,” said Lawrence. “The students write the progress notes and H&Ps, see the patients, meet with the families. They do all the things that a resident or an intern would do with patients, in addition to all the ICU procedures. They get hands-on experience doing central lines, peripherally inserted central catheters (PICC), thoracentesis, paracentesis, lumbar punctures and endotracheal intubations.  The MGH IHP students get access to all of that. They get to do all those things in a supportive and collaborative environment.”

Over the past four years, the nurse practitioner students rotating at Cooley Dickinson have been exclusively from the MGH Institute of Health Professions. 

“In my experience, the students who come from the MGH IHP are excellent and very well prepared,” observed Lawrence. “Their students are super-motivated. They know what they want to do. They are interested in acute and critical care, they want to work in a hospital setting, and they're eager to learn.”

That eagerness to learn has led to a steady word-of-mouth campaign resulting in a stream of students who don’t let the two-hour drive from Boston get in the way.

“At one point I had two students who did an Airbnb, and they would come out and book several days in a row - they would do it that way,” recalled Lawrence. “They both really raved about the experience because they got access to all of this equipment, and they were able to do things and independently manage patients in a way that they really weren't doing in the other clinical placements.” 

With Lawrence, MGH Institute students are getting an education you won’t find in any classroom.

“Because doctors-in-training get so many more reps than nurse practitioners, I try and accelerate things by telling IHP nurse practitioner students, ‘You need to learn the true language of medicine that doctors use,’ so I bring that to them. On rounds, I empower them and say, ‘Go in, see the patient, do your exam, produce a plan, sketch out your plan and present, just like an intern would do.’ 

“That experience and having autonomy is how you learn. Even calling a consultant. If we have a patient that's really sick - they have a GI bleed, for example – I tell our student, ‘Call the gastroenterologist. Give them the history. Tell them what the labs are, do all of these things because that's what you're going to have to do when you do this job.’”

When a rotation is complete, Lawrence is gratified knowing he’s helped someone take a significant step in their career. 

“I really enjoy helping the people that are going to do this job,” noted Lawrence, “and getting them those reps that I keep talking about because it puts them on a path where they are hopefully going to have a little bit more early success.”

Success runs both ways. Not only is the nurse practitioner student well equipped to make an impact on Day 1, but the system will add another high-level hire thanks to the training at the MGH Institute and the clinical rotations it designs. 

“The MGH Institute has the potential to be a great onramp for new employees – it really does,” concluded Lawrence. “The students are in our system. They know the facilities. They know the teams. They're out there doing rotations with our people. And we get to learn a lot about these potential employees. That's a big part of it.”

And one of the reasons why Lawrence loves what he does. 

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