Anne Norwood, an NP at the Johnson Health Center in Lynchburg (seen here with 6-month-old Naomi Hernandez), precepts students to "pay it forward."

You’re a busy nurse in a bustling clinic. Why precept?
I enjoy it, and it’s a good thing to do—and it’s our professional responsibility. Nurses are focused broadly on education, whether it’s patients, parents, or other professionals—and for me, that always struck a chord. Precepting continues the wave!

What are your students like?
I love teaching NP students. They’re pretty self-motivated; they come ready to learn and perform so well that it makes my job easy, and makes teaching a pleasure.

Are there special things students always learn from you?
Whether I deserve it or not, I get credit for a lot of wisdom that’s spread out there. It’s not so much the terms, or the advice, as it is focus areas. Students know pediatric development backwards and forwards, up and down, when they finish their 15 weeks with me. The difference between what somebody does at six months and nine months is important.

"Precepting really makes a difference, and by the way, somebody did it for you. It's giving back; it's our responsibility."

Veteran NP Anne Norwood, a UVA preceptor for more than 23 years

My dad was a dentist, so also I stress oral care. When that first tooth comes in, we say, “OK, now you’ve got a tooth and you’ve got to keep it clean.” No bottles in bed. Many people don’t begin brushing until kids have a full set of teeth—that's too late.

I also stress realistic history-taking and charting, which is valuable in the real world. If the kid’s in here for a cold, we don’t necessarily need to ask if their eczema is flaring up. Same with the physical exam: You’ve got to find that balance between accuracy and completeness but also efficiency.

Then there are the tricks of the trade: how to hold the otoscope on squirming kids; How to examine a baby when they’re in mom’s lap—three-quarters of exams are done that way; how to be already evaluating the child as you’re talking with the mom, before you even lay a hand on them; how to group questions so they’re logically connected.

And many times, we make our best guess. You're often not going to see 100 percent of an eardrum—you’ll likely see 50 percent. Is that enough to make a call? Usually it is. Trust yourself.

And remember to talk to the person who can talk to you, whether it's a five year-old or a teenager. "Tell me what's going on," rather than, "Are you anxious?" will usually get you more of a response. Don't lead the witness.

Has precepting changed your nursing?

It's kept me on my toes. Students are often up on the very latest research, and while I keep up-to-date, there's always a lot of information coming in, so I learn from them as well. Sometimes, my students talk in a way with a parent that I might not have considered, and I see that it works. In practice, you can get in a rut, saying the same thing, teaching the same thing—but with someone else there, too, you're a learner, too.

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