Getting Familiar With the Nurse Practitioner Role: Re ﬂ ection From an International Practicum The Journal for Nurse Practitioners

This is a re ﬂ ection on a 2-month international practicum at the Bassett Medical Center as part of my elective course during my ﬁ nal semester of graduate school at the Zurich University of Applied Sciences. The tran-sition from being a registered nurse (RN) to being a competent nurse practitioner (NP) presents challenges such as adapting to the new role as an experienced RN to an aspiring NP, learning about the role of autonomy, and new responsibility for patients, and fully executing the NP role. This means that becoming familiar with the role of an NP with a focus in cardiology is, in my case, of particular importance. To overcome this un-certainty, I chose an international clinical placement in a country with experienced NPs to build up knowledge for transitioning from RN to NP, professional development, and self-assurance.

International clinical placement generally has numerous advantages, such as educating students about global health disparities and preparing them to care for underprivileged and diverse populations. 1 In my case, acquiring a practicum in a country with an established nurse practitioner (NP) role facilitated the first step in transitioning from registered nurse (RN) to NP in cardiology, developed my professional skills in pursuing best practices in all situations and built confidence in decision making.

My Experience Abroad
Initially, one of my goals was to improve my clinical skills in managing patients in cardiology with clinically complex situations. Nevertheless, during the 8-week practicum, I gained experience in comprehending and actively understanding the NP role in the United States by shadowing a highly skilled NP.
The NP I shadowed worked in the Bassett Medical Center Cardiothoracic Surgery Department. His job description, role, and duties might differ from NPs who work in other departments. The NP's role and relationships with the other health care team members were of the utmost importance within the clinical setting. Establishing relationships with other team members is essential for fostering a sense of trust and understanding among the group members. 2 To bridge the gap and achieve beneficial interdisciplinary collaboration, it is necessary to have a thorough understanding of the role. 3 Furthermore, my mentor, who has 25 years of experience as an NP, has dealt with insurance regulations, restrictions, approvals, and denials and has a better understanding of the intricacies of the system. Moreover, according to my NP mentor, although New York state recently granted full authority practice, 4 an NP in the US must adhere to stringent practice standards and regulations, particularly in medication situations. In retrospect, there were instances where the practice was within the NP's scope of practice; however, the facility's policy and procedures did not permit it. As a result, amidst being applicable to all health professionals, it is crucial for NPs to strictly comprehend and become familiar with the hospital's policy and procedures and work within the scope of practice from a legal standpoint.
Because the environment in which some NP work is complex and constantly shifting, a mindset receptive to lifelong learning and a strong desire to continually update and improve knowledge and skills are considered necessary. Continuing education is also required when an NP in Switzerland needs to re-register. However, registration as an NP is not mandatory in Switzerland in contrast to the US, where licensure, license renewal, and continuing education are required to practice as an NP.
My NP mentor strongly emphasized providing evidence-based patient care and making treatment plan decisions based on upto-date research and practice standards. Furthermore, the international clinical placement allowed me to apply the theoretical concepts I learned from the ZHAW master's program in nursing in everyday practice. Take communication as an example. It is essential for an NP to have effective communication skills. The Situation, Background, Assessment, and Recommendation (SBAR) communication tool has been integral to my clinical experience. It serves to enhance and standardize professional communication. Errors in communication could be significantly reduced as a result. Additionally, I was able to put into practice the idea that any form of nonverbal communication carries significance. In the course of one of our consultations, a patient appeared unmotivated, disturbed, and worried. He also avoided eye contact the whole time. As the

Contents lists available at ScienceDirect
The Journal for Nurse Practitioners j o u r n a l h o m e p a g e : w w w . n p j o u r n a l . o r g consultation continued, we learned that he had recently lost his money to gambling and that his spouse had died.
Owing to the nature of the acute care setting, my NP mentor was more likely tasked with critical thinking and finding solutions to immediate issues than to long-term problems.
Through this practicum, I have recognized that the autonomy of an NP makes their role indispensable. Prioritization, conflictresolution skills, and leadership ability are all components that enable an effective workplace for an NP.
The interactive, collegial, and constructive environment at Bassett Medical Center increased my commitment and prepared me better for the role of an NP.

What I Have Learned
Throughout my international clinical placement, I realized the significance of pharmacology. Even though most NPs in Switzerland do not write prescriptions, NPs are still expected to make medication recommendations for a patient's treatment. An NP should be up-to-date on the latest pharmacologic guidelines. Also valuable is the therapeutic use of oneself. This entails using your personality when caring for a patient. The therapeutic use of self includes knowing when to use humor, appropriate communication, and how to properly address your patient.
Because of this placement, I started thinking of myself as an NP. I was given the opportunity to gain newfound self-awareness and inspiration while also broadening my professional network. I was able to hone my clinical and problem-solving abilities and gain more certainty in making decisions, all of which contribute to a more positive outcome and help improve the quality of care and patient safety. This gave me more self-assurance about the role I wanted to be in.
This clinical placement has helped me effectively recognize and contemplate the role of the NP toward the patient, the health care team, and the organization. When I take into account both my strengths and weaknesses in the NP role, I have the impression that I am beginning to acquire an in-depth understanding of the NP's role. Nonetheless, I still have a long way to go before I feel comfortable calling myself an NP. Even though I am still very early in my NP career, this learning experience has taught me a lot, and I am confident that I will continue to learn throughout my NP profession.

Conclusion
The importance of NPs to the health care system is evident. 5,6 It is essential to have a solid understanding of the NP's role and the scope of their practice to facilitate the provision of high-quality care and the treatment of individual patients. By gaining insight from countries with firmly established NP roles, it is possible to lay a solid foundation for NP roles and enable the exchange of best practices among different organizations.