April Rowe Neal and Ashley Busch

Nurse practitioner students need to have the skills to independently practice as a proceduralist within their clinical setting. To support these practice demands, our FNP students are required to take an office procedures course prior to initiation of their clinical hours. Being an efficient proceduralist requires the student and provider to understand and complete informed consent, discuss procedural details with the patients, and provide test results and appropriate follow-up and written documentation. During student clinical experiences, it has been identified that not all preceptors provide procedural opportunities for our FNP students. To fill this practice gap, we have created and provided an office procedure simulation opportunity for students to complete within their final year of graduate nursing school.

We created simulated experiences that required students to integrate all steps of a procedure by simulating a mole removal, including informed consent, organization of supplies, use of a punch biopsy for mole removal, as well as specimen labeling. For the purposes of the procedure, students were informed that the history and physical exam were already completed, and they were serving as the proceduralist. Chicken thighs with bobas served as moulage for mole removal and materials already within the simulation center served as the procedure supply bundle.

1. Effectively communicate with patient about procedure obtain informed consent and necessary post-procedural care
2. Perform punch biopsy procedure following standard clinical guidelines and safety protocols
3. Interpret pathologic findings accurately to inform diagnosis and treatment plan.
4. Complete written documentation of the procedure, including an evidence-based management plan

• Chicken thigh with moulaged “mole” – 6mm x 5 mm – partial boba under chicken skin with brown paint on top
• Office procedure pack with sterile towels and drape
• Suture kit
• Saline Practi-Vials labeled Lidocaine with epinephrine
• 3 cc syringe 25 gauge 1-inch needle (or similar) blunt tip for drawing up lidocaine
• Sterile gloves
• 2x2 gauze
• 8mm punch biopsy
• Suture materials
• Specimen cup and label

1. Create an office procedure pack using 2 underpads and 4 disposable towels. The first underpad should have a hole cut in it to represent a drape. Wrap drape and towels in the second underpad and secure with tape and add label.

2. Collect other procedural supplies into a bin for students to organize.

3. Prepare bobas cut into 5-6mm pieces. Lift the skin of chicken thigh and use super glue to adhere boba to chicken thigh. Replace the skin and add brown paint to discolor skin and represent a mole.

4. Faculty serve as the "patient" with the student reviewing brief patient data and completing informed consent. After the procedure is completed, the patient hands a pathology report to the student.

5. After completing the procedure, students were expected to complete a procedural note, integrating pathologic findings and outlining the evidence-based management plan.