Rotation | Community Health Center, School (Elementary/High School) Based Clinic

I completed my final rotation of my nurse practitioner program last week! Whoo hoo! Since then, I have been busy with moving back to Sacramento for my last week of classes (and a cumulative multi-station objective structured clinical examination (or OSCE), which I have to pass in order to graduate). Now, my last in-class week is coming to a close, and I can finally post something that might be helpful for those rotating at a community health center or school-based clinic setting.

The community health center I rotated through in San Jose is an Federally Qualified Health Center (FQHC). In a nutshell, FQHC's provide outpatient primary care health services for the underserved. For more information, you can check out the Fact Sheet by Centers for Medicare and Medicaid Services (CMS) above.

Nicole's Clinical Tip: Once you get the name of the clinical site you will be at, do your research on them. See what services they offer on-site or send to other places.

Before getting started at your rotation in the community health center or school-based clinic, get familiar with the population they serve (so that you can provide more culturally sensitive care) and the local antibiogram (helpful for antibiotic stewardship especially if you're not familiar with the area).

Without further ado, here's what you should know to get ready for this rotation:

Conditions/Diagnoses/Symptoms

• Birth Control Methods and Contraception - Intrauterine Device (IUD), Nexplanon, Medication
• Sexually Transmitted Infections (STI's)/Sexually Transmitted Diseases (STD's)
• Bedbugs
• Diabetes
• Hypertension
• Hypothyroidism / Hyperthyroidism
• Medication Refills - Even for those going out of the country/trips for some months
• School Physical Exams
• Back Pain
• Muscle Strain/Sprain
• Immunizations - Clearance for school, sports, travel. Checking to see if any immunizations are missing. Know how to do immunization catch up, especially in children.
• Gastroenteritis
• Gastritis / H. pylori - How to diagnose. Treatment options.
• Pre-Expoxure Prophylaxis (PrEP) for HIV - What this consists of, patient considerations, how to offer/present this option to patients
• Acute Pharyngitis
• Pre-natal care
• Rashes
• Cerumen Impaction
• Antibiotic Stewardship - Including alternative treatments if the patient has antibiotic allergies
• Tuberculosis - Especially how to diagnose and what to do for latent
• Annual Wellness / Physical Exams
• Shortness of Breath
• Asthma
• Tuberculosis Screening / Testing
• Herpes Simplex
• Urinary Tract Infection
• Acute Pain
• Abdominal Pain
• Influenza
• Depression
• Anxiety

Tests

• Strep Swab Test - How to do and interpretation of results
• Mono Spot Test - How to do and interpretation of results
• Flu Swab Test - How to do and interpretation of results
• Urinalysis - How to do and interpretation of results
• Labs - How to order, how to interpret lab values, what labs to order
• Point of Care Glucose Check - How to do and interpretation of results
• Point of Care A1C Check - How to do and interpretation of results
• Fluorescein Test - How to do and what you're looking for
• Tuberculosis (TB) Test/Screen - How to read the results and next steps if result is positive

Diagnostics

• 12-Lead EKG - How to do; how to interpret, diagnose and treat

Skills

• Surgery Clearance - Considerations
• Intrauterine Device (IUD) / Nexplanon Placement (Note: This requires special training, which I did not have at the time, so I observed during my rotation.)
• Ear Irrigation
• Prescription Writing (Electronic at this facility)
• Intramuscular and Intradermal Injections
• School Physical Exams - Considerations
• Papanicolaou (Pap) Smear Test
• Pelvic Exam
• Follow-up with patients regarding labs results, diagnostic results, and after emergency department visit

And that concludes my long list of everything. There is definitely more things that are out there in the primary care setting; but given the season and time of year, this is "all" I saw during my rotation in this setting.

Community health center rotation completed!

Nicole's Clinical Tip: If rotating through a FQHC, one of my suggestions is to familiarize yourself with different insurances, such as the Family Planning, Access, Care, and Treatment (Family PACT) program (more info via the link).

As always, let me know if you have any suggestions for things to add to help other students or feel free to reach me with any questions via the contact form on the "Contact" tab! 

- Nicole G.
@nextwithnicole