PRECEPTING NURSE PRACTITIONER
STUDENTS: JOYS AND PITFALLS
Eileen R. Giardino, RN, PhD, ANP-BC, FNP-BC
Associate Professor
UT Health - Houston – School of Nursing
Houston, TX
Program Objectives:
The participant will:
• Learn ways to improve the precepting
experience
• Improve evaluation of NP student
performance
• Understand legal aspects of the preceptor
role
• Relate NP study findings of expectations of
NP preceptors to clinical practice
The value of preceptors
Preceptors:
• Are valuable resource to every NP program
• Are essential to strength & viability of NP
programs
• Teach students essential clinical skills
• Evaluate student competence & performance
• Serve as professional role models & socialization
experts
• Help students learn how to function in “real world”
• Have both positive and negative qualities! (Ulrich,
2011)
Why Be A Preceptor
• Part of the professional role
• Teaching/evaluating is part of what we do as NPs (Ulrich, 2011)
• Satisfaction of “giving back” (Lyon and Peach, 2001)
• Essential part of process for NP students to learn their
profession (Burns, et al, 2006, Barker and Pittman 2010)
• Students keep us “on our toes” (Suzewits, 2002)
• Enhance quality of clinical practice
• Contribute to professional development of SNPs. (Giardino &
Giardino, 2013)
• Preceptors enjoy teaching, want to develop the
profession, support NPs in primary care (Giardino & Giardino,
2013)
Preceptor Expectations
Preceptor should expect:
• To communicate with or have program faculty visit clinical
site during semester
• Support when needed from program faculty
• Orientation to student/program curriculum
• Know what students able/expected to do at practice site
• Schools send students to site with little to no information about
what student should do or is able to do at their site
• CEU credit for precepting
Precepting Rewards
• Some programs pay stipends, most don’t (GNE Grant)
• Some programs offer adjunct faculty appointment
• Precepting keeps you sharp and current
• Enhances professional reputation
• Satisfaction in doing the “right thing”
• Assures continuing excellence in NP profession
NP program responsibilities
• Understand what preceptors expect from students
• Cultivate preceptors
• Address preceptor needs & concerns that stem from
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•
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student supervision.
Have faculty available to address preceptor concerns
Communicate with preceptor & site for any needed issues
Respect that preceptor/site are graciously working with
your students
Students are ‘guests’ at the site
Patient Expectations
The patient should/must:
• Agree that student may participate in visit
•
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Can inform patients at initial visit that practice educates clinicians
Having a student is part of the practice philosophy
• Know that visit might take additional time d/t student
• Be seen by the provider as well
Often patient impressed that provider is a teacher
Study findings regarding precepting
• Liability concerns
• Conflicts between student’s educational needs and
practice expectations to increase provider productivity
[Lyon & Peach, 2001]
• May face issues they are unaware of or unprepared for
when precepting nurse practitioner students (Hayes, 1994)
• Preceptors report greater self-confidence in rating
students when they have had training in the precepting
process (Aagaard, Teherani & Irby, 2004)
Study Findings - Giardino & Giardino, 2013
• Preceptors felt students weak in generating & prioritizing diff
diagnoses
• Increase the focus on student generated differential diagnoses throughout the
clinical experience
• Many preceptors do not directly observe the SNPs conducting a
physical examination.
• Watch SNPs perform physical examination on patients at various times
throughout the clinical experience
• Opportunity to offer specific feedback around physical examination skills
• Support SNP verbally presenting the patient case using a SOAP format
• Preceptors work with students because
• They enjoy teaching
• Want to develop the profession
• Support NPs in primary care
• Important for NP program to support preceptors through
• recognition of willingness to precept
• Recognition of commitment to foster next generation of 10 care providers
Logistics of Having Students in Practice
• Space in practice for
• extra exam room for student to see patient
• talking with student privately
• student to be when not seeing patients
• Time factors
– Precepting takes additional energy even when it doesn’t take much
more time
• Melding time it takes to precept into the productive schedule
• Study in rural practice indicated that
• parallel precepting strategy was 12 mins 24 sec per visit
• & “regular” consultation (without precepting) was 13 mins, 27 sec
• Walters, Worley, Prideaux & Lange, 2008
• Experienced preceptors take less time per visit with comparable
outcomes (Baritt, 1997), (Vinson, 1997)
• The more you precept, the better it gets from a time
perspective
Principles for Precepting Success
• Different learners, different levels of experience, different
techniques
• Often we precept the way we were precepted
• Not necessarily the best way to proceed
• Remember what helped you the most to learn
• The larger our repertoire of clinical teaching techniques,
the more likely we are to help students be successful
Techniques To Help Precepting
• Determine student’s clinical goals.
• Allow student opportunity to interact with patients
• Choose appropriate patients for student
• Request student to give a case presentation
• Question student about case details
• Allow student to give differentials and state a plan
Feedback Techniques
• Get a commitment
• What do you think is going on?
• Probe for supporting evidence
• What led you to that conclusion?
• Teach general rules
• Many times when . . .
• Reinforce what was right
• ”You did an excellent job of . . .
• Correct mistakes
• Next time this happens, try this . . .
• (Neher, Gordon, Meyer, Stevens, 1992)
Principles of Evaluation
• Difficult part of the process
• Difficult to tell student that s/he not performing well
• Be honest
• Give specific examples of positive and negative situations
• Should be constructive and based on skill development
• Should be consistent for student’s level of practice
• Should be respectful-focus on actions and preparation not
personality
• Can be day to day feedback or interval evaluation
• Include assignments for further study or improvement
• Should include communication to the faculty
Dealing With Challenging Students
• Patient safety is a primary concern
• Trust your judgment - Go with your ‘gut’
• A failing student will often have limited insight or lack of
personal awareness
• Early communication of problems to student & faculty
• Expect professional behaviors and professional dress
• Articulate your expectations at outset of experience
• Identify poor professional behavior or boundary breeches
• Communicate expectations for change
Dealing With Challenging Student
• DOCUMENT, DOCMENT, DOCUMENT
• Focus on behaviors rather than personality
• Tell Faculty – Expect a site visit
• Faculty should be supportive of your evaluation
• Suggest strategies for reassignment if necessary
Some Precepting Don’t’s
Don’t:
• precept a student when overcommitted & stressed
• fail to review your students’ work
• assume that student’s documentation is adequate or
appropriate
• put student down in front of the patient
• hesitate to mention issues that are a source of annoyance
or concern
• From: Paulman, P.M. (2001) Family Medicine 33:10, 730-731
Legal or Liability Considerations
• Site needs an affiliation agreement in place
• Know what agreement states
• See patients and review notes
• Consider what skills student able to perform
• Who is responsible if student gets needle stick or
contracts HBV?
Questions? Comments?