NP Clinical Placement and
Preceptor Guidelines
January, 2014
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Table of Contents
Preceptor Guidelines: NP Clinical Placement and Preceptor Selection – for BSN-DNP Students
Preceptor/Clinical Site Criteria ............................................................................... P. 3
Process for Preceptor Request and Approval ......................................................... P. 3
Student Responsibilities ......................................................................................... P. 4
Preceptor Responsibilities ...................................................................................... P. 5
Faculty Responsibilities.......................................................................................... P. 6
Appendix I, Preceptor Intent Form ............................................................................. P. 8
Appendix II Preceptor Professional Profile Form ....................................................... P. 9
Appendix III, Log of Clinical Hours/Clients Seen ...................................................... P.10
Appendix IV, Preceptor Evaluation of Student Nurse Practitioner ............................ P.11
Appendix V, Interview Questionnaire for New preceptors of NP Students ............... P.13
Appendix VI, Faculty Evaluation of Nurse Practitioner Student ................................ P.14
Appendix VII, Performance Improvement Contract ................................................... P.17
Appendix VIII, Faculty /Student Evaluation of Preceptor for NP Students ............... P.18
Appendix IX, Faculty Evaluation of NP Clinical Sites ............................................... P.19
Appendix, X, Process for Preceptor Request and Approval ....................................... P.20
Appendix, XI, Student Responsibilities for Clinical Placement ................................. P.21
Appendix, XII, Preceptor Responsibilities for Clinical Placement............................. P.22
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College of Nursing
East Tennessee State University
Preceptor Guidelines:
NP Clinical Placement and Preceptor Selection – for BSN-DNP Students
Preceptor/Clinical Site Criteria
 NP students in the BSN-DNP program are required to complete a minimum of 500 supervised clinical
hours of direct patient care, distributed as defined by clinical credit hours and addressing their
specialization and population focus. An additional 160 hours are required as part of NRSE 6800
Residency.
 For MSN-DNP students, a transcript review will be conducted to evaluate clinical hours brought to the
program.
 Students should seek a variety of clinical experiences during their studies, including both rural and urban
clinics, a variety of patient populations, and time at ETSU nurse managed clinics.
 Preceptors must have a current unencumbered state license and national certification, as appropriate, in
the population-focused or specialty practice area.
 The preceptor must have one or more years of experience in an area of practice relevant to the student’s
clinical need.
 Preceptors who are an advanced practice nurse must be masters or doctorally prepared. If necessary,
exceptions may occasionally be made by the faculty clinical coordinator, as guided by professional
standards and guidelines.
 The clinical site must see a volume of patients sufficient to allow the student an adequate number and
array of patients to meet the clinical education needs for the specified course. Typically a minimum of
five to six patients per clinical day in the specific area of practice is expected. More advanced students
will progress to seeing a larger number of patients per day.
 Students may not use their workplace (office, unit of a large organization) as a clinical site.
 Students may not use relatives or close friends as preceptors.
 Students may spend no more than two semesters with an individual preceptor without faculty approval.
 Students should have no more than two preceptors during a single clinical course without faculty
approval.
Process for Preceptor Request and Approval
 A list of previously approved preceptors is maintained by the Graduate Student Services Coordinator,
Office of Student Services.
 By the end of the third week of the semester preceding the next semester’s clinical (sooner if possible),
the student submits the Preceptor Intent form (Appendix I) and Preceptor Professional Profile (Appendix
II). This means that placement requests need to be submitted at least one semester in advance. Students
are encouraged to look for and establish clinical sites the summer before entering the Fall program for
Health Assessment practicum. Students should be proactive in finding clinical placement sites for all
patient populations (Young & Middle, Older Adult, Women’s Health and Pediatrics) upon entering the
program. Establishment of these sites early on helps guarantee student placement due to competitiveness
of nursing schools, medical schools, residents, and PA programs. The Preceptor Intent form/Professional
Profile identify preceptor(s) the student would like to be assigned to for the next semester’s clinical
course.
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Completed placement requests must be submitted to the Clinical Course Coordinator.
The Clinical Course Coordinator approves or disapproves the preceptor via communication on the
designated D2L site.
If the preceptor is not approved, the faculty member notifies the student and the student will need to
submit another choice.
If the student is unable to find an appropriate preceptor as identified through the faculty review process,
the student is expected to contact their clinical faculty.
The Graduate Student Services Coordinator assures the preceptor has current unencumbered state
licensure.
The Graduate Student Services Coordinator assures there is a current contract for the preceptor/agency,
or arranges for one, then notes the results on the designated D2L site.
Students may not begin clinical until the preceptor approval process, including preceptor/agency
contract, has been completed and documented on the designated D2L site.
The student follows the progress of preceptor approval via the designated D2L site.
Clinical faculty also follow the approval progress on the designated D2L site.
See Appendix X for a flowchart that describes the process for preceptor request and approval.
Student Responsibilities
 Follow the preceptor approval process as listed above.
 Be sure that all clinical placement requirements are up-to-date and on file in the Office of Student
Services (OSS).
 Provide the preceptor with your own and clinical faculty contact information, preceptor orientation
materials, clinical performance evaluation forms, and course specific clinical practice goals and
objectives. Be sure to get the preceptor’s direct line contact information as well.
 Meet with the preceptor to discuss the preceptor’s expectations of the precepted clinical experience.
 Work with the preceptor to develop a clinical schedule; notify the preceptor as much in advance as
possible if changes need to be made. The clinical site, preceptor, and faculty member need to be
contacted for late arrival or absence.
 Review clinical goals with the preceptor at the beginning of the semester and discuss progress in meeting
these goals throughout the semester. Share with the preceptor: Your specific goals for the clinical
experience, your clinical learning needs, your level of clinical practice development – strengths as well as
areas for improvement.
 Be professional in dress, demeanor, behavior, and communications during all clinical experiences. Come
to clinic prepared with essential resources (prescribing manuals, treatment guidelines, hand-held
electronic devices, etc…)
 Discuss with the preceptor the most common types of patients or diagnoses seen in the practice, and
reporting/documentation preferences; Identify templates and resource materials for managing these types
of patients.
 Read, read, read! Be proactive in looking up exam techniques, lab protocols, new diagnoses, treatment
guidelines, management approaches, standard and new pharmacologic agents, etc…
 Be proactive in engaging the preceptor in discussions about patient interactions, practice approaches,
treatment options, protocols/guidelines, teaching handouts, requisitions, documentation, follow-up
practices, and overall patient management.
 Request feedback from the preceptor regarding your clinical performance.
 Accept responsibility for expenses incurred during clinicals, including travel expenses to and from the
clinical sites.
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Accept responsibility - Neither the university nor the clinical agencies are liable for injuries a student
may sustain or the diagnoses or treatment of any illness a student may contract while in an agency for
clinical purposes. Neither the university nor the clinical agency are liable for the loss of personal
property.
Complete a clinical log for each clinical day, obtain preceptor signature, scan, and submit to D2L drop
box clinical course for that intended semester in accordance with the schedule indicated on the course
syllabus (Appendix III). Documented hours must be associated with direct patient care. Lab hours not
associated with direct patient care may not be counted toward the required clinical hours.
Communicate regularly with your clinical faculty member. Keep your clinical faculty member informed
of your clinical experiences and progress in meeting the clinical course objectives and competencies.
Notify the clinical faculty as early as possible of any difficulties experienced in the clinical rotation.
Assure that the preceptor completes mid-semester and end-of-semester evaluations of student
performance and reviews with student. The preceptor may fax or mail the evaluations to course faculty.
See fax number and address at bottom of form. (See appendix IV)
Thank the preceptor, clinic staff, and professional colleagues for their time, support, and
expertise. A formal thank you letter documenting the number of clinical hours is appropriate and
highly appreciated.
See Appendix XI flowchart as a visual reference describing student responsibilities for clinical
placement.
Preceptor Responsibilities
 Read the Preceptor Orientation PowerPoints, Clinical Preceptorship: Shining the Light for the Future,
and Preceptor Orientation Power Point For the Nurse Practitioner Program (available on the Preceptor
page of the CON website: http://www.etsu.edu/nursing/graduateprograms/preceptor_orientation.aspx).
 Sign the Preceptor Signature form at the end of the NP Preceptor Orientation PowerPoint, to document
completion. Return the signed form to the faculty directly, via student or fax. (Fax number is: 423-4394100).
 Arrange a schedule for student to be at the clinic a sufficient number of hours; notify the student as far in
advance if possible should any changes need to be made.
 Please inform the student as early as possible (or have the clinic manager contact the student) if a formal
clinic orientation is required or if required for access to electronic medical records.
 Orient the student to the office and clinic facilities: staff members, policies, attire, protocols, patient flow,
records/documentation, requisitions, accessing other departments, communications, preceptor practice
preferences and expectations.
 Understand and support the nurse practitioner role.
 Provide the student with access to patient clinical records, documentation, and electronic clinical
information systems if available.
 Discuss with the student your expectations and parameters for precepted student practice. Be direct about
what you want relative to patient flow, sharing in the management of visits, and documentation.
 Student observation of the preceptor should be limited to the first 1-2 clinical days. Be intentional in
modeling and explaining your organization, prioritizing, patient evaluation, exam, diagnostic decisions,
management, patient education, and follow-up.
 By the 2nd clinical day the student should begin seeing a few patients in a dependent clinical role. Over
the next several clinical days/weeks, the student should become increasingly independent, but always
with preceptor oversight of student practice.
 Assist the student with the selection/inclusion of appropriate and increasingly challenging learning
experiences.
 Review the student performance evaluation criteria on the Preceptor Evaluation of Student form, and
help the student develop competencies in those areas (see Appendix IV).
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Help the student gain knowledge and use critical thinking in the preceptor’s area of clinical expertise.
Use of the Socratic Method to question the student on their thinking, reasoning, decisions, and priorities
is a good approach to facilitate learning: What do you think is going on? What led you to that
conclusion? What are the other possibilities that need to be considered? How did you identify that…?
How would your approach be different if..? What factors lead you to ..?, What are the most important
elements of…?, etc...
Assure that the student’s physical assessment, diagnoses, plan of care, and documentation are appropriate
for each patient that the student sees. Request that the student identify specific data from their Hx, PE,
diagnostics, differential, follow-up plan, or other elements of care. Be available to consult with the
student or to assume responsibility for care as needed.
Encourage and expect the student to become increasingly more responsible, pro-active, and self-reliant
during the semester.
Provide constructive feedback to the student both formally and informally, integrating teaching with
evaluative comments and suggestions for growth or improvement.
Address conflicts or concerns with the student as early as possible, clarifying your expectations and
identifying solutions or necessary adjustments.
Complete the mid-term and final student evaluation forms and return to the faculty electronically by
email, mail or by fax.
Contact the clinical faculty if there are any clinical or professional problems or concerns.
Complete and sign (using full signature) the daily clinical log.
See Appendix XII flowchart as a visual reference describing preceptor responsibilities for clinical placement.
Faculty Responsibilities
 Review the Professional Profile Form completed by the proposed preceptor.
 Contact potential new preceptors to thank them for their willingness to serve as a preceptor and obtain
answers to questions on the New Preceptor Interview form (Appendix V).
 Assist students in choosing a preceptor if they have difficulty achieving this on their own.
 Review clinical logs on a regular basis and notify the student promptly if there are problems such as
inadequate numbers or types of patients to meet the clinical course objectives.
 Communicate regularly with the student regarding their clinical experiences and progress.
Communication with students occurs in the form of emails, telephone contacts, response to journal
entries, feedback on written assignments, and other approaches as needed.
 Clinical faculty make at least one site visit per semester. During the site visit faculty will evaluate student
performance, the clinical environment, and preceptor engagement. Additional site visits will be made if
there have been an insufficient number of patients to adequately assess student performance, or if there
are concerns about clinical performance or professional conduct. If the placement is more than 150 miles
from Johnson City the faculty may choose to teleconference rather than make a site visit. This can be
accomplished by phone conference, adobe connect, iPhone, iPad or other technology capability.
Complete the Faculty Evaluation of NP Student Clinical Performance (Appendix VI) and forward
original copy with signatures to Graduate Student Services Coordinator in OSS.
 Notify students as early as possible in the case of at-risk or unsatisfactory clinical performance.
Determine the specific deficiencies and establish corrections that need to be demonstrated, as well as the
timeframe for making the corrections. Meet with the student and document these processes using the
Performance Improvement Contract (Appendix VII). Provide a copy of the contract to the student, the
preceptor, the Clinical Course Coordinator, and the student’s academic file.
 Clinical faculty conducts the student’s final clinical performance evaluation and determines the clinical
course grade. The clinical faculty member is responsible for determining whether or not the student has
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met the clinical course objectives. In case of extenuating circumstances, assignment of a grade of
Incomplete and negotiation of additional clinical hours occur at the discretion of the faculty member,
requiring preceptor agreement as applicable.
CNR submits an online evaluation for each preceptor and clinical site (Appendix VIII, IX) to CNR at end
of semester. There will be a email from NRC with provided link for each form when completed to return
to NRC for data collection and analysis. Once completed, NRC statistician will send the original forms of
faculty/student evaluation of preceptor and faculty evaluation of NP clinical site to Graduate Student
Services Coordinator in OSS. Preceptor evaluations are reviewed annually to inform and update the list
of approved preceptors.
Approved, Graduate Programs Faculty 10/4/2012
Revised, July, 2013
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Appendix I
EAST TENNESSEE STATE UNIVERSITY
COLLEGE OF NURSING
Preceptor Intent Form
Today’s Date
Student Name
Gold-Mail Address
@goldmail.etsu.edu
Course for which preceptor is being requested
Semester:
Fall
Spring
Summer
Year
Preceptor’s full name
Preceptor’s credentials (i.e., FNP, ANP, MD, etc.)
Agency name
Agency street address
Agency city
Agency telephone
Agency state
Agency Zip
Agency fax
Type of practice
Are you employed by this agency? Yes
No
Have you precepted at the graduate level with this preceptor/agency before? Yes
If yes, for which course?
No
How many hours do you plan to complete with this preceptor?
If, for the same practicum, you will be precepting with an additional preceptor (s), please explain below.
Progress toward finalization of this placement will be documented on the Preceptor Approval D2L site. Before beginning clinicals
you must ensure that: 1. The clinical faculty has approved the use of this preceptor; 2. The preceptor’s credentials have been
verified by the Office of Student Services; and 3. A contract is in place. In addition, you must ensure that you have met all clinical
requirements (i.e., immunizations, liability insurance, etc.).
By clicking this box, I acknowledge that I have read, understand, and will abide by the above statements.
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Appendix II
EAST TENNESSEE STATE UNIVERSITY
COLLEGE OF NURSING
Preceptor Professional Profile Form
For ETSU NP Student Clinicals
PRECEPTOR INFORMATION
First Name:
Middle Initial
Preferred mode of contact:
Last Name
Email address
Telephone
Fax
SITE INFORMATION
Site Name
Street Address
City
State
Zip
County
EDUCATION/LICENSURE/EXPERIENCE
Education: Degree
School
Degree
School
Degree
School
Licensure: Professional License Number
Professional License Number
Certification:
Experience:
Year
Year
Year
State
State
Expiration Date
Expiration Date
Professional Certification Number
Expiration Date
State
Professional Certification Number
Expiration Date
State
Years of experience in current position
Years of overall experience in the role
PATIENT POPULATION
Types of patients seen at your
clinical site (check all that apply)
Percent of time your practice Average number of each
serves each patient type
patient type seen per day
Children
%
patients/day
Adolescent
%
patients/day
Women
%
patients/day
Adult
%
patients/day
Older Adult
%
patients/day
*Please include a business card, if available
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Appendix III
ETSU College of Nursing
Log of Clinical Hours/Clients Seen
*O - Observed preceptor
D - Direct supervision
C - Consulted with preceptor
Name: _________________________________________________
Site:
_________________________________________________
Directions: Please include all information requested in both sections. Logs are due weekly at class time. Keep your own record or copy.
Add a second page as needed.
Clients Seen:
Client
Dx. Code
Level of
Date
Initials
Presenting Problem/Intervention/Follow-up
Student
And Age
(Use one block per client)
Participation*
Clinical Hours for the Week of : ________________________________
Specific Hours in Clinical
Daily Total
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Comments:
Weekly Total
_____________
Total Time To Date _____________
Preceptor Signature: ____________________________________________________
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Appendix IV
ETSU College of Nursing
Preceptor Evaluation of Student Nurse Practitioner
Please complete this form so that we may have your professional opinion about how our student is functioning in your clinical setting.
We would like you to assess the student mid-way thru his/her clinical hours with you and again at the end of the semester. We would
like to identify any specific clinical/educational areas that need to be addressed, and also to rate clinical progress. Please rate this
student with consideration of their level in the BSN to DNP program.
Student’s Name: _____________________________________
Please check one: Mid-semester report ______
Clinical Practicum level semester: 1,2,3,4 (Circle)
End of semester report _______
Below
Standards
Needs Work
Average
Above
Average
Below
Standards
Needs Work
Average
Above
Average
Communicates effectively with clients
Demonstrates cultural awareness and sensitivity
Obtains appropriate history including HPI, ROS,
PMH, medications, FH, and relevant social history
Performs appropriate and accurate PE for the
presenting problem using correct technique and
equipment
Orders appropriate diagnostic labs and tests when
indicated
Chooses correct medication and dosage
Able to calculate medication dosage, when
indicated
Formulates list of differential diagnoses (considers
at least 3 diagnoses for most patients)
Arrives at correct diagnosis based on clinical data
Creates evidence-based treatment plan that
includes medication, life-style modifications,
referral, and a plan for follow-up
Provides anticipatory guidance, teaching,
counseling, and specific information about the
diagnosis
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Communicates detailed follow-up plan, including
relevant and cardinal symptoms for which they
should seek treatment
Documentation reflects the history, physical exam,
and treatment plan, and is organized and complete
Uses references effectively and efficiently in the
clinical setting
Presents patients to preceptor in thorough, concise,
and organized manner
Able to identify patients whose health needs are
urgent or critical
Completes patient encounter in a timely manner
Maintains professional standards including dress,
timeliness, language
Demonstrates interest and takes initiative in
learning
Strengths: ____________________________________________________________________________
_____________________________________________________________________________________
Areas needing improvement: _____________________________________________________________
_____________________________________________________________________________________
Preceptor signature: _________________________________________ Date: ____________________
Student Comments: ____________________________________________________________________________
____________________________________________________________________________________________
Student Signature: _______________________________Date: __________________________________
Thank you for completing this report. If you have any concerns or questions please contact the course coordinator or graduate program
executive aide for course faculty coordinator information in the College of Nursing at East Tennessee State University: phone: 423439-5626. Fax: 423-439-4100. Mail address: ETSU College of Nursing Attention to (course faculty name) PO Box 70629, Johnson
City, Tn. 37614.
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Appendix V
East Tennessee State University
College of Nursing
Interview Questionnaire for New Preceptors of NP Students
NP Faculty: When requests for new preceptors are received, please contact the proposed preceptor to learn about
their practice, clinic setting, and areas of expertise. Please consider the topics listed below when evaluating their
suitability as an NP preceptor.
Thank proposed preceptor for their willingness to allow an NP student to work with him/her.
 How many years has preceptor been in practice
 What type of experience does s/he have
 Is s/he willing to have an NP student in their practice
 Has the individual served as a preceptor for NP students
 Do you currently have NP students in your practice? If so, how many
 How many patients do you see in your practice per day
 How many days per week do you practice
 How many patients will the student be able to see
 What age groups do you see
 What is the most common age of patients
 Types of patients seen in practice: Acute, chronic, children, elderly
 Type of practice: primary care, urgent care, hospitalist, long term care
 What type of patient records: paper chart or EMR
 Will student be able to access patient records or EMR
 Will student be allowed to dictate/document
 Will student receive orientation to the practice/EMR
 Is an electronic clinic information system available
 What formal orientation is required
 Does preceptor have final authority to accept a student or are additional permissions needed
Obtain the preceptor and clinic manager’s direct contact information (email, direct phone, voicemail).
Share with the individual the preceptor orientation materials available and the need to work collaboratively with
the clinical faculty member.
Inform the individual that the student will be contacting them closer to the start of the clinical experience to
arrange specific clinical hours and learn about orientation requirement.
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Appendix VI
ETSU College of Nursing
Faculty Evaluation of Nurse Practitioner Student
Student’s Name: ______________________________________
Below Standards
Date:_________________
Needs Work
Average
Above Average
Consistently has
traits circled in
this column.
Requires detailed
assistance
Sometimes has
traits circled in
this column.
Requires
moderate
assistance
Consistently
demonstrates
traits circled in
this column.
Requires minimal
assistance
Always
demonstrates the
traits circled in
this column.
Requires no
assistance
Impolite
Unclear
Inappropriate
terminology
Impolite
Unclear
Unprofessional
terminology
Impolite
Unclear
Inappropriate
terminology
Impolite
Unclear
Unprofessional
terminology
Polite
Clear
Appropriate
terminology
Polite
Clear
Professional
terminology
Polite
Clear
Appropriate
terminology
Polite
Clear
Professional
terminology
Demonstrates cultural
awareness and sensitivity
Unaware
Insensitive
Unaware
Insensitive
Aware
Sensitive
Aware
Sensitive
Reviews chart prior to patient
encounter
Neglects
Incomplete
Complete
Complete
Obtains appropriate history
including HPI, ROS, PMH,
medications, FH, and relevant
social history
Performs appropriate and
accurate PE (specific
components) for the
presenting problem using
correct technique and
equipment
Critical omissions
Incomplete
Inaccurate
Irrelevant
Incomplete
Inaccurate
Irrelevant
Thorough
Accurate
Relevant
Thorough
Accurate
Relevant
Critical omission
Poor technique
Error (component
or technique)
Omission
Poor technique
Error (component
or technique)
Complete
Correct technique
No errors
(component or
technique)
Complete
Correct technique
No errors
(component or
technique)
Identifies appropriate
diagnostic labs and tests as
indicated
Critical omission
Needless
Inappropriate
Omission
Needless
Inappropriate
Appropriate
Appropriate
Chooses appropriate
medication and therapeutic
dosage
Dangerous
Inappropriate
Inaccurate
Requires detailed
assistance
Dangerous error
Requires detailed
assistance
Inappropriate
Inaccurate
Requires
moderate
assistance
Error
Requires
moderate
assistance
Appropriate
Accurate
Requires minimal
assistance
Appropriate
Accurate
Requires no
assistance
Accurate
Required minimal
assistance
Accurate
Requires no
assistance
None
Incorrect
Incomplete
Incorrect
Complete
Correct
Complete
Correct
Communicates effectively with
clients
Communicates effectively with
office staff, nurses, and other
professionals
Able to calculate medication
dosage, when indicated
Formulates list of differential
diagnoses (considers at least 3
diagnoses for most patients)
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Inaccurate
Requires detailed
assistance
Inaccurate
Requires
moderate
assistance
Accurate
Required minimal
assistance
Accurate
Requires no
assistance
Neglects critical
or multiple factors
Omits multiple
factors
Incorporates most
factors
Incorporates all
factors
Critical omissions
Incorrect
Incomplete
Incorrect
Complete
Accurate
Complete
Accurate
Detailed
Never
Rarely
Usually
Always
Neglects
Incomplete
Includes most
information
Includes all
information
Critical omissions
Incorrect
Incomplete
Incorrect
Complete
Accurate
Complete
Accurate
Detailed
Has references and uses them
effectively and efficiently in
the clinical setting
Never
Rarely
Usually
Always
Presents patients to preceptor
in thorough, concise, and
organized manner
Very disorganized
Critical omissions
Needs intense
cuing
Somewhat
disorganized
Omissions
Needs moderate
cueing
Organized
Complete
Needs minimal
cuing
Organized
Complete
Concise
Needs no cueing
Able to identify patients whose
health needs are urgent or
critical
Not recognized
Considers but
doesn’t recognize
Recognizes and
identifies
Recognizes and
identifies, and
initiates treatment
Completes patient encounter
in a timely manner
Never
Rarely
Usually
Always
Maintains professional
standards including dress,
timeliness, language
Pattern of being
late
Unprofessional
dress
Unprofessional
language
Pattern of being
late
Has dressed
inappropriately
Has used
inappropriate
language
On time
Appropriate dress
Appropriate
language
On time
Appropriate dress
Appropriate
language
Demonstrates interest and
takes initiative in learning
Apathetic
Does not seek
learning
experiences
Some interest
Needs
encouragement
Demonstrates
interest
Takes initiative
Inquisitive
Seeks additional
information to
share
Takes initiative
Arrives at correct diagnosis
based on clinical data
Creates evidence-based
treatment plan that includes
medication, life-style
modifications, referrals, and a
plan for follow-up
Provides anticipatory
guidance, teaching, counseling,
and specific information about
the diagnosis
Provides written information
to patient, when appropriate
Communicates detailed and
clinically sound follow-up
plan, including relevant and
cardinal symptoms for which
they should seek treatment
Documentation reflects the
history, physical exam, and
treatment plan, and is
congruent, organized and
complete
Strengths:
Areas needing improvement (address specifics of any low ratings on table above. Use separate sheet if needed):
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Additional comments:
Faculty signature: _________________________________________ Date: ____________________
Student signature: _________________________________________
Student comments:
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Date: _____________________
Appendix VII
East Tennessee State University
College of Nursing
Performance Improvement Contract
______________________________has demonstrated at-risk performance in NRSE_______(course number).
(Print name)
Critical area of the evaluation:
Student’s Strengths:
Areas for improvement:
Specific actions for progression include:
Services/resources Recommended/Required:
In order to meet the objectives of NRSE_______, the following must be demonstrated in the established timeline:
Failure to accomplish the specified actions/behaviors may result in unsatisfactory course performance.
Student comments:
This Performance Improvement Contract is mutually developed and agreed upon by:
_________________________
Student
_________________________
Date
_________________________
Faculty
_________________________
Date
Resolution:
Comments:
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Appendix VIII
East Tennessee State University
College of Nursing
Faculty/Student Evaluation of Preceptor for NP Students
Course Name:
Semester:
Student Name:
Preceptor Name:
Site:
Total # of hours spent with this preceptor:
1.
2.
3.
Preceptor Responsibilities
Preceptor worked with student to approve
written time schedule of clinical hours.
Preceptor arranged for student orientation to the
clinical site, completed and signed the Preceptor
Orientation Form .
Preceptor integrated the student into the work of
the clinic at an appropriate pace.
4.
Preceptor supervised student/client contacts
directly or through consultation
5.
Preceptor allowed student access to patient
clinical records
6.
Preceptor allowed student to present their
assessment, diagnosis and plan, discussed plan
of care with student, and validated student
findings and plan or care.
Preceptor participated in the evaluation of
student’s clinical performance by providing
guidance suggestions for areas of improvement
Preceptor provided appropriate guidance for
student level of experience
7.
8.
9.
Preceptor was knowledgeable in his/her area of
expertise.
10.
Preceptor had a good basic knowledge of nurse
practitioner role.
12.
Preceptor consulted with nursing faculty at time
of site visit to assure student progress.
13.
Completed the midterm and final Preceptor
Evaluation in a timely manner
14.
I would recommend this preceptor and site for
future clinical experiences.
Yes
No
Comments
Comments:
Faculty/Student Signature: ____________________________________________
18
Date _________________
Appendix IX
Faculty Evaluation of NP Clinical Sites
College of Nursing
East Tennessee State University
Agency: ______________________________ Academic Term: ___________________
Faculty evaluator: ____________________________________ Date: ______________
Type of Placement: _______________________________________________________
Please respond to each statement using the following scale:
4
3
2
1
/
/
/
/
Strongly
Agree
Disagree
Strongly
Agree
Disagree
N/A
/___________
Not
Applicable
1. Clinical site is receptive to accepting students for precepted clinical placements
____
2. Clinical site provides the student with adequate orientation to the facility
____
3. Clinical site provides a sufficient quantity of high quality learning experiences
____
4. Patient volume is adequate to support a high quality learning experiences
____
5. Clinical site organization and processes facilitate highest quality clinical practice
____
6. Clinical site staff are receptive to and supportive of student learning experiences
____
7. Clinical practice resources promote highest quality practice
____
8. Patient records and documentation resources are available to students
____
9. Facility is clean, well-organized, and up-to-date
____
10. Clinical site facilitates students performing dictation
____
11. Health care providers demonstrate excellent role modeling and professionalism
____
12. Patients at this facility receive excellent quality health care
____
Do you recommend continued use of this clinical site?
Yes
Comments:
19
No
PROCESS FOR PRECEPTOR REQUEST AND APPROVAL
Logon to www.etsu.edu/d2l ADMIN0001-681-CON Preceptor Approval
Process. If you are not enrolled in the
site, contact Graduate Student Services
Coordinator
FLOWCHART KEY:
Blue = Student
Peach = Faculty
Gold = Graduate Student
Service Coordinator
Green = Activity Completed
Review the Preceptor Approval
Process and Guidelines located
under the Content tab
Student begins preceptor/clinical
site search.
Student locates willing
preceptor/clinical site and submits
two forms to appropriate drop box
in D2L: 1. Preceptor Intent Form
and 2. Preceptor Professional
Profile
Faculty reviews D2L
site and assesses
preceptor/clinical
site.
Disapproves?
Approves?
Graduate Student Services Coordinator assures preceptor
has: 1. Current unencumbered state licensure, 2. Current
contract. Graduate Student Services Coordinator notes on
D2L site by placing a “Y” for Credentials and Contract. If
no contract is available, one will be initiated.
Placement is finalized when grades
reflect “Y” for Faculty OK and
Credential Check and “Done” for
Contract.
Approved DNP Programs
Curriculum Subcommittee
12/02/13
20
STUDENT RESPONSIBILITIES FOR CLINICAL PLACEMENT
Ensure that all clinical
requirements are on file and upto-date with the Office of Student
Services.
With each clinical experience discuss
with preceptor common diagnoses,
patient illness, documentation,
resource materials, treatment
guidelines, standards and new
pharmacologic drugs, etc.
Ensure that final approval for
placement has been given on
Preceptor Approval D2L site.
Complete clinical log for each
clinical day with preceptor
signature and submit to clinical
faculty on course D2L site. (Log is
located in Preceptor Guidelines)
Provide preceptor with student
and faculty contact information,
clinical performance evaluation
forms and clinical syllabus.
Communicate regularly with your
clinical faculty
Meet with preceptor to discuss
preceptor’s expectations and
clinical experience and develop
clinical schedule with
preceptor.
Send a formal thank you in
appreciation of their serve and
documenting number of clinical
hours to the preceptor.
Discuss with preceptor
beginning of semester clinical
goals such as clinical learning
needs, clinical experience
needs, strengths, and areas for
improvement.
Obtain Preceptor Signature
Form from preceptor and
download to course dropbox
in D2L
When notified by Center for
Nursing Research personnel,
complete Student Evaluation of
Preceptor following the link
provided.
21
PRECEPTOR RESPONSIBILITIES FOR CLINICAL PLACEMENT
Review the student performance
evaluation criteria (provided by
student) and help the student
develop competencies related to
the evaluation tool.
Complete Preceptor
Professional Profile and give
to student.
Access Preceptor
Orientation at
http://www.etsu.edu/nursi
ng/graduateprograms/prec
eptor_orientation.aspx.
Complete 1. Clinical
Preceptorship: Shining the
Light for the Future and 2.
Preceptor Orientation
Power Point.
Help the student develop critical
thinking and clinical reasoning
skills.
Assure the student’s physical
exam, diagnosis, treatment plan
and documentation are
appropriate for each patient
Sign Preceptor Signature
Form at the end of the
orientation and give to
student.
Consult with student about each
patient.
Develop with the student
a clinical schedule, a
clinical orientation and
access to the EMR if
necessary.
Foster student independence,
responsibility, self-reliance and
pro-activity in determining
patient clinical outcomes.
Provide student with
access to patient records,
documentation, and
electronic information.
Clinical observation period
begins. Student should observe
with the preceptor for 1-2 days.
By the end of the second day,
student should be seeing patients
dependently with preceptor.
Over the next several days the
student should become
increasingly independent and
progress to independent patient
encounters with preceptor
oversight.
Provide constructive feedback
and opportunity for
improvement; address conflicts
or concerns, clarify expectations
and identify solutions as
indicated.
Complete mid and final
evaluation.
Contact clinical faculty for any
professional problem or
concern.
22
Complete and sign daily clinical
logs (provided by student).