The Catholic University of America

  Preceptor Guidelines

Preceptor Guidelines Contents

Role of preceptor

Preceptors, as clinical educators, are integral to the professional development of advanced practice nursing students. The responsibility of advanced practice nurses to “mentor other …nurses and colleagues” is highlighted by the American Nurses Association’s document Nursing: Scope and Standards of Practice (2004). The preceptor is one who “engages the student in the guided experience of applying knowledge to practice.” The preceptor serves as a role model and promotes clinical and professional competency, student autonomy, and socialization into the particular role the student has chosen (NONPF Preceptor Manual and ACHNE,Graduate Education for Advanced Practice Public Health Nursing, 2007)). At The Catholic University of America, the preceptorworks in partnership with faculty to provide the student with opportunities to develop and refine necessary skills and critical reasoning in the clinical management of patients, or populations. Preceptor are provided with a copy of the course and clinical objectives for each student’s rotation as well as information about the student’s mastery of past clinical objectives. Preceptors will be expected to provide students’ with formative and summative evaluations, usually at midterm and at the completion of the course. However, final course grades remain the responsibility of the course director. 

Preceptor selection criteria

Preceptors are selected based upon a number of important criteria. CUA believes that the quality of our clinical programs is related directly to the outstanding team of preceptors who partner with us in providing graduate students with clinical training. If a student requests consideration of a new preceptor not previously known to the faculty, faculty will evaluate the preceptor and setting using their established criteria. Faculty consider three main areas when considering a preceptor: individual preceptor qualifications, strengths of the clinical setting, and needs of the individual student/course.  

Individual preceptor qualifications. 

All preceptors are considered to be experts in the area of practice in which they will work with students. Preceptor curriculum vitae, including professional practice experience, are maintained and updated regularly. For NP students, preceptors must be currently licensed (and certified) to practice with the population of interest. While preceptors for nurse practitioner students are expected to have at least two years of clinical experience, they usually have much more. Advanced practice nursing students will be placed with preceptors who possess the legal authority, clinical expertise, and practice experience to assure their competency as expert practitioners. The majority of preceptors for graduate students are advanced practice registered nurses whose role and population of interest match the student’s career path. Physician and physician assistant and public health preceptors are used if their qualifications and practice settings best suit the student’s clinical learning needs. The important role of interprofessional teams in care management has created opportunities for student learning with other health professionals such as those in the fields of social work, psychology/psychiatry, nutrition and public health. For NPs, the number of hours spent with other team members is limited and is planned in accordance and in compliance with national certification standards.  Other key variables related to effectiveness of an individual preceptor include personal characteristics, such as interest and enthusiasm in student teaching, flexibility, and communication skills.

Clinical setting

The clinical setting in which the preceptor works is a key factor to consider in choosing a preceptor . For NPs, questions that must be answered satisfactorily and meet the particular course objectives include: What are the demographics of patients seen in this setting? What types of health services are provided? How much time is allowed for a student to spend with each patient? Does the setting have adequate space to allow the student to spend sufficient time with patients, without holding up the pace of others? How will students use documentation? How many patients are typically seen in a day? Will students have opportunities to observe preceptors , if necessary? Will preceptors be willing to observe students? Will the setting and preceptor allow students to progress when they are ready to more independently assess patients, present patients to the preceptor and suggest management? Will there be opportunities to follow patients? Will preceptors provide students with additional opportunities for learning, such as reviewing lab findings and radiology, making referrals, making home visits, participating in rounds and meetings with other health care professionals. Finally, will the preceptor maintain adequate supervision over all care provided by students? 

Individual student progression

Graduate students progress through clinical courses in a program plan that is designed by faculty to assure that they develop clinical competencies in a systematic way that is integrated with didactic course work. Before beginning any clinical course, all students first complete a comprehensive three credit advanced health assessment course. All students are expected to be able to perform complete and accurate health histories and physical examinations before beginning clinical. Subsequent clinical objectives for students are arranged sequentially. Therefore, clinical course objectives are important determinants in selecting a preceptor for a student. In a first clinical for NPs, where refinement of history taking, physical examination and differential diagnosis are primary objectives, a preceptor who has more time available to spend with a student and a setting where more comprehensive care is provided may be ideal. Later in a student’s program, a preceptor who expects students to move at a faster pace and is comfortable with a more independent student may be a better fit. Similarly the setting itself helps shape the choice of a preceptor to assure that the patients seen (level of acuity, gender, diagnoses, cultural heterogeneity, language, and procedures) match the learning needs of the students for that course. APHN students also follow a progression in their clinical training that is guided by faculty advisement and based on development and mastery of core public health competencies.

Benefits of precepting

Preceptors report many individual and varied reasons and benefits associated with precepting students. Preceptors often note the satisfaction they receive in knowing the value of what they are contributing to the “next generation” of APRNs and APHNs. Some feel the need to “pay back” the debt they incurred during their own professional education and believe that it is a professional responsibility. A great number report that they themselves benefit from the stimulation and challenge of working in collaboration with a student. The student’s questions may stimulate the preceptor to investigate the latest evidence for a problem or dig deeper for an explanation. As one NP preceptor said, “ it is sometimes too easy to get lazy in primary care and do what you have been doing for years. You know that what you are doing is safe, but does it really reflect the latest thinking about a problem? Having a student with me nudges me to check out the literature again and see if there is a better way. Or I can ask the student to look up a problem and verify our management. Often students are doing this all the time in class so they are very comfortable with these requests. They may even have easier access to the latest resources…”. An important benefit to community and public health professionals is the gratification of advancing the practice of public health nursing. It offers additional networking opportunities with other community and public health practitioners and the satisfaction of sharing knowledge and experience. Finally, it develops professional ability to coach others towards the goal of health for all. 

Preceptors also report that serving in this role brings status and recognition within their organizations. Some preceptors report that their organization’s willingness to allow them to precept is an important indicator of how the organization values teaching, growth, and professional autonomy. “Even in a busy practice setting, an employer who would not allow me to precept would tell me a lot about what they value and their overemphasis on the bottom line.”

Faculty appointments

CUA offers appointments to preceptors in accordance with their level of involvement with graduate programs and based on the individual’s qualifications. Most preceptors are clinical educators and receive yearly certificates of recognition. Others who precept consistently and contribute in other ways, such as serving as guest lecturers, may apply to the Dean for adjunct faculty status.

 

The SON is deeply grateful to its preceptors and is committed to supporting them. Preceptors are provided a list of classes and lectures at the beginning of the semester and are invited to attend any of interest. For example, a nurse practitioner who has begun to see more adolescents in his/her practice may elect to attend targeted lectures offered in the adolescent course. Others may choose to attend classes on motivational interviewing, ADHD, and mental health screening in primary care. The CUA SON presents monthly presentations about topical issues in Global Health on the first Wednesday of each month to which all preceptors and clinical colleagues are invited. Faculty are ready to provide preceptor with letters of recognition and acknowledgement of hours spent precepting, which may be used for recertification. The SON has offered tuition benefits to preceptors , allowing them to enroll in one SON course a year at a reduced tuition rate. This benefit is dependent upon yearly University funding. Preceptors may also benefit by partnering with faculty on research projects, manuscripts, and other outreach activities in the community, such as sports PE clinics, immunization clinics, and health fairs.

Teaching skills & methods for NPs

Preceptors will want to begin by reviewing course objectives as well as the student’s past clinical experiences while in the graduate program. Overall, preceptors are responsible for assisting students in refining the skills they need to provide quality patient care within the context of a particular clinical setting. The following general guidelines should assist the preceptor :

  1. Ask the student what specific clinical competencies they hope to achieve in this clinical rotation.
  2. On the first encounter, allow the student to observe your patient interactions. Explain to student the that as an experienced practitioner, you are able to move more quickly through your assessments, but that you will expect the student to be more thorough as a novice and require more information from the history and PE to arrive at accurate differential diagnoses.
  3. Directly observe the student’s interpersonal, psychomotor, and communication skills in history-taking and physical examinations at the beginning of the rotation. It is expected that while you will continue to assess the student’s skills throughout the rotation, through less direct methods such as verification of physical findings, having the student present patients to you , and review of student’s documentation, directly observing them in history taking and physical examination is critical. Direct observation may allow you to quickly recognize any deficits that need remediation as well as provide you with the assurance necessary to allow the student more independence in his/her practice.
  4. When introducing patients to the student and asking their permission to see a student, explain to the patients that you will come back in at the end of the student’s exam to talk to them.
  5. Continue to listen to feedback that may be offered by patients, families, and office staff.
  6. Assist the student in identifying short term goals and ways to meet them. Feel free to identify one particular skill that you ask the student to focus on each day.
  7. Freely ask a student questions that will help you to understand his/her clinical reasoning skills and knowledge of a particular clinical problem.
  8. Engage with a student by gently challenging his/her assumptions or diagnoses.
  9. There are many teaching strategies that can be employed to assist a student to learn the many facets of patient care: have the student follow-up patients with phone calls and referrals: review patient lab work with the student; assign the student a particular clinical question or problem to research.
  10. Recognize that clinical work is varied and unpredictable. Feel free to use alternative teaching strategies when patient load is too busy to allow adequate time for processing each patient with the student. Some preceptors have the student see patients individually in the morning and then have the student observe the preceptor in the afternoons when they get “behind.”
  11. Focus on quality rather than quantity with the student.
  12. Communicate early and freely with the student and faculty member about any concerns you may have.
  • Let the student and faculty member know if the student does not arrive with the skills you expected or if they fail to make expected progress.
  • Let faculty know if you become concerned that you do not have enough time to continue to precept. Preceptor often put unrealistic demands upon themselves when they precept. Faculty may be able to offer suggestions about ways to structure your day with the student so that you can continue to serve as a valuable preceptor without undue burden.

 

Preceptor resources

The following links and resources provide preceptor with valuable strategies for working with students in today’s busy clinical and community settings:

Patient Presentation & Precepting Resources

Practical Guide to Clinical Medicine

Oral Case Presentation Guidelines