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School of Health Science Division of Nursing

Family Nurse Practitioner Program Preceptor Packet

2023-2024

Dear Colleague,

Thank you for agreeing to serve as a preceptor for our graduate nursing student in the MSN Program at American International College (AIC). This program would not be successful without your commitment to the education of our future Family Nurse Practitioners. Your expertise will contribute toward the competency of the professional nurse under your tutelage.

As a preceptor you will mentor a student as he/she transitions into the role of an advanced practice nurse. An important responsibility of a preceptor is to facilitate application of the knowledge students learn in their course work with actual clinical experiences. In the clinical setting, the student will work directly with you and under your supervision; to plan, provide, and evaluate patient care. Along with the student you will decide what learning experiences are needed to meet the student's goals and the objectives of the course. While the AIC nursing faculty is not present on-site, scheduled visits will be made with you and the student. We encourage you to contact the clinical faculty member, at any time, with questions or concerns.

As you read through these documents, please do not hesitate to call the Assistant Director of the FNP Program or the Director of Nursing with questions. In addition, clinical site preceptors and students will be provided with contact information for the AIC supervising clinical faculty, prior to the student's placement at the clinical site.

Although AIC provides no financial compensation for your service, the College acknowledges your participation in this program and graciously appreciates your endeavors in furthering the development of advanced practice nursing. We appreciate your willingness to promote the education of future family nurse practitioners. It is a valuable contribution that we hope proves to be a meaningful experience for all.

Sincerely,

 

Clinical Course Expectations

Clinical Course Expectations: The following is a description and expectation of the role of the FNP student in the 7-week modular clinical courses.

Thank You Letter and Documentation of Precepted Hours:

• At the end of the clinical semester, the preceptor will receive a "Thank You" letter that contains documentation of the amount of precepted hours completed.
• Please allow 2-4 weeks after the semester has ended for your letter of completion to arrive.

Preceptor's Role in Working with Students:

• Assists students to meet overall goals and objectives for the clinical experience based on student outcome objectives provided by the student, and/or college
• Oversees and is responsible for coordinating with the student any other learning activities within the clinical setting.
• Identifies and discusses the student's needs to meet the course objectives
  • Assesses the nature of patient care encounters that will enable the student to meet his/her learning objectives at this level in the NP curriculum
• Utilizes appropriate teaching methods to help the student meet his/her learning
• Evaluates whether the student's goals and objectives have been
  • Orients student to the clinical site and agency Discuss with student the preferred method for communication with clinical preceptor and/or clinic site.
  • Discusses preceptor and agency expectations for the documentation of patient
• Facilitates an informal collaborative and mutually respectful environment in which to learn.
• Communicates issues of concern or unsafe practice (student behavior, clinical skills, and/or student progression) regarding the student to the clinical faculty
• Maintains ongoing communication with faculty as
• Reviews the objectives of the course, and student's clinical objectives to determine the type of learning opportunities that will enhance the student's
• Directs the student to resources and evidence-based
  • Discusses guidelines for student interactions and feedback on student
• Listens and provides constructive feedback on student's case presentation, assessment, and management skills.
• Demonstrates and critique patient
• Promotes critical thinking and diagnostic reasoning
• Provides a variety of evidence-based learning experiences with appropriate patient populations. If available, encourage participation in interdisciplinary team
• Facilitates student's progressive independence in clinical knowledge and
• Completes student's clinical evaluation

Preceptor Clinical Evaluations and Grading:

• The preceptor and clinical faculty evaluate clinical performance to assess the student's ability and the achievement of clinical objectives. Failure to perform at a satisfactory level as determined by preceptor and clinical faculty will be communicated to the course faculty and the Assistant Director of FNP. Unsatisfactory performance constitutes unsafe clinical practice or failure to meet objectives of the clinical component of the course. This may result in clinical (therefore a course) failure. The student must pass both the clinical and didactic portions of the course to successfully pass the course and proceed in the program. The preceptor should communicate with the clinical faculty at any time the student's performance is of concern.

• The preceptor will complete a clinical evaluation tool for each course that he or she is precepting the student. The preceptor will receive an email with a link to Typhon, our student tracking system, where evaluations are housed & If the student is being precepted by more than one provider at a site, an evaluation will need to be completed by each provider.

Preceptor's Role in Working with Clinical Faculty

• Respond to clinical faculty's request to discuss student clinical performance
• Communicate any concerns immediately with
• Accommodate faculty request for a site visit; site visits will occur at least once during the student's tenure, and at any time a visit is deemed necessary by you the preceptor and/or faculty.
• The preceptor may request a faculty site visit at any time he or she believes the student requires further evaluation.

The Clinical Faculty will be expected to:

• Provide guidance and supervision for the student during the preceptorship
• Make on-site visits once during the student's tenure at the college. Additional visits may be required, as needed.
• Establish a collaborative relationship with
• Maintain communication with preceptors and other agency

Preceptor Provided Student Orientation:

The preceptor will provide a student orientation to the clinical site, which should include, but not be limited to:

• Parking
• Where to store belongings, coat, books
• Lunch and coffee break policies
• Break room
• Bathrooms
• Introduction to staff at site
• Any site-specific requirements not completed prior to beginning clinical Agency policies
• Introduction to electronic health record/computer
• Telephone system
• Layout and overview of physical site
• Examination rooms
• Equipment found in rooms
• Other necessary equipment, equipment closets
• Clean utility/laboratory
• CLIA Waived tests
• NP office
• Where student can chart, review records
• Typical flow of your day
• Typical patient mix: what diagnoses the student can expect to encounter
• How you work with collaborating physician
• Time allotted per patient
• Basic billing and coding

Preceptor Teaching Tips & Resources:

Avoid using the same teaching-learning approach for everyone. Students learn in many ways. Some are visual, oral, or written learners, some concrete and some abstract, and others are multidimensional. Recognize that your own style of learning may be very different from the student’s. Spend some time to get to know your student:

Find out your student's prior experiences, skills, talents, and learning needs. Knowing the student's current knowledge base and readiness to learn helps both of you know how much work you have ahead of you. This is essential to help the student see the gap between where they are and where they need to be.

Create a positive and safe learning environment:

Safe environments are ones where the student can feel vulnerable revealing their lack of knowledge and asking questions. Students are more likely to take risks when the teacher creates a safe environment. Admitting what one doesn't know or making a

wrong decision is an uncomfortable feeling for anyone. Allow students the opportunity to learn from their mistakes. Establish mutual trust, respect, and support.

Give frequent feedback throughout the clinical semester:

Your feedback is vital to shaping the novice FNP student's current and future practice. We rely on and greatly value the role of the preceptor, so your feedback should be ongoing, corrective, yet encouraging. Do not wait until an evaluation to make a correction or give an encouraging comment.

Share your passion for your role as provider:

You are teaching by example all the time. Students learn as much from observing your behavior and communication of caring as they do from listening.

Repeat the important points:

Important points bear repeating. Repeat important facts in various ways. Repetition and application are required for learning to take place. Repeat the important points!

Ask questions:

Helping the student to explore ideas from various perspectives can foster learning. The preceptor guides the student to seek a deeper understanding. You are also teaching them how to think, to critically appraise a situation and to apply diagnostic reasoning. Using questions will teach them how to elicit information and begin to model the critical thinking necessary in the clinical setting. Ask questions that encourage students to demonstrate the thinking process that led to the right answer.

Talk out loud about your decision-making process:

This is a critical step. The FNP student needs to hear how you came to a diagnosis, ruled others out, etc. Share your thought process that led to making decisions. Problem solving skills can be learned. Point out the factors in the clinical situation that guided your thinking.

You don't have to be perfect.

The student expects you to know the answers to most questions but does not expect you to be perfect. Acknowledging your own limits and then demonstrating how you go about finding information, or correcting a situation is an important step for the student to learn.

Break larger tasks into step-by-step skills:

Sometimes breaking a concept down to two points may be better than one long answer. Give feedback on the performance of each step of the process. Give rationale during demonstration. Allow active practice and repetition.

Be punctual, present, presentable, professional, and personable:

Students will naturally model their own practice after those they work with.

Whether you are new to precepting nurse practitioner students, or are looking for new resources, please consider the following resources:

AANP: American Association of Nurse Practitioners Toolkit

NONPF: National Organization of Nurse Practitioner Faculties

This site also contains the competencies that the FNP student will be responsible for acquiring. The website has a preceptor portal with helpful information for preceptors.

Leveled Expectations

Beginning Student:

• Students spend the initial time observing the
• The preceptor should validate student assessment
• Student management plans need significant
• Student needs high level of direction, which decreases as skill level increases. As student progresses, the preceptor allows student to take on more independent

Intermediate Student:

• Students become more proficient in analyzing data, is more skilled at assessing and formulating management plans.
• Students improve their use of time and
• Students may require assistance in prioritizing and coordinating
• Students require support and assistance for complex
• The student is ready to demonstrate other NP functions such as patient/family teaching and participating in teams.

Advanced Student:

• A student is expected to perform all role actions in an organized, efficient, skillful, and independent manner.
• Student is expected to engage in interdisciplinary role collaboration, consultation, and referral.
• Student and preceptor develop a more collegial *Adapted from MUSC College of Nursing

How to Proceed During Precepting

These stages may occur at the first clinical site, and at each new clinical setting. In the role of a preceptor, many factors will influence your day-to-day work with our students. Consider the following as a guide/expectation when designing your preceptorship.

• Typically, we expect that at the beginning of any clinical semester, the student receives an orientation, and for the first day or two the student should be allowed time to adjust to the new setting and role.
• Consider having the student observe how you proceed with a visit; is there a chart or other electronic system where you see your roster?
  • Have the student observe entire encounters
• Discuss the various aspects of the visit; history, ROS, physical exam, diagnostic reasoning, differentials, how you determined a diagnosis, order diagnostics, prescriptions, referrals, patient education, follow-up
  • Have students tell histories and present to you
• Have student follow you and perform aspects of the exam
• If a student is struggling in an area, focus on that aspect of the
• Have students perform the physical
• Have student perform history and physical exam and present findings and discuss
• preliminary
• Review and provide feedback for SOAP note documentation
• We encourage the OLD CART (onset, location, duration, characteristics, aggravating factors, what relieves the symptom, what has been tried) methodology when evaluating symptoms in the HPI
• Typically, students need guidance with the ROS
• Explain and demonstrate how you make a referral, consultation, order laboratory and other diagnostics, how to write a prescription electronically, by hand
  • Explain how you handle a difficult patient encounter
• Explain when you send a patient to the emergency department
• Explain other aspects of your role relevant to the nurse practitioner student
  • In beginning semesters: Advanced Health Assessment and FNP 1/Adult Medicine students will require more guidance and reassurance-
  • Ideally, the student should have approximately 6-8 patient encounters in an 8-hour period, pro-rated as This is expected to progress as both the student and semesters progress
• Primary Care Il/FNP 2 Pediatrics & OB/GYN, students are in a new specialty and again, require guidance and reassurance
• Primary Care Ill/FNP 3 Older Adult & Complex Patient, students are also learning new information, however, should be honing their process.
  • Capstone: students will be focusing on a special population
• Refer to course objectives that will be provided for current curriculum
• We ask that you aim for the FNP student to ultimately be able to perform a history and physical exam, present findings to you and demonstrate some beginning diagnostic reasoning, discuss differentials, and ideas for a treatment plan to include medication, diagnostics, education, and follow-up. They can use resources that they bring with them e., Epocrates, or those you may have in the office/clinic.

This may take some time, depending upon many factors, however it should be the goal to have the student perform an entire visit, with your guidance.

Policies:

Attendance: Clinical Attendance and Absence

• Attendance at 100% of clinical experiences is expected of every student. If a student is to be absent, he/she must notify the preceptor and clinical New dates will be scheduled to ensure all clinical hour requirements are met.
• Punctual attendance is
• If the student is going to be late to the clinical area, the student is expected to call the clinical site as soon as possible.
• When the student cannot attend a scheduled clinical shift, the student must:
• Call the clinical preceptor or designated contact person at the clinical site prior to the start of the clinical session or as soon as possible; and o Call the clinical faculty as soon as possible.
• Failure to adhere to these attendance policies will result in an "Unsatisfactory" evaluation and will be grounds for failing the course.

Procedure for Injuries Sustained at Clinical:

Should a student sustain an injury at their clinical site, the student should seek first aide for the injury immediately and report the injury to the clinical preceptor. If the injury requires further care, the student should report off to the preceptor, and seek the appropriate level of care. The student is free to choose where he or she seeks care and may use the Dexter Health Services at AIC. However, the student should also follow the policy of the facility they are at. The student will notify their clinical faculty, who will in turn notify the Assistant Director of FNP Program or Graduate Nursing Director, to follow- up with any mandatory reporting. The student may be required to complete paperwork at the site, as required by policy. If the student has sustained an injury that requires time off from clinical or impairs their ability to safely perform the functional abilities required for nursing practice, the student must provide documentation from their medical provider stating they are able to return and perform the duties required at their clinical site.

Weather Advisory and Cancellations: In the event of inclement weather, students are expected to follow the procedures for AIC cancellations. If the student is scheduled for a clinical day, and AIC cancels classes or initiates an early dismissal, the student should not report to the clinical site, rather, contact their clinical faculty and preceptor to reschedule.

Also, students travel from various locations, we have no way of determining the weather conditions in each area. Therefore, we request that students use their best judgment, if inclement weather exists, and the student does not feel safe, that they cancel and reschedule their clinical hours with the preceptor and notify their clinical faculty.

If inclement weather becomes apparent once the student is at the clinical site, and he or she believes in their best judgment that traveling has become unsafe. The student is required to decide with their preceptor to leave the clinical site. The student is required to complete any patient interactions, report to the preceptor, and decide to reschedule the remaining clinical hours, prior to leaving the facility. Any unreported absences may jeopardize a patient' s well-being and constitute unsafe nursing practice. This may be grounds for dismissal from the program.

If the preceptor is not going to be at the clinical site, or leaves early due to inclement weather, we request that you notify the student and reschedule at a more convenient time.

All clinical hours cancelled due to inclement weather, or any other reasons are required to be completed later for successful completion of the course.
 

Safe Student Practice in Clinical Settings:

A student whose pattern of behavior is found to be unsafe may be terminated from a clinical for reasons of unsafe practices at any time during the semester and receiving a non-passing grade for the course.
 

Definition of Safe Student Practice in Clinical Settings:

The student's behavior must follow the legal and ethical codes of nursing. Students promote the actual or potential well-being of patients, health care workers, and self in the biological, psychological, sociological, cultural, and spiritual realms; demonstrate accountability in preparation, documentation, and continuity of care; as well as show respect for the rights of individuals.

Indicators to be used as guidelines for evaluation safe practice are:

Regulatory: The student practices within the boundaries of the Commonwealth of Massachusetts Nurse Practice Act, the guidelines and objectives of the Division of Graduate Nursing and follows the rules and regulations of the health care agency.

Ethical: The student practices according to the American Nurses Association Code of Ethics, Standards of Practice, and the Commonwealth of Massachusetts Nurse Practice Act and the National Council of State Boards of Nursing Code of Good Moral Character.

Biological, Psychological, Social, Cultural, and Spiritual Realms: The student's practice attempts to meet the total needs of the human system from a biological, psychological, sociological, cultural, and spiritual standpoint.

Accountability: The student's practice demonstrates continuity in the responsible preparation, documentation, and promotion of continuity in the care of clients.

Human Rights: The student's conduct shows respect for the individual, client, health team member, faculty, and self, including but not limited to the innate, legal, ethical, and cultural realms.

Procedure Relating to Unsafe Student Clinical Practice

The following actions will be taken when a faculty member identifies behaviors that indicate unsafe student clinical practice which warrant removal from the clinical site. Any student behavior demonstrating unsafe practice in the clinical setting may result in immediate failure of the clinical rotation.

1. The student is immediately removed from the clinical site and is to see the course coordinator as instructed.
2. The clinical faculty will be notified immediately, who will notify the Assistant Director of the FNP program or Director of Nursing

Procedure for Impaired Student Performance:

Any behavior observed by faculty/preceptor, who may be potentially dangerous to a client's health and safety is cause for clinical failure.

1. The student is immediately removed from the clinical site and clinical faculty is notified. Should a student be removed from the clinical area for this reason, a meeting between the student, faculty, Assistant Director of the FNP Program and Director of Nursing will take place.
    
2. The faculty will notify the Director of Nursing of any other behavior, which would be grounds for discipline by the Commonwealth of Massachusetts Board of Registered Nursing and may result in course failure