Are We Asking Too Much of Preceptors?

If you're a nurse practitioner student, or an NP who recalls your grad school days, you know that finding a clinical preceptor can be a total nightmare. Unless you have a number of connections in the healthcare world, convincing a provider to take on the responsibility of training you isn't easy. Patient care and the demands of an employer take precedent over accepting a student, as they should. Even the most altruistic NPs must work - without this they wouldn't be able to serve as preceptors anyway. 

As an experienced nurse practitioner, I have considered serving in the preceptor role. I enjoy teaching and mentoring and practice in a vibrant clinical environment. The department where I work is a supportive place to learn, so I would love to give a student a chance to learn and grow there. Logistical problems, however arose when I began to consider the task. 

First, at the time I was thinking of precepting, I was compensated on a productivity basis. The more efficient I was in my practice and the greater number of patients I saw, the more money I earned. Taking time and focus away from providing patient care to precept could make a dent in my paycheck. While my work as a nurse practitioner isn't all about the money, I couldn't justify sacrificing my income as my husband and I established ourselves and had personal financial goals to reach. 

Second, the logistics of precepting a student were complex. The medical director where I worked was open to the possibility of a student or two in the department. However, I would need to get formal approval from the hospital as well. Working in a large health system meant bureaucracy and red tape when it comes to requests like working with students. I was willing to navigate these complexities, but it would require significant time on my part - not a luxury available to every nurse practitioner.

I recently spoke with a pediatric nurse practitioner who also practices in Nashville where I work. She has served as a preceptor for a number of years. While she enjoys the role, she expressed that she has experienced similar setbacks in her position. The clinic where she is employed is owned by a teaching hospital that is more accommodating to the time and logistics of hosting students. However, teaching does cause her to work more slowly and means that at times she must take charts to complete home with her in the evenings.

This NP also noted that a number of her students had attained prior preceptorships where the provider wasn't able to take the necessary time to mentor students leaving them with significant knowledge gaps. There isn't a formal curriculum for precepting and hands-on clinical experience for nurse practitioner students meaning each graduates with a different level of experience

The precepting problem is a big one for the nurse practitioner profession. Students have a difficult time finding providers of all kinds to help with their training. A clinical experience in a less supportive or clinically bland environment means a lesser degree of education than one's peers. While there are a few benefits to experienced nurse practitioners, physician assistants, and physicians willing to serve in these roles, often the financial implications and time constraints of doing so outweigh the benefits.

Nurse practitioner schools will need to address this issue in coming years as the number of students enrolling in NP programs grows. If they don't, the quality of education for upcoming NPs stands to decrease. Lack of available clinical sites will delay more and more graduations and force students to train in facilities that aren't equip for doing so. 

Compensating preceptors or healthcare facilities financially for training NP students is one option to look at. Several private companies are already matching students with preceptors for a cost. This expense might also one day be rolled into nurse practitioner school tuition. What do you think the solution to the preceptor problem should be?

 

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Comments

How about some form of student loan forgiveness as an incentive for precepting? For those that work for private practice or in a facility that does not qualify for typical loan forgiveness programs it would provide an alternative. It would open the doors to potential preceptors that may feel it not worth there limited time otherwise.

AGACNP-BC

Hi, I presently direct a FNP program. It is so difficult for the student to find preceptorships as well as myself. I try to help as much as I can but in the Boston area, the area is too saturated with students requiring preceptors in Family medicine, internal medicine, pediatrics, and ob/gyn. The more I read blogs about this topic, I realize that this is a national problem. I also agree that not all students' experiences are alike and yes, their education definitely will have gaps. The ANCC and AANP boards require only 500 clinical hours and most schools offer more but still I feel that this isn't enough especially when asked to squeeze it into 2 semesters. I realize students want more skills in their education but as an accredited program, there are standards that have to be met that include research, etc. A great student can help out immensely on a busy day in clinic but a weak student does not. As a profession, we can not expect preceptors of NP students to take students for free. There has to be some compensation and standardized traning for preceptors across every program. I also agree that NP students should have recent RN experience in a medical clinical area. New RN graduates should adjust to their new RN roles before taking on the NP role. NP schools need to have stricter admission policies i.e. new RN grads, RN experience in a clinical field. If not, the student is set up for some amount of failure. A RN could have 10 years of experience but if they are working in a business office setting and have not been working in the clinical area, they will also have trouble in the NP clinical setting. There are always students that surprise me so I know there are always exceptions but overall I think we need standardization.

Jennifer

The volunteer Preceptor model probably predisposes to gaps and inconsistencies in the experiences among students. A student's experiences are also limited by the Preceptor's schedule and workload during the Preceptorship; at our Pediatrics practice, a Summer experience is mostly physical exams, while an experience during cold months will include many sick visits. Preceptors volunteer their time, and are encouraged to do so by both the profession and by the certifying organizations. Paying preceptors may not be the answer, as many of them are already employed full time; will employers object to a full-time employee "moonlighting" during the regular workday? Preceptors would also have the added academic responsibilities and expectations to which any school faculty generally adhere. This might be more readily accepted at Teaching facilities than at community hospitals and office practices. I precepted for about 20 years, and I agree with Bill and with Judy that a student's having previous nursing experience is invaluable. My past students who had ER experience already knew how to approach the family and ask pertinent information for the office visit. I have spent significant time with more than one student just teaching them to ask patient and family for the concerns of today's visit. Many of my students have echoed Ida Bell's comment that while graduate programs are happy to enroll as many students as possible, they often do not provide help with finding preceptors, or do not have enough preceptor names on their lists. I have precepted students who needed to delay graduation while they sought preceptors in the required health fields. Nursing also needs to look at the expectations of prospective employers; does the employer expect to hire a person who still requires mentoring and experience, or is ready to "hit the ground running"? Perhaps defined Residency programs (similar to those in Medicine/Surgery) are an option to be explored. I think that the changes need to be made by curriculum and program designers.

Ruth PNP

I had some very good preceptors, sometimes finding a preceptor was not easy especially womens health. When I graduated I realize that there where gaps in my training. I was very disappointed and angry that I had spent alot of money for my advance degree only to realize that I was only going to have to spend more to get the skills, and knowledge that should be part of the curriculum in these programs. When I went back to school I had years of experience in an ED setting which has been a huge advantage for me, I can,t imagine starting as an Advance Practice nurse with no prior experience with the lack of training we are receiving in these programs. I think the programs should quit focusing on research and actually teach the skills an APN will need to function in the healthcare setting

Judy FNP

I have been fortunate to 1) be able to find my own preceptors - we have started our 2nd to last semester and many students have neither their peds or women's health clinicals set up yet! and 2) the 2 preceptors I have had so far, love precepting and do it regularly.
But I think preceptors need to take a break so as not get burned out. Don't commit to precepting students back to back, take a break. And as students, we need to do our part in being prepared. Even if the didactic is at the same time as clinical, read ahead. Ask the preceptor on the first day what are the most important topics/procedures you should know, and then read ahead or get on youtube! I think as a preceptor I would be frustrated if a student knows nothing and then I am spending way more time teaching than just guiding.

Stephanie- FNP ...

Graduate schools are more than happy to take your money as a student. Unfortunately, most schools offer no help finding preceptors. I think that schools need to focus on the RN clinical care shortage rather than spitting out advanced practitioners that struggle finding jobs because the market is flooded.

Ida Bell ARNP

I am a student about to graduate, I had to leave my state of Maryland to Ohio Toledo for my OBGYN clinical because no one will take me.As a student I am paying a hefty amount in tuition. I do agree that the school needs to help fine preceptors and give them an incentive to help student.finding a preceptor is so hard that student are spending about two more years in schools.schools really need to fix the problem.

Doris Neng

Students with 2+ years experience as a RN are a joy.
Students with less RN experience - not so much

Bill

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