One of my most rewarding roles is being a preceptor to nurse practitioner (NP) students in my primary care faculty practice. Watching them "get it" confirms the critical role clinical preceptors play in the education of future NPs.
I will never forget my first preceptor; I speak of him often to my students. Dr. X was an 88-year-old general practitioner (physician) who had recently moved his practice from his home to a community health center because the paperwork involved with insurance billing and reimbursement had become too convoluted for him. He had been accustomed to being paid in goods and cash, but the advent of insurance coverage for some and the high cost of providing care in the U.S. healthcare system no longer lent itself to traditional exchange. His patients were devoted to him, and some of the families that saw him crossed 4 to 5 generations. My experiences with him during rotations made me realize that quality and caring could go hand-in-hand to improve patient outcomes in a busy environment where the majority of patients were disadvantaged and resources were limited. It was a great way to start my training.
Helping students
Faculty must rely on clinical preceptors to help students apply what is learned in the didactic portion of a course. Some students come with a solid knowledge base and strong physical assessment skills, making it easier to focus on helping them develop critical thinking and clinical decision making competencies. Students with less knowledge and skills will need more guidance and supervision throughout the experience.
It is important that students feel welcome and safe in your practice environment. I encourage students to take a risk and venture a diagnosis (not a random guess) based on the information collected. Whether gently or bluntly, pushing students toward increasingly greater responsibility for an encounter helps them progress to meet course and practicum goals. Practice is based on evidence, and students are taught to search and find the best research evidence. I remind them that guidelines are just that-guidelines. As students acclimate to the practice and the light bulb comes on, learning and teaching can become a reciprocal process between student and preceptor.
Multitasking as a preceptor
The role of preceptor requires the NP's full attention, but the patient remains the primary focus, and the preceptor should also consider their preferences. Because my practice is in an academic setting, patients expect that students will participate in providing care. Besides patient preference, the preceptor must keep the needs of the practice in mind. Payne, Heye, and Farrell state this dilemma clearly: "The preceptor is expected to provide day-to-day clinical teaching while meeting clinical practice expectations. Meeting these expectations is not always easy. The common thread, however, is communication that builds collaborative relationships."1 The key is communicating requests, capabilities, and expectations. The school must clearly express its needs; the agency must let the school know what is possible; and both must clarify the desired outcomes.
Future colleagues
NP education is complicated. State and national criteria guide curricula. The vision and mission of individual schools might vary slightly, but in the end, the patient is the center of all activity, and the goal is to achieve the best-possible health outcomes. Training the next generation of NPs is part of the plan. I do intend to retire one day; as a preceptor, I love contributing to the personal and professional growth of our future colleagues.
Jamesetta Newland, PhD, RN, FNP-BC, FAANP, DPNAP
EDITOR-IN-CHIEF [email protected]
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