Nurse faculty have the opportunity to assist clinically focused nurses to be effective clinical preceptors for all levels of nursing students. In the rush to gain clinical knowledge and experience, most clinically focused nurses do not receive or seek out education in clinical teaching during their own education programs, leaving them without the practical skills and knowledge about precepting nursing students. This article provides practical, concrete suggestions for nurse educators to increase preceptors' comfort with their new role.

Tips

Before the Experience

Nurse faculty can assist preceptors through discussion and provision of information before the experience.1 First, nurse faculty can ask the preceptor to remember how they wanted to be treated as a student to gain insight into how students would like to be treated. The preceptor should be encouraged to remember that nursing students are often adult learners, bringing many experiences, goals, and talents to the clinical practicum. Students may come from a different generation or culture, requiring that the faculty member provide resources for the preceptor to learn more about these differences.

In addition to ensuring confidentiality about patients, it is important to preserve confidentiality for all involved in the clinical experience. Preceptors should be cautioned not to talk about other students or faculty members with the student they are precepting and should be reminded they are role models for students. A nurse's comfort as a preceptor will be increased through learning about the student's educational program. Nurse faculty should provide an overview of the student's program, program handbooks, course syllabi, and course content.2 It is important to inform preceptors of the level of the student, where they are (by semester or year) in their program. There may be other ways for preceptors to be involved in the education of the student, for example, participating in online discussions, simulation experiences, or volunteer opportunities. Lastly, nurse faculty can frame the clinical experience as an opportunity for preceptors to learn from students, stressing the positive reciprocal relationships.

Start of a Clinical Precepting Experience

As a preceptor, nurses should take time at the start of the day, or to find a time as soon as possible, to set clear expectations. For example, preceptors might say, "This is how I would like the day to go[horizontal ellipsis]" and then explain the day, the usual routine, and their role; "How would you (the student) like the day to go?"; and "How, where, and when would you (the student) like to receive feedback?" with the goal of providing immediate feedback, away from others.

During the Experience

Nurse faculty should emphasize the importance of the preceptor's choice of words with students. As nurses choose their words carefully with patients, they should be equally careful with students. One poorly chosen word or phrase can negatively affect the student's experience. The preceptor can use phrases such as "This time I saw you do ___. Next time I'd like you to try ___." Nurses are also responsible for a variety of interventions, tasks, and procedures that may present opportunities for student learning. Helping the student to understand their approach to working together in these opportunities will preserve a positive learning environment.

Sometimes the preceptor's ideas may conflict with the student's. It is important for preceptors to remember that the student has been exposed to the latest information, and there may be several approaches or ideas that are accurate.3 Words and phrases that preserve a positive precepting experience in this situation include "Tell me more about your rationale and why you want to do it this way/use this method/about this method"; "This is interesting. Can you tell me the evidence that supports your way of doing this?"; and "It's fine that you might do this differently, as long as you have evidence to back up your actions."

Preceptors are encouraged to ask the student questions throughout the day. "Tell me about your patient" is an effective and nonthreatening way to ask for a report on the student's patient. Another example is "I may ask you questions throughout the day. I don't expect you to know the answer the first time we work together, but by the third time, I will." This challenges students to recognize that they are responsible for retaining information.

Sometimes students become frustrated as they try to "please" each individual preceptor. It is not uncommon to hear that a previous preceptor asked the student to complete a task in a different way. Suggested preceptor phrases to address this situation include "There are differences between approaches, but today I'd like you to try it this way"; "I do it this way because[horizontal ellipsis]"; and "This is going to be a time to see how each of us works, and then you can select a way that works best for you."

It is important to remind preceptors to step back and let the student perform a task or intervention rather than taking over. Observation of the student's provision of patient care, while still being responsible for the care, is an important preceptor skill. After gaining permission from the patient, the preceptor can say, "I'm going to examine the patient first and then you repeat the exam so that I can guide you." Another approach is "We haven't worked together before. Until I get comfortable with your skills, I would like to watch you do[horizontal ellipsis]."

Preceptors should observe the student's body language and facial expressions, as well as be aware of their own. Observations about the student's appearance may elicit important information from the student: "You seem[horizontal ellipsis]."

Ending the Experience

Part of the role of the preceptor may be to provide an evaluation at the end of the experience. Nurse faculty should encourage preceptors to write notes to themselves throughout the precepting experience. As busy nurses, they will likely not remember details at the end of the experience, and these notes will refresh their memory. Preceptors should be asked to find a private place to give feedback to students. The faculty member should familiarize the preceptor with the evaluation process and strategies before the experience. When completing the evaluation, preceptors should focus on their observations of the student's performance, providing more than 1 example whenever possible. Preceptors should try to provide more positive than negative evaluative comments. Preceptors might ask students about their perceptions of the experience, avoiding "yes/no" questions. Other phrases include "Tell me what went well for you today" and "Can you think of anything that you want to work on next?" Preceptors also can identify the topic or specific behavior by stating their observations ("I saw[horizontal ellipsis]" or "I observed[horizontal ellipsis]") and should suggest changes or ways the student can improve.

After the evaluation is completed, preceptors may find that asking for feedback on their own performance provides valuable information to improve their skills: "What could I have done differently today that would have helped you? This helps me to be a better preceptor." This requires that the preceptor is open to hearing the student's feedback and has a trusting relationship with the student.

Conclusion

Precepting students in the clinical setting is challenging, even for an experienced nurse. Nurse faculty can assist preceptors with a plan for the beginning, middle, and end of the clinical precepting experience to ensure a quality student experience. Notes from this article and examples of questions and phrases to use can be placed on preceptors' mobile phones to keep these suggestions at their fingertips. Having concrete ideas for words and phrases to use when communicating with students will help nurses become effective preceptors.

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