NP Clinical Preceptorships

Spacklehead, MSN, NP · Sep 16, 2008

I chose to attend a school that admitted only a certain number of NP students per year in order to make sure that they had enough preceptors lined up to guarantee students a spot once they reached the clinical portion of the program. I really like not having to worry about finding someone to be my preceptor semester after semester, especially since there are so many nursing schools in my general area that would make finding a preceptor on my own highly difficult.

I also like knowing that most of my preceptors have already had students at their sites so they already have an idea of what to expect from us and what we need to be learning while there.

I feel you do have every reason to be concerned, especially if you don't already know of NPs or docs who are willing to function as a preceptor for you.

psychonaut · Sep 17, 2008

I chose to attend a school that admitted only a certain number of NP students per year in order to make sure that they had enough preceptors lined up to guarantee students a spot once they reached the clinical portion of the program. I really like not having to worry about finding someone to be my preceptor semester after semester, especially since there are so many nursing schools in my general area that would make finding a preceptor on my own highly difficult.
I also like knowing that most of my preceptors have already had students at their sites so they already have an idea of what to expect from us and what we need to be learning while there.
I feel you do have every reason to be concerned, especially if you don't already know of NPs or docs who are willing to function as a preceptor for you.

At the orientation, they showed the numbers for those in each track (FNP, PNP, and nursing ed). The numbers were about equal to the undergrad program, with there actually being more entering NP students than entering BSN students! This is with fewer grad-level instructors than undergrad instructors.

It seems clear to me that the school is using on-line classes and "find your own preceptor" as ways to pack in as many students as possible, as you hint at above. I think your decision to attend a school with limited enrollment and set preceptors is a wise one, and I am having more and more misgivings about the program I am looking at (I'm not yet in, just taking classes as a non-admitted grad student).

Thank you for your insights, it's nice to know I'm not alone in my misgivings.

ERnurse04 · Sep 18, 2008

I am a FNP Student graduating in December. My school required us to find our own preceptors as well. It was a huge challenge. Right now I am scrambling to finish up my rotations so that I can graduate in December. I have yet to find a preceptor for Long Term Care or Rural Health. I would hunt down preceptors in the beginning of the program and be in good terms so you'll have them lined up for your major clinical courses in the end. Good Luck!!!

core0 · Sep 18, 2008

Note: I posted this as a bump to an older thread, and it got no responses. Figured I'd try it as a new thread to see if it fared any better. Really curious to get some views of current/former NP students.
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I attended an orientation today for the NP program I am going to attend, and I was dismayed to learn that students in this program are required to find their own preceptors. The program is essentially entirely on-line, although it is a brick-and-mortar state university (same school I got my bsn from).
Along with the concerns raised in this thread regarding scrambling to get a preceptor/site, I have another worry related to this. I am concerned about the preceptor not being having been "vetted" in any way regarding educating an NP student. I would imagine that the situation would be better if the preceptors had an existing relationship with the school, felt they had a "stake" in the students and the program, etc.
I'm sure the overwhelming majority of those who agree to precept are skilled and educated professionals. However, does an agreement to precept a student maximise the clinical educational opportunity of the student? It was stated in the orientation that those professionals who agree to precept will be contacted by the school, a precepting handbook provided, a site visit done (though at what point the visit would occur was unclear). But how much time and effort into these matters can an otherwise undoubtably busy MD/NP put into designing a productive experience for the student?
I appreciate how much individual initiative and responsibility are needed from the student in this situation, i.e. the experience will not be "handed" to the student, and the student will need to aggressively seek out opportunities for learning, clearly state an interest in maximizing the clinical experience, study on one's own to be prepared for those opportunities, etc. It just seems so...disorganised and capricious. I guess I would prefer a bit more rigidity, both in experiences offered and student expectations.
Am I right to be concerned? Obviously this system is not uncommon in msn/np education especially with the large number of on-line programs in existence. Is it more successful than not?
Greatly appreciate the opinions and experiences of others on this board, especially those that have been in this situation.
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Addendum:
I've also been closely researching the PA educational model. Seems to me that this situation (students required to find their own clinical sites/preceptors) is much more the exception than the rule in PA programs, which seem to (universally) emphasize standardized clinical experiences. Am I off-base here? Core0, your input would be greatly appreciated.

There are a couple of differences in the educational model. PAs are required to do rotations in FP, IM, EM, OB/GYN, Psych, Surgery and Peds. The requirement are fairly stringent and meant to ensure that PA programs produce a fairly consistent product. The standards are administered by ARC-PA. Failure to abide by the standards can result in a program being shut down (and has). Even some fairly well known programs have been placed on probation for violating the rules.

ARC-PA has dual missions. The first is to protect the public by ensuring that PA students are trained to a standard. The second is to protect students from getting a substandard education. ARC-PA has long recognized that forcing students to get their own preceptors can bring about substandard experience. For a long time this was ignored but about three years ago this was addressed. The first was to require the programs evaluate each student rotation in a consistent manner regardless of the geographical location. This has had the consequence of diminishing rotations that the students set up if the program does not have the resources to evaluate them. The second was to place in a statment that programs should not require students to procure their own preceptors. Like many organizations ARC-PA has its own taxonomy. Must indicates a requirement that is absolute. Should indicates a requirement that is so important that its abscence must be justified. Usually when a requirement is moving toward must requirement ARC-PA makes it should for a few years to allow schools to adjust. So a lot of people think the writing is one the wall for this. Full accredidation requirements can be found here:

http://www.arc-pa.org/Standards/3rdeditionwithPDchangesandregionals4.24.08a.pdf

To my knowledge there were only three PA programs that required students to find their own preceptors. Interestingly two of these were the dual PA/FNP programs. The other was a program that only accepted RNs (although now its open to other healthcare professionals). One of the PA/FNP programs has dropped the FNP and encourages but does not require students to find their own preceptors. The other two as far as I know still require students to find their own preceptors. One of them will be evaluated in 2009 and PA educators are looking on with interest. All three of these programs are the last remaining MEDEX programs. MEDEX was an interesting experiment in providing primary care PAs. In the original model the student was placed with a single preceptor for their clinical experience. With the increase in different clinical experiences required, most of the programs have gone away from this model. These programs retain portions of the model including requiring or encouraging students to find their own preceptors.

The issue with NP schools is probably money. It is very expensive to maintain and evaluate preceptor sites. My program for example had four full time employees (PAs) that did nothing but evaluate sites, follow up on evaluations, evaluate students at sites and find new sites. Since the program had been around for some time they had literally hundreds of sites to place students at. Unless the program is willing (and required) to participate at this level clinical experiences are likely to be hit or miss.

David Carpenter, PA-C

Advanced Practice Columnist / Guide · Sep 18, 2008

The issue with NP schools is probably money. It is very expensive to maintain and evaluate preceptor sites. My program for example had four full time employees (PAs) that did nothing but evaluate sites, follow up on evaluations, evaluate students at sites and find new sites. Since the program had been around for some time they had literally hundreds of sites to place students at. Unless the program is willing (and required) to participate at this level clinical experiences are likely to be hit or miss.

...and I think in the case of the OP, the fact that some NP programs are offered as a distance format. It would definitely be hard for an online program to arrange, much less monitor, clinical placements for students who are not even residents of the state where the campus is located. Finding your own preceptor can be done but not without a huge burden on the student. I think the NP associations can step in to address this issue. And since ANCC considers preceptorship of a NP student as one of the categories of requirements for recertification, we ought to have a national database of preceptors for each NP specialty available to online students.

core0 · Sep 19, 2008

...and I think in the case of the OP, the fact that some NP programs are offered as a distance format. It would definitely be hard for an online program to arrange, much less monitor, clinical placements for students who are not even residents of the state where the campus is located. Finding your own preceptor can be done but not without a huge burden on the student. I think the NP associations can step in to address this issue. And since ANCC considers preceptorship of a NP student as one of the categories of requirements for recertification, we ought to have a national database of preceptors for each NP specialty available to online students.

The OPs program was described as brick and mortar. However, even in the case of programs with students at different sites it should be possible (and required) for the programs to evaluate the experience. Considering the money that some of these programs receive this should be doable. In the PA world, one program last year evaluated sites in 27 states as well as the Dominican republic, Kenya, Scotland and Australia. Its about actually spending some of the tuition on things important for education.

If you want to look at the reason behind this it crystal clear. NP and CNS programs (with the exception of the WHNP) are the only provider programs that do not have a single seperate accrediting agency for the profession. This problem was identified as far back as the mid 80's. Its been the subject of multiple reports and commissions. There is even an AANP white paper that lays out suggested methods of resolving this.

http://www.aanp.org/NR/rdonlyres/B336F230-01DC-4D6E-8B17-2FF3455638E3/0/WhitePaper.pdf

However, 8 years after the white paper nothing has been done. Until this issue is addressed its going to be hard to do anything to guarantee basic student protections.

David Carpenter, PA-C

psychonaut · Sep 19, 2008

Thank you all for the responses!

To be clear, I consider my program to be "de-facto" distance ed. It is not described as such, and it is located within a brick-and-mortar state university. However, I am learning that ALL of the classes are on-line only. Those classes classes with an "lab" actually only meet once, with the "lab" assignments (this is physical assessment) actually completed by the student sending a video of an assessment to the course instructors. Several students are from out of state, a few from elsewhere in the state, and the majority from the same city as the program. Also, as I originally mentioned, students are responsible for setting up their own preceptorships. None of this became apparent until orientation.

Frankly, since so many of us students are residing in the same city, I don't see any legitimate reason why the school isn't more involved in the preceptorship portion. The NP program has been around for several years, and the BSN program for many, so the school has plenty of contacts in the city for clinical sites. With there being so many students in the grad program, I'm coming to the conclusion that it is all about getting as many (paying) warm bodies into the program as possible.

David: thank you for the response. I've been researching the PA profession for about a year now, and your posts (here, the PA forum, and SDN) have been instrumental in helping me to learn about your profession. I'm coming to the conclusion that the NP educational/credentialling model leaves a lot to be desired. My concern regarding this current topic is a case in point; I am very uncomfortable in leaving my clinical preparation to such a hit-and-miss situation.

To be perfectly honest, I really prefer the PA educational model. I thought I had talked myself out of trying the PA route. I had three main reasons:

1) Cost: the PA school I would apply to is about 5x the cost of the NP program. Especially tough to rationalize since the income and day-to-day practice of the two professions seem pretty close.

2) Work: Not able to in PA school (*maybe* some per diem during didactic, but no way during clinical rotations). Absolutely doable in NP school.

3) Admittance: Tougher for PA school, need some shadowing with a PA, and LORs are tough because my best sources would be the higher-ups in both my nursing school and at my job. Admittance is guaranteed for the NP program.

I am conflicted at this point. I am very uneasy about my NP program, and I frankly wanted to try for PA all along. Taking on an additional 100k in loans (at least) on top of the 44k I have from my two undergrad degrees is a daunting thought (to put it mildly). However, my CASPA is complete (minus narrative and LORs), I have completed all of the PA school pre-reqs, and I am working on some prospects for shadowing, so I guess it's becoming more and more clear which way I'm leaning.

I'm glad I'm taking these two grad classes (that's a whole 'nother rant) and that I attended the orientation before actually being in the program, I feel that I will be making an informed decision because of it.

Thanks again for everybodies responses!

ivanh3 · Sep 19, 2008

I attended an orientation today for the NP program I am going to attend, and I was dismayed to learn that students in this program are required to find their own preceptors. The program is essentially entirely on-line, although it is a brick-and-mortar state university (same school I got my bsn from).
Along with the concerns raised in this thread regarding scrambling to get a preceptor/site, I have another worry related to this. I am concerned about the preceptor not being having been "vetted" in any way regarding educating an NP student. I would imagine that the situation would be better if the preceptors had an existing relationship with the school, felt they had a "stake" in the students and the program, etc.

I am also an FNP student at a school that has a brick/mortar campus and also does online/distance instruction as well. I understand your concerns, but here is the thing. Many of the traditional and distance programs require the student to find their own clinical sites. Here in Atlanta where I live I don't know of a single school (traditional or otherwise) that does not require the FNP student to find their own preceptor. I have had discussions with students from all of the major traditional schools in the

Atlanta area. Even Emory University students have to go through this. I think your concerns about a decent preceptor is valid, but remember you are part of the screening process. What is their background? Credentials? Teaching expierience? If your feeling is that this person is not open/approachable or they are too busy to discuss this then they are probally not going to make a good preceptor.

You discussion regarding PA model vs FNP model is also valid. I wish the FNP programs would not be so "anti medical". There is a serious disconnect with promoting advance practice nursing AND knocking the medical model. I am in FNP school more because I was already a nurse. I would have gone the PA route otherwise. I don't get too caught up in the total amount of hours for either route because the majority of PA/FNP grads specialize and will get their training on the job along the lines of physcian interns/residents. There are exceptions of course, but that is my take on it.

I will say this. Start your search now, because even after you find a preceptor there often has to be site agreement or contract and it can take the legal departments weeks or even months to get that paperwork done. Hope this helps.

Ivan

psychonaut · Sep 20, 2008

Ivan:

Yes, I am coming to realize that students finding their own preceptors is much more the rule than the exception in NP education. It would appear to go hand-in-hand with the trend towards distance ed in these programs.

As I mentioned in my original post, I can appreciate the level of self-direction and responsibility required in a graduate program, expecially a graduate-level *clinician* program such as NP. I can see merit in the argument that finding and vetting a preceptor/site, and taking the initiative in maximising the experience (i.e. seeking out and requesting new/challenging experiences), are all part of helping develop an independent practitioner.

This is the argument I heard often in my BSN studies, whenever we would complain about the school not going further in providing opportunities for us, expecially in clinical matters.

However valid the argument may be, I still suspect that the real reason for this is pretty simple: cramming in more students into the program, and lowering your overhead costs as much as possible.

Should I decide to actually enter the NP program, I certainly will take your advise and seek out preceptors early in the process. Your perspective is appreciated, thank you.

inthesky · Sep 21, 2008

Thank you so much for this thread! I am currently working on my DNP applications. Unfortunately, Arizona does not have any non-online programs. I might even attend the university in the city I live in, but still will need to deal with it fully online. I had a vague idea that I would need to find my own preceptors, but I really did not thoroughly contemplate it. This adds a bit more panic, but it will really help me later.

psychonaut · Sep 21, 2008

inthesky:

I am in the position where I am able to take 4 of the required MSN classes as a "non-admitted" grad student, prior to actually applying to the program.

Turns out to be a good thing. For one thing, I am getting a taste of what classes in the program will be like. Even more importantly, I was able to attend an orientation with all of the admitted MSN students. This was *very* educational. Between the presentors and speaking to my fellow students, I learned a lot of things that are not disclosed in the on-line info that the school provides (not implying any deception on the part of the school).

This is where I learned that students will have to arrange their own preceptorships, that the physical assessment lab is conducted by sending videotaped assessments to the instructors, and that the FNP students will spend little-to-no time in any hospital environment (we were actually told that we could accompany our preceptor if they rounded on inpatients, but to "keep our hands in our pockets" and not do anything, only "shadow").

Knowing these facts before actually applying is allowing me to make an informed decision on whether I want to continue with the program, before obligating myself. If you can do similar, it might be wise. An information session, or at least some e-mails to the graduate coordinators/instructors might be called for.