Boycott schools that make you find your own preceptors

Nursing Students NP Students

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When I was looking around at FNP programs, I found out that some programs, both online and at traditional brick-and-mortar schools, made their students find their own preceptors. I find this to be absolutely absurd. Medical schools would never make their students arrange all their own clincial hours. Why should nurses stoop down to such idiocy? I think this just makes the NP industry look cheap, like they are just out to make $$ rather than provide a quality education. I think nurses should start to stay away from these programs. Any thoughts?

Specializes in Emergency.
My personal/professional opinion is that NP programs should not admit more students than they can provide and monitor quality preceptors. The extant literature has demonstrated the importance of clinical preceptorships and mentoring to the education/preparation of novice nurse practitioners; it certainly seems to be an essential part of preparing quality NPs and, professionally, I don't find it acceptable that some programs have relinquished control of this key factor to (what accounts to be) chance. In my humble opinion, students don't have the knowledge to evaluate which providers will be quality preceptors and this should be done by professionals with experience in the field. A student finding a preceptor that saves travel, money, and time is wonderful for the student but there needs to be safeguards in place that ensure that convenience does not come at the expense of education. I know for a fact that there are preceptors out there that students just love but don't provide them with adequate preparation.

For me this boils down to two issues: 1. does the program provide the preceptors to the students and 2. does the program take appropriate measures to vet and monitor preceptors on a dynamic basis. If a program is not actively and continuously vetting/monitoring the preceptors provided than they can actually do more harm than good, so that (for me) becomes the most important part of the equation.

I feel that NP programs can/do have a duty to their students, and to the NP community as a whole, to provide quality preceptors; that statement includes both "quality" and "provide".

While I agree with much of what you say BostonFNP, I disagree with a couple of things. First, I don't believe that it is too difficult for a student to find preceptors who have what they need. In my case, I live and work with these folks, where any representative from my program lives thousands of miles from here and has no personal contact with them. While some providers in my community have precepted for my university in the past, that is a much smaller pool than the entire provider pool of my community that I have contacts with.

I do think that you are very correct, that it is the programs responsibility to vet and monitor the clinical practicum regardless of who identifies the preceptor. I don't think that is different for either type of program.

I know there have been several studies that have shown that students who are allowed to do their program of study in their hometown are far more likely to work in that town as well compared to students who move to the town where the university resides. As one of the goals of the NP profession is to help grow rural providers, and fill the needs of rural providers, it would be a bad thing to limit NP education to force schools that do not have ties to communities to find preceptors in that community, and it would be even worse to force students in rural locations to move to get their education.

I have never seen any evidence that shows a correlation between who finds preceptors and quality of education from the program, do you know of any? I only ask because you tend to be very fact based, and opposed to NP programs allowing students to provide preceptors, so I figured if anyone had data you would.

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I agree with you. Found it rather interesting though when that was being discussed in a similar thread many moons ago, I vaguely recall at least one person defending the practice as being professional or that is the way "everybody does it", or whatever, I don't remember. For one, I would definitely stay away from any program that failed to deliver the minimum that a student is paying big bucks for. JMO

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While I agree with much of what you say BostonFNP, I disagree with a couple of things. First, I don't believe that it is too difficult for a student to find preceptors who have what they need. In my case, I live and work with these folks, where any representative from my program lives thousands of miles from here and has no personal contact with them. While some providers in my community have precepted for my university in the past, that is a much smaller pool than the entire provider pool of my community that I have contacts with.

I do think that you are very correct, that it is the programs responsibility to vet and monitor the clinical practicum regardless of who identifies the preceptor. I don't think that is different for either type of program.

I know there have been several studies that have shown that students who are allowed to do their program of study in their hometown are far more likely to work in that town as well compared to students who move to the town where the university resides. As one of the goals of the NP profession is to help grow rural providers, and fill the needs of rural providers, it would be a bad thing to limit NP education to force schools that do not have ties to communities to find preceptors in that community, and it would be even worse to force students in rural locations to move to get their education.

I have never seen any evidence that shows a correlation between who finds preceptors and quality of education from the program, do you know of any? I only ask because you tend to be very fact based, and opposed to NP programs allowing students to provide preceptors, so I figured if anyone had data you would.

zmansc,

Every time this comes up, you defend it because it worked for YOU. I understand that it worked for you. We all do. But things just fell fell into place for you - you had a network of contacts and were able to set up excellent clinical sites. Your case, however wonderful, is NOT typical. This forum is inundated everyday with people begging for preceptors because they can't find one. There are tons of people setting up clinical sites from schools that DON'T vet the preceptor and do not do site visits. I've read stories of people precepting with their friend who signs them off for more hours than they actually did, people precepting with clueless new grads, etc. We are making PROVIDERS - people who make the final decision in a patients healthcare. If even one student can slip through the cracks and have terrible clinicals that lead them to be unprepared for taking care of a patient, that is one too many.

Basically, you have to stop looking at this from your point of view and really think about the dangers. Think about all the ways a self directed clinical site can go wrong. Think about the fact that while the intentions may be good (to help train rural providers) that's not how most schools are using it. Do you think Kaplan and Walden and the other for profit schools have students find clinicals because they care about rural healthcare providers? No, we all know the real reason they do it, and it's embarrassing for the schools, and ultimately the profession. Look beyond your personal situation and realize that supporting this practice probably creates 1 good situation for every 100 bad ones. It's not worth it. They can find another way to support rural healthcare development because this isn't working.

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Specializes in Adult Internal Medicine.
First, I don't believe that it is too difficult for a student to find preceptors who have what they need.

This is likely our difference in perspective. Here is my personal and professional rationale:

1. I was educated in a program that provided preceptors and closely monitored both preceptor and student via clinical decision making small groups (3-4 students per faculty member). The faculty discussed each student prior to assigning preceptors and placed students with the preceptor they felt would best suit the students goals and learning style. They also placed each student with one preceptor/clinical environment that took that student out of his/her comfort zone. For me, this was in low-income urban women's health. Looking back this experience was pivotal in shaping the NP I am today; if the school hadn't forced me (and I had classmates that were frustrated they didn't get that placement because that was their interest area) I wouldn't have ever chosen a clinic/preceptor like that and I would have missed out. The school knew better than I did what my education needed. Several other classmates had similar experiences. I now volunteer at a free clinic because of that experience and that is a good thing for the profession, for me, and for the public (I hope).

2. Even though my program provided preceptors/placements, I applied to and was accepted into a fellowship program for my last semester that was done through a prestigious local medical school and residency program at a prestigious academic medical center. My program actually fought me on it because they felt it was not the best environment for me to learn. They finally accepted it, I completed the fellowship, and in retrospect, they were absolutely right. It sounded great on paper but it did little for my ultimate preparation for practice.

3. When I was a student, I would have vehemently argued your side of the issue. It wasn't until I could reflect back on my education/preparation after my first year of practice or so that my perspective shifted. Now that I precept and teach, I can see this even more clearly.

You make a good point about rural programs and preceptors. If only rural (or high-need) regions used this system that would be one thing but it's spreading like wildfire through even major medical areas.

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Specializes in Emergency.
zmansc,

Every time this comes up, you defend it because it worked for YOU. I understand that it worked for you. We all do. But things just fell fell into place for you - you had a network of contacts and were able to set up excellent clinical sites. Your case, however wonderful, is NOT typical. This forum is inundated everyday with people begging for preceptors because they can't find one. There are tons of people setting up clinical sites from schools that DON'T vet the preceptor and do not do site visits. I've read stories of people precepting with their friend who signs them off for more hours than they actually did, people precepting with clueless new grads, etc. We are making PROVIDERS - people who make the final decision in a patients healthcare. If even one student can slip through the cracks and have terrible clinicals that lead them to be unprepared for taking care of a patient, that is one too many.

Basically, you have to stop looking at this from your point of view and really think about the dangers. Think about all the ways a self directed clinical site can go wrong. Think about the fact that while the intentions may be good (to help train rural providers) that's not how most schools are using it. Do you think Kaplan and Walden and the other for profit schools have students find clinicals because they care about rural healthcare providers? No, we all know the real reason they do it, and it's embarrassing for the schools, and ultimately the profession. Look beyond your personal situation and realize that supporting this practice probably creates 1 good situation for every 100 bad ones. It's not worth it. They can find another way to support rural healthcare development because this isn't working.

future- I can basically say the same to you. You always attack programs that are online, and/or have students identify preceptors. You take any issue and blow it out of context and assume it means that the system in general is bad and should be thrown out.

So to get back to the issue at hand. There are programs that high quality that are online and their are programs that are high quality that are B&M. There are high quality programs that provide preceptors (as BostonFNP's story suggests) and their are high quality programs that do not provide preceptors. I believe there are also low quality programs in all of those scenarios as well. I do not believe just because a program allows the student to identify preceptors, that it is automatically bad.

I also know for a fact, that your statement in an earlier post that these programs do not monitor the clinical practicum is patently false, and you should be ashamed of making statements like that regardless of if you knew that or not. If you didn't know the answer, then don't answer the question, if you did know the answer and lied about it, that just proves how biased your answers are.

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Specializes in Emergency.
This is likely our difference in perspective. Here is my personal and professional rationale:

1. I was educated in a program that provided preceptors and closely monitored both preceptor and student via clinical decision making small groups (3-4 students per faculty member). The faculty discussed each student prior to assigning preceptors and placed students with the preceptor they felt would best suit the students goals and learning style. They also placed each student with one preceptor/clinical environment that took that student out of his/her comfort zone. For me, this was in low-income urban women's health. Looking back this experience was pivotal in shaping the NP I am today; if the school hadn't forced me (and I had classmates that were frustrated they didn't get that placement because that was their interest area) I wouldn't have ever chosen a clinic/preceptor like that and I would have missed out. The school knew better than I did what my education needed. Several other classmates had similar experiences. I now volunteer at a free clinic because of that experience and that is a good thing for the profession, for me, and for the public (I hope).

2. Even though my program provided preceptors/placements, I applied to and was accepted into a fellowship program for my last semester that was done through a prestigious local medical school and residency program at a prestigious academic medical center. My program actually fought me on it because they felt it was not the best environment for me to learn. They finally accepted it, I completed the fellowship, and in retrospect, they were absolutely right. It sounded great on paper but it did little for my ultimate preparation for practice.

3. When I was a student, I would have vehemently argued your side of the issue. It wasn't until I could reflect back on my education/preparation after my first year of practice or so that my perspective shifted. Now that I precept and teach, I can see this even more clearly.

You make a good point about rural programs and preceptors. If only rural (or high-need) regions used this system that would be one thing but it's spreading like wildfire through even major medical areas.

BostonFNP -

It sounds like your program did a great job of finding the ideal settings for you. I agree that in an ideal world, if we all were in areas where the school had a great deal of knowledge about the providers in our towns, then I would totally agree with you that the school should at least provider preceptors, although I still feel that there are positives to allowing students to find preceptors as well.

However, in my situation, and that of most of my cohorts and many, many other NP students, live in rural areas where no schools have detailed knowledge about the providers in our towns. So, my perspective is that I still feel it is a very important mission of the NP profession to do what it can to support the education of students in rural locations and thus help produce providers who are more likely to continue living and providing in those underserved areas. And to do that, some capabilities need to exist for the program to find the preceptors for the student. In my programs case, that is for me to identify some preceptors and give the program that jump start on the process. Just so we are clear, I would be in total agreement if the proposal was to tighten the requirements on programs so that they do a better job of vetting preceptors (regardless of who identifies the preceptor), or if it was that programs have more monitoring of clinical practicums built into their program (again regardless of who identified the preceptor), but I have to object to the proposal of boycotting or getting rid of programs that have students identify preceptors. I just think that proposal (and some of the comments from others on this thread) went too far to the extreme and resulted in slander of programs like mine which is not ok. I'm all for open dialog, but I'm not for misrepresentation (which I am not accusing you of).

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I find it ridiculous that schools make you find your own preceptor. As if graduate school isn't hard enough. There needs to be a standardized system nationwide when going to NP school-the application process, statements, and references. Thus far, it has been a discouraging process for me.

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Specializes in Nursing Education, CVICU, Float Pool.
future- I can basically say the same to you. You always attack programs that are online, and/or have students identify preceptors. You take any issue and blow it out of context and assume it means that the system in general is bad and should be thrown out.

So to get back to the issue at hand. There are programs that high quality that are online and their are programs that are high quality that are B&M. There are high quality programs that provide preceptors (as BostonFNP's story suggests) and their are high quality programs that do not provide preceptors. I believe there are also low quality programs in all of those scenarios as well. I do not believe just because a program allows the student to identify preceptors, that it is automatically bad.

I also know for a fact, that your statement in an earlier post that these programs do not monitor the clinical practicum is patently false, and you should be ashamed of making statements like that regardless of if you knew that or not. If you didn't know the answer, then don't answer the question, if you did know the answer and lied about it, that just proves how biased your answers are.

Praise!!!

Sent from the iPhone of PatMac10, RN

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Specializes in Nursing Education, CVICU, Float Pool.
BostonFNP -

It sounds like your program did a great job of finding the ideal settings for you. I agree that in an ideal world, if we all were in areas where the school had a great deal of knowledge about the providers in our towns, then I would totally agree with you that the school should at least provider preceptors, although I still feel that there are positives to allowing students to find preceptors as well.

However, in my situation, and that of most of my cohorts and many, many other NP students, live in rural areas where no schools have detailed knowledge about the providers in our towns. So, my perspective is that I still feel it is a very important mission of the NP profession to do what it can to support the education of students in rural locations and thus help produce providers who are more likely to continue living and providing in those underserved areas. And to do that, some capabilities need to exist for the program to find the preceptors for the student. In my programs case, that is for me to identify some preceptors and give the program that jump start on the process. Just so we are clear, I would be in total agreement if the proposal was to tighten the requirements on programs so that they do a better job of vetting preceptors (regardless of who identifies the preceptor), or if it was that programs have more monitoring of clinical practicums built into their program (again regardless of who identified the preceptor), but I have to object to the proposal of boycotting or getting rid of programs that have students identify preceptors. I just think that proposal (and some of the comments from others on this thread) went too far to the extreme and resulted in slander of programs like mine which is not ok. I'm all for open dialog, but I'm not for misrepresentation (which I am not accusing you of).

Praise again!

Sent from the iPhone of PatMac10, RN

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Specializes in Cardiac, ER.

It is interesting to read the different opinions and experiences with this whole process. I work in a town with a pop of about 170,000. There are two major healthcare organizations in my town. I have worked for one of them for 17 years. We also have a huge rural area we serve and will be doing at least part of my practicum hours in a rural setting, which is fine. My current delima is finding a family practice preceptor. I have heard names of several docs but I really don't know many at all. Most of the family docs in my area do not admit to the hospital, we have hospitalists who admit. The hospitalists do not have office hours or see patients outside of the hospital setting, therefor do not qualify as a preceptor. My school is a brick and mortar local private college. Most of my courses are online. They do not provide preceptors and the only guidance I am getting is "yes we've used that person before, or no I don't think anyone has ever used that person". I don't have the luxury of 'interviewing' a preceptor to evaluate personality or find a good fit. I am making phone calls as fast as my fingers can dial. I am instructed to speak with an office manager who "checks with the doctor" and gets back to me. I have had multiple providers tell me that they have students scheduled through 2016,..which means people would have had to schedule this time before they were even accepted into the program! Part of the problem is the three major colleges that offer a MSN/DNP program in my area. There are too many students and not enough preceptors! I still feel that the college should offer some sort of guidance, and have some way of evaluating the learning experience with each provider. I guess you could assume that if the students do well in the course, the teaching was adequate. I have just heard stories about really poor clinical experiences. I will obviously avoid those providers, but at this point I will have to take what is offered. I understand that my learning experience will most likely be what I make of it,....it is just frustrating to find this struggle worse than the course load!

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Specializes in Nursing Professional Development.
Some prefer to have the flexibility to find their own preceptors, personally I would not want to go to a school that forced me to go to a preceptor I do not know or have input on.

There is a huge difference between "being allowed to find your own preceptor" ... and "being forced to find your own preceptor."

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There is a huge difference between "being allowed to find your own preceptor" ... and "being forced to find your own preceptor."

I think that perfectly sums up how I feel about what zmansc has been saying.

zmansc, we understand that sometimes rural students need to set up their own clinicals since they don't have local programs. BUT as llg stated, there is a huge difference in having that as an option versus being required to do it because your school refuses to help. Why can't you see that? No one is saying it should never be allowed, but it should ONLY be allowed as a secondary option for students in rural areas. There is no excuse for these programs located in huge metropolitan areas not to set up clinicals.

Basically, and I've said this before, all programs should be required to find clinicals for students who live within a certain school radius. If you choose to attend at a distance, then the school is not required to find them. However, if you choose to move within a 50 mile radius for the clinical portion, the school must find them and set them up.

its a very simple solution and it makes no sense that you are so against this. It preserves your precocious ability to find them if you choose, but also doesn't let crappy programs get away with not providing them out of greed and laziness.

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