Question re: NP and clinical experiences...

elkpark · Oct 21, 2009

Besides once you are that far in your career and academics I don't think you should have to be baby sat and have your school make your arrangements for you.

I don't see it as a matter of being "baby sat" -- I see it as a matter of the school ensuring that the quality of education/supervision you're going to receive (as a student in their program) is up to their standards (and, frankly, worth the tuition you're paying). What if a student ends up being supervised by an NP who is a slacker and teaches the student lots of bad habits and short cuts?? Just because someone local is willing to supervise you, that doesn't mean you're going to get a good education from that person. Schools are required to vet the backgrounds and regularly evaluate the performance of their own faculty and adjunct faculty -- what provision is there for evaluation of preceptors that students find on their own in their own communities?

ALCCRN · Oct 22, 2009

I'm in an online program and have (with minimal effort) arranged my own clinical rotations. The school has a list of locations (nationwide) that have an existing contract with the school-making the process easier, but initiating a contract is not a lot of extra effort. It has been a great experience and allowed me to focus myself in areas that I didn't have much experience in (i.e., OB/Peds).

I'd also like to add that instructors from the University visited me onsite each semester to evaluate me and my preceptor.

studentmom6263 · Oct 26, 2009

Am currently in the process of trying to secure a clinical site for spring '10 and this is not easy. Not sure what will happen if no one takes me. The problem seems worse because this is my first clinical semester. Although I have 20+ of solid experience, people apparently think they will need to be my babysitter. Frustrating, for sure.

studentmom6263 · Oct 26, 2009

I absolutely agree with you. Even if I do find a preceptor (which seems like a big if right now), how do I know that the person who agrees to give me a chance is a competent clinician or a good teacher?

ALCCRN · Oct 26, 2009

We evaluate our preceptors each semester. So if a student has a preceptor that is "less than desirable" they include that in their preceptor's evaluation. The preceptor does not see it- it is simply for the school. I would suggest that if you are this concerned about it, that it be a question you ask upon admission to the program.

carachel2 · Oct 26, 2009

If NP programs are ever going to be taken more seriously and placed up on par with PA schools, they are going to have to take the begging for preceptors factor out of the program. I am currently doing my practicum which means almost 400 hours of clinical experience this semester. Most of these hours are with one preceptor who is doing all of this without being paid. For her personally, this requires daily time away from patients to teach (although I try to completely minimize the time needed for instruction between patients) AND she puts her own patient relationship on the line since her patients could conceivably get tired of being seen by "the student." We have only 2-3 class meetings this semester...where is our $$$$ going? The money should go to the primary preceptor for this semester.

elkpark · Oct 26, 2009

If NP programs are ever going to be taken more seriously and placed up on par with PA schools, they are going to have to take the begging for preceptors factor out of the program. I am currently doing my practicum which means almost 400 hours of clinical experience this semester. Most of these hours are with one preceptor who is doing all of this without being paid. For her personally, this requires daily time away from patients to teach (although I try to completely minimize the time needed for instruction between patients) AND she puts her own patient relationship on the line since her patients could conceivably get tired of being seen by "the student." We have only 2-3 class meetings this semester...where is our $$$$ going? The money should go to the primary preceptor for this semester.

ITA. In the programs which operate like mine did, even in the later semesters in which we could choose our own clinical placement (from an established list of possibilities), all of our clinical supervision was provided by "legitimate" adjunct faculty members who were paid by the school to provide us with clinical education/supervision that was known to be up to the high standards of the overall program. I, personally (and I'm not being critical of anyone else here, JMHO), would not have been comfortable with (paying tuition for) any other kind of arrangement.

core0 · Oct 26, 2009

If NP programs are ever going to be taken more seriously and placed up on par with PA schools, they are going to have to take the begging for preceptors factor out of the program. I am currently doing my practicum which means almost 400 hours of clinical experience this semester. Most of these hours are with one preceptor who is doing all of this without being paid. For her personally, this requires daily time away from patients to teach (although I try to completely minimize the time needed for instruction between patients) AND she puts her own patient relationship on the line since her patients could conceivably get tired of being seen by "the student." We have only 2-3 class meetings this semester...where is our $$$$ going? The money should go to the primary preceptor for this semester.

The money should be going to develop more preceptors and ensure that the ones that are there are doing a good job. Preceptors should want to teach not simply look at it as a way to make more income. There are some PA (and MD) programs that reimburse preceptors but in my opinion it doesn't always lead to a good rotation.

The problem is standards. Until there are standards in place to ensure that a student has a good clinical experience nothing is going to change. When you ask where the money goes? In the case of PA and medical schools we know pretty well where it goes. My program with 50 students per year in clinicals (10 rotations x 5 weeks a piece) had four full time clinical instructors who spend most of their time either visiting sites to make sure everything was going OK and that all the expectations were met. The rest of the time they spent working on developing new sites and the paperwork that goes with them. The DO program down the road here has 8 clinical instructors who do the same thing for the DO students. Thats the level of commitment you should see from the program. Realistically, the only reason that the system is the way it is, is that the accrediting agencies require it. 20 years ago PA education was largely dependent on the student finding their preceptors. This was identified as a major educational flaw in the mid 80's and the ARC-PA moved to correct it. Hopefully in the next few years the last 2-3 programs that get away with this (kind of) will be taken care of.

If this is going to change its going to have to come from some sort of accreditation program for the programs (similar to what exists for CRNAs).

David Carpenter, PA-C

elkpark · Oct 26, 2009

The money should be going to develop more preceptors and ensure that the ones that are there are doing a good job. Preceptors should want to teach not simply look at it as a way to make more income. There are some PA (and MD) programs that reimburse preceptors but in my opinion it doesn't always lead to a good rotation.

I agree with most of what you say, but you sound like (I'm pretty sure it's not really what you mean) you're starting off with the ol' "martyrdom/calling" argument -- nurses (and other healthcare providers) should do their jobs simply for the love of helping others, and not expect any kind of compensation for it ... :) Of course preceptors should want to teach, and I assure you that adjunct faculty anywhere do not get paid enough for the effort required to "simply" see it as an easy way to make more money. But if teaching is an important, worthwhile professional function, then people should get paid for doing it! I don't see it as an either/or question -- either someone is a good preceptor and, therefore, willing to precept for free, or, if they want to get paid, they must not be doing it for the "right" reasons and must not be a good preceptor -- people who are good at educating/precepting and are willing to put forth the extra time and effort to do so should be compensated fairly for doing so.

carachel2 · Oct 26, 2009

[The problem is standards. Until there are standards in place to ensure that a student has a good clinical experience nothing is going to change. When you ask where the money goes? In the case of PA and medical schools we know pretty well where it goes. My program with 50 students per year in clinicals (10 rotations x 5 weeks a piece) had four full time clinical instructors who spend most of their time either visiting sites to make sure everything was going OK and that all the expectations were met. The rest of the time they spent working on developing new sites and the paperwork that goes with them. /QUOTE]
Well, this is not too unlike what we have in our NP program and it still doesn't address the actual problem of not having "preceptors." We have clinical instructors who visit each student clinical sites at least 2-3 times per rotation. Standards are being met and we are measured against expected learning objectives.
We have two full-time faculty who are devoted to the paperwork and recruitment of new preceptors. The problem is that preceptor positions (not clinical faculty) are still largely voluntary.

core0 · Oct 27, 2009

I agree with most of what you say, but you sound like (I'm pretty sure it's not really what you mean) you're starting off with the ol' "martyrdom/calling" argument -- nurses (and other healthcare providers) should do their jobs simply for the love of helping others, and not expect any kind of compensation for it ... :) Of course preceptors should want to teach, and I assure you that adjunct faculty anywhere do not get paid enough for the effort required to "simply" see it as an easy way to make more money. But if teaching is an important, worthwhile professional function, then people should get paid for doing it! I don't see it as an either/or question -- either someone is a good preceptor and, therefore, willing to precept for free, or, if they want to get paid, they must not be doing it for the "right" reasons and must not be a good preceptor -- people who are good at educating/precepting and are willing to put forth the extra time and effort to do so should be compensated fairly for doing so.

To some degree I agree that people who are good at educating should be paid fairly. However, the key to this is the word fairly. In reality a program cannot compensate fairly but instead compensates at some lower rate. The concept in psychology is know as cognitive dissonance:

http://findarticles.com/p/articles/mi_g2699/is_0000/ai_2699000062/?tag=content;col1

The classic work on this was done in 1957. There is another industrial psychology article that worked this angle in different ways. Three groups of people were asked to do a task. One group was asked to volunteer. Another group was paid a dollar for the task. The final group was paid $20. Unsurprisingly, the group that was paid more did more work than the group that was paid less. However, the group that "volunteered" did the most work. It has its roots in social cognition and how we see ourselves. Similarly from the student side when the students were told that the teacher was either paid or volunteer. The students perceived the volunteer teacher as more motivated and a better teacher.

http://psp.sagepub.com/cgi/content/abstract/18/2/245

All of this is a long way of saying that there is good data that the best way to provide a good educational environment is to use volunteers that are there because they want to volunteer (in my opinion).

Ideally a person should volunteer because of duty to the profession and a duty to make sure that the students get a good educational opportunity. I have some extrinsic compensation in that I can add adjunct faculty or some such to my CV (which gets looked at every year). In addition my certifying agency gives me hour for hour category II CME every year for precepting students so there is some reward there. In the end I precept because in the past another PA or MD or NP took the time to precept me and I'm simply paying it forward. A financial reward would simply smack of desperation.

David Carpenter, PA-C

elkpark · Oct 27, 2009

To some degree I agree that people who are good at educating should be paid fairly. However, the key to this is the word fairly. In reality a program cannot compensate fairly but instead compensates at some lower rate. The concept in psychology is know as cognitive dissonance:
http://findarticles.com/p/articles/mi_g2699/is_0000/ai_2699000062/?tag=content;col1
The classic work on this was done in 1957. There is another industrial psychology article that worked this angle in different ways. Three groups of people were asked to do a task. One group was asked to volunteer. Another group was paid a dollar for the task. The final group was paid $20. Unsurprisingly, the group that was paid more did more work than the group that was paid less. However, the group that "volunteered" did the most work. It has its roots in social cognition and how we see ourselves. Similarly from the student side when the students were told that the teacher was either paid or volunteer. The students perceived the volunteer teacher as more motivated and a better teacher.
http://psp.sagepub.com/cgi/content/abstract/18/2/245
All of this is a long way of saying that there is good data that the best way to provide a good educational environment is to use volunteers that are there because they want to volunteer (in my opinion).
Ideally a person should volunteer because of duty to the profession and a duty to make sure that the students get a good educational opportunity. I have some extrinsic compensation in that I can add adjunct faculty or some such to my CV (which gets looked at every year). In addition my certifying agency gives me hour for hour category II CME every year for precepting students so there is some reward there. In the end I precept because in the past another PA or MD or NP took the time to precept me and I'm simply paying it forward. A financial reward would simply smack of desperation.
David Carpenter, PA-C

Well then, David, why stop with just precepting?? Why not do your "regular" job on a voluntary basis? Why don't we all provide our professional services on a voluntary basis and live off charity? We could beg on the streets in our spare time (our limited spare time, after we worked harder at our regular job than we would have if we were getting paid a reasonable wage). I see the dawning of a beautiful new world ...