Practice Site Logistics and Arrangements

• Notify appropriate individual (office manager, practice coordinator, etc.) of request for precepting.
• Arrange for student orientation, including computer access.
• Arrange clinical schedule with the student (days, hours).
• Inform and prepare staff for student arrival and participation.
• Help the student learn the consultation and referral process in the clinical setting.
• Be aware of information in the legal affiliation agreement with the student's program.
• Review personal and course/clinical objectives with the student.

Preceptor Requirements

• Complete online Preceptor Profile which includes:
  • CV/resume
  • Professional license information
  • Documentation of specialty certifications
• Provide current contact information to the faculty.

Communication

• Discuss any problems with the student and faculty.
• Enable student documentation of patient care consistent with the requirements of the clinical site. (If students have limited access to EHR, they can document on a form that may assist with preceptor's own computer charting).
• Be available onsite when the student is present.

Patient Encounters

• Facilitate access to a variety of patients as students increase their clinical skills.
• Validate student findings and provide feedback regarding their accuracy and significance.
• Discuss and approve the plan of management with the student, including diagnostic, therapeutic and follow-up plans.

Evaluation

• Provide formative and summative evaluation to document student performance, consistent with the student's agreement and personal and course objectives.
• Confer with the faculty advisor and student to discuss the student's progress and learning needs.

Preceptor Expectations of Students

Interview
A preceptor may require an interview prior to accepting the student. This interview provides the preceptor with an opportunity to determine the student's level of learning and the "goodness of fit" among the student, preceptor and site. A meeting with the preceptor also allows the student to learn if the site will provide adequate experiences to meet both the course clinical learning objectives and the student's individual learning objectives (Barker & Pittman, 2010). In the absence of an interview, the clinical faculty member will assess the appropriateness of the clinical setting and preceptor assignment.

It is the responsibility of the APRN program to provide the preceptor a copy of the course objectives and clinical evaluation criteria and forms. Individual student learning objectives should be provided by the student.

Review of Past Clinical Logs
Student logs/encounters provide a substantive indicator for discerning whether the student's learning needs are being met. The student's records of past patient encounters provide valuable evidence of the patients, their medical problems, medications prescribed and patient education provided at each encounter. Most students are required to keep a written or electronic log of the de-identified patients they have seen and the nature of the patient care encounters they have experienced in their past clinical practice.

Preparation
The student should prepare for the clinical practicum as recommended by the preceptor and faculty member. This preparation includes developing individual learning objectives, conferring with faculty on specific learning needs and seeking independent learning experiences to improve autonomy and self-confidence. Students keep a log of their clinical experiences and make note of areas needing refinement as they progress through the experience. The preceptor should discuss the specific patient population and the most common clinical problems to expect in the clinical site. The student can prepare for the clinical practicum by reading current reference material. Students should focus on appropriate assessments and treatment for the clinical problems most frequently managed by the preceptor.

Clinical Hours and Attendance
The student should schedule clinical practicum hours considering the preceptor's schedule and availability - not the student's schedule or convenience. Prior to beginning the clinical practicum, students and preceptors need to agree on the days and times the student will be in the clinical site. The student's personal and work schedules are expected to accommodate participation in the required number of clinical hours specified by the clinical course, consistent with the APRN program requirements, policies on academic standards and the preceptor's agreed upon clinical schedule.

The preceptor must be notified by the student, prior to the beginning of the clinical day, if the student will be absent due to illness or emergency. On the first clinical day, students should identify the procedure for contacting the preceptor in case of absence. It is also the student's responsibility to notify the faculty member of the absence and negotiate with the preceptor making up the clinical time, when possible. If the student is not attending clinical as scheduled, the preceptor should notify the course faculty member immediately. The student must understand that they are not permitted to be in the clinical setting if the preceptor is absent, unless an appropriate substitute preceptor is present.

If a student fails to complete the required number of clinical hours for the practicum, they are not automatically permitted to make up those hours. Agreement by the preceptor and faculty must be obtained prior to any extension of the clinical practicum. Making up incomplete clinical hours and absences related to unexpected illness (of the student or preceptor) should be discussed between the course faculty, preceptor, agency and student.

Professional Appearance
Students are expected to dress appropriately and professionally in the clinical setting; the clinical site may specify the dress code. Student behavior should be consistent with standards of confidentiality established by HIPAA and the clinical agency. Student identification badges should clearly identify the student's name and program/university affiliation.

Evaluation of the Preceptor and Clinical Site
Following the clinical practicum, the student should provide feedback to the preceptor on the quality of the learning experience, including the effectiveness of the preceptor's teaching and mentoring. In addition, students should provide the faculty with feedback on the effectiveness of the clinical practicum in meeting learning outcomes as well as the clinical site for facilitating learning.

Managing the Clinical Experience
Mentoring and role modeling strengthen socialization in advanced clinical practice. Observing the preceptor's interactions with other professionals, staff and patients enables the student to assume this new role. As students successfully integrate the role of the APRN, they begin their journey from novice to expert.

By organizing clinical learning within a time-constrained environment, the preceptor enriches learning experiences for the student. The preceptor communicates with the office staff about scheduling patients, the availability of exam room space and specific procedures (e.g. suturing) that would enhance learning with minimal disruption of the office routine.

Getting Started

• Discuss individual preceptor expectations and teaching style. Will the experience be fast-paced or will the schedule be modifiable according to the needs of the student?
• Introduce student to the clinical site, confidentiality and personnel policies and to other members of the staff and provider team. Explain the role of the student and the length of time of the clinical placement.
• Review program course objectives from syllabus.
• Determine student's personal learning objectives and priorities.
• Allow the student at least one day to "shadow" the preceptor so the student understands the particular style and pace of the clinical environment.

Teaching Techniques

• Deliberate reflection: Provide rationale for assessment and treatment of patients/families. Allow time for brief questions as interactions with patients unfold and the student observes care.
• Developing a problem-oriented focus: Select a concept or problem area for each clinical day that enhances clinical learning (e.g., physical exams of various age groups, management of several patients with the same condition, consulting and referrals).
• Readying: Brief the student before entering the patient room. What are the tasks required prior to meeting the patient? What resources are available to the student to prepare for the care of this patient/family?
• Initiation: Introduce the student to the patient and request the patient's permission for the student to perform a history and physical exam and other elements of the encounter.
• Pattern identification: Assist the student to recognize patterns/ constellations of signs and symptoms. Assist in thinking through differential diagnoses, relating assessment data and developing working diagnoses.
• Clinical problem solving: Teach in the patient's presence. Student presents signs and symptoms in front of patient/ family. Use the "teachable moment" in response to the student's presentation.
• Controlling the number of teaching points: Limit teaching to one or two key critical components per student-preceptor interaction.
• Feedback method: Guide the student's clinical reasoning through a developmental process, beginning with analyses of specific experiences and student self-assessment, then identifying relationships between clinical experiences and specific concepts, and finally discussing patient care at the level of concepts.
• Critique and evaluation: Assess the student's level of knowledge and understanding, filling in gaps and showing relationships between and among key concepts.
• Student reflection-in-action: Use staffing time after each patient encounter to help the student reflect on progress and the need for continued development and practice. Promote student reflection-on-action at midway and final points in the experience. Encourage collaborative discussion that guides the student in understanding critical relationships between prior knowledge and new clinical experiences and guide the student in self-evaluation and critique.
• Student evaluation: Assess student's level of clinical competence, using evaluation materials supplied by the APRN Program. Take into account the student's current level of experience. Beginning students will demonstrate lower levels of accomplishment than students nearing the end of their clinical experience.

The Last Clinical Day: Summing up

• Provide time for the student to "debrief" regarding the entire clinical experience. Ask what went well, what they would like more of, what they will carry forward into their own practice.
• Provide honest, clear and specific suggestions for the student's continued development as an advanced practice nurse. Suggest additional clinical experiences to enhance the student's learning and growth in the APRN role. Help the student make connections with other providers who might add knowledge and skill preparation.
• Discuss written evaluation with the student and return the completed evaluation to the faculty member.

Evaluation
Academic Standards and Student Evaluation Criteria
Preceptors need to be aware of the academic and professional standards set forth by the student's institution as well as the criteria and expected dates for the evaluation of the student's performance. Faculty members may include criteria for clinical failure or the minimum performance required for the student to pass a clinical course. Advanced practice students are registered nurses and subject to the quality and safety criteria defined in their state nurse practice act.

Formative evaluation
Formative evaluation is an assessment by the preceptor in the form of feedback to the student regarding their performance during the clinical practicum. Ongoing feedback provides the student with the opportunity to enhance their performance during the course of the clinical practicum. Role performance areas in which the student has achieved competence should be discussed with the student as well as those areas that have been identified as weak and needing improvement. Specific recommendations from the preceptor on strategies for improving clinical performance will be helpful to the student and can be documented in anecdotal notes and midterm evaluation.