NP Clinical Preceptors: Challenges and Opportunities
Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC, FNAP
Clinical rotations provide NP students with “real world” practice experience as they prepare to transition from the role of student to clinician. It is important to make the most of the learning opportunities you encounter during clinical rotations. This is a valuable opportunity to acquire hands-on experience, learn or apply new skills (eg, suturing, EKG or x-ray interpretation), and engage in knowledge building in a practice setting, which will make you a more able, effective clinician when you enter practice. To help you prepare for this step in your education, I asked Fitzgerald Health Education Associates NP Certification Review and Advanced Practice Update faculty members, all practicing NPs and experienced NP preceptors, to share their insights on what NP students can do to be successful in clinical rotations.
Fitzgerald faculty contributed pearls, tips, and advice for this article. Here are our combined suggestions:
Tip 1: Establish shared expectations
A clinical rotation works best when the preceptor and student discuss their expectations prior to the first meeting in the clinic. Before you arrive for your first day of rotations, have a conversation with your preceptor in which you discuss:
- Your level of prior experience, including how far along you are in your NP program, which clinical rotations you’ve completed (if any), and your prior nursing and other professional experience.
- What level of involvement in patient care your preceptor expects of you during your first session—observing, documentation, performing exams, seeing patients yourself, and the plan you and your preceptor have created to work towards more independent/collaborative work in the exam room;
- Your learning objectives for the rotation and any specific skills that you would like to address that are pertinent to the current rotation.
Covering these topics up front will allow each of you to set appropriate expectations and plan a successful clinical experience. It also allows you to establish an accurate baseline, with responsibility and expectations increasing as you gain experience.
Tip 2: Don’t forget the little details
During the initial conversation with your preceptor, ask questions about small but important details pertaining to the clinical site, such as parking, dress code, hours, lunch/meal breaks (is there a refrigerator to put lunch in? Plan on bringing lunch, as in most practice sites, there will not be access to a cafeteria or other places to grab a quick bite to eat), lab coat (do they wear them in the office or do they prefer that clinicians do not wear them?), reference texts (are there books in the office?), and wifi. Wifi access is needed so you can use important clinical apps on your smart phone. Note that your phone should be limited to clinical uses. Most clinical practices block social media sites that should not be used while at your clinical placement.
Tip 3: Visit the office/clinic before your first clinical day
Visiting your rotation site will allow you to meet the staff and get a tour of the facility, which in turn can help to alleviate those initial feelings of anxiety. Be sure to contact them in advance to find out when is a good time to schedule a visit. If driving, ask where you are able to park. If taking public transportation, find out the options ahead of your visit.
Tip 4: Be prepared
Ask for documentation of the top 10 differential diagnoses in your upcoming rotation. Now your work begins, to learn the assessment, work-up, and evidence-based practice treatments used for those conditions, as well as the recommended follow-up. Ensure that you have access to a clear and concise prescribing reference.
Tip 5: Be proactive in your experience and use your time wisely
As you advance through your clinical rotation, you need to take on more responsibility, with the goal of operating self-sufficiently with minimum coaching by its conclusion. Be sure to make the most of each opportunity along the way. When seeing a patient with your preceptor, rather than passively observing, actively think about what questions you’d ask the patient and how the patient’s responses affect the clinical picture as you understand it. As you get more comfortable with the role, be proactive and advise your preceptor that you would like start the next patient visit by finding out the chief complaint, and doing a review of systems and medication reconciliation. Then perform the physical exam together with your preceptor for the first few visits, with the goal to move to performing the physical assessment independently. Be sure to have your list of differentials ready, along with your working diagnosis and treatment plan.
Keep in mind also that any “down time” you have during your rotation is really an opportunity to build new knowledge and skills. Use these moments to research something you encountered in clinic or to learn more about your patient’s health history, plan of care, and educational needs.
Tip 6: Maximize the opportunity to learn/practice clinical skills/procedures
Seek out assistance from your preceptor and his/her colleagues on opportunities to interpret EKGs, labs, x-rays, etc., as well as observe, with a goal of moving to performing common procedures that are an expected part of primary care.
Tip 7: Review each clinical day
At the end of the session, make time to talk with your preceptor about the day’s experiences, lessons learned, and any interesting or confounding clinical scenarios encountered. This is also a good time to evaluate your progress and identify areas where you need to increase your knowledge or understanding and where further research is required.
Tip 8: Treat all staff, regardless of role, with the respect they deserve as part of the healthcare team
Engage with all individuals in the practice setting, as they are all part of the team and essential to the care of the patient and to your success. Some of your best supporters and allies will be the front office and clinical support staff. They will have your back and help you if they consider you a part of the team. Clean a room, escort your own patient to the exam room, make your own phone calls, and the like. Keep in mind, though, that acknowledgment, interaction, and interest in their roles will be remembered long beyond your gracious gesture.
Tip 9: Learn how to use the electronic medical record (EMR) system
Learning the EMR system early on increases efficiency. The brief tutorial on using the EMR that you receive from IT department staff members often is not sufficient, and you should insist on a deeper, more detailed understanding. Often the best way to go through a tutorial is to say, “I have this patient with an upper respiratory infection, let’s start by opening their chart and moving from there.”
Tip 10: Ask questions and be honest about what you know and where you need help
Always ask questions when you feel uncomfortable, are curious, or encounter something you don’t understand. And be sure to review the steps for clinical skills and procedures before you perform them. It is okay to say, “I don’t know,” as doing so allows your clinical instructor to turn that into a teachable moment. Also, being upfront about what you know and don’t know is essential to properly balancing patient safety and your educational needs. At the same time, don’t ever hesitate to offer a diagnosis or suggestion for a test, treatment, or drug choice. This is the only time in your career where the only consequence of being wrong is learning something.
Tip 11: Be grateful
Remember that you are a guest, and preceptors generously donate their time to mentoring students. Tell your preceptor you are appreciative of what they are teaching you and be flexible.
Tip 12: Never forget the kindness and generosity of your preceptors
Make sure to return the honor by precepting NP students in the future.