Why Be a PreceptorLink Preceptor?
Earlier this year a student contacted us for assistance in finding a preceptor for her spring clinical rotation. As with every student, we’re excited to help! She described her fantastic preceptor from her current rotation and mentioned this NP had agreed to precept her again if needed.
Many of our students use the same preceptor for multiple rotations, especially in areas where preceptors are not as plentiful. But what are the advantages and disadvantages to this strategy?
Why Work Under the Same Preceptor?
Relationships take time. Unfortunately, many clinical rotations seem to end about the time you and your preceptor find a steady rhythm. You know how to best present a patient to the preceptor. Your preceptor knows which cases will challenge you. By returning to a previous preceptor with whom you’ve worked well in the past, you have an opportunity to build on that relationship and grow your skills without the awkward adjustment period. At this point, you should be more of a benefit to your preceptor too.
If you think you might want to work in the clinic with your preceptor, and your preceptor is considering hiring a new graduate, these hours working together could lead seamlessly into your first NP position. Even if your preceptor isn’t sure they are ready to add another provider when you start, they might find you an indispensable part of the clinic with whom patients are already comfortable.
Why Choose a Different Preceptor?
Every clinic and hospital department has a different culture. While you may find yourself comfortable within the culture of your current preceptor, you may be missing out on an opportunity that offers more variety and valuable learning experiences. By branching out to multiple preceptors, you learn to be flexible in working with different types of mentors and office staff. You will have an opportunity to see different patient management styles, charting systems, and practice styles.
Working with a variety of patient types will definitely help you in the long run. For example, in your current rotation, you may see mostly geriatric patients, which means you have little experience in pediatrics or women’s health. By choosing a different setting that treats more of these other categories of patients you widen your experience which benefits all your patients and your career.
Plus, every preceptor has a different leadership style. As a provider, you’re a leader in the clinic. Observing how various providers treat and relate to other staff members helps you formulate your own leadership style. You’ll learn what works and what doesn’t from multiple perspectives.
Choosing your preceptor or being matched to a preceptor is a big deal for your future career and your patients’ care. Staying with the same preceptor may be a good idea, especially if you hope to transition into a position there. After all, you are already “tested” and partially oriented! However, we also encourage students to branch out and not remain with the same preceptor for every rotation.
A healthy mix of both new and known preceptors builds your skills and your career.
Sometimes working with a patient is like herding chickens! They run all over the place, and it’s hard to get to the heart of the matter. Or the patient may be so focused on the appointment, you have a difficult time ending the visit. We talked to other NPs and found these tips and tricks that work for them and might work for you too!
Scripts to Focus the Challenging Patient’s Attention
Redirect patients to the subject at hand. “I love catching up with you, but I really want to be able to address your medical needs. How are you tolerating the X that we started you on last time?” At the end of the visit, “I don’t mean to cut you off, but we only have 5 minutes left, and I’d like to discuss X with you. Can we focus on that now?” Then change directions with direct questions, if possible.
When patients come in with a laundry list of complaints (isn’t this all the time?!), say something along the lines of, “Wow, you have a lot of concerns. Since we only have X minutes, what do you feel is most important to focus on today?”
Tactics for Ending the Appointment
Practice scripts to end your patient visit politely and kindly. “I’m so sorry, but I really need to get to my next patient,” or “I’m so sorry, but we really need to end the visit for today.” You might feel you need to add, “Do you want to schedule a follow-up to address this more?” “Why don’t we follow-up in X days/weeks/months to see how things are going.” “You know, I really want to be able to fully understand and address this issue. Can we schedule a follow-up appointment to discuss it?”
If you’re still having trouble, assign office staff to knock and say, “Excuse me, but Dr. Black is on the phone for you,” or a similar code word when an allotted time is passed, especially if you are in a room with a known Chatty Cathy. Telehealth/telepsych providers also find this technique helpful. Alternatively, staff can announce on the overhead intercom that you are needed to help end the visit.
Telehealth/telepsych providers can also try saying, “Oh, it looks like my next patient is online. I’d better wrap this up. Is there anything else we need to talk about, or should we get you scheduled for a follow-up?”
Near the end of the appointment time, review the most pressing problem and possible treatment plans. As appropriate, suggest 2-3 options for plans: Do we change the dose or therapy? Do we start or change medication or treatment? Do we refer? Do we want to give it some more time? If appropriate, bring the patient into the decision-making. The answer can help guide the timeframe for the next step. Then, sum things up. Review any med changes or instructions and head towards the door. One hand on the doorknob helps give patients the hint.
If that doesn’t work, walk the patient to the scheduler to make their follow-up when you need to get them out the door. Most patients appreciate this extra step. Yes, it takes a little more time, but it can help show the end of the visit. (Hopefully, your scheduler can manage him/her!)
As you walk away, remind patients they can message or call you, as needed and can always move up a visit. I often end with a very warm, friendly comment. “It was so good to see you, and I’m glad you are well,” or “I’m so glad you came in to discuss this with me. We’ll work together to get to the bottom of this.”
In the end, you may need to just schedule a longer appointment for some patients that always need more time.
Benefits of Digital Communication
Not every patient question or concern requires an office visit. Educate your staff on how to screen calls and messages before they come to you. Provide guidelines for when the patient needs an office visit or when it needs to be referred to you for a call-back or follow-up. (Err on the safe side though. Your MA may not understand what is important!) Along this line, one popular suggestion was that if a patient message requires more than a yes or no answer, an appointment should be scheduled.
Some clinicians find messaging back instead of calling back is a more effective way to respond to patients, however, if a patient is always calling in or messaging you, consider scheduling him/her for more frequent follow-up visits or a telehealth call where you can at least bill for your time.
I love working with my patients and helping them address their health concerns, but we all have patients who require more time than others. What tactics have you found to help you manage your time with these challenging patients?
Clinicians are always looking for ways to manage their patient care time most effectively. You care about your patient and want to hear about their trip to the Grand Canyon/Daughter’s Wedding/List of complaints a mile long, but you still have to maintain your schedule and your sanity! We got feedback from NPs across the nation, and here are some tips that might help!
Take Full Advantage of Your Staff
Your support staff acts as the front line to your schedule. Educate and delegate to your support staff so they pre-screen the visit and manage patient expectations. You may even provide scripts for them such as, “I’ll let the NP know that you have several issues to discuss, but she/he might not be able to address them all today. We can always schedule a follow-up visit if needed though.”
As part of this pre-screen process, have back-office staff give patients depression screens, vision screens, etc., as appropriate before you see the patient. Depending on why the patient is there, checklists or templates can be helpful and may be completed by the patient ahead of time or with you.
A good Medical Assistant/back-office person can help you know what to expect before you enter your patient’s room. A sticky note or message that says, “Pt here for a rash on back but BP 180/100” can help you focus on the most important things. Learn your staff’s knowledge level. Sometimes they know the patient better than you, especially if you’re new to the practice.
Implement Standard Processes
While some visits require more than the allotted time, others may not fill the entire appointment.
Use these “simple” visits (if there is such a thing) and refills to help you make up/save time. If someone is just there for a refill, and they are doing well, create a process where you review things as appropriate, give them the refill, and move on to the next patient. “It sounds like things are going well on your current regimen. I’ll give you x months of refills and see you back in X months. Does that sound like a plan?”
Some clinicians find starting the day 30-60 minutes before patients to prep charts can be a time-saver in the end. Review your schedule, review records/labs/imaging, prep notes, including the Plan section to note the things you intend to address, such as a prior complaint, lab work, med changes, etc. In many settings, over time you will get to know your patients and their diagnoses, and this can help in being able to cut to the core of the visit.
If you find yourself routinely going over on time, using a timer app or timer on your phone/watch can help you keep an eye on the clock. You might even let the patient know that you are doing this to help keep you on time with patients. Set an alarm to warn you of the half-way point and/or when you have 5 or 10 minutes left. Train yourself to cue the patient on the time limit when the timer buzzes. “It looks like we only have 5/10 minutes left for this visit. Is there anything else you would like me to know?”
If you are in a setting where you see the same patient regularly, during your patient’s first appointment, outline the amount of time you have for visits. Let them know you value their time, and you will do your best not to be late. Along that line, you or your practice setting might want to establish a late patient policy. Do you accept late patients? What is the cut-off? If a patient is 10 minutes late, let them know that you want to provide them the maximum amount of time you can, and if they are late, it may cut into the time you can spend with them. Obviously, this only works if you are generally on time!
End the Charting Time Warp
Charting eats up more time than we’d like, and it’s often left to the end of the day to complete. Use these ideas to chart faster and prevent this task from eating up your precious time.
Caring for patients can be extremely rewarding, but it can also be full of challenges. What techniques do you use to help manage your patient care time with quality and TLC?
PreceptorLink was born from necessity. Nurse practitioner students like you have struggled to find preceptors for years. As clinics require NPs, PAs, and physicians to see more patients in a day, we’ve witnessed the availability of preceptors decline. Paying preceptors an honorarium for their time fills the gap for students who can’t find a preceptor, however, we never intended for it to be your first stop. Before you give us a call, check out these five ways to find a preceptor without paying. (Hint: #1 is a little-known secret that will widen your opportunities immensely.)
#1 Compact State
Thirty-nine states participate in the Nurse Licensure Compact (NLC) that allows RNs with a license in one of those states a reciprocal license in the other participating states. If you cannot find a preceptor in your state where you are licensed, you are legally able to cross state lines to take a preceptor if both states are part of the NLC. This opportunity opens many doors, especially for NP students looking for psych preceptors where telepsych is accepted.
As you search for preceptors, consider areas where you have relatives who might allow you to stay with them during your rotation. You may also weigh the pros and cons of staying in a hotel for the duration of your rotation if you find a preceptor out of town.
If your state is not an NLC state, it might be worth checking into getting a license in an NLC state so you have the option of finding preceptors beyond your state’s borders.
(This applies only to your RN license, not your APRN, and you should always check with your state board to confirm compact state status.)
#2 Be Prepared
Take a minute before you start your preceptor search to inventory your professional persona. Finding a preceptor is increasingly competitive. You’ll improve your chances dramatically by polishing your resume to ensure it highlights your nursing experience and background. Start with the most recent NP rotation experience, but also include your RN experience where relevant.
While you’re updating your resume, scroll through your LinkedIn and Facebook accounts. Your LinkedIn account should include the same or similar information as your resume. As you view your Facebook account consider how posts you’ve written or shared might be viewed by prospective preceptors. Many times preceptors will review a candidate’s social media for a idea of their personality and fit.
#3 Your Network
Remember the old saying it’s not what you know but who you know? When it comes to finding an NP preceptor, who you know makes a big difference. Your instructors, co-workers, family members, and friends all offer potential connections to NPs, PAs, and physicians who could be willing to act as your preceptor. Ask everyone you know.
You widen your network by joining your state association for nurses and nurse practitioners along with national associations. Start with the general nurse practitioner associations, then widen your net to include associations for the specialty with which you need a preceptor. Some of these associations have opportunities for you to announce your needs to their members. And now that associations are conducting in-person meetings again, you have opportunities to meet potential preceptors face-to-face.
#4 Social Media Resources
Right behind your network, your Facebook and LinkedIn profiles have the potential to be your second greatest asset. Use the platforms to connect with nurse practitioners, NP groups, and nursing organizations. Some NP groups on both LinkedIn and Facebook allow you to announce your need for a preceptor. Other groups have the sole focus of connecting students with available preceptors for free.
Use social media to research prospective preceptors to find who you may know in common and ask for an introduction. Or reach out through private messaging on a clinic’s social media page. Prior to the COVID-19 pandemic, NP students routinely hit the pavement going clinic to clinic seeking out preceptors. With an influx of patients and concern for safety, this method has been discouraged over the last two years making finding preceptors that much more difficult. Social media can help fill the gap.
#5 Online Ads
Online ads with Indeed and LinkedIn offer additional digital sources for finding your next preceptor. While online ads aren’t free, you’ll pay for the ads versus paying a preceptor which is typically less expensive. Do some research on the best way to word your ads and how to target those ads to reach your top prospects.
Finding a preceptor can turn into a full-time job in some areas where competition is high and preceptors are less plentiful. If you’re struggling to find the right preceptor for your upcoming rotation, check out our list. We work with thousands of preceptors all across the United States. If you don’t see the rotation you need, reach out to us. We have new preceptors joining us every day.
Over the last two years, nurse practitioners, PAs, and doctors have been on the frontline of treating patients during the COVID-19 pandemic along with nurses, social workers, and other healthcare workers. The stress of the pandemic combined with high patient expectations and oftentimes low workplace support has led to burnout among many healthcare workers. The AMA reports 49% of physicians experienced burnout at the end of 2020. In February 2021, a report by the Journal of Nurse Practitioners recorded the rate of burnout of Primary Care Provider Nurse Practitioners at 22.6% to 25.1%. Those working in ICU and ER settings are feeling the stress even more.
If you’re experiencing exhaustion and other signs of burnout, you are not alone. We can’t control the number of patients who enter your clinics each day, but we can help you find ways to help create a work-life balance. Your mental and physical health affects the quality of care you offer your patients and your family. To help, we asked providers how they create more balance in their lives. Here’s what we found:
▶ Even though you are busy in the hospital or clinic, try to stay well hydrated, particularly with water. Even mild dehydration can affect you mentally and physically.
And, along that line, don’t hold it too long!
▶ Find exercise in everyday activities: park further away from the building, take the stairs, do squats to pick up items from the floor, do curls with the laundry detergent, etc.
▶ The best time of day to exercise is whenever you can do so consistently, but studies show that exercising first thing in the morning can increase the chances that you will maintain an exercise program because morning workouts leave less room for excuses. Plus morning workouts can help you sleep better at night. But do whatever you can maintain consistently.
▶ Set a reminder on your phone or computer to remind you to exercise. (Hello, lunges down your hallway!)
▶ Find a workout buddy.
▶ Speed walk around the inside of the clinic or outside every hour or two.
▶ Hire administrative help at work or home or housekeeping or chore help at home if possible.
▶ Use dot phrases to cut down on charting time. This can make a big difference in charting time! Put in the time up-front to save you time down the line.
▶ Learn to leave work at a set time even if all the charting isn't finished.
▶ Work part-time for a while if you're feeling burned out. It’s not always possible, but if it is, it can really help.
▶ Schedule your work for four 10-hour days to get an "extra" day off.
▶ Prep meals so you have lunch ready and don't snack on junk all day. Think about or plan your meals for the week ahead of time so you know what to buy and when 5:00 pm rolls around, you know what’s for dinner.
▶ Avoid time wasters. Your time is valuable.
▶ Find ways to exit long, unproductive conversations with patients and co-workers.
Some tips when precepting:
📌If you have students, allow them to chart the note, and then you review it, make any changes, and sign off. This is legal and can improve efficiency when precepting.
📌Have students make call backs and follow-ups when you are in ear-shot and can concur with their comments/advice. It’s good practice for students and can help providers save some time. Provider and student should both sign off on correspondence.
What creative steps have you taken to create more work-life balance and reduce burn out?
You’re winding up your final semester in nurse practitioner school, it’s time to dust off your resume and prepare for the job hunt. Some areas of the country have more nurse practitioners than positions, so it’s important to present your best self to future employers.
First Impressions Matter
Your first impression starts before you ever answer a call or meet with a prospective employer. Check out this list of dos and don’ts as you enter the workforce of clinicians.
Polish your resume
Update education to include advanced degrees
Clean up your social media (yes, prospective employers are looking)
Write a cover letter
List only nursing and clinical history (No need to include your year working at Dairy Queen in high school.)
List experience and education starting with the most recent
List clinical rotations (Experienced NPs can eliminate this section)
Use a synopsis of the type of patients you treated
Keep it simple. (1-2 pages is generally sufficient.)
Don’t include your full address. City and state are fine. (This protects you.)
Don’t list your high school or non-industry jobs
Don’t list long descriptions of your work (Employers know what nurses do. See note above about synopsis of patients treated instead.)
Don’t use crazy fonts or colors.
Preparing for the Interview
Congratulations! If you’ve scored an interview you’re well on your way to a new career as a nurse practitioner. In today’s world, most first interviews happen via video call. That doesn’t mean you get to skimp on being prepared though.
Start by making sure you’ve dressed appropriately. By wearing your full interview attire including pants or a skirt you’ll feel more self-confident which comes across in the interview even if the interviewer never sees more than your top half. Make sure you’ve styled your hair and look your best.
Find a quiet place for your interview with reliable internet. Test the connection beforehand. Also, do a run-through of the interview by turning on your device’s camera and seeing what your interviewer sees. Now’s the time to move the dirty clothes in the background that you didn’t realize would show in the camera shot.
Possible Interview Questions
We can’t possibly list all the interview questions you might be asked by a prospective employer. We know our favorites, but we did a little research too.
Here are some of the most common and general interview questions you’ll probably be asked:
Prospective employers will more than likely also ask situational questions such as:
Review clinical cases you’ve handled and have several stories prepared for the interview. If you haven’t managed any cases exactly like the ones your interviewer describes, relate the case to one you have experienced.
You can find lists of great questions to help you prep for the interview online. Some of our favorites are on LinkedIn, Indeed, and The Interview Guys.
Negotiating the Deal
If you’ve gotten this far in your process, go ahead and do an arm pump and a happy dance. You’ve aced the resume and interview process, and you’re looking at a job offer. Hold up before you sign on the dotted line. The deal you’re being offered may look good at first glance, but take another look. Are you happy with the salary? The vacation time? The extra benefits?
If not, now’s the time to speak up. You don’t have to accept an offer that’s not in line with your goals moving forward. You can negotiate a deal that allows you to move closer to the lifestyle you want to have. Barbara Phillips, APRN, GNP, FNP-BC, FAANP, covers some great information about the business side of being a nurse practitioner. We especially like this article with tips on how to ask for what you want.
Yes, by negotiating you do run the risk your prospective employer won’t step up to meet your requests, then you have to decide whether or not this is the job for you. On the other hand, you might just end up with a more comfortable salary, an extra week of vacation, or dedicated charting time.
Completing your nurse practitioner degree and passing boards opens an entire world of opportunity for you. We can’t wait to see how you grow our profession!
Studying to become a nurse practitioner and treating patients has changed quite a bit over the last 10+ years. You’re probably not handwriting notes from class or patient encounters anymore (unless the internet is down, ugh). And lucky for you, smartphones and computers offer easy access to all the information you need. We’ve scoured social media groups and the internet to compile this list of must-have apps for anyone in our profession. Have another app you love that we haven’t listed? We want to hear about it. Leave us a comment or shoot us an email.
Billed as your “online writing assistant,” Grammarly is the one app on this list everyone needs to download. The free version highlights potentially misspelled words as well as grammar mistakes. It’s your very own editor in your back pocket. Need a little more help with your papers or notes? For a very reasonable price, Grammarly’s paid version offers more detailed suggestion and can check your work for plagiarism.
Imagine having access to the world’s leading physicians at your fingertips. UpToDate “delivers the evidence powered by clinical expertise from the world’s leading physicians.” The program is available through the internet on your desktop or laptop or as a mobile app on your smartphone or tablet. You can purchase an individual subscription or clinics and hospital groups may purchase subscriptions for their entire staff. As treatments and technology change, clinicians need access to evidence-based resources at their fingertips. You’ll find what you need on UpToDate whether you’re researching in your office, in the hallway between patients, or at home after hours.
We’ve all had that patient, the one with a half-dozen drug allergies and a list of current medications even longer. How will the medication you normally prescribe for a UTI or staph infection interact with their current medication list? Epocrates is there to help. This app allows you to compare interactions with up to 30 medications at a time plus see whether or not your patient's insurance will cover the medication and determine dosing instructions.
Family Practice Notebook
Family practice covers a lot of ground. Clinicians in this realm diagnose and treat a little bit of everything. FPNotebook, a rapid point-of-care medical reference, gives you access to medical books focused on the topics and details you need for easy access. It even includes images you can use to prepare for procedures or for patient demonstrations.
Developed by the Agency for Healthcare Research and Quality (AHRQ) to support the independent U.S. Preventive Services Task Force (USPSTF), this app assists primary care clinicians in choosing the screening, counseling, and preventive medication services that are appropriate for their patients. Reviewers say the app “puts evidenced based recommendations literally in the hands of clinicians that they can use as they see patients throughout the day.”
Your clinic, like many others, includes x-ray, but no on-site radiologist. Sublux makes “X-rays accessible for all medical providers -- not just radiologists.” Reviewers recommend this app for all nurse practitioner and medical students. The app not only teaches the basics of plain radiography, it also includes evidence based treatments.
Is your patient at risk for atherosclerotic cardiovascular disease (ASCVD)? With this risk estimator, you can estimate your patient’s risk and develop a customized plan to lower that risk all from your device.
If you haven’t maxed out your phone or tablet’s memory with all these apps, stay tuned, we’re just getting started. Technology means you don’t have to spend hours searching for diagnosis options or treatment plans. You and your patients benefit from information at your fingertips. All these apps are helpful for general practice clinicians as well as specialists, but it’s not exhaustive. We’ll be adding more posts about apps for speciality clinicians over the next few weeks. Subscribe to our newsletter to receive updated information from our blog and for updated lists of available NP preceptors.
Why should I consider becoming a Nurse Practitioner preceptor?
Precepting is an opportunity to provide a service and give back to nurse practitioner (NP) students. You are also a part of building a brighter future for the students and for the community by partnering with nurse practitioner programs to provide the essential clinical experience needed for education. In addition to helping students, you will find yourself growing professionally and enhancing your clinic while building your Curriculum Vitae or resume. Preceptors may also have the opportunity to gain adjunct faculty member status at an academic institution often while fulfilling recertification requirements. Preceptors often also find themselves re-energized for their career through mentoring, learning new information from students, and clarifying their own thinking through explaining clinical reasoning while also discovering their mentoring or teaching style. Other benefits may include gaining access to library resources, access to UpToDate or Epocrates, and/or continuing education offerings. Be sure to ask the school what preceptor incentives they offer.
Sometimes preceptors can receive an honorarium or tax credit for precepting. PreceptorLink does provide an honorarium if desired. Check with your state to see if they offer tax credits for precepting.
How does precepting benefit patients?
Patients will receive additional attention and care while also contributing to the development of the next generation of nurse practitioner clinicians!
How does precepting help students?
Clinical rotations are a mandatory part of nurse practitioner education. Following a preceptor is an opportunity to apply what was learned in the classroom to clinical practice and to learn more skills and knowledge not found in the classroom.
What do I need to do as a preceptor to prepare for students?
The first step is to learn and understand the level your incoming student is at in their program. Clarify course practicum objectives and competencies as well as faculty expectations and ”meet” with your student via email, phone, or in-person prior to the start of their rotation. Ask for a current resume and consider interviewing the student to gain a better understanding of their background and experience. Doing this will allow you to learn about the student’s strengths, areas of improvement, and experience goals. Provide the student with resources and reading materials that will help them learn about your patients’ population. Providing students with the 10-20 most common diagnoses seen in the practice can be a valuable tool for students. Students should be expected to review them and be very familiar with them before they start the rotation. Also, review course and objectives before the rotation begins.
What should I expect from my students?
Students should be able to complete the paperwork and training required by their academic institute and arrange clinical rotation dates and times with you in a timely manner. Requirements may include a copy of the student’s immunization record, RN license, student ID, and computer and EMR training. Students should work around a schedule that is convenient for you, not the other way around.
Students should introduce themselves to your staff members as student nurse practitioners and inquire about the clinical procedures at your facility. Students should be punctual, dressed professionally, and come prepared. Preparation may include any reading or information you ask the student to brush up on before beginning their rotation. Students should have a laptop or smartphone and other reference materials on hand if that is recommended.
Students should only treat patients under your direction and, after the student has been with you for some time, give the student the opportunity to see the patient first then present to you to discuss the patient’s care and treatment plan before seeing the patient together. Students should discuss documentation specifics with you. Read more about student documentation requirements here. And finally, students should be interactive and eager to learn during every rotation.
We have found that it is best to make your expectations clear and in writing upfront, so there is no confusion once a rotation occurs. What seems obvious to you may not be to a busy student!
Question: We have nurse practitioner students who rotate through our practice. Can we use their notes in the same way medical student notes are used?
Answer: Great question! Rules for nurse practitioner and physician’s assistant students documentation have changed in the last couple of years. As of January 1, 2020, clinicians can now use notes written by students. Specifically, when providing professional services, clinicians may now review and verify notes in a patient’s medical record made by other physicians, residents, nurses, students and other medical team members rather than re-documenting the information.
The change in documentation requirements developed after a 2018 rule change by the Centers for Medicare and Medicaid Services (CMS) reduced the burden of documentation for clinicians but also created unintended consequences for nurse practitioner and physician assistant preceptors and the students under their supervision. As a result, many clinicians abruptly stopped precepting which created a disruption in education for NP and PA students. The American Academy of Nurse Practitioners (AANP), the American Academy of Physician Assistants (AAPA), nursing and physician stakeholders began rallying for changes to the 2020 final rule.
The efforts by these groups proved effective and in November 2019, CMS revised the Medicare Claims Processing Manual, Chapter 12 Section 100.1.1 to update the policy on Evaluation and Management documentation. The policy now allows documentation by students and other medical team members to be verified by the acting clinician. The clinician must perform or re-perform the physical examination and all medical decision-making activities for the patient but no longer has to re-document notes from a student assisting in the medical services.
This rule change aligns with today’s productivity demands for medical clinicians while also improving patient access to high quality care.
Clinical training is essential for nurse practitioner preparation and preceptors are a vital part of that training process. Without preceptors, nurse practitioner students would miss out on invaluable clinical training and skill development.
Most nurse practitioners are clinically trained under the supervision of a volunteer preceptor. In some instances, nurse practitioners who trained under a volunteer preceptor “pay it forward” by becoming volunteer preceptors themselves. However, many issues have developed in the clinical training system for nurse practitioners. Most of those problems have been largely related to the reliance of today’s volunteer nurse practitioner preceptors.
Some of those in the industry believe that compensating preceptors would resolve much of the issues reported with the current system. Others believe that paying preceptors would create more problems than they would solve. Today, we’re presenting arguments for both sides of the debate.
Why Preceptors Should Be Compensated
Primary care provider shortages have caused increased demands on current providers. As a result, many health care organizations have increased productivity requirements for providers in order to mitigate the provider shortage. Along with this, the increased need for preceptors from academic institutions is also overwhelming clinicians for their time.
Proponents of compensating preceptors believe that providing payment would help alleviate the challenge of meeting productivity standards. The pay for precepting covers the loss of workload productivity payment by a healthcare organization. Proponents also say that providers who are compensated have a higher satisfaction as a preceptor. Compensation also recognizes the value of the essential service of the clinicians and it provides pay for their time, knowledge, and skill.
The Case Against CompensationOpponents of compensation believe that payment will further increase an already burdening challenge for schools and nurse practitioner students to find preceptors. To meet the demands, some preceptors have begun charging for their services. A 2016 blog post written by Patrice Brown in the blog “Minority Nurse” alleges the prices for preceptors begin at $200 per week per student.
Paying preceptors may also develop unintended consequences. Companies that broker clinical placements by charging nurse practitioner students and programs have increased in number. This may not seem like a bad idea but opponents question if these companies are helping students and programs or taking advantage of them. There is also the question of who oversees quality assurances for these companies. Without oversight, these companies can set their own standards and regulations which could be disadvantageous for customers.
Compensation may also force smaller schools into a bidding war with larger, well-financed schools. Small schools may lose long-term preceptors as a result. Opponents of compensation believe the cost of preceptor pay ultimately falls on the student. This can disrupt student diversity by narrowing who can afford to complete the program.
Though opponents of paying preceptors bring up valid concerns, many of these points like the need for an oversight committee can be remedied. Paid preceptors are more likely to be reliable and provide a higher quality of training for students.
Quality, value, and education are our top priorities at PreceptorLink. We were founded and are operated by a nurse practitioner who understands the needs of students and the demands of practicing clinicians. Whether you are a student seeking placement or a clinician who is ready to be rewarded for their time, skills, and knowledge, PreceptorLink is here for you.
Here are important things to remember before you start your clinical rotation:
1. First of all, clarify the site's and your school's expectations in advance. This will save many headaches in the end.
2. Help fill out the paperwork for the office as much as possible to make it easier for the clinical site. If the preceptor can just sign the paperwork, that is helpful for him/her.
3. Try to be more of an asset and less of a burden to the practice. Help when you can. You have skills and talents that can be valuable to them. Offer to make a hand-out for something that may be beneficial to them. Then make it! Offer to take back the next patient, do vitals, and start the history. This will help make precepting more efficient.
4. Everyone is a learning opportunity: the lab tech, front office, medical assistant, billing person…they are all usually experts in their own area! Learn from them. If it is ok, spend some time in each area. Or perhaps follow a patient all the way through from check-in to check-out. This will help you to understand patient flow and you may be able to help here and there. (This is obviously individual to office settings/preference, and schools may not consider this time "clinical" but that does not mean it is not valuable.)
5. Look for ways to say thank you. Whether it’s bringing homemade cookies, coffee or just a great, friendly and helpful attitude, it all makes a difference.
6. Remember, your actions affect students after you!! We can’t tell you how many times we have heard “We don’t take students anymore because the last one we had…” Don’t contribute to preceptor burnout or be the reason a preceptor/site stops taking students!
7. If you mess up/feel like someone doesn’t like you/don’t feel you are learning…keep this in mind: Every experience, even an undesirable one can be a useful learning experience. Take away the good and the not-so-good. Use it to help make you a better provider. Back to #6: Make an effort to fix the situation. Don’t be afraid to sit down and talk to your preceptor/office staff if you feel friction. Politely say something like, “I really appreciate being here. I value the time you and others are giving to help me grow. Is there something I can do to help this situation?” Find a way to say something positive about them: “You are so good with patients, and I want to learn from you.” Or, “You are amazingly organized, and I want to learn how to emulate that…” Watch your tone and attitude. Remember, they are sacrificing for YOU! They do not “need” YOU. You need THEM! Bring your faculty in if needed.
8. Patients need to accept you too. If it is available, look at what is noted as the reason for the visit. Sometimes it’s on the schedule or the MA may have written it. You may want to quickly look something up before entering the room. After you have been cleared to see a patient and instructed how much you can do on this visit, enter the room with a warm, friendly smile. A friendly attitude will warm up the grumpiest patient. Look the patient/family in the eyes and introduce yourself to everyone. You can decide about shaking hands. If they are sick, you may just do introductions. Find out who is with the patient today, if applicable. Note that. (“Patient is here with husband, George.” “Patient is here with his mother, Anne.” Ways to introduce yourself include, “Good morning! I’m Lynn McComas, and I am the nurse practitioner student who is working with Dr. Smith today. We will be working together to see you today. Tell me what is going on/what brings you in/how we can help today…”
9. Ask your preceptor what types of patients they typically see and what are some things you should be familiar/comfortable with before starting clinicals. This is super important! Make cheat sheets; review material; have immunization tables... Look at our Resources Page. Walk into clinicals as prepared as possible, and you will feel better and make a good impression.
10. Please read the post I wrote on LinkedIn: A Message to FNP Students Doing Their Pediatrics Rotations. Read this no matter what rotation you are doing- even if it is not peds! The advice applies to all rotations.
11. Know what you should bring to clinicals: laptop, lab coat, lunch, nametag, any special reference books or apps you might want to get.
12. Ask about attire. You want to fit into their practice. Be professional, clean and appropriate. Do they wear scrubs or street clothes? No plunging necklines, short skirts, tattoos or multiple piercing showing. If you aren’t sure- clarify and err on the side of conservative.
13. Make sure you know what needs to be accomplished for you to start well in advance: EHR training; immunizations; criminal background check...Every site has different requirements, and we can't track every site. It is up to you to ask and follow through. Do it early!
14. Ask how they prefer you present a patient, then practice that. Some clinicians are very particular about this. Make up your own cheat sheet. Here are some references for you:
Great resource! https://meded.ucsd.edu/clinicalmed/oral.htm
Clinical Links to many great sites (Thank you, UCSD.) https://meded.ucsd.edu/clinicalmed/links.htm
Great Tips for those being precepted: https://lms.rn.com/getpdf.php/1789.pdf
15. Find out when you should be there for clinicals- start and end of day. Don't assume you can leave early. Expect to be there the same schedule as your preceptor. Many times, preceptors complain that students leave early and that frustrates them. Stay and help as much as possible. You chose to go to school at this point in your life. Please don't make excuses for daycare, work, or traffic. Don’t make that the preceptor’s problem.
16. As your rotation progresses, you should be able to be an asset to the practice. You should have a system in place and know how to “roll!” Don’t be afraid to fly! You will wish you had when you are on your own. On the other hand, if your preceptor isn’t ready, you need to respect that. Refer back to #7 and #8.
17. Preceptors generally want a relationship with your school faculty. Encourage and foster that. Help make the process as easy as possible for them.
18. You can do this!! Utilize every minute, every patient, every opportunity. You will be glad you did when you are taking your exams and out practicing!
We wish you only success in your clinical rotations and hope these suggestions will help ensure that! You got this!!!
Lynn McComas, DNP, ANP-C
President and CEO Preceptor Link and PL Team
Dear FNP students,
I recently had the pleasure of spending 3 days with some amazing pediatric nurse practitioner (PNP) colleagues at the National Association of Pediatric Nurse Practitioner (NAPNAP) Conference in Denver. I met some of the most wonderful nurse practitioners from across the spectrum: PNPs, students, faculty members, Deans of Nursing, and other types of nurse practitioners (NPs). It was a sincere pleasure networking with so many nurse practitioners who have dedicated their professional lives to improving the lives of children and their families. As I heard several times over, “Children are NOT little adults!” They were enthusiastic and earnest in their desire to increase their pediatric knowledge base and to connect with colleagues.
Interspersed in the energy however, I repeatedly encountered a recurrent theme I would like to share with you. These nurse practitioners are inundated with requests for preceptors. Most love to teach and want to share their knowledge and passion with the next generation of NPs. The problem they report is that the next generation of FNP students often appear apathetic and lackadaisical about learning pediatrics! This disinterest in learning pediatrics is causing these pediatric preceptors to feel disheartened and disinterested in teaching FNP students. Here are some of the comments they reported FNP students have said in their pediatric rotations: "I am only here to get my hours done and become an FNP.” "I am not going to do peds when I get out- I am only doing this because I have to do this to graduate." Even if the student doesn’t directly verbalize this, the disinterest is obvious to these dedicated practitioners (and the office staff).
This attitude is unacceptable and troublesome, and it’s causing preceptors to quit precepting. These pediatric preceptors (whether NP, PA or MD) are dedicating their time to educate you! Precepting results in decreased productivity, which often results in less income. They spend their time and energy compiling educational material and carefully crafting teaching plans for you. They miss out on family and personal time so they can stay late and work with you! They want you to be excited and interested about pediatric healthcare! It is not fair to these dedicated professionals to act otherwise. We must train our FNPs well in pediatrics because children and their families deserve quality healthcare.
FNP students, a disinterested attitude is NOT ok! FNP faculty, please counsel students that this is NOT acceptable. FNP schools, please carefully screen students. Regardless of the area in which you end up working, you must be respectful and appreciative of your preceptor and his/her specialty. Soak up every morsel of knowledge you can from every clinical rotation. Before you know it, you will be out and practicing, and lives will depend on you. (If nothing else, it will help you on Boards.)
There is a serious preceptor shortage, especially for pediatric rotations, and this is only making the problem worse. I am dedicated to helping improve the preceptor problem for nurse practitioners, and I continue to search for ways we can help with this issue. Students, being gracious and interested in your clinical rotations will motivate preceptors. If preceptors don’t feel appreciated, they won’t precept! Compassion and passion are some of the characteristics that make nurses special. Demonstrate those behaviors at every clinical rotation. The profession and your future patients need you and are counting on you.
We have all seen it. The symptoms are undeniable and can be very distressing for family, friends, and especially the patient him or herself: Depression, anxiety, G.I. disturbance, increased occurrence of unrelated medical problems… Patients are often seen crying, complaining, yelling out expletives, despondent and doubting their future and past choices. They are very difficult patients to help because, quite frankly, as things stand today there is no good cure. Preceptor Shortage Traumatic Stress Disorder (PSTSD) is undeniably an increasing challenge for the medical profession today.
So I jest, but not really. There is nothing funny about the current situation and The Preceptor Problem. (Yes, I am capitalizing that on purpose.) It is absolutely tragic that students have to struggle so much to find mentors. Sadly, from what I see, the problem seems to be getting worse. Perhaps it’s my slanted and unique perspective, but I see it everywhere and most of the people who are complaining/begging/angry/crying are not clients. I see it on Facebook, LinkedIn, at every nurse practitioner meeting I attend, and I hear it from every practice, student and medical provider. I know this is a huge, nationwide problem and not just something seen in a small population of students. In this post, I’d like to bring up some issues that I would like our profession to consider. Be kind in your remarks! Let’s work together for some positive changes to The Preceptor Problem and find a cure for PSTSD!
It was hard before, but some schools are making it even harder for students. In a perfect world, nurse practitioners would predominately precept nurse practitioner students. However, we are far from a perfect world. Due to many factors, there is an undeniable preceptor shortage. Yet some schools are requiring more time with a nurse practitioner and allowing less or no time with physicians, physician assistants (PAs), Certified Nurse Midwives (CNMs) or other qualified providers. Let’s face reality: First of all, there are more physicians than nurse practitioners practicing. Additionally, more often physicians own the practice, and they can make a decision about whether to take student or not, so it’s easier to find physician preceptor. On the other, most often nurse practitioners have to ask permission of administration, and, due to many factors, they are often declined even if they’re willing to precept. There’re many other reasons it’s easier to find a physician preceptor but those are the major ones.
Then there are the schools that have increased the requirement for family practice rotations. They are denying wonderful sites that provide geriatric, urgent care, home health, adult, and even pediatric populations because they are not “Birth to Death Family Practices.” Family practices are inundated with requests for preceptors. As medicine has changed, “birth to death family practices” are becoming less common. Often there are other sites available and willing, but because they don’t fall into a narrow definition mandated by the school they are denied. Since we work with so many different schools we know that there are requirements for students but the requirements seem to vary drastically from school to school. Why is it fine for some and not others?
Fortunately, not all schools have such restrictive requirements. Some allow some specialty hours as long as a majority of general hours are completed. And, of course, some schools help students find preceptors. Power to these schools! The reality is, however, even if every school helped find preceptors there would still be a shortage of preceptors. I just think we have to look at different alternatives to our current system. We must be open to these alternatives and stop trying to do things the way we used to do them.
Another way schools could help students is to be less restrictive with dates for clinical rotations. Some schools are flexible and even allow students to start early. Bravo! But other schools do not allow that flexibility and some will not even allow a student to complete hours over a short period of time, instead mandating that the rotation be spread out over several months. This is a huge problem for students who are willing to move to other areas in order to complete his/her rotation. If the student can get his/her hours done over a shorter period of time and then return home it reduces travel costs substantially. Why is it that some schools allow this and others do not? No, it is not ideal to get the hours done over a short period, but it seems we need to make some concessions given this challenging situation.
We have a wonderful, respected and growing profession. Many methods we use to train our students are still valid and effective, but we must be willing to change with the times. There are things our profession can do to make it better and not harder for students. Let’s be open to these ideas and changes. Let’s not make requirements so strict and narrow that it makes it nearly impossible to find what students need in order to graduate. I don’t know if changes are being made because students are not passing the Boards or because schools feel philosophically it’s the way it should be done…I just don’t know. What I do know is that, as we speak across the nation there are countless students suffering from the cruel and devastating consequences of PSTSD- Preceptor Shortage Traumatic Stress Disorder. Let’s work together to stop this devastating problem!
PreceptorLink (formerly Advanced Practice Link) is in the ridiculously difficult and often thankless business of matching students to preceptors. We have a team of people working 24-7 to help find preceptors because we know how difficult it is for a student who works part/full time and has a family at home to find time to search for a suitable and willing preceptor. We are dedicated to finding solutions to The Preceptor Problem and will continue to work on this issue.
Part II: What We Can Do About The Preceptor Problem for Nurse Practitioner Students: A Message To Students
Part I addressed the Schools. Part II is directed towards Nurse Practitioner Students. As mentioned in Part I, issues related to the Preceptor Problem for Nurse Practitioner Students are multi-factorial.
Dear NP Students: You are the future for the profession! Keep this in mind when you are out there: We support you! First of all, hang in there. You can get through this and will have “NP” behind your name…eventually! For the most part, it’s a great profession with many opportunities. Here are suggestions and input from my perspective as a NP of 20+ years and business owner:
Most students are not guilty of some of the worst “offenses” mentioned here, but it only takes a few (or one!) to turn off a potential site or preceptor. Please do not think this commentary implies that I put the sole blame on students for The Preceptor Problem for NPs. (And, yes, I have heard every one of these comments from preceptors!) As I said, the issues are multi-factorial but this commentary addresses The Student.
First of all, I am sorry that it is so difficult to find a preceptor these days, but it is the reality until things change- and many things need to change. Here are some tips in the meantime:
My Two Cents: Thoughts About The Direction of Our Great Profession and the Preceptor Problem... Part I: A Message to Nurse Practitioner Schools:
I love being a Nurse Practitioner and am a huge advocate for Advanced Practitioners in general, but there are things that concern me about the direction we are going as Nurse Practitioners (NPs). In my current roles, I’m in a unique position to really see the issues from many different angles. In this first blog, I’m directing my thoughts to NP schools. These are the places where it all begins: our alma maters. Are there some things the schools could do to help with this problem? These are my thoughts on a subject of which I have become quite versed. Follow up blogs will address the same issue in regards to the student, the preceptor and the practice sites. I believe there are things we can do in all of these areas to address the problem of the Preceptor Shortage.
We all see schools pouring out students but then see countless students struggling to find preceptors. This is not news to anyone in our profession and the situation is getting worse. This problem affects all of us in the field! The balance is just too far off and, if this continues, I am concerned it will damage our profession. Current research studies demonstrate positive outcomes for nurse practitioners (NPs), but if we can’t train quality NPs this trend is not likely to continue. I’m concerned that we are setting ourselves up for trouble.
I frequently hear practice sites saying things like, “We only train med students, so we don’t take NP students; We don’t take students from XXX University; We are too busy to take students; It is too much work to take students,” or just plain, “We don’t precept.” The current system is unsustainable. Something has to change before it’s too late.
Here are my thoughts on the challenges we face in this growing profession and some ideas on how we might change them:
To the Nurse Practitioner Schools:
As a longtime NP with a desire to help and make positive changes to her beloved profession, Lynn often writes opinion pieces about the NP profession.
"Why NPs train on the backs of physicians"