Why Be a PreceptorLink Preceptor?
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• NP-owned and operated by Lynn McComas, DNP, ANP-C, a longtime NP who is dedicated to and understands the NP profession.
• We pay you the honorarium you desire or donate your honorarium to charity.
• Our experienced team of Clinical Coordinators understand preceptor matching because we've been doing it for almost 8 years! Who else can say that!? You will have your own Clinical Coordinator, and you will always have access to our NP-owner.
• We help with paperwork. We will help simplify the burdensome paperwork as much as possible.
• We are honest and reliable. 
• We can screen your students for you to your preference. 
• We can manage all of your student submissions in our Direct Referral Program at no charge. 
• We have an extensive database of preceptors and many long term relationships because building great relationships is what it is all about. 
• We are problem-solving experts! Whether it's with the preceptor, the student, or the school, we know how to avoid and solve problems.
• We are dedicated to improving the preceptor problem for APRNs! Something must change! 

We'd love to see your submission on our platform! 

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. 

• Using Dot Phrases, templates, text expander, or copying forward prior notes and editing can be big time savers when you are following up on a patient.
• Allow time for charting in your visit, if possible. Learn to type while talking but try to keep up the eye contact as much as possible. 
• If you can, consider using a scribe. Scribe services can be a real time-saver for clinicians. Yes, it costs money, but it will save time and sanity!  
• Learn to leave work at a set time even if all the charting isn't finished.

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?

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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?
 
 

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. 


Grammarly
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.

UpToDate
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.

epocrates
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.

USPSTF
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.”

Sublux
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.

ASCVD
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.











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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. 




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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!!! 
 
Warmest regards,
Lynn McComas, DNP, ANP-C
President and CEO Preceptor Link and PL Team
 

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:

1. First of all, I understand that there are requirements for the various NP degrees, but perhaps it's time we revisited these requirements.  Just because we've always done it that way doesn't mean it is the only way or even the best way.  I don't pretend to know the ins and outs of running an Nurse Practitioner program, but based on my unique perspective, I do have some ideas that might help the situation. At least consider these thoughts...
2. There are so many students looking for the same thing: Family Practice; OB/Gynecology; Pediatrics.  As everyone knows, there is a shortage of family practice providers, so how can we pour out more students and expect them all to find family practice sites?  Yes, Family Nurse Practitioner (FNP) students need to see family practice sites, but to have time in endocrine, cardiology, dermatology, orthopedics, wound care, occupational health, urgent care, emergency room, nursing homes…so many other sites would be beneficial too! Many of those sites will take students but don’t get asked. Please consider looking outside the very limited boxes of Family Practice, Pediatrics and OB/Gyn. Physician Assistants (PAs) do varied rotations and many end up working successfully in primary care.  Those specialty areas are all things we see in primary care. Students would still need some time in Family Practice (FP), but please allow students more hours in specialty practices. That will help unload the multitude of students all looking for family practice sites. The same is true in Pediatrics. Pediatrics preceptors are VERY hard to find, especially for the FNP student. There just are not enough available/willing sites for the number of students.  Please allow students in Pediatric rotations to do some specialty Pediatrics practice.  And allow them to do their Pediatrics rotations in a Family Practice that sees a fair number of children.  
3. Consider allowing students more flexibility with whom they can use as preceptors.  It is very helpful when schools allow NPs, M.D.s, D.O.s, Physicians Assistants (PAs), Certified Nurse Midwifes (CNMs) and other Masters-prepared and higher preceptors. Please don’t make requirements so narrow: “FNP students have to work with an FNP for pediatrics and not a Pediatric NP.”  That makes it nearly impossible!  “Must be a primary care Internal Medicine practice.” Those are a dying breed these days and very hard to find!  “Can’t work with the same preceptor for more than one term.”  If the student finds a good and willing preceptor, please allow them to continue!  Finding preceptors is HARD!! Please don’t make it even harder.
4. If possible, be flexible with the order of rotations.  It’s not always doable, but that would help this situation.  If they find an OB/Gyn preceptor willing to take them for a rotation, allow them to do that rotation at that time.  I know some schools do the didactic portion followed by the clinical rotation, so this might not work in that case. 
5. Consider adding Nurse Practitioner-run clinics.  It works for medical schools and it works for NPs.  One of our local schools does it, and it is a great solution. It’s a lot of work, but it benefits the community and students: http://www.csusm.edu/nursing/studenthealthproject/
6. Please, please, take only quality students and give them a quality education.  The profession is counting on you for this.  Train them how to do the things they need to do to be competent (preferably excellent) practicing NPs.  If you can’t provide hands on (online schools), consider sending them to trainings where they can do hands on.  It is very hard to teach a student to do a pelvic or rectal for the first time on a patient in clinic.  Who would want to be that patient?  A paid pelvic model is much better for learning.  It just makes our profession look like we don’t train our students well enough.  We are under the scrutinizing eye of the public and medicine as we push forward to get full practice authority for NPs nationwide. We need to make sure we are putting out quality practitioners.
7. Thank you, NP programs for helping train the next generation!  We are a great profession and we want to stay that way. 

Next blog will continue the discussion and be directed towards Students.