Managing Student Problems in Clinicals

If you precept long enough, there is a good chance you will have an NP student who needs to be counseled or have their behavior addressed. Handling difficulties with a student during a clinical rotation can be challenging, but it's important to know how to handle the situation if it occurs. It’s essential for the preceptor to approach the situation professionally, constructively, and with the best interests of the preceptor, student, patients, and institution in mind. 

Before we get into the details, one thing I’ve heard from students several times before is that they had no idea there were issues or that the issues were that significant. So, whether this was something that was not understood by the student, not taken seriously by the student, or never clearly addressed with the student, following these steps will help avoid any confusion.

Here are steps and best practices for preceptors facing such issues:

 1. Self-Assessment and Documentation: 

Before taking any steps, assess your feelings and perceptions. Make sure your concerns are based on objective observations and not personal biases. Document specific incidents or areas of concern in detail. This can help the student understand your exact concerns. This documentation can also be crucial in case other parties need to be involved.

 2. Private Discussion with the Student: 

Initiate a private, one-on-one conversation with the student. The key here is to be:

- Clear and Specific: Outline your observed behaviors or performance issues.

- Constructive: Instead of just pointing out problems, suggest ways for the student to improve.

- Empathetic: Understand that students can have off days, and external pressures can affect performance. Listen to their side of the story.

- Non-confrontational: Use "I" statements instead of "you" statements to reduce defensiveness. For instance, "I noticed that…" instead of "You always…".
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 3. Set Clear Expectations and Develop an Action Plan:

Together with the student, create a plan to address the areas of concern:

- Goals: What should the student achieve by the end of the rotation? (Or end of week or month)

- Steps: How can they achieve these goals?

- Timeline: By when should they achieve each step?

- Feedback sessions: Regularly scheduled check-ins to evaluate progress. Determine how often the feedback should occur and follow up accordingly. 


 4. Ongoing Feedback:

Regular feedback is crucial. Praise improvements and address new or continuing issues promptly. This helps the student understand that you're not just focused on their weaknesses but also appreciate their strengths.

 5. Involve Faculty if Necessary:

If the problems persist despite your interventions, or if there are serious concerns about patient safety or professional behavior, it might be time to involve the student's academic faculty.

- Communication: Ensure you communicate your concerns clearly and provide your documentation.

- Collaboration: Work collaboratively with the faculty to decide on the next steps. They might provide additional resources, recommend remedial work, or suggest other interventions.


Precepting a challenging student can be difficult. Fortunately, this is not a frequent occurrence! But if you need it, there are also links on our Resources page with videos on Precepting the Challenging Student. While I hope that things do not escalate, there are times when the student needs to be removed or dismissed from the clinical rotation. We’ll discuss that challenging topic in an upcoming issue. We’ll also discuss things from the student’s perspective on Managing Preceptor Problems in Student Clinicals because they can happen on both sides! Stay tuned. In the meantime, keep on learning, and thanks for precepting!


About the Author: Lynn McComas, DNP, ANP-C, is an experienced nurse practitioner and an expert on the topic of precepting. Determined to make a difference in “the Preceptor Problem,” Lynn went on to obtain her Doctorate in Nursing Practice (DNP) at the esteemed Duke University, where she focused on solutions to this problem. She is the owner and founder of PreceptorLink®. The company’s goal is to simplify and streamline the process of preceptor matching while maintaining quality and professionalism throughout.