Precepting In An Outpatient Setting

Ready for some real-world precepting tips? Let’s dive in! Here's an example of how one of our nurse practitioners precepts her students in a primary care office.

Meet Kate, FNP: This is how "Kate, FNP" precepts in her outpatient primary care practice. While this example is set in an outpatient primary care environment, these tips can apply to various outpatient settings.

Observation vs. Jumping In

How much observation is needed? This largely depends on the student’s experience level and the preceptor’s style. Some preceptors expect students to jump right in and start seeing patients on the first day. It's crucial to clarify expectations beforehand to avoid any surprises. Personally, I recommend allowing students to observe at least a few patients first. This approach allows them to understand the preceptor's style and helps the preceptor gauge the student’s interaction with patients.

As for ongoing observation, hands-on experience is key for students, so observation should be kept to a minimum unless it’s a brand-new procedure or experience. Of course, patient care and safety are always the top priorities. Students, remember you are representing both your preceptor and the site, so you want to make a positive impression. But don’t be afraid to engage with patients when given the green light—it's the best way to learn.

Kate’s Approach to Precepting

Kate allows her students to observe for the first day or two. During this time, she speaks out loud as she charts and works around the office, which doubles as an orientation for the student. Then, she gradually allows the student to start to take the lead while she observes. 

Once Kate feels comfortable, she sends the student into the patient room to obtain the history and perform a focused exam independently. Of course, it's important to get the patient's consent for the student to be involved. This can be done by the preceptor or staff simply saying, "Kate is working with an NP student today. [Student’s Name] will start the exam, and then Kate will follow up afterward. Is that okay?" The front desk can also mention this during check-in.

After the student sees the patient, they review the history and findings with Kate. Together, they develop differential diagnoses and probable treatment plans before going into the room to see the patient. Kate performs her own exam, clarifies any remaining questions or history, and they complete the visit as a team.

Charting: The Next Step

Allowing the student to learn how to chart is a vital part of the process. There are several ways to approach charting. Some options include:

• The student acting as a scribe. Then Kate reviews and signs off.
• The student charting independently, with Kate reviewing and signing off.
• If the facility does not allow the student to chart, the student can chart on an iPad for Kate to review.

It's important to follow facility guidelines and preceptor preferences. CMS permits students to chart as long as the preceptor reviews and signs off. Always clarify what is permitted for students at your facility.

This is how one preceptor manages her outpatient practice. What about you? If you’re a preceptor, share some strategies that have worked for you. Or, if you’re a student, what have been some of your best (or worst) experiences? Keep on learning! 

Lynn McComas is CEO and founder, PreceptorLink, and a recognized expert in precepting nurse practitioners and advanced practice provider students. With over two decades in primary care, Lynn has served as a coach, advisor, mentor, and preceptor for countless health care professionals, including NPs, nurses, and medical assistants. She co-founded a successful skills and procedures business and speaks nationwide on NP-related issues.
Lynn is also a regular contributor on LinkedIn, KevinMD, Facebook, YouTube, Instagram @preceptorlink, X @LynnMcComas, and her blog, where she addresses the growing NP and PA professions and the urgent need for preceptor sites. Her unique perspective, shaped by her business, clinical, and educational experiences, positions her as a key voice in tackling preceptor shortages. Lynn is committed to driving change—through a paradigm shift in NP education, reducing barriers, offering preceptor incentives, and advocating for reforms within the profession.

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