Advanced Practice Preceptor Orientation

Before the NP student starts their clinical rotation with you, here are a few suggestions:

• Become familiar with the course syllabus and learning objectives/outcomes. (The faculty will provide a copy of these documents to you upon your agreement to precept the NP student). Review and clarify, if necessary, the required outcomes for the course.
• Let the course faculty know your preferred method of contact should the need arise. Otherwise, faculty will assure that ongoing communication will occur between the preceptor, student, and faculty through periodic clinical site visits and preceptor consultation via telephone and/or email correspondence.
• Get to know your preceptee by learning how he/she learns best, reviewing his/her clinical learning objectives and learning about his/her strengths and areas for improvement.
• Visit the Preceptor Portal from the National Organization of Nurse Practitioner Faculties. This site offers excellent resources for preceptors and contains a “Frequently Asked Questions” section. You can find the portal at: https://www.nonpf.org/page/PreceptorPortal

The University of the Incarnate Word (UIW) bestows upon its students a Doctor of Nursing Practice (DNP) degree upon graduation. Graduates are trained to be interprofessional practice ready, culturally competent and adhere to the UIW core values of faith, service, innovation, truth, and education. As caregivers, UIW DNP graduates will:

1. Integrate nursing science with ethical, biophysical, psychosocial, analytical and organizational sciences to plan, implement and evaluate advanced practice in nursing at the doctoral level.
2. Design, implement and evaluate evidence-based interventions and interrelationships using advanced levels of nursing practice and systems thinking.
3. Synthesize concepts from epidemiological, biostatistical, environmental and medical sciences related to clinical prevention and population health in order to develop, implement, and evaluate interventions that improve access to health promotion and disease prevention efforts for culturally diverse and vulnerable populations.
4. Lead initiatives to develop and implement best practice to improve the quality of care within the continuum of the individual, organizational, and/or community levels.
5. Design and implement processes to translate evidence and improve outcomes of practice in accordance with national standards.  
6. Use information technology and research methods to promote safe, timely, effective, efficient, equitable and patient centered care. 
7. Develop, evaluate, and provide leadership for health care policies related to health care financing, resource management, practice regulation, access, safety, quality, efficacy, equity and social justice.  
8. Lead interprofessional teams using effective communication, collaboration, and consultation skills in developing and implementing practice models, guidelines and standards of care, peer review, health policy and scholarly products.
9. Appreciate commitment to lifelong learning of self and peers that incorporates professional nursing standards and accountability. 

Upon completion of the DNP program, students will have attained the knowledge, skills, values and confidence to pass either the Family Nurse Practitioner (FNP) or the Psychiatric Mental Health Nurse Practitioner (PMHNP) board certification exam.  The students will assume an active role serving in a variety of settings as a Doctor of Nursing Practice and are eligible for recognition by the state of Texas as an Advanced Practice Nurse (APRN).  The APRN is a registered nurse who, through additional study and experience is able to provide direct care (consistent with the focus of their course of study) to patients. This care may be rendered in the primary, secondary, or tertiary setting as consistent with the program of study. The University of Incarnate Word Ila Faye Miller School of Nursing post BSN to DNP program prepares students for the Nurse Practitioner (NP) role in accordance with the APRN Consensus Model.

As part of preparation for advanced practice nursing as a Nurse Practitioner (NP), skills in advanced physical assessment, psychosocial assessment, and management of health and illness needs in primary/acute and long-term care are mastered. The role of the NP integrates health maintenance, disease prevention, physical assessment, diagnosis, and treatment of common episodic and chronic problems with equal emphasis on health teaching and disease management. The NP practices with a high level of independence and decision-making in ambulatory, acute and chronic settings, functioning as a member of a health care team in collaboration with physicians and other professionals.

The NP practices in collaboration with physicians in organized health care systems or in medical office settings. Identification and treatment of urgent and complex problems and recognition of the need for medical referral or consultation are important components of the APRN role.

A Clinical Preceptor is an experienced advanced practice nurse (APRN), physician assistant (PA), or a physician (MD or DO) with both clinical practice experience and teaching skills. The preceptor has four general roles, as described below.

1. Role Model – As a role model, the preceptor demonstrates effective leadership, interpersonal skills, and expertise in their professional role. Decision-making by the preceptor is based on scientific and behavioral principles.
2. Educator – As an educator, the preceptor must be familiar with principles of adult learning. Integration of these principles into the education process helps meet the needs of the learner.  The preceptor, faculty liaison, and student will collaborate to identify the expected outcomes and design experiences to meet individual learning needs.
3. Advisor – As an advisor, the preceptor is in a helping role. The preceptor provides support by creating an environment to facilitate a sense of psychological safety.  The student is guided toward self-direction using the strategies of collaborative goal setting.  The preceptor facilitates the social and professional transition of the student into the practice setting.
4. Evaluator – As an evaluator, the preceptor is to provide formal and informal feedback to the learner that is objective and based on achievement of expected outcomes. The preceptor participates in the evaluation process, providing feedback, which motivates learning by validating that the student is achieving the expected outcomes or by identifying additional needed knowledge or skills. Achievement of goals is reviewed periodically. The preceptor may make written recommendations for future learning experiences. However, the course faculty are responsible for the assignment of the final grade earned by the student.  Preceptors are academically and experientially prepared to serve as role models for graduate students in their preceptor role.

General

Students are encouraged to have a variety of clinical experiences that will encompass all aspects of their advanced practice role and expose them to patients within different clinic settings. 

1. Students may not have a clinical preceptorship at a practice setting where he/she is currently employed, nor may they be paid for clinical as part of their working hours.
2. Students may not have a clinical preceptorship with a provider with whom they are a patient of that provider.
3. The majority of clinical experiences during the clinical preceptorship must be at the participation level or higher. Total observation is not acceptable for the majority of clinical rotation.
4. Students must receive “Passing” on all clinical evaluations from faculty during clinical site visits (Standardized Patient observation may serve as a clinical site visit.)
5. The preceptorship component must be successfully completed in order to pass the course. The preceptorship component consists of:
6. One faculty clinical site evaluation (usually at midterm) and additional site visits as needed. Please note that in some circumstances and/or clinical situations, a conference with the preceptor (via telephone or online) may take the place of a physical site visit. The faculty, in consultation with the preceptor, will make this determination. Clinical evaluation forms will be completed by each preceptor, with each documenting on the appropriate clinical evaluation form.
7. Clinical log documentation of student’s experiences.
8. Students who are deemed unsafe or fail to meet the expected clinical course outcomes and clinical competencies in any clinical course in the required program of study will receive a course grade of “F”. Behaviors constituting clinical failure include, but are not limited to, the following:
9. Demonstrates unsafe performance of an expected clinical competency
10. Needs continuous and specific detailed supervision to meet clinical competencies resulting in an inability to independently meet clinical competencies by the conclusion of the course
11. Continues to make questionable decisions after multiple instances of faculty/preceptor feedback and guidance
12. Demonstrates the inability to adapt to new ideas and roles
13. Fails to submit required written clinical assignments and documents
14. Failure to maintain a current unrestricted license to practice nursing in the State of Texas or a compact state
15. A declaratory order from the Texas State Board of Nursing or a compact state
16. Request by the agency/preceptor for removal from a clinical agency or site for concerns related to clinical competence, professional integrity, or ethical standards that would preclude the student from being placed in another clinical agency
17. Any behaviors defined in the provisions of the Texas Administrative Code, Rule §217.12 - Unprofessional Conduct and including falsification of any course documents.

Clinical Preceptor Agreement

Preceptor agreements specify a relationship between the student and preceptor for a specific time period. Therefore, students are required to have preceptors sign a new agreement each semester. The preceptor agreement must be signed by the clinical faculty member, student, and preceptor prior to beginning clinical practice:

1. Complete and submit required documents before beginning the clinical experience to the UIW course faculty.
2. Clearly write the name, address, telephone, fax and e-mail address of the clinical instructor as information to share with the preceptor.
3. Clearly write the name, address, telephone, fax and e-mail address of the preceptor. Preceptors must meet established criteria in accordance with the position description included in this NP Preceptor Manual. Once an individual has agreed to precept the student, the UIW faculty or staff will verify that the individual’s credentials are current and valid. The verification will be completed online through the appropriate state board website. A copy of the data will be attached to the Preceptor Agreement and submitted for retention in the clinical tracking system or student files.
4. The student is responsible for submitting updated health forms, immunizations, CPR certification, criminal background checks to the UIW School of Nursing.

Scheduling of Clinical Hours

Clinical practicum hours are to be scheduled at the convenience and availability of the preceptor. Students are not to ask preceptors to conform to a schedule that meets their personal and employment needs. The student's personal and work schedules are expected to accommodate participation in the required number of clinical hours prescribed by the clinical course. Students and preceptors need to agree on the days and times that the student and preceptor will be in the clinical agency prior to beginning the practicum experience. Unless otherwise stated in the syllabus, students are expected to begin the clinical practicum when the course begins and the necessary paperwork has been submitted to ensure adequate time to complete assignments. Clinical hours must be completed during times that school is normally in session and faculty is available.

Professional dress and behavior

1. Students are representatives of UIW School of Nursing and must present themselves as ambassadors of this program. They are expected to be respectful to preceptors, faculty, staff, patients, and their families. Reports of unprofessional behavior will result in the student being counseled and possibly subject to review and termination.
2. Students should be professionally dressed and wear an ID badge that identifies them as a UIW School of Nursing Graduate student. The appropriate use of uniforms or lab coats should be determined through the preceptor/student interview. Students are expected to conform to the dress code of the clinical site where the coursework is completed.

Preparation for Clinical Practicum

The clinical practicum extends the learning environment of the classroom to integrate theoretical concepts with clinical practice. Students should prepare for the clinical practicum by developing individual learning objectives, as previously discussed. Students should prepare for clinical by reading course texts and professional journals and using audiovisual and electronic learning aids.  The preceptor may recommend materials and topics for review prior to the first clinical day. The student should review the common clinical problems relevant to the clinical site population. Follow-up reading of current reference material following the clinical day provides the student with the opportunity to increase the breadth of scientific and clinical knowledge gained in the clinical arena.  Guidelines for preparation include:

1. Students are expected to have full knowledge of entrance requirements for clinical, including credentials, dress, location, timing, etc., before scheduling the first clinical day at the clinical agency.
2. Students are responsible for their own health and other requirements, such as current CPR certification and immunizations, in order to fulfill the clinical requirements on the first day. In accordance with the UIW School of Nursing and agency policies, students without health clearance should not enter the clinical setting.
3. Documentation that Criminal Background checks have been completed should be in student files.
4. On the first clinical day, discuss questions about computer access, the procedure for preceptor co-signing documents, eating and parking arrangements, and the communication with other disciplines.
5. Students may need to complete additional requirements, at the discretion of the individual clinical agency, such as orientation, computer training, drug screening, etc. Any additional costs related to such requirements will be at the expense of the student.  Furthermore, students may not count additional trainings (i.e. agency orientations or computer-training) towards their clinical hours and/or course requirements.    

Attendance

Performance of clinical hours at the negotiated times and days with the preceptor is required. Careful attention to attend clinical on the days which the preceptor can accommodate the student is important. It is the student’s responsibility to monitor the number of hours completed, and plan on completing the required number of hours for the term. The student is responsible for adjusting his/her personal and employment commitments so that the required number of clinical hours can be completed. If the student does not complete the required clinical hours for the term, s/he cannot expect the preceptor to continue the precepting relationship. Extension of the clinical period with the preceptor cannot be assumed but is granted only by agreement with the preceptor and UIW School of Nursing graduate faculty. Exceptions related to unexpected illness of the student/family and or preceptor should be discussed with course faculty and the parties involved.

When the student cannot attend clinical on a day that it is scheduled, the student must notify immediately the preceptor.  Leaving a message or email for the preceptor or faculty is not acceptable. Professional role behavior is expected. The student should discuss with their preceptor the expectations for notification should a change in schedule or unexpected absence occur. Failure to notify the preceptor as negotiated, prior to the beginning of the scheduled clinical day, is unacceptable and may place the student and clinical placement in jeopardy.

Responsibility of the School of Nursing

1. Ensures that preceptors meet qualifications in Rule 214.10, Rule 215.10 or Rule 219.10, as appropriate.
2. Initiates a Clinical Affiliation Agreement between the preceptor’s organization and the School of Nursing. The agreement will be signed by the preceptor’s organization and the appointed representative for UIW.
3. Ensures that the written agreement delineates the functions and responsibilities of the affiliating agency, clinical preceptor and nursing program.
4. Provides the course work and laboratory experiences that establish the foundation for clinical practice.
5. Ensures that clinical experiences using preceptors occur only after the student has received applicable theory and clinical experiences necessary to safely provide care to clients (within course or curriculum), as appropriate.
6. Provides the preceptor an orientation to the philosophy, curriculum, course, and clinical objectives of the nursing education program. Discusses student expectations, skills performance, student guidelines for performance of procedures, and methods of evaluation.
7. Facilitates faculty site visits to preceptorship sites to evaluate the student and to assist the student and preceptor, as needed, in accomplishing the clinical learning objectives/outcomes.
8. Provides the materials required for evaluation of the student's performance in the preceptor's clinical setting.
9. Assumes overall responsibility for teaching and evaluation of the student.

Responsibility of the Faculty

1. Responsible for identifying and evaluating clinical sites for appropriateness of learning experiences and ensuring completion of site evaluation forms.
2. Responsible for assigning students to appropriate clinical sites in collaboration with the experiential learning coordinator.
3. Responsible for assuring all documents are completed related to the preceptorship, including the facility/agency contract, preceptor information form, preceptor CV(or resume) on file, and preceptor agreement (See Appendix ).
4. Provides recognition to the preceptor (if requested) for participation as a preceptor via certificate.
5. Orients the faculty, student and the preceptor to the clinical experience.
6. Responsible for meeting with the preceptor and student during the semester for evaluation purposes.
7. Responsible for providing immediate consultation and/or support of the preceptor when needs or problems are reported.
8. Responsible for seeking preceptor input regarding the student’s performance.
9. Responsible for collaborating with the student in completing the Student’s Evaluation of Preceptor form at the end of the semester (see Appendix).
10. Using clinical objectives for the specific semester, Clinical Faculty will evaluate and document the student’s progress and specify satisfactory/unsatisfactory completion of clinical competencies. All relevant documents must be completed by the end of the semester (see Appendix).
11. Provides feedback to preceptor regarding performance as preceptor and the clinical learning experience.
12. Will develop remediation plan for student if not progressing in course as expected.

Responsibility of Agency

1. Retains ultimate responsibility for the care of clients.
2. Retains responsibility for preceptor's salary, benefits, and liability.
3. Communicates the preceptor program and expectations of preceptee to other agency personnel who are not directly involved with preceptorship.

Responsibility of the Preceptor

1. Provides a setting in which the student will see patients and gain experience in clinical practice.
2. Functions as a role model to provide clinical teaching and supervision for the student in the practice of evaluation and management specific to patient care needs.
3. Discusses with faculty/student arrangements for appropriate coverage for supervision of the student should the preceptor be absent.
4. Co-signs all records and orders written by the APRN student unless otherwise restricted.
5. Signs the student’s clinical hours tracking log each day the student is present in his/her clinical site. An original signature must appear after each date that clinical hours are logged. Only days where the student participated in direct patient care may be counted for hours (see Appendix).
6. Makes contact during the semester with the student and faculty to discuss the student's progress and learning needs as needed.
7. Provides input regarding clinical evaluation of the student and completes the clinical evaluation form at the midterm and at the end of the semester for the student(s) he/she is precepting. The preceptor is required to sit down with the student to go over the evaluation at which time the preceptor and student are to sign the evaluation form (see Appendix).
8. Evaluations may be emailed directly to the clinical faculty by the preceptor or hand delivered by the student. The Preceptor is expected to notify faculty immediately when unsatisfactory performance of the student is in question.
9. Gives feedback to the nursing program regarding clinical experience for student and suggestions for program development.

Responsibility of the Student

1. Completes the Student Profile (see Appendix) in a timely fashion.
2. Is responsible for providing the preceptor with the NP Preceptor Manual to include appropriate evaluation tools and intent of relationship documents (see Appendix) as well as course clinical objectives.
3. Responsible for assuring that Preceptor Agreement and preceptor CV/Resume are submitted and approved before beginning clinical.
4. Submits a completed student profile to the preceptor on or before the first clinical day (see Appendix).
5. Establishes a mutually agreeable schedule for clinical time with the preceptor. He/she will come to the clinical experience prepared to perform in accordance with assigned learning activities in accordance with course.
6. Demonstrates ability to manage progressively complex patient care situations (including differential diagnosis, treatment plans, and patient teaching) in accordance with his/her academic progression.
7. Arranges for preceptor's supervision when performing procedures, as appropriate.
8. Follows policies and procedures established in the practicum site and keeps the preceptor informed about cases and learning activities.
9. Respects the confidential nature of all information obtained during clinical experience.
10. Functions under the Nurse Practice Act statues and regulations for expanded nursing roles. Students and faculty of the UIW Ila Faye Miller School of Nursing and Health Professions are covered under a blanket medical liability policy. Additionally, students are required to carry Needlestick/Exposure Insurance.
11. Participates in conferences with the preceptor and faculty to discuss progress, problems, and learning needs.
12. Contacts faculty by telephone, pager or email if faculty assistance is necessary.
13. Maintains accurate records of clinical time on the Clinical Hours Tracking Log and/or the computerized clinical tracking system. The Clinical Hours Log document will be completed, including the preceptor’s signature each day the student is in the clinical site. An original signature or electronic confirmation in the clinical tracking system, by the preceptor, must appear after each date that clinical hours are logged. Only days where the student participated in direct patient care may be counted for hours. The clinical log will be submitted to faculty (see Appendix) as directed by Program Coordinator.
14. Completes the computerized clinical log and submits reports at designated intervals to the faculty.
15. The student may be required to pay travel expenses for faculty traveling outside a specific geographic area of Bexar County for student clinical evaluation. Alternative arrangements may be negotiated with faculty.