PLU Nurse Practitioner Preceptor FAQs

Definitions: What is a preceptor?

What is a preceptor?

The answer to that question has provoked some careful thought by many authors. Limiting the definition to the clinical preceptor for a student nurse practitioner, preceptors can be nurse practitioners, physician assistants, physicians, and other health care clinicians such as psychotherapists and counselors.

The NP preceptor is a licensed individual in clinical practice providing direct hands-on patient or client care who accepts a student into that practice so as to provide supervised clinical experience for the student. The preceptor is a role model, a direct supervisor of a NP student’s clinical practicum, and a teacher. The NP preceptor helps create and shape not just the next generation of nurse practitioners but next years’ nurse practitioners, perhaps even the next NP hired at that same clinical practice.

Legal Definitions
The Washington State Nursing Care Quality Assurance Commission (NCQAC) has provided a definition of preceptor in regulatory law as the Washington Administrative Code (WAC), WAC 246-840-533 https://apps.leg.wa.gov/wac/default.aspx?cite=246-840-533
The NCQAC also has a Concise Explanatory Statement from 2019 in response to questions about the legal definition:
https://content.govdelivery.com/attachments/WADOH/2019/04/05/file_attachments/1187485/Concise%20Explanatory%20Statement_PreceptorRules_NCQAC.pdf

Professional Definitions
The professional authorities such as the National Organization of Nurse Practitioner Faculties (NONPF) and The American Association of Nurse Practitioners (AANP) have definitions or definitional documents.

NONPF
https://www.nonpf.org/page/PreceptorPortal_Main In general, this is an excellent resource for Nurse Practitioner preceptors.

AANP
https://www.aanp.org/practice/clinical-resources-for-nps/a-checklist-for-faculty-preceptor-to-enhance-the-nurse-practitioner-student-clinical-experience If you are not a member of AANP, you may ask the directly for the checklists. heather.graves@plu.edu

Theoretical or Academic Definitions
Scholars have analyzed the concept of preceptor and preceptorship, too. Although some people use the term mentor as synonym, there are distinguishing characteristics of a preceptor. For one, the relationship between preceptor and student is more time limited. The focus is also more intensely aimed at acquiring the knowledge, skills, and judgement required by an individual course’s goals and objectives (Billay & Yonge, 2004). Preceptors empower and support as much as they lead and teach (Wardrop, Coyne, Needham, 2019).

References for What is a preceptor?

Refs: Billay, D. B., & Yonge, O. (2004). Contributing to the theory development of preceptorship. Nurse Education Today, 24, 566-574.
Wardrop, R., Coyne, E., & Needham, J. (2019). Exploring the expectations of preceptors in graduate nurse transition: A qualitative interpretive study. Nurse Education in Practice, 34, 97-103.

Benefits

Why have students in your practice?

Precepting is a chance to give back, to stay inspired, and to create and shape the next nurse practitioners. See Preceptor Benefits “Be the Bridge between Academics and Practice.”

Are there any tangible benefits for a preceptor?

Yes! Please see the Benefits of Precepting “Concrete Benefits.”

What are other benefits?

See Benefits of Precepting “Concrete Benefits” and “Career Development.”

Can I earn continuing education (CE) hours for precepting?

Yes for AANPCB re-certification (see next question How do I get credit…).
No.  Washington state WACs specify that precepting does not qualify for continuing education credit as required for licensure: https://apps.leg.wa.gov/wac/default.aspx?cite=246-840-533

PLU preceptors can receive up to 8 hours per year of free CE plus additional discounted CE through the Center for Continued Nursing Learning (CCNL). Preceptors must register for and attend standard CE offerings of the CCNL to earn CE hours.

How do I get credit for precepted hours towards AANPCB re-certification?

PLU will provide you each semester with a formal thank you letter to document your precepting hours. For questions please contact Heather Graves at heather.graves@plu.edu

AANP recognizes precepting as an option qualifying for up to 25 hours of non-pharmacology continuing education credit for re-certification. https://www.aanpcert.org/recert/ce. See also
https://www.aanp.org/student-resources/np-certification.

Do I get paid for precepting?

At this time, preceptors are not directly reimbursed. With care organized between the family nurse practitioner (FNP) and the FNP student  (see Basics of Precepting), mostly a typical number of patients can receive care during the standard office or clinic hours. For psychiatric-mental health nurse practitioners (PMHNP), the practice can provide care to approximately one to two fewer patients per day than would typically be seen. It is important to remember that students are learning, not yet licensed as an ARNP, and are not ready yet to be independently responsible for patient care.

While some states have provided a tax credit for precepting (https://www.aacnnursing.org/NewsInformation/News/View/ArticleId/21656/News-Watch-7-11-18), Washington State does not yet have such legislation. In the future, although not yet in effect, national organizations such as AANP and ACNM are planning to introduce federal legislation to possibly recognize a tax credit and perhaps even reimbursement for precepting. Stay tuned through your professional organizations including ARNPs United of Washington State (AUWS) https://auws.enpnetwork.com/

There are benefits that are not strictly financial. [See Preceptor Benefits.]

Is there a tuition discount for precepting?

PLU alumni receive a 10% tuition discount for PLU courses such as in the post-master’s DNP Program. Please contact Heather Graves at heather.graves@plu.edu.

Preceptors can receive 8 hours per year of CE for free, sponsored by a HRSA ANEW grant, and are also eligible for a discount on all other CE offerings at the Center for Continued Nursing Learning.

How do I get Internet access to the PLU library system?

Preceptors may use the Mortvedt Library and its resources on campus. Library resources are not available off-site.

The University of Washington’s Library plus additional resources such as ClinicalKey may be accessed on-line by all RNs licensed in Washington state through www.heal-wa.org.

Requirements and Expectations

What are the requirements for precepting a student?

PLU uses the standard requirements for precepting as defined by WAC 246-840-533 and National Organization of Nurse Practitioner Faculties (NONPF). American Association of Colleges of Nursing (AACN) also has criteria for precepting that PLU follows.

Washington State WAC 246-840-533 2a and 2b [https://apps.leg.wa.gov/wac/default.aspx?cite=246-840-533] specify that a preceptor must have “an active, unencumbered nursing license at or above the level for which the student is preparing;
(b) Has at least one year of clinical or practice experience as a licensed nurse at or above the level for which the student is preparing.” Additional requirements are also listed in this WAC.

NONPF: https://www.nonpf.org/page/PreceptorPortal_Main

AACN: https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Criteria-Evaluation-NP-2016.pdf

After I meet the preceptor requirements, what is the next step in the process?

Please contact PLU’s NP Clinical Placement Coordinator at seguind@plu.edu 253-535-7046 who will be happy to manage and assist you with the procedures to become a preceptor.

What are the expectations of a preceptor?

See What is a preceptor? and Basics of Precepting.

See also the AANP website for a checklist of expectations of the preceptor and of the faculty:
https://www.aanp.org/practice/clinical-resources-for-nps/a-checklist-for-faculty-preceptor-to-enhance-the-nurse-practitioner-student-clinical-experience

If you are not an AANP member, for a copy of the checklists contact: heather.graves@plu.edu

See also the NONPF website https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/docs/checklistforfacultypreceptor.pdf

What is the commitment?

Preceptors commit to excellent patient care as provided by a nurse practitioner student, supplemented as necessary by the preceptor. Preceptors are the licensed professional responsible ultimately for patient care and for signing the documentation in the patient’s medical record.

Preceptors also commit to the memorandum of understanding (MOU) as agreed to by Pacific Lutheran University and the preceptor’s administrator regarding nurse practitioner students. If a preceptor is unable or unwilling to continue as a preceptor through the end of the expected time period, typically a semester at a time or shorter, the preceptor needs to let the clinical faculty, PLU’s Clinical Placement Coordinator, and the practice administrator know as soon as possible.

What is the time commitment?

The preceptor provides a preceptorship to the NP student typically for the term of the clinical course. Usually the student starts with the preceptor on the 2nd or later week after the start of the clinical course. However, some courses and their preceptorships are split into modules and then the student might be placed in a preceptorship for only part of the course. Preceptors are not allowed to precept after the date the course ends.

PLU’s academic calendar follows a Fall, J-term (a single course taught intensely in January), Spring, and Summer semester schedule. For exact dates, check the PLU academic calendar at https://www.plu.edu/catalog-2019-2020/academic-calendars/2020-21-academic-calendar/ and scroll down to graduate programs.

If I agree to precept, do I have to precept a student every semester?

No. PLU accepts your volunteering as a gift. PLU also is aware of the possibility of compassion fatigue and burnout. You are free to choose to precept on a semester-by-semester basis.

If I agree to precept a student, can they get their hours only with me?

No. There are opportunities for learning that are best realized when the student has the continuity of experience in a single setting with the same preceptor. However, a few clinical courses require a specialty focus and the student learns best with a specialty healthcare service and/or specialty provider.

How are placements or practicums arranged?

PLU finds and arranges practicums for NP students. If a student requests a particular preceptor or preceptorship, for example in the student’s rural home town, PLU will manage the details of a contract or Memorandum of Understanding (MOU), onboarding requirements, and other legal and administrative requirements.

For many courses, PLU makes every effort to pair a student with a nurse practitioner in the same category as their program track, family nurse practitioner or psychiatric-mental health nurse practitioner. For other learning experiences, NP students are paired sometimes with a preceptor whose practice meets the specific objectives of the clinical course. For NURS 774 Women and Children in Primary Care, the FNP student might be matched to a pediatric nurse practitioner or pediatrician as a preceptor. For NURS 655 PMHNP III Psychotherapies across the lifespan, a PMHNP student might be matched to a family and marriage counselor/therapist as a preceptor.

PLU’s current Health Resources and Services Administration (HRSA) Advanced Nursing Education Workforce (ANEW) grant No. T94HP30874 is committed to providing clinical practicum experiences in rural areas, medically underserved areas (MUA), and health professional shortage areas (HPSA). All but two counties in Washington state qualify as MUA for psychiatric-mental health services.

Who provides malpractice insurance?

PLU provides malpractice insurance (liability coverage) for the NP student and the clinical faculty member. PLU does not provide malpractice insurance for the preceptor in the preceptor role. Preceptors are covered by their own malpractice insurance. It is prudent to confirm that the preceptor’s liability coverage includes teaching and/or precepting students.

What should I expect from the NP student?

Students should be prepared to provide care to patients that is accurate and complete and meets professional guidelines and standards, under the direct supervision of the preceptor. Students should also be able to review the evidence for their decisions and be able to explain the rationale for their reasoning and decisions. The learning emphasis should be on accuracy and comprehensiveness of care, with speed and efficiency a secondary goal.

Students should demonstrate all professional behaviors, such as appropriate grooming and demeanor, appropriate interactions with patients and all staff, and respect for all people and the system in which care is being delivered. Students are required to meet all requirements of the clinical practice such as policies relating to dress codes, cell phone use, HIPAA, and documentation of care. Students are responsible for notifying clinical faculty and the preceptor and any other personnel who need to know of tardiness or absence as much in advance as possible.

How much can a student be involved in patient care, treatment, and procedures?

Students should meet the course goals and objectives, providing all care within the scope of ARNP practice in Washington state. One of the preceptor’s primary roles is to supervise the student’s direct provision of care, treatment, and procedures. Although students are novices or beginners, they are expected to provide hands-on care to the best of their education up to that point. If there is any initial observation experience required, it should be limited.

See also the CMS Manual System, Pub 100-04 Medicare Claims Processing, Transmittal 4068 dated May 31, 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R4068CP.pdf (scroll down to Chapter 12 section 100.1.1 section B. E/M Service Documentation Provided By Students–the third page—where changes are in red.)

How do I know what a student should be able to do at this point in their program? How will I know what to focus on with students?

Pre-course interactions should include the faculty providing the preceptor with course goals, other expectations for the course, and the place in the curriculum of this course, for example beginning NP student in a first clinical practicum or final-semester clinical practicum. The preceptor should also be given the entire syllabus for this course.  You may ask the clinical faculty for an overview of the PLU DNP curriculum also.

Professional standards specify that clinical faculty should include a pre-course visit to meet the preceptor, to orient the clinical faculty to the practice, and to develop a positive working relationship and collaboration with the preceptor. Washington State WACs also specify clinical faculty confer at least three times during the student’s clinical experience—beginning, midpoint, and end.  More frequent contact and/or visits are also possible as needed.

How are students screened?

PLU requires background checks for all nursing students, including graduate students. If a clinical site requires repeat or additional background checks, PLU students must also meet these screening requirements before clinical preceptorships. Please contact the Clinical Placement Coordinator as soon as possible about background checks if your clinical site has independent requirements, to allow enough time before the start of the semester for both the clinical faculty and the NP student to meet these requirements.

Admission standards for the NP program require an unencumbered RN license in Washington State that already includes a background check at least initially. NP students have successfully passed all pre-requisite courses for clinical practicums that include, among others, Advanced Physical Assessment, Advanced Pathophysiology, Advanced Pharmacology, and Primary Care Procedures and Diagnostics. Additionally, NP students must meet GPA and professional behavior requirements to continue to register for courses in the NP programs.

PLU NP students must be registered for the appropriate clinical course and have paid tuition. Students are concurrently taking a classroom didactic/theoretical course while participating in the preceptorship.

Will I have contact with clinical faculty during the student’s rotation?

Yes. In addition to expectations for preceptors, there are expectations for clinical faculty: https://www.aanp.org/practice/clinical-resources-for-nps/a-checklist-for-faculty-preceptor-to-enhance-the-nurse-practitioner-student-clinical-experience.
If you are not a member of AANP, you may ask directly for the checklists from lead faculty for the clinical course.

Professional standards include a pre-course visit to meet, orient the clinical faculty to the practice, and develop a positive working relationship and collaboration. More frequent contact and/or visits are also possible as needed. Pre-course interactions also should include the faculty providing the preceptor with course goals, other expectations for the course, and the place in the curriculum of this course, for example beginning NP student in a first clinical practicum or final-semester clinical practicum.

Washington state WACs require at least three times to confer, at the beginning, midpoint, and end of the preceptorship.

PLU endorses the Triad Model (Paton 2010; Zawaduk, et al. 2014), where the clinical faculty has a relationship with both the student and the preceptor and where the faculty’s role includes support for the preceptor, as needed. PLU also endorses the Academic-Practice Partnership Model (Amirehsani, et al. 2019) that encourages mutual understanding and learning objectives for each student.

Can I contact the College of Nursing if I have any questions, concerns, or issues while precepting a student?

Yes. It is expected that preceptors will contact the clinical faculty for questions, concerns, or issues always. If clinical faculty do not provide a satisfactory response, the preceptor may contact the course lead faculty as named on the full syllabus.  If further concerns remain, the preceptor may follow the chain of command and contact the Director of Graduate Programs or even the Dean of the School of Nursing. Clinical faculty should be available routinely throughout the semester as needed.

Evaluations

Will I have to provide feedback on the students I precept?

Yes. Preceptors should provide day-by-day feedback to the student and will also provide a final evaluation. It is standard to note both strengths and areas to work on. For more detailed information about preceptor feedback to students, see Basics of Precepting.

Does the preceptor grade or evaluate the student?

Evaluate yes, grade no. Preceptors contribute crucial input in the student’s evaluation. Both the preceptor and the clinical faculty do so.  However, the grade is determined by the clinical faculty.

How are NP students evaluated for the preceptorship?

Students are evaluated according to how well they have met course goals and objectives. Course goals and objectives align with professional standards and Washington State ARNP scope of practice laws and regulations.

What do I do if a student is not meeting expectations?

Do not ignore problems with a student’s clinical practice. Whether it is professional behavior such as arriving late or unprepared, lack of knowledge such as not recognizing the signs and symptoms for a diagnosis or its first line treatment, or concerns about the student’s understanding or commitment to NP practice, the preceptor will be the first to identify a problem and can be the first to address solving it. While the preceptor can make allowances for nervousness and varying individual needs for orientation, guidance to the student regarding expectations are appropriate from the beginning. See the short videos from the National Organization of Nurse Practitioner Faculties (NONPF) https://vimeo.com/118248471 and https://vimeo.com/118248472. See also Basics of Precepting Challenging Students

If the preceptor then encounters resistance or simply inattention to improvement, preceptors should contact the clinical faculty, letting the student know about this contact. PLU uses a Performance Progression Alert (PPA) document for mutual agreement between the student and the clinical faculty. Even though the preceptor is essential and central to the student’s clinical learning and provides critical input, the preceptor does not bear the burden of a final decision about the student’s grade or success.  After reasonable effort has been made to support the student meeting expectations, the clinical faculty will determine the grade the student has earned.  Neither the student, PLU, future patients, nor the profession benefit from “failing to fail” a student who is not meeting expectations even after every effort has been made to help the student.

NB:  The preceptor may decide to terminate the preceptorship unilaterally and at any time.

Last updated June 30, 2020
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