Scenario 1: You have a new group of clinical preceptors who report to you on the medical surgical unit. Within the first two weeks on the unit, one of your preceptors has arrived late three days in a row. On further investigation you find that the preceptor has told the students to go ahead and start the patient's care alone. This is the first medical surgical experience for this cohort of students.
Preceptors must be aware that barring any practice emergency, such as a code call or a floor incident their presence is not only expected but legally required for students to perform procedures. A preceptor, who is unaware of this reality, may be in need of coaching on the part of faculty with regard to awareness of expectations of the program as well as the preparedness of the students being taught. The first aspect of an intervention plan for a preceptor that arrives late to a skills or practice setting would be to reiterate the above information and further communicate the preparedness of the students in their charge. When clinical or other demands and responsibilities of their job interfere with their ability to be timely in a clinical care setting for a student interaction the preceptor must never instruct students to perform procedures on patients without their presence, instead they must delay the student experience, seek out another preceptor who can fill in (in the appropriate skill area) and/or seek out an onsite faculty member to begin the student orientation to the skills. Furthermore the preceptor needs to be aware that the students have limited opportunity to learn these clinical skills and that their time with the preceptor is essential to their development of competency. Additionally, the faculty needs to address the timing of clinical student exchanges, the communication of those times and their possible interference with the timing of the facility workflow, this concern needs to be directed first at the preceptor and second to those who might determine the workflow of the preceptor. Reiterating these requirements, scenarios and protocols, in addition to offering the preceptor a chance to step down, if he or she feels that the preceptor role is interfering with his or her own clinical responsibilities, would be the best course of action in this scenario to improve the clinical experience for this group of students and future students.
Preceptor Educational Needs Plan for Scenario 2
Scenario 2: Often nurses who are preceptors are RNs but do not have a BSN. The hospital is applying for magnet status and is encouraging RNs to continue their education and obtain their BSNs. One of your preceptors has just spoken to you about wanting to go back to school to complete an education. The preceptor is a full-time nurse at the hospital and supports a family, and therefore cannot take time off to go back to school at the local university.
The student/preceptor/faculty relationship and experience is clearly a relationship of mutual learning and skills development. The setting allows students, preceptors and even faculty the opportunity to learn and/or refresh clinical as well as theoretical evidence-based practice protocols. A preceptor who sought to improve her professional status through the obtaining of a BSN would be encouraged by the faculty to do so. In this scenario the RN sees barriers of her time and availability. The faculty instructor might provide her with a little bit of clinical as well as professional research, supporting the time constraints by seeking out alternatives and presenting them to the RN. For instance the instructor might recommend that the RN take community college classes for his or her prerequisites for a BSN as they are often much more flexible in their offerings, offering weekend and evening classes to those who are in the community working. In this manner the RN might be able to come into a BSN program with one to two years of credits already achieved. The instructor should also look into the option of a BSN program that is online, offering some course material on demand and other material in a university setting to be done more flexibly. The instructor might also support the RN in meeting with a faculty adviser at the university to see if there is some possibility that the RN can in fact take courses there, given the constraints of his or her time and that the barrier to doing so might not be surmountable. Several universities offer programs that step up practicing clinical providers through rapid advancement programs that offer courses and give credit for clinical experience. This may in fact be available in some form locally or online and the instructor can serve as a guide to providing the RN with such contact information as is applicable to the scenario.
Barker, E.R., & Pittman, O. (2010). Becoming a super preceptor: A practical guide to preceptorship in today's clinical climate. Journal of the American Academy of Nurse Practitioners, 22(3), 144-149. doi:10.1111/j.1745-7599.2009.00487.x