OPCWI Webinar Series: APN Preceptor Development

Denise Pacholski, MSN, RN, CNPLecturer

Kent State University College of Nursing

ohiochc.org

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Nurse Practitioner Clinical Education Clinical experiences are essential to NP education

Goal is to prepare NPs to manage care of patients with optimal health outcomes

Clinical experiences Individualizes education

Links classroom education to real patient management

Develops standards and strategies for practice

Develops the student into the NP role

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Stakeholders in Precepting NP students Preceptors

Opportunities

Professional Growth

Patients

Students Translate didactic information into clinical skills

Nurse Practitioner Programs

Health Institutions Future employment

4Typical sequence to precepting APRNs Contact to precept

By faculty or student

Agree to do it Faculty will check to be sure an affiliation agreement is in place

Will have student onboard to facility

Faculty will contact preceptor and provide information/handbook

Meet with student In person, by phone, email

Objectives for course and student Go over course objectives and the student’s clinical objectives

Patient care and experience

Evaluate Submit evaluation online or on paper depending on school

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General Expectations Understand where the student is at in their program

Communication Clear guidelines and expectations

Open communication is vital

Review and clarify objectives Course practicum and Student Clinical objectives

Meet the student prior to practicum Can be in person, by phone, or email

Set up schedule

Student Onboarding Students should complete any paperwork or training that each institution

requires

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Student Expectations Arrange clinical dates and times

Students should work a schedule convenient to preceptors

Orient to the clinical site

Student Onboarding Students should complete any paperwork or training that each institution requires

Professionalism Punctual

Prepared

Professional Attire

Identification

Patient Experience Preceptors direct care

Documentation

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Preceptor Information Name and contact information of faculty member supervising the

student

May be given a handbook or email with attachments with pertinent information

Number of hours needed and the time frame

Site visits

Student evaluations

Syllabi to course Both Didactic and Clinical

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Documentation

Students should discuss documentation specifics

Some agencies only allow documentation to be done by the licensed provider

If policy permits, student documentation should be done in the patient record Should include their name and that they are a student (i.e. Jane Smith, RN,

APRN Student)

It is their responsibility to review the notes with their preceptor and be sure it is co-signed

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Preceptor Expectations Appropriate clinical experience

Look at course objectives See if site is appropriate

Learning Environment Consider where the student is both educationally, but also in their career Students learn by example as they observe preceptors in clinical situations, decision making

processes, and interactions with patients, family, and peers Provide enough support for the student to feel comfortable to ask questions and discuss ideas Create an environment that is conducive for learning

Feedback Helps to avoid any misunderstandings or surprises Address any challenges early to help facilitate success

Evaluation

10Evaluation ExampleInstructions: Completed by the Preceptors regarding the Students, answered on an As needed basis. Before beginning an evaluation, the preceptors will be asked to select which student they are evaluating, followed by the date of the evaluation period.

Quality Rating Legend5 Excellent 4 Above Average 3 Average 2 Below Average 1 Poor Not

I. Subjective Data Collection Skills:Ability to extract, organize, interpret and documentrelevant historical data from the patient or significantothers.

Additional Comment:

(Answer required for each option.)

Quality Rating 5 4 3 2 1

II. Objective Data Collection Skills:Ability to obtain, organize, interpret, and documentphysical assessment finding in a timely manner.

Additional Comment:(Answer required for each option.)

Quality Rating 5 4 3 2 1

III. Diagnostic Data Collection & Interpretation Skills:Ability to order and interpret appropriate screening anddiagnostic tests in a primary care setting.

Additional Comment:(Answer required for each option.)

Quality Rating 5 4 3 2 1

IV. Problem Identification:Ability to analyze and interpret subjective, objective, anddiagnostic data in order to formulate logical and accuratedifferential diagnoses and prioritize patient problems andhealth risks.

Additional Comment:

(Answer required for each option.)

Quality Rating 5 4 3 2 1

V. Health Education, Counseling & Patient Communication:Ability to provide accurate and effective informationthrough verbal and written communication in accordance tothe patient’s level of understanding.

Additional Comment:

(Answer required for each option.)

Quality Rating 5 4 3 2 1

VI. Communication with Preceptor:

Additional Comment:

(Answer required for each option.)

Quality Rating 5 4 3 2 1

VII Communication with Health Care Team:Ability to communicate effectively through verbal andwritten communication with other members of thehealth care team.

Additional Comment:

(Answer required for each option.)

Quality Rating 5 4 3 2 1

VIII Therapeutics:For disease prevention and in treating commondisorders: ability to select appropriate vaccines, andnutritional supplements and cost-effective medications(including familiarity with dosages, contraindications,side effects, toxicities, interactions and monitoring.

Additional Comment:

(Answer required for each option.)

Quality Rating 5 4 3 2 1

IX Nurse Practitioner Role Development:

Progress in delivering primary health care within their own abilities and scope of practiceassuming a collaborative role with other health care professionals.

Additional Comment:

(Answer required for each option.)

Quality

X. Identify the student’s strengths:

1.

2.

3.

(Answer required for each option.)XI. Identify the areas where improvement is needed:

1.

2.

3.

(Answer required for each option.)XII. Additional Comments:

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Providing feedback Provide feedback on their performance

Give feedback in a professional manner that is not demeaning, but constructive

“Ask, Tell, Ask” Method ASK students how they think they did

TELL them how you interpreted it; tell them what they did correct and give positive feedback, but also tell them what needs improvement and provide specific, direct feedback

ASK students how they will change or what they may do differently next time

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What if there are issues/concerns/problems??? Do not hesitate to discuss any issues or concerns with the supervising faculty

Faculty are there to provide support and guidance to preceptors

Guidelines should be given in regards to when and how to contact them

Faculty will collaborate with you on any questions, issues or concerns throughout the student’s rotation

Feedback should be actively solicited about the student’s progress

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Course Objectives Can help to give clear guidelines and expectations including course

content, objectives, and expectations

Clarify course practicum objectives and competencies, and faculty expectations

Review these objectives with the student prior to starting clinicals or on the first day

Can always contact faculty for the course syllabi

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Example Course ObjectivesCourse Objectives: Using relevant evidenced-based interventions and strategies, manage

and plan individualized primary care for adults across the lifespan to attain short and long term patient health care goals.

Incorporate biological and behavioral patient parameters for the identification and application of primary, secondary, and tertiary prevention measures in the clinical area.

Integrate evidence-based research to decrease complications in patients with multiple co-morbid conditions and chronic conditions across the lifespan.

Demonstrate competence in evaluation and management of a variety of clinical presentations in simulated patient exam setting.

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Example of Student Clinical Objectives Identify three common complications of a chronic disorder in patients

that presents to the office for follow-up appointments for chronic healthproblems.

Evaluate the effectiveness of the patient's current treatment regiment for a chronic disease process using national guidelines andindividualized plans for follow-up visits of patients with a chronic healthproblem.

Correctly identify the first line HTN medication that a patient should beplaced on when deemed necessary for blood pressure

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Student Objectives

Objective Review objectives with the student and alter them as needed

Plan How do they plan to meet this objective?

Evaluation Criteria How do they plan to evaluate how they have met this objective?

Outcome

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Tips for successful precepting Be realistic

Keep daily feedback short and realistic

Okay to teach in small bits

You cannot teach everything in one day!

Share teaching with your colleagues Seek out unique opportunities and procedures

Seek out abnormal findings or interesting cases

Avoid burnout Take one student at a time

Identify certain days as student days

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Mentoring your student Adapting to the student role

Functioning in the clinical role

Managing information overload

Juggling student and personal life

Reducing stress and anxiety

Develop time management skills and productivity

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NP Education and PCMHs and FHQCs

PCMHs and FHQCs are widely accepted models for how primary care should be organized and delivered throughout the health care system

The delivery of primary care is: Patient-centered

Comprehensive

Coordinated

Accessible

Committed to quality and safety

Adapted from the AHRQ definition at www.pcmh.ahrq.gov/

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Students in PMCHs and FQHCs

NP education needs to utilize the principles of PCMHs and FQHCs Would help to guide their education in establishing a solid foundation in

primary care

NP students are positioned to help with the shortage of primary care providers

Providing clinical opportunities in these settings will aid in developing them into these roles

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Interprofessional Collaboration

Most health care providers were educated with those in their own profession

However, when delivering care, there are various interactions needed from other providers in different professions

Research supports that collaboration improves coordination, communication, and quality and safety of patient care

IOM in 2010 recommended that nurses should be educated with doctors and other health professionals, both as students and later (RWJ, 2011)

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Interprofessional Collaboration

Is not the norm today

Is promising to help with: Reducing medical errors

Improving quality of care

Improving access to care

Meeting the needs of diverse populations

Need to rethink how we educate and train providers in all professions in patent care

Team approach

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Key principles from PCMH/FQHCs that are important to NP education

Provide patient centered care in clinical encounters Experience continuity in relationships

Demonstrate collaborative care with patients, families and other professions Work effectively with others as a member or leader of a health care team

Provide patient care that is compassionate, coordinated, and effective in health promotion and treatment of health issues

Demonstrate knowledge of access to care, non-traditional encounters, and care outside of the physical practice Telehealth, E-visits, group visits, etc…

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Meeting the need May require additional resources

May need to include other disciplines that have not traditionally taught certain students

May need resources for infrastructure development to provide students with necessary tools

Will need to find ways to better assist and compensate PMCHs and FHQCs for taking on students

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References American Academy of Nurse Practitioners (2014). Mentoring assessment.

http://www.aanp.org/images/documents/fellows/Mentoring

Corbridge, S., Sparbel, K., and Kapustin, J. (2012) Partnering in Nurse Practitioner Education: Welcome to Precepting. NONPF. Available at http://www.nonpf.org/?page=PreceptorPortal_Main

Robert Wood Johnson Foundation (2011) What can be done to encourage more interprofessional collaboration in health care? Patient Centered Care/A RWJF Collection. Available at: http://www.rwjf.org/en/library/research/2011/09/what-can-be-done-to-encourage-more-interprofessional-collaborati.html

APN Preceptor Development

Kathryn Kort, NP-C

ohiochc.org

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Objectives:

Learn how to best incorporate students in a meaningful way into the patient care activities of your FQHC

Enhance the teaching skills of FQHC preceptors

Engage your entire health center staff in the student teaching efforts of your FQHC

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Students as Part of the Team

Nurse Practitioners Physicians Dieticians Pharmacists Therapists Office staff Students Patients and their family

Setting up for Success

ExpectationsA “normal” DayHistory of the

practice

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Get Started

Follow at first

Then encourage independence

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Strategies for Preceptors

Alternate patients with the student

Delegate research to students

Students as teachers

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Improving Everyday!

Share resources

Let them DO

Research together

So What ELSE do you DO??

You Are Not an Island

DelegationCollaborationOpportunity

APN Preceptor Development

Suzette Viola, FNP

ohiochc.org

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Anyone can preceptDoing it well is another story….

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BARRIERS TO GOOD PRECEPTINGin the underserved arena….

1. shortage of primary care providers 2. increase # of patients looking for PCP

“The increased access to services through health insurance expansion coupled with a shortage of community providers is leading to a national service gap for an estimated 56 million individuals”

(NACHC,2012)

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BARRIERS TO GOOD PRECEPTINGin the underserved arena….

3. increase in clinical complexity

4. more emphasis on productivity

5. staff in the office setting are not uncommonly task-based versus relationship-based

6. multi-disciplinary approach to care requires a multi-disciplinary approach to teaching

J Bone Joint Surg Am, 2012 Dec 05; 94 (23): 2177 -2184 . http://dx.doi.org/10.2106/JBJS.J.01966

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Nationwide schools of Nursing have responded!

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UPSIDE DOWN

More Young NP’s than we have experience ones to mentor them

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SODOTO

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FACILITY-BASED IDEAS

1. Consider clinical site placement coordinators

2. Protect the new

Hold student placement for 6-12 months for the new hire

3. Challenge the old

provide incentive to mature provider to continue to grow

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BEGIN AT THE BEGINNING

Before the students arrive support your staff

DAY/WEEK ONE

Exchange Schedules

Contact info

Personal/Professional Expectations

Boss/Teacher Expectations

Introduce Staff… all of them.

Yourself... who are you and what makes you tick

Patient population Bridges Out of Poverty by Ruby

Payne

DAY/WEEK ONE

Explain Concept of multidisciplinary

team approach... Difference between private practice and CHC model of care

Flow of the office

Computer Basics of all outpatient clinical

computer programs

How to gleem important info

Communicate How to talk medical…

Presenting a patient

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MOVING FORWARDSeeing Patients…

All students at all levels … HPI+ROS+Exam

Keep a tight reign on the complexity and volume (1 AM/1 PM). Charting needs to be done and signed off in 4 hour blocks

Limits late nights for you, anxiety for your patients and keeps positive learning experiences for your students

Allows practicing multidisciplinary approach

Special projects… ADD parent handouts, local available immunization clinics/AA meetings

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Practicing interviewing skills

Teasing out important clinical components while filtering the noise. Talking with a purpose.

ITS A LEARNED SKILL

Patients spoke uninterupted an average of 12 seconds Fam Med. 2001 Jul-Aug;33(7):528-32.

MOVING FORWARDSeeing Patients…

DO’s Try to establish a “mini” panel of

patients… follow up is the foundation of satisfaction in primary care

Before/After clinic day huddle

Try to get an extra exam room to allow student extra room

Jump out of the student role if staff need help

Initially talk to the staff through me initially

Mirror my charting style

DONT’s No Charting in the Room Don’t get so far behind that

everyone is frustrated. Don’t wait on feedback –

positive or negativeo If negative focus on the behavior

in the context of how it affects patient outcomes

o Formal performance evaluations are written forms of your ongoing verbal communication. If intervention required.. “to help figure things out”

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Are New NP Grad ready to take the primary care role in an underserved setting?

“From New NP to Primary Care Provider:

Bridging the Transition through FQHC-Based Residency Training” Margaret Flinter, PhD, APRN, c-FNP

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COMPLETION

The Gift is for ALL

Questions?55

EVALUATIONPlease complete the evaluation that pops up directly following today’s webinar.

CME CREDITSOnce you have successfully completed the evaluation, you will receive your certificate of 1 hour of CME credit via email by the end of the week.