Invaluable and essential
Preceptors shape the future for new practitioners and for nursing
by Tatum Lyles Flick
It’s a centuries-old practice: A more experienced practitioner guides a nursing student in how to apply the classroom education they have acquired. As days go by, the student learns from their preceptor and gains expertise in patient care and communications. Eventually, after hundreds of hours of experience, the student becomes a colleague.
“When a student enters their final year in any of the 12 advanced practice nursing specialties, they need at least 500 direct patient care clinical hours,” says Elizabeth Rapisarda, MBA’87, BA’80, assistant dean for clinical placement at VUSN. “A preceptor is a practicing clinician who gives their time and support to train the next generation of advanced practice providers.”
Clinical rotations under different preceptors allow students to apply what they learn in class and simulations to real-life situations. Most find the experience exciting, though sometimes intimidating, and a good preceptor helps them step into clinical practice with confidence.
“Students benefit from sustained interaction over time as they build competency and confidence, and preceptors start to allow greater independence,” Rapisarda explains. “That growth makes a big difference in a student’s confidence level to become a competent provider.”
Marina Gayed, a future women’s health NP, says she enjoyed watching herself grow. Gayed was precepted by Norma J. Krantz, MSN’98, at the Nashville Breast Center. “As a student, you know a little bit of everything, then when you get to the clinic, you incorporate all of those details into one big picture,” Gayed says.
Krantz says she talks through clinical problems and decisions so that students can learn how to process the information and make decisions.
“I talk out loud about how I’m thinking because that’s what they need to learn,” Krantz says. “The students are excited and want to soak this information up like a sponge. They ask questions about what they learned in class. That keeps me open to learning new information and sometimes thinking outside of the box.”
Gayed says her experience with Krantz helped her overcome her shyness. “You have to ask patients very personal questions because you’re trying to build a care plan. If you don’t ask questions, then you’re not going to be able to direct anyone to the right path,” Gayed says.
Krantz has precepted 17 VUSN students since 2005. She says she was able to get where she is because other nurse practitioners and physicians were willing to precept her as a nurse practitioner student. “I wanted to pay it forward and hope others will too.”
Beyond the Classroom
Preceptors play a crucial role in helping students translate classroom learning into real-life situations, evaluate their fit for a specialty and prepare to practice on their own.
Adult Nurse Practitioner David McDowell, MSN’12, precepts students in his Shelby, North Carolina, practice. He helps his students to start to think in patterns and make connections. “The clinical rotation is where students put all of the book work, study, tests and readings into a live situation,” he says.
One of his students was Amy Herink, a dual family nurse practitioner/nurse-midwifery student. Herink says she felt being mentored helped her grow.
“Nothing really compared to learning from an advanced provider,” Herink says. “Our preceptors give us a lot of freedom and independence to work into the role of nurse practitioner, and then they give us the safety net of their experience and their knowledge. Having that has increased my confidence significantly.”
The more students McDowell has worked with, the more he enjoys mentoring.
“It’s fun to teach and see people go from day one, where they’re following you around and not really saying anything, to the end of the rotation, where they’re kind of coming out of the room telling you what’s going on,” McDowell says. “The biggest part of helping patients is just listening to what they have to say.”
Herink says McDowell taught her how to communicate with patients so they are understood and how to advocate for that patient population. “Preceptors are absolutely critical to shaping the next generation of nurse practitioners, and I don’t think we can put enough emphasis on how important they are to nursing education,” she says.
Precepting Through COVID
In recent years, preceptors played a pivotal role in moving students forward during the onset of the pandemic.
“When COVID hit, everything shut down and we had to pull students from clinicals for a couple of weeks,” Rapisarda says. “We made the decision to restart clinical training based on input from preceptors. They ensured that those students received the training they needed and completed their programs. We could not have done it without their help.”
Professionals volunteer for a lot of reasons. Many enjoy working with students, some enjoy helping mold future clinicians, others like to keep up with what their alma mater is doing to educate and prepare future NPs. Assistant Professor Michael Gooch, DNP, MSN’05, says that students love precepting with an alumnus. “Every program is a little different, so when the preceptor and the student have been to same school, it gives them some connectivity.”
I will never forget my preceptors.
They will always be my role models and motivation.” —Marina Gayed, WHNP student
Preceptors come from many backgrounds. Some are VUSN NP or nurse-midwifery alumni, while others are physicians, nurse practitioners or nurse-midwives from other schools, or other health care professionals.
In addition to the satisfaction that comes from sharing knowledge, preceptors report that they benefit in other ways. “Those who precept consistently enjoy teaching and do it as a way to give back to the profession, but there are lots of benefits,” says Associate Professor Leslie Hopkins, DNP, MSN’93, Adult-Gerontology Primary Care Nurse Practitioner specialty director. She says that precepting helps organizations find potential employees and learn about the latest evidence-based practice guidelines.
Matching students with preceptors across 12 VUSN programs takes a lot of work; VUSN has approximately 500 students in clinical rotations and 1,000 preceptors, and always needs more. Each student has at least one primary preceptor per term who evaluates that student’s progress, but many students work with and learn from numerous practitioners. Depending on the specialty, a student may be mentored by as many as 10 health care professionals before completing their degree.
Once health care professionals decide they’d like to be preceptors, they work with VUSN faculty and staff on the details. They may complete a questionnaire, have a phone or Zoom conversation, or meet in person with a VUSN representative. They’ll review a clinical syllabus for the student’s course and talk about how their daily activities and evaluations might help students become proficient in treating patients. Their agency completes an affiliation agreement with Vanderbilt and discusses requirements.
Clinical sites range from small rural clinics to large metropolitan hospital outpatient and inpatient clinics; in the case of programs like nursing informatics, clinical sites can be with agencies that evaluate health care information.
(Preceptors) give us the safety net of their experience and their knowledge.” —Amy Herink, FNP/NM student
Not all of what students learn from their preceptors relate to clinical skills. Adult-Gerontology Primary Care NP student Yelena Reese has worked as a registered nurse for almost a decade but learned new skills in her journey to become an NP, including how to offer conversational interactions with patients while also helping them achieve their health goals.
“Previously, I took way too much time collecting patient history and sometimes was carried away with conversations about nonhealth-related issues,” Reese says. “It was especially challenging with elderly patients who needed to talk to someone as much, if not more, than to get medical help. My preceptor taught me how shift the conversation to the issue at hand without appearing dismissive or uninterested.”
Reese’s experience helped solidify her desire to practice in adult gerontology.
“Working with my preceptor showed me a different side of gerontology I did not see in the acute care setting or at my current ambulatory job, working with kidney transplant recipients,” Reese says, noting her placement allowed her to work with elderly patients with health issues who still enjoy life while aging gracefully. “They were such a joy to interact with that I looked forward to their appointments and the opportunity to catch up. I certainly hope I will take care of elderly patients like that wherever I end up working.”
As students look for experience to complete their programs, a team of dedicated VUSN faculty and staff works tirelessly to find enough preceptors for students in Nashville and across the country.
“The need for more preceptors limits the number of students we can take in certain specialties,” says Gooch, who teaches in the Emergency Nurse Practitioner Specialty. “They are an integral piece of our program. For example, in the ENP program, students complete around 1,000 hours of clinicals. Without preceptors, that would be impossible.”
Beyond Tennessee Needed
A major challenge to the need for preceptors is recruiting them in areas where MSN students live and work outside of Middle Tennessee.
Pediatric Primary Care NP student and five-year RN Jessica Lloyd lives in West Virginia and needed a local preceptor. Unfortunately, the nearby university-based health system gives priority to students from that university. “It was hard to find a primary care practice in pediatrics that didn’t already have students or wanted to precept somebody who wasn’t a WVU student,” she says.
Then program director Brittany Nelson, DNP, BS’00, MSN’01, introduced her to Vanderbilt alumna Caitlin Henby Nelson, MSN’18, who was moving to West Virginia. Even though the two lived miles apart, Lloyd made the three-hour round trip regularly for the experience and feels that it was worth every minute.
“It turned out to be the biggest blessing in disguise because I had a fantastic experience—my preceptor has been the biggest blessing in my clinical journey so far,” Lloyd says. “I wish all students were able to have a VU alumni preceptor because it makes the transition so much easier. Regardless of how long ago they went through the program, they understand what Vanderbilt upholds for their clinical standards and what they expect of students.”
Nelson works at a rural health clinic in primary care pediatrics and volunteered to mentor Lloyd.
“A couple of years into practice, I thought I would like to give back to the VUSN community,” Nelson says. “Precepting is a tangible way to do that. One of my preceptors told me, ‘You don’t have to know everything to be a preceptor. You just have to be willing to learn with the student and be humble enough to be able to admit when you don’t know.’ That made me feel a lot more comfortable taking students earlier in my career, and I would say I’ve not regretted it at all.”
Nelson enjoys mentoring future colleagues and recognizes the benefit of working with students, who often have fresh ideas and knowledge of new guidelines.
“They share with me the things that they’re learning, and there are things that I do not remember or that are new to me,” Nelson says. “I find that students are a great way to keep me on my toes. Also, I know that if I’m teaching somebody, I really need to know my stuff.”
In return, Lloyd says Nelson taught her something that makes a difference in pediatric care: focus on each family as a whole, rather than one patient.
“Caitlin encouraged me to treat the family as a unit and provide for all of them, and that is something if I precept in the future I will carry into that experience,” Lloyd says.
Nelson’s main goal is to help students understand where to look when they do not have an answer and to instill confidence.
“As time progresses, I encourage my students to be as independent as is safe and as they feel comfortable,” Nelson says. “I feel like that was definitely a hallmark of a really good preceptor—someone who let me see patients as independently as possible, and sort of have a tough patient interview before coming back around and helping me work through it. Students begin to understand their roles as nurse practitioners better and are able to feel confident being the NP.”
To Nelson, mentoring is closely tied to the career she has chosen.
“Maybe that is the best part of nurse practitioners as a community—we’re very collaborative and supportive of one another,” Nelson says. “Being a preceptor is like welcoming our new colleagues into the field. We get to be the face that welcomes them as colleagues, and we get to train them to provide the excellent, comprehensive care that is characteristic of nurse practitioners.”
In their commitment to make sure students leave the program well-educated and thoroughly prepared, the school’s clinical placement team is asking for help.
VUSN has started a new initiative
to find more preceptors to help students grow through this critical step in their training. Part of its efforts includes celebrating the many people who already support the program.
Being a preceptor is like welcoming our new colleagues into the field.” — Caitlin Henby Nelson, MSN’19
“It’s not just the provider who precepts the student,” Rapisarda says. “All the office staff and other providers in the practice play important roles in supporting our students.” The school regularly sends thank you gifts to providers’ offices to express its gratitude, and last year launched a Preceptor of the Year program to honor those who volunteer. A preceptor of the year is named for each specialty, and he or she receives a plaque, gifts and recognition. Starting in summer 2022, the preceptor of the year recipients will be invited to the school’s August pinning ceremonies to receive their awards as part of the celebration.
School of Nursing faculty say any medical professional who enjoys teaching and has the patience to listen and help someone grow from a student into a confident practitioner would make a good preceptor.
Lessons learned from preceptors remain with graduates throughout their careers. “I will never forget my preceptors,” Gayed says. “They will always be my role models and motivation.”
Those interested in becoming a preceptor can reach out to clinical faculty or the clinical placement office, or find information online at https://nursing.vanderbilt.edu/preceptor/index.php.