Adult/Family Nurse Practitioner Program NSG 6687 – Nurse Practitioner Preceptorship

The College of St. Scholastica School of Nursing

Department of Graduate Nursing

Preceptor Manual 2007-2008

1200 Kenwood Avenue Duluth, Minnesota 55811-4199

(218) 723-5975 • 1-800-447-5444 Fax: (218) 733-2295

Dear Preceptor: The College of St. Scholastica Department of Nursing Graduate Program faculty and students would like to thank you for your willingness to precept graduate students. We greatly appreciate the sharing of your time, expertise and knowledge with our students. Your contribution to advanced practice nursing is immeasurable. The preceptor Manual provides a Description of the Clinical Experience for Students and Preceptors, developmental progression of NP students, the skill progression of the FNP student, the course syllabi, the preceptor agreement and an evaluation. Student Responsibility

• Meet with preceptor to present, discuss and plan for meeting goals of the practicum. • Present contract to preceptor for signature. • Submit signed contract to faculty member. • Follow through with the agreed upon plan. • Complete a student evaluation of the clinical site. • Submit completed clinical experience summary log to faculty member and a copy to the preceptor.

Faculty Responsibility

• Provide preceptor with course syllabus and student evaluation form. • Monitor progress of the student. • Complete a minimum of one site visit to evaluate student progress or evaluate student personally by

special arrangement. • Complete an evaluation of the student, and final grading.

Preceptor Responsibility

• Plan with the student clinical experiences to meet student practicum goals. • Sign clinical agreement and return to The College of St. Scholastica. • Supervise clinical activities of the student, providing ongoing feedback as to progress. • Inform faculty member if/when student is not progressing at an acceptable pace. • Complete an evaluation of the student form, and return directly to the faculty member. • Sign the student clinical experience summary log form at the completion of the practicum, retaining

a copy. If you have any concerns about the student or experience please contact me or the faculty member. I can be reached at 218-723-5975 or email at polson@css.edu. Quality practicum experiences are the hallmark of our graduate program, and because of your commitment to advanced practice nursing education we are able to maintain these standards. We are confident that your influence will positively improve the health care of the public for years to come. In addition, we also hope you will find the experience personally and professionally rewarding as well. Sincerely,

Pam Olson Graduate Nursing Department Clinical Coordinator School of Nursing Enclosures

TABLE OF CONTENTS

Description of Clinical Experience for Students and Preceptors ...................................................... 1 Developmental Progression of NP Student: A Guide for Preceptors................................................ 2 Skill Progression of ANP Student ...................................................................................................... 3 Skill Progression of FNP Student ...................................................................................................... 4 Course Syllabi: NSG 6687 ................................................................................................................. 5

Attachments

NP Student Clinical Evaluation Rubric ............................................................................................. 1 Contact Information Form ................................................................................................................. 2 Preceptor Agreement ......................................................................................................................... 3

1200 Kenwood Avenue Duluth, Minnesota 55811-4199

(218) 733-2279 • 1-800-447-5444 Fax: (218) 723-6472

Description of Clinical Experience for Students and Preceptors Nursing 6687 Nurse Practitioner Preceptorship Course objective The key objective of Nursing 6687 is an introduction to primary care of adults and elders (ANP students) and patients of all ages (FNP students). Clinical Hours 270 hours of clinical experience for the semester. Clinical experience may begin after successful completion of fall semester coursework and with approval of Graduate Program coordinator and faculty (please refer to graduate program handbook for details). Clinical Expectations This course is the final clinical experience for students in the Family Nurse Practitioner and Adult Nurse Practitioner tracks of the graduate nursing program. Students will have completed almost all of their didactic coursework before the beginning of this course. One assignment that students have is to follow a patient with a chronic illness over the course of at least three visits. It would be optimal for the student to see the patient in more than one setting if possible. Please encourage your student NP to discuss this assignment with you. Students at this level will need a short (1-2 day) orientation to the site if it is new to them. After the completion of the orientation, the student should be proficient at performing a history and physical exam as well as eliciting appropriate differential diagnoses along with a beginning plan for most patients. As the student’s skill level develops and preceptor confidence in the student’s ability increases, the preceptor may chose to take a less active role. This may involve having the student present the history findings, differential diagnoses and a possible plan. The preceptor may re-examine areas of the objective findings as appropriate; discuss differential diagnoses and collaborate on plan of care. The goal, of course, is to increase the skill and independence level of the FNP student. By the end of the semester, most students should be able to manage 12-15 patients per day under the supervision of the preceptor. Thank you for sharing your time and expertise with this NP student. If you have any specific questions regarding this clinical experience, please do not hesitate to call or email me. Please direct any specific questions regarding this clinical experience to:

Laurie Ash, DNP, CNP, RN Assistant Professor of Nursing 218-733-2279 lash@css.edu

THE COLLEGE OF ST. SCHOLASTICA

School of Nursing Graduate Department of Nursing

Developmental Progression of NP Student

A Guide for Preceptors

The beginning level NP student:

• Spends time observing preceptor. • Gradually takes on increasing aspects of the patient encounter. • Requires significant involvement and direction from preceptor which decreases as skill level

increases. • Assessment skills should be validated by preceptor. • Management plans require significant preceptor involvement. • Will assume more independent responsibilities as progresses through program.

The intermediate level NP student:

• Becomes more proficient in assessment, clinical decision making, and formulating management plans.

• Is more proficient with use of time and resources. • May require assistance in prioritizing and coordinating care. • Requires support and assistance for complex cases. • Is ready to demonstrate other NP functions including teaching, participating in teams, and

quality improvement activities.

The advanced level NP student:

• Is expected to perform all role functions including increasingly complex case load in an organized, efficient, skillful and independent manner.

• Is expected to engage in interdisciplinary role collaboration, consultation and referral. • Develops a more collegial relationship with preceptor. • May feel overwhelmed with future role responsibilities and may benefit from sensitive

preceptor support. Adapted from: Collaborative Rural Nursing Practitioner Project. Preceptor Manual. University of Minnesota, School of Nursing, 1995. Hayes, E. (1994). Helping preceptors mentor the next generation of nurse practitioners. Nurse Practitioner, 19(6), 62-66.

THE COLLEGE OF ST SCHOLASTICA

School of Nursing Graduate Department of Nursing Skill Progression of ANP Student

Course Content Level of Student

Clinical Expectations/ Patient Encounter

Goals

Age specific content

6627 Adult Health Assessment

H&P’s : focused and comprehensive

Demonstrate assessment skills for adults

Begin to learn labs

Beginning

Lab experiences; independent assignments including age /

developmental specific H&P’s; demonstrates clinical competence of

complete physical exam

One module/lecture

about older adult considerations

One module about adolescent

6683 Primary

Health Care Management

II-Adult

Comprehensive well exams

Focused visits Acute and chronic

problems of the adult Unstable common chronic conditions (asthma, Diabetes) Stable, uncommon chronic conditions

Intermediate

180 hours

6-10 patient encounters per clinic day

Beginning to add age specific

considerations (adolescent, adult, older adult- older adult case study)

6687 Nurse

Practitioner Preceptorship

Refocus on family systems

Complex, multi-problem, syndromes

Synthesis of previous clinical courses (see patients of all types)

Intermediate to Advanced

270 clinical hours

10-15 patient encounters per

clinic day

Intermediate age specific

considerations (All ages)

THE COLLEGE OF ST SCHOLASTICA School of Nursing

Graduate Department of Nursing Skill Progression of FNP Student

Course Content Level of Student

Clinical Expectations/ Patient Encounter

Goals

Age specific content

6629 Pediatric Health

Assessment

H&Ps Demonstrate assessment

skills Beginning

Lab time Independent assignment

Demonstrates assessment skills

Course focuses on Pediatrics & adolescent

6627 Adult Health Assessment

H&P’s : focused and comprehensive

Demonstrate assessment skills for adults

Begin to learn labs

Beginning

Lab experiences; independent assignments including age /

developmental specific H&P’s; demonstrates clinical competence of

complete physical exam

One module/lecture

about older adult considerations

One module about adolescent

6681 Primary

Health Care Management I

-Pediatrics

Comprehensive well exam H&P

Focused visits Stable chronic conditions

(asthma, diabetes)

Beginning

140 hours of clinical in a primary care setting with

emphasis on pediatric health;

4-6 patient encounters per clinic day

Pediatric & adolescent

6683 Primary

Health Care Management

II-Adult

Comprehensive well exams

Focused visits Acute and chronic

problems of the adult Unstable common chronic conditions (asthma, Diabetes) Stable, uncommon chronic conditions

Intermediate

180 hours

6-10 patient encounters per clinic day

Beginning to add age specific

considerations (adolescent, adult, older adult- older adult case study)

6685 Prenatal

Health Assessment of the pregnant/lactating female

Co-management of the pregnant/lactating

woman with MD or CNM

Comprehensive & focused OB history and

exam Management of acute

problems in a pregnant or lactating woman

Beginning to intermediate

15 hours

(It is recommended that the student sees pregnant and lactating women in 6683

also).

Adolescent and young adult female

6687 Nurse

Practitioner Preceptorship

Refocus on family systems

Complex, multi-problem, syndromes

Synthesis of previous clinical courses (see patients of all types)

Intermediate to Advanced

270 clinical hours

10-15 patient encounters per

clinic day

Intermediate age specific

considerations (All ages)

THE COLLEGE OF ST. SCHOLASTICA School of Nursing

Graduate Nursing Program

NSG 6687 – Nurse Practitioner Preceptorship

Spring 2008

Syllabus

FACULTY: Laurie Ash, DNP, CNP, RN Siobhan McMahan, MSN, MPH, RN E-mail: lash@css.edu (site visits only) Office: Science 3206B E-mail: smcmahon@css.edu Phone: 218-733-2279 Office: 3206A Phone: 218-733-2209 COURSE OBJECTIVES:

• Demonstrate competence and independence managing illness/health status and creating strong patient/NP relationships that incorporate cultural sensitivity.

• Evaluate and integrate research findings to improve primary health care of clients.

• Utilize various methods of evaluating and monitoring the quality of nurse practitioner practice and

delivery of primary health care services.

• Examine employment issues, such as ways of negotiating nurse practitioner positions.

• Examine the influence of family, environmental, developmental and psychosocial factors on health and illness in the context of the delivery of primary care.

• Define strategies to maintain work-life balance in practice.

REQUIRED TEXTBOOKS: Title: Nurse Practitioner’s Business and Legal Guide Author: Buppert Publisher: Jones and Bartlett Edition/Year: 2nd ISBN: 0763735949 Additional information: none Type: Recommended resource Title: Chronic Illness: Impact and Interventions Author: Lubkin, I. & Larsen, P. Publisher: Jones and Bartlett Edition/Year: 2006 ISBN: 987-0-7637-3594-4 Additional information: none Type: Recommended resource Title: Student Workbook to Accompany Sixth Edition Chronic Illness: Impact and

Interventions Author: Lubkin

Publisher: Jones and Bartlett Edition/Year: 2008 ISBN: 978-0-7637-5775-5 Type: Recommended resource RECOMMENDED TEXT: Title: Safe, smart billing and coding for evaluation and management: An educational module. Author: Buppert, Carolyn Publisher: www.buppert.com Edition/Year: 2004 Type: Recommended resource COURSE REQUIREMENTS:

• Clinical hours: 270 – turn in clinical log. Clinical Time is P/F to be determined by instructor and preceptor(s).

• Online Discussion (40%).

• Comprehensive Management Plan (40%).

• Presentation of the Comprehensive Management Plan (20% of grade).

STUDENT RESPONSIBILITIES: It is the responsibility of the student to:

• Be prepared and participate in class, on campus, or online. • Maintain communication with course faculty regarding progress; that includes frequent checking of e-

mails and responding to requests for general announcements and for WebCT coursework.

• Maintain communication with Graduate Nursing Office; inform office of any changes in your program progress and any change in contact information.

• Maintain ongoing communication with your academic and thesis/project advisors. Submit assignments

on time or negotiate with faculty for an extension.

• COMPLETE prerequisites of all courses for which you are registered prior to the first day of class. If incomplete grades are not cleared prior to class, you will not be allowed in the class.

If there are any questions regarding meeting any of the above responsibilities, you will be reviewed by the Admissions and Progressions Committee (GPC) and at risk for not being able to progress in the program. RUBRIC FOR ONLINE DISCUSSION: A general evaluation rubric is: A (35-40 points) = Well developed ideas; introduces new ideas; stimulates further discussion; responds consistently; demonstrates application of content B (30-34 points) = Developing ideas; sometimes stimulates discussion; responds consistently; some application of content C (25-29 points) = Poorly developed ideas; does not add to the discussion; responds inconsistently; little or no application of content

F (<29 points) = Did not enter the discussion; responds inappropriately or refers to inaccurate material GRADING: 94% - 100% = A: Exceptional 81% - 83.5% = B- 91% - 93.5% = A- 77% - 80.5% = C+ 87% - 90.5% = B+ 74% - 76.5% = C: Minimally Acceptable 84% - 86.5% = B: Acceptable 70% - 73.5% = C-: Not acceptable ACADEMIC HONESTY: Academic honesty and integrity are highly valued in our campus community. Academic honesty directly concerns ethical behaviors which affect both the academic environment and the civic community. Academic dishonesty seriously violates the integrity of the academic enterprise and will not be tolerated at St. Scholastica. See student handbook for policy details. ADA STATEMENT: Students with disabilities, physical or learning, are entitled to appropriate accommodations. It is the student’s responsibility to notify the Access Center far enough in advance to allow a reasonable amount of time to approve of and provide the accommodation. Students who are taking courses on campus or in a distance format must contact the Access Center at 218-723-6552 to make such arrangements.

THE COLLEGE OF ST. SCHOLASTICA School of Nursing

Graduate Department of Nursing NP STUDENT CLINICAL EVALUATION RUBRIC

Student_______________________________________________ Course_____________________ Date________________ Clinical Site_________________________________ Preceptor ____________________ Faculty_________________________ Rating Scale:

Strongly Agree Agree Disagree Strongly Disagree Not Applicable/ Not

Observed 4 3 2 1 NA/NO

1. Student establishes effective nurse practitioner-patient / family relationships by creating an environment of rapport, professionalism and mutual trust.

4 3 2 1 NA/NO

2. Student obtains a comprehensive and problem focused health history based on presenting symptoms, age, developmental stage.

4 3 2 1 NA/NO

3. Student performs a comprehensive and problem focused physical exam based on presenting symptoms, age, developmental stage.

4 3 2 1 NA/NO

4. Student formulates appropriate differential diagnoses through a systematic clinical decision making process of interpreting history, physical exam findings and diagnostic information.

4 3 2 1 NA/NO

5. Student employs appropriate diagnostic and therapeutic interventions with consideration of safety, efficacy, acceptability, cost.

4 3 2 1 NA/NO

6. Student considers safety, efficacy, acceptability, cost when utilizing pharmacotherapeutic modalities and provides appropriate patient education including regimen, side effects and interactions.

4 3 2 1 NA/NO

7. Student delivers health promotion and disease prevention services based on age, developmental stage, family history and ethnicity.

4 3 2 1 NA/NO

8. The student accurately and concisely presents patient scenario to preceptor and initiates appropriate consultation and referral services when the presenting problem exceeds student scope or skill level.

4 3 2 1 NA/NO

9. Student provides appropriate anticipatory guidance, education and counseling to patients/families based on needs assessment, mutual goal setting and evidenced based rationale.

4 3 2 1 NA/NO

10. The student utilizes appropriate information resources/ technology during patient encounter to support decision making without negatively impacting patient rapport.

4 3 2 1 NA/NO

11. Student documents the patient encounter in a comprehensive, accurate, organized, succinct manner

12. The student protects patient confidentiality and privacy. 4 3 2 1 NA/NO 13. The student demonstrates cultural and spiritual competence by respecting the value and dignity of individuals without regard to gender, religion, socioeconomic status, sexual orientation, and ethnicity.

4 3 2 1 NA/NO

14. The student follows infection control practices throughout patient encounter ( i.e. hand washing)

4 3 2 1 NA/NO

15. The student recognizes his/her own clinical/ professional competencies and areas for growth and formulates plans for improvement Strengths: Growth Areas:

4 3 2 1 NA/NO

16.The clinical site meets the student learning needs 4 3 2 1 NA/NO

RESULTS: _____ Pass (3,4 in all areas). _____ Recommend plan for improvement and or re-evaluation to assess progress (2 in any area). _____ Failure to progress : Clinical skill not at expected level of NP student/ student did not meet expectations of plan for improvement (evaluator discretion).

COMMENTS: Signatures:

Student: ______________________________ Preceptor_____________________________ Faculty_______________________

Contact Information Thank you for agreeing to precept a College of St. Scholastica student. During the student’s clinical experience, it is important that we remain in close contact with you, as his or her clinical preceptor. To assess the student’s progress, the faculty would like to be in touch with you by phone at least once midway through the student’s clinical hours. This will be arranged in advance at your convenience. Please indicate below how we can best communicate during the semester. Feel free to contact me at any time during the semester should a problem or question arise. Pam Olson Graduate Nursing Department Clinical Coordinator 218-723-5975 ________________________________________________________________________________ Your contact information and preferred contact method: Name: _______________________________________ Clinic Name: _______________________________________ Phone: _______________________________________ Email: _______________________________________ Please include this form with your signed preceptor agreement and return to the Graduate Nursing Department at The College of St. Scholastica in the enclosed envelope.

The College of St. Scholastica Master of Arts in Nursing Program

Preceptor Agreement

_____________________________________________________________________________

Student Name:_____________________________

Course Name:______________________________

Course Number:____________________________

Preceptor Name:___________________________________ Credentials: (CNP/CNS/MD)_______

(Please print clearly to ensure correct spelling)

Email Address:_________________________________ Telephone #:_______________________ Preceptor RN/MD License #______________________________ Expiration Date:_____________ NP Certification #______________________________________ Expiration Date:_____________ I agree to participate as a preceptor for the above student in the Master of Arts in Nursing Program at The College of St. Scholastica. I understand this participation involves demonstration, teaching, and supervision of the student’s learning in the clinical area required. The hours will be arranged between the above student and myself for the time frame specified above. _________________________________________________________________ ________________________________ Preceptor Signature Date Clinic Name:_____________________________________________________________________

(Please print clearly to ensure complete & correct spelling)

Clinic Address:___________________________________________________________________ (Street) (City) (State) (Zip) Clinic Phone Number:_____________________________ Clinic Fax:_______________________ Affiliate with health care system:_____________________________________________________ (If no affiliation, indicate “None”) Clinic Administrator / Manager Name and Title:_________________________________________ Administrator / Manager Phone (if different than clinic):___________________________________ NPI Number:_____________________________________________________________________

Instructions: Please complete this form In Its Entirety for EACH Preceptor with whom you arrange a Hands-On clinical experience. Since preceptor agreements must be in place before the experience begins, please return completed forms to the Department of Gradute Nursing as soon as possible. Preceptor signature is required for form to be complete.

Circle all that apply: Fall Spring Semester Academic Year: 200___ - 200___ Number of hours/semester ________________

Preceptor Agreement returned:_________________ Entered in Database:____________________