CRNA Student Preceptor Issues

The Challenge of CRNA Preceptor Problems

You have put so much into your pursuit of a certification, job, and career as a Certified Registered Nurse Anesthetist (CRNA) that you surely don't need preceptor problems among your other potential CRNA program issues. Your entry into your CRNA program very likely first required that you earn a bachelor's degree in nursing, a license as a registered nurse (RN), and gain at least a year's experience as an RN in a critical care unit. You now hope to earn your CRNA master's degree or CRNA doctoral degree to enter CRNA advanced nursing practice. Reaching your goal of CRNA practice will take you at least seven years of nursing education and practice. But as accomplished as you already are as a registered nurse and as far along as you are in your CRNA program, preceptor issues can nonetheless arise. If you face CRNA preceptor issues, retain national academic attorney Joseph D. Lento and the Lento Law Firm's premier Student Defense Team. Call 888-535-3686 or go online now for the skilled and experienced representation you need to save your CRNA education and career.

A CRNA Preceptor's Role and Responsibility

A preceptor is an advanced practice nursing student's clinical supervisor. The American Association of Colleges of Nursing publishes an APRN Clinical Preceptor's Guide explaining in detail what a preceptor does. The guide states that “the APRN clinical preceptor serves as a role model by incorporating evidence-based education best practices to ensure safe and effective patient outcomes.” The preceptor thus ensures both safe patient nursing services and effective clinical nursing training. A preceptor is a bridge between education and practice, integrating the two functions of training nurses and caring for patients.

The Source of CRNA Preceptor Issues

Good nurses and good nursing instructors may be relatively common. But as the American Association of Colleges of Nursing's APRN Clinical Preceptor's Guide shows, a good preceptor must be both a good nurse and a good nursing instructor. That dual requirement bridging the two fields of nursing and education can make good CRNA preceptors hard to find. A white paper by the American Association of Colleges of Nursing admits that “APRN programs are … particularly challenged to be able to provide adequate numbers and quality of clinical training sites and preceptors.” You thrive, survive, or struggle in your clinical CRNA training based on the skill of your CRNA preceptor. Given the dearth of highly qualified preceptors, your CRNA preceptor issues are not surprising.

The CRNA Preceptor Requirement

CRNA students, like students in other advanced practice registered nurse (APRN) programs, must generally complete clinical instruction under preceptor supervision. Nursing schools depend on accreditation by the Commission on Collegiate Nursing Education or a similar organization having Department of Education recognition. Without accreditation, nursing schools cannot qualify their students for federal student loans and aid. To meet Commission on Collegiate Nursing Education standards, your nursing school must provide clinical CRNA instruction under the supervision and scrutiny of a qualified preceptor. And you must therefore meet your preceptor's expectations at the level your CRNA program requires. You can't avoid preceptor involvement in your CRNA program, although, with skilled and experienced student discipline defense representation, you may well be able to solve your preceptor problem.

CRNA Preceptor Examples

Georgetown University's leading CRNA program, offering a Doctor of Nurse Anesthesia Practice (DNAP) degree, provides an example of the close supervision and, the program hopes, close professional relationships that CRNA students may develop with their faculty preceptors. Indeed, Georgetown's CRNA program considers its preceptors to be mentors and touts how a strong preceptor can be with a CRNA student “every step of the way.” Similarly, the University of Pittsburgh's leading CRNA program offers a CRNA Preceptor of the Year award to promote preceptor recruitment, engagement, and recognition and reward CRNA preceptors for their “dedication to the nurse anesthetist profession and for [their] training and mentorship of future professionals.”

Your preceptor experience thus should have been a good one, even a capstone experience for your CRNA education and training. You should have had a preceptor who had teaching and interpersonal skills worthy of a true mentor professional, perhaps one on whom you could rely for wisdom and advice throughout your CRNA career. Your CRNA clinical training should entail hundreds of hours of CRNA practice in your clinical placement literally, most likely in a hospital but perhaps also in a clinic or private patient practice setting, under a mentor preceptor's sensitive and astute guidance. But as the above American Association of Colleges of Nursing white paper reveals, professional staffing shortages, institutional issues, individual idiosyncrasies, and other causes beyond your control may nonetheless have contributed to your CRNA preceptor problems.

CRNA Preceptor Supervision

To appreciate the source and scope of your CRNA preceptor problem, be sure that you understand how CRNA preceptor supervision should occur. Your CRNA preceptor is, of course, a nurse anesthetist practicing in your clinical placement. Your CRNA preceptor doesn't generally show slides and lectures in a classroom. Indeed, your CRNA program and your preceptor's employer may limit your preceptor's student supervision to just two, you and one other CRNA student. You and your preceptor should not expect a classroom-like, instructor-model relationship. Instead, your CRNA preceptor should be accompanying you, and you accompany your preceptor on nurse anesthetist rounds. You and your preceptor should, in that sense, appear more like professional colleagues than a teacher and student, especially in the presence of conscious patients evaluating their own care. Your CRNA preceptor's willingness to take on extra preceptor duties may indicate that your preceptor wants to teach, not just to mentor CRNA students but to teach them as a full-time faculty member. But the evidence-based practice your CRNA preceptor is supposed to be supervising means that your preceptor should be watching and guiding what you are doing to ensure patient safety and positive outcomes, not so much telling you what to do in the future while doing it on the preceptor's own.

CRNA Preceptor Evaluation

While your CRNA preceptor should be watching and helping you practice nurse anesthesia duties rather than lecturing you and showing you what to do, your CRNA preceptor does have one critical teaching role. Your CRNA preceptor must complete evaluations of your nurse anesthesia practice sufficient to document your meeting the profession's standards in the clinical setting. Your CRNA preceptor should be objective in evaluations, giving measurable indications of your practice within or outside of professional standards, depending on your skill or lack thereof. Unfortunately, some preceptors don't have training or skill in assessment and will substitute subjective terms for objective measurement, even though strong CRNA programs like the one at the University of Iowa will offer substantial preceptor training. Condemnation without measurable specifics does little or no good, especially when your CRNA program must review your preceptor evaluations to ensure you meet program outcomes, like those at the University of Iowa's CRNA program. Your CRNA program must also retain preceptor evaluations to document to accreditors that the program meets those standards.

Your CRNA Preceptor Problem

From the above discussion, you probably already have good indications of the potential sources of your CRNA preceptor problems. Those sources may include the shortage of qualified CRNA preceptors, preceptor training shortcomings, and subjective rather than objective preceptor evaluation. But you may find other sources for your CRNA preceptor problem. You may find that your CRNA preceptor just doesn't have the right character, personality, insight, sensitivity, or commitment to maintain close and positive one-on-one professional relationships with CRNA students. Call it a “personality conflict” if you wish. But highly trained medical professionals are not necessarily known for their interpersonal skills or supportive bedside manner. Your CRNA preceptor may be a brilliant clinician and, indeed, likely is. But it might be unusual if your CRNA preceptor was also a wonderfully gifted communicator in close supervisory, professional relationships. Your CRNA preceptor may even take the approach of challenging you to toughen up, including occasionally taking it on the chin. You don't want or expect coddling, but you also may not benefit from an unduly gruff and unhelpful preceptor personality or approach.

CRNA Clinical Challenges

Of course, a CRNA student's extraordinarily challenging clinical environment can fuel any fire already ignited by preceptor and CRNA staffing shortages, lack of preceptor training, personality conflicts, and lack of preceptor interpersonal skills. Even if you had a perfect CRNA preceptor, you might face some issues managing everything your nurse anesthesia clinical placement throws at you. That challenge is exactly why you need and deserve a qualified CRNA preceptor. Your preceptor should be ready, willing, and able to step into the breach whenever you need your preceptor to do so because of the new clinical issues you are encountering. Indeed, your CRNA preceptor is likely still seeing new clinical presentations from time to time and maybe even still needing the consultation of other highly trained professionals to manage those new challenges. Yet your CRNA preceptor may instead mistakenly or unfairly construe your natural and foreseeable challenges adjusting to your clinical placement as deficiencies in your knowledge, skill, or commitment.

Nursing Program Evaluation of CRNA Preceptors

When you face CRNA preceptor problems, you may mistakenly assume that you are the first CRNA student to encounter those problems with your particular preceptor. That assumption may well not be the case. Your CRNA clinical program director, who recruits, trains, employs, and evaluates CRNA preceptors, may well know that your preceptor lacks skill or has other problems. Your CRNA program should be acting on that information to train, guide, or decline to further employ problematic preceptors. But that accountability is not always present. That's when you need the help of a skilled and experienced student defense attorney advisor to address your preceptor problem with school officials to avoid your school discipline.

Specific CRNA Preceptor Expectations

According to an advanced nursing practice training program jointly developed by Indiana University and the American Association of Clinical Nurse Specialists, CRNA preceptors, and other nurse specialist preceptors should be looking for certain things from their students. A CRNA preceptor should, above all, focus on the CRNA student's knowledge and skill in each CRNA competency area. Strong CRNA programs will help their preceptors recognize competence in each area in these categories:

• comprehensive, accurate, and detailed knowledge of patient anatomy and disease and prescribed medicines, therapies, and methods, consistent with the training of a competent nurse anesthetist;
• sound, standard-meeting, and effective skills appropriately applied in varied clinical settings according to accepted nurse anesthesia practices;
• strong ethical commitments integrated into minimally developed professional character for the consistent use of the above nurse anesthetist knowledge and skills; and
• professionalism within the norms and customs of nurse anesthesia practice, including devotion to institutional culture sustaining sound and strong professional relationships.

Negative Preceptor Evaluations

If those are a CRNA preceptor's reasonable expectations and the expectations of your CRNA program's clinical director, then you should be able to recognize the following common deficiencies CRNA preceptors may reflect in their evaluations. Consider these common deficiencies when you attempt to dissect and assess the fairness of your CRNA preceptor's evaluation. If your CRNA preceptor's evaluation objectively documents that you are not meeting program standards in one or more of the following ways, then you and your retained counsel may need to negotiate appropriate remedial relief. If, on the other hand, your CRNA preceptor's evaluation does not fit within the following common deficiencies and instead is overtly subject or comes entirely out of left field, then you and your retained attorney may take another approach to negotiate for a new preceptor or other appropriate relief. A negative CRNA preceptor evaluation might reasonably include:

• objective documentation of your inadequate knowledge of nursing, nurse anesthesia, anatomical, and medical terminology;
• objective documentation of your inadequate knowledge of nurse anesthesia medicines, methods, and practices;
• objective documentation of your inadequate skill in administering anesthesia and applying other nurse anesthetic methods and practices;
• objective documentation of your inadequate skill communicating with, reassuring, and gaining the respect and confidence of nurse anesthesia patients;
• objective documentation of your inadequate skill in professional interactions when accepting physician and supervisor orders and communicating patient conditions and professional needs;
• objective documentation of your inadequate skill in recording nurse anesthetic activities while documenting patient events and conditions;
• objective documentation of your neglect of nurse anesthesia patients and duties;
• objective documentation of your incomplete performance of assigned nurse anesthesia duties;
• objective indications of physical injury your substandard nurse anesthesia practice caused patients to suffer;
• objective documentation of your inability to win physician and colleague trust and confidence in your nurse anesthesia practice;
• objective indications of your unprofessional communications, poor personal hygiene, or unacceptable demeanor or dress;
• objective documentation of your frequent unexplained absences, tardiness, early departure, and other lack of commitment to your nurse anesthesia assignments; and
• objective documentation of your inability to prioritize nurse anesthesia assignments, manage multiple assignments, and conform your practice to the requirements of multiple supervisors.

Examples Illustrating Unfair CRNA Evaluation

Consider the following examples illustrating how a CRNA preceptor may unfairly misconstrue your skilled, knowledgeable, and committed CRNA performance as reflecting one or more of the above common deficiencies. Yes, you could have just missed the mark in your CRNA program placement. Your preceptor may have been right on the mark in evaluating your practice as deficient. But then, you should be able to say so from the preceptor's report reflecting your own records, memory, and experience. In that case, you and your retained attorney may need to negotiate CRNA program relief to avoid your failure to progress, discipline, and dismissal. But on the other hand, you may have performed competently in your clinical placement and yet suffered an unfairly negative preceptor evaluation in one or more of the following ways:

• your preceptor alleges that you insulted and offended one or more professional colleagues when to the contrary, those colleagues misheard, misunderstood, or misconstrued your innocent and well-intentioned remarks;
• your preceptor concludes that you lacked sound and adequate nurse anesthesia knowledge when to the contrary, you knew everything you needed to know and more but reasonably misunderstood your preceptor's ambiguous questions, requests, or remarks;
• your preceptor concludes that your nurse anesthetic practice injured or endangered patients when instead others responsible for the patients committed errors or the patients followed their natural course of treatment and disease;
• your preceptor concludes that you failed to perform assigned nurse anesthesia duties when instead your preceptor or field placement site did not assign those duties or schedule you for work at those times, or you did complete the work, but your preceptor made mistaken observations;
• your preceptor concludes from a patient report that you communicated offensively, insultingly, or otherwise inadequately or inappropriately with patients when instead, patients made false, confused, or demented reports or mistook the identity of the offender;
• your preceptor concludes that you did not properly document your nurse anesthesia work and patient observations when instead you completed all required documentation accurately, but others misfiled or deleted your work; or
• your preceptor concludes that you failed to gain the respect, trust, and confidence of your colleagues when instead, your colleagues harassed, disrespected, and demeaned you.

Consequences of CRNA Preceptor Problems

You should promptly retain skilled and experienced student defense attorney advisor representation if your CRNA preceptor's evaluation was deficient in one or more of the above ways, and your CRNA program is nonetheless threatening you with discipline and dismissal based on that evaluation. Don't underestimate the potential consequences of CRNA preceptor problems. Your CRNA program could indeed discipline and dismiss you or require you to repeat a clinical course or academic year for failing to progress or for unprofessional conduct because of preceptor problems. You could lose faculty references and recommendations for desired placements and posts. You could also lose your professional reputation and face professional disciplinary charges for nursing misconduct. Malpractice liability could also arise in the event of allegations of patient injury. And your personal consequences could include loss of university housing and medical care and acceleration of student loans. Take CRNA preceptor problems seriously.

CRNA Preceptor Problem Solutions

Fortunately, you and your retained student defense attorney advisor can take steps to address your preceptor problems. A sound first step in any professional relationship is to communicate diplomatically, respectfully, and factually with the other professional without accusation or rancor. You have likely already tried unsuccessfully to do so with your CRNA preceptor. Your next step is to request your faculty supervisor's review and intervention. A good faculty supervisor may be able to straighten things out. But again, you have likely done so unsuccessfully. Your next step is to climb the institutional ladder, seeking review and intervention from your CRNA clinical program director. Again, you may have already done so unsuccessfully.

The Role of a Student Defense Attorney Advisor

Your next and biggest step, though, is to retain a skilled and experienced attorney advisor. Your CRNA program officials may feel that their hands are tied in imposing any solution because of preceptor and placement site relationships. Indeed, you may already be involved in your CRNA program's disciplinary proceedings. When you retain an attorney advisor to appear in your matter on your behalf, you untie the hands of your program's administrative officials. Your retained attorney advisor can communicate, advocate, and negotiate with program officials over positive options for resolution that avoid your program discipline while also satisfying officials that they can respect program standards and procedures. Your retained attorney advisor can invoke protective procedures, advocate at due-process hearings, take necessary appeals, and even negotiate with oversight officials for alternative special relief after you have exhausted all formal channels.

Retain a Premier National Academic Attorney Advisor

Your best move, if you face CRNA preceptor problems and your CRNA program is unwilling or unable to afford you any relief is to retain national academic attorney Joseph D. Lento and the Lento Law Firm's premier Student Defense Team. Join the hundreds of college, university, and professional program students nationwide who have successfully avoided dismissal or discipline with the skilled and experienced representation of the Lento Law Firm's Student Defense Team. Call 888-535-3686 or go online now.