Nursing Student Preceptor Issues

The Preceptor Requirement

Nursing students who undertake advanced education, especially in Master of Nursing and Doctor of Nursing practice programs, are very likely to come under the supervision of nursing preceptors. Indeed, the national accrediting agency for nursing schools, the Commission on Collegiate Nursing Education, ensures the quality of nursing programs in part by recognizing only those programs that include clinical training under qualified preceptors. Your nursing school cannot offer an accredited advanced nursing program without requiring you to practice nursing under a preceptor's eye. If you expect to earn any of the following advanced nursing degrees or specialty certifications, then you will very likely face preceptor evaluation:

• Master of Science in Nursing (MSN);
• MSN -- family nurse practitioner (FNP);
• MSN -- adult gerontology primary care nurse practitioner (AGNP);
• MSN -- adult gerontology acute care nurse practitioner (AGNP);
• MSN -- psychiatric-mental health nurse practitioner (PMHNP);
• MSN -- care coordination;
• MSN -- nursing education;
• MSN -- nursing informatics;
• MSN -- public health nursing;
• MSN -- nurse executive, leadership, and administration;
• Advanced Practice Registered Nurse Master of Nursing (APRN);
• APRN -- clinical nurse leader (CNL);
• APRN -- clinical nurse specialist (CNS);
• APRN -- certified registered nurse anesthetist (CRNA);
• APRN -- certified nurse-midwife (CNM);
• Doctor of Nursing practice (DNP).

The Preceptor Experience

In the best case, the preceptor experience can be a capstone to your nursing education. The University of Washington School of Nursing describes clinical precepting as one of the school's “most precious resources in preparing the next generation of advanced practice registered nurses and advanced systems and population health experts. Clinical preceptors have a deep interest in and commitment to our academic programs and demonstrate excellence in clinical practice and community service. Clinical preceptors provide an invaluable piece of students' clinical education.” The University of Washington School of Nursing expects its students to have “high-quality, precepted clinical experiences on a quarterly basis as part of their education.” Doctor of nursing practice (DNP) students, in particular, may spend between one to three days a week under a preceptor for a full year of clinical placements. The University of Washington School of Nursing properly boasts that the preceptor experience gives students “an extraordinary opportunity to learn and work alongside skilled mentor-preceptors through clinical rotations.” Those preceptor experiences can take place in:

• hospitals
• community clinics
• nonprofit agencies
• private medical practices
• school, college, or university wellness centers

The Preceptor's Role

The American Association of Colleges of Nursing describes the role of a nursing student's preceptor as follows:

Clinical Preceptor is a vital component of the clinical education process in creating a safe setting for the [Advanced Practice Registered Nurse] student to gain experience and develop clinical competency to effectively manage the population consistent with the role for which they are being educated, ... across the life span management of patients for the family nurse practitioner student. While not an all-inclusive example, the APRN clinical preceptor serves as a role model by incorporating evidence-based education best practices to ensure safe and effective patient outcomes.

A preceptor's position as role model sounds good. Preceptors are practicing professionals who may want someday to teach or at least want to maintain a relationship with your nursing school. Yet preceptors do not have a classroom of students. You may be your preceptor's only student. Nursing schools tend to limit preceptors who are working full time to supervising just one student at a time, while preceptors working part-time may have a two-student limit. Given the close and individual relationship you will likely have with your preceptor, your preceptor might even take you to lunch and tell you about nursing careers. But notice in the American Association of Colleges of Nursing's description of the preceptor's role that the role focuses on evidence-based education practices. Evidence-based practice means that the preceptor is supposed to be looking at what the nursing student is actually doing and whether the student's actions ensure safe and effective patient outcomes. Clinical practice under a preceptor is where the proverbial rubber meets the road. Your preceptor is about to let you know whether your nursing education has done what it should to prepare you for real practice.

Preceptor Evaluation

Clinical experiences in nursing aren't simply about your survival. It isn't just a question of whether you made it through. Instead, your preceptor will evaluate your clinical work to let your school know how you've done. For example, the University of Pittsburgh School of Nursing maintains a policy on Clinical Preceptors for Graduate Students stating, “Master's [and Doctor of Nursing Practice] students will be required to complete precepted experiences in selected practicum courses, under the direction of qualified preceptors.” The same policy describes the preceptor's role as being “responsible for facilitating student learning and providing a safe place for students to practice.” The kicker, though, is that the same policy requires preceptors to “complete a student evaluation at the end of the precepted experience.” Precepted clinical work isn't a free ride. You must take the work seriously because your preceptor is evaluating you against nursing professionalism standards. Under the University of Pittsburgh's School of Nursing preceptor policy, the nursing professor “[r]etains responsibility for ultimate evaluation of the student with input from the student and the preceptor,” but the preceptor has the direct supervision and evaluation role. Your future rides in part on how well or poorly you impress your preceptor.

The Preceptor Problem

An evaluation may not sound all that threatening. After all, graduate students in nursing have already had a lot of evaluation in their lengthy education. But most or all of that evaluation was by teachers and professors who had training, skill, and experience in evaluating students. And little or none of that evaluation was by a practicing professional who had only one or two students and, potentially, little or no experience supervising and evaluating students. Just because you've done well with teacher and professor evaluation doesn't mean you'll do equally well when you have a busy and potentially inexperienced preceptor evaluating you. Any evaluator, whether an experienced teacher or a busy professional, can have personality conflicts or other issues with individual students. But preceptors can have more of those issues because of their peculiar place in clinical practice and peculiar role of focusing and relying on just one or two students at a time. Preceptors are human. Their employer doesn't employ them to coddle nursing students but instead to get their job done. You can face preceptor problems.

The Clinical Challenge

Preceptor problems can hemorrhage in challenging clinical settings. Preceptors aren't walking around the ivied halls of academia, mulling student performance. Preceptors are paid professionals with substantial patient caseloads, demanding supervisors of their own, and other pressing real-life problems. Preceptors may work in slammed emergency rooms, tense operating rooms, and overwhelmed intensive care units. The preceptor's work may already challenge the preceptor's mind, will, and emotions. Because of the clinical setting and their critical care role, preceptors may not be your touchy-feely sort. They may instead be demanding, with very high expectations. Indeed, they should be pushing students to do their best, setting high expectations. But preceptors may also be very ready to let an intimidated nursing student and the student's school know that the student hasn't met those expectations.

What You Need to Show Your Preceptor

Preceptors properly focus on several competencies in their supervised nursing students. You need to prove yourself competent in each of those areas. You may, in fact, be fully competent in all areas. But having competence is one thing while proving it is another thing. You can be as knowledgeable and skilled as any nursing student anywhere, but you still need your preceptor to recognize those competencies. Your preceptor will want you to show that you have:

• complete, comprehensive, and accurate knowledge of anatomy, illnesses, medicines, therapies, and methods;
• strong, consistent, and effective skills in applying accepted nursing practices in varied clinical settings;
• sound ethical commitment and well-developed professional character to use your knowledge and skill for patient care, comfort, relief, and healing;
• mature professionalism, including clear sensitivity for institutional and professional customs, culture, and norms sustaining professional relationships and interactions.

Bad Preceptor Reports

You may have all of the above competencies, or you may still be developing those competencies when you begin your clinical courses. But either way, you may experience bad preceptor reports. Your preceptor's final written evaluation may be negative, reflecting specific alleged deficiencies in, or broad condemnations of, your clinical work. Your preceptor may even report and complain, orally or in email or other writing, early in your clinical rotation and long before final evaluation, to the assigned clinical professor or the nursing school's staff member administering student clinical work. Whatever the timing and mode of your preceptor's bad report, a bad report could include any of the following allegations:

• inadequate knowledge of nursing and medical terminology;
• inadequate knowledge of nursing methods and practices;
• inadequate skill in applying known methods and practices;
• inadequate skill in communicating with patients;
• inadequate skill in accepting orders and communicating with physicians;
• inadequate skill documenting medical conditions and nursing practice;
• neglect of patients and nursing duties;
• incomplete performance of assigned nursing duties;
• physical injury to patients from poor nursing practice;
• mental and emotional disturbance of patients due to poor communication;
• patient disrespect for medical colleagues due to poor nursing;
• inability to garner trust and confidence from physicians and colleagues;
• unprofessional communications and actions toward colleagues;
• poor personal hygiene, comportment, dress, and demeanor;
• late arrival, early departure, or unexplained absences for assigned duties;
• lack of attention to detail and lack of organization in nursing practice;
• failure to properly prioritize assigned nursing duties;
• inability to manage multiple assignments;
• inability to take direction from multiple supervisors and colleagues.

An Example Unfair Bad Report

A nursing student who isn't prepared for clinical practice or doesn't have the commitment and discipline for it can certainly receive a bad preceptor report. Sometimes, we get the poor evaluation that our work deserves. But at other times, skilled and committed nursing students who are meeting nursing standards can receive an unfair bad preceptor report. Remember that preceptors are human, with their own motives and idiosyncrasy. And they may not have adequate training as supervisors and evaluators. But no matter the unfair cause, you could receive a shockingly unfair bad preceptor report. For example, a preceptor might allege, in a telephone call or email to your clinical course's professor, or in a final evaluation, any of the following unfair and inaccurate deficiencies:

• that you were rude, condescending, or unprofessional with colleagues, when instead colleagues misunderstood or misconstrued your appropriate words and actions;
• that you lacked critical nursing knowledge, when instead you had the knowledge but innocently misunderstood your preceptor's direction or question;
• that your nursing skills endangered patients, when instead others were responsible for the error, injury, or other event or deficiency that the preceptor observed;
• that you neglected assigned work, when instead your preceptor failed to assign the work to you, or you completed the work, but your preceptor failed to observe the completion;
• that you communicated inappropriately or inadequately with patients, upsetting those patients, when instead patients exhibited dementia or confused you with others;
• that you failed to accurately document your nursing work and observations when the clinical site instead lost or deleted your complete and accurate documentation; or
• that you failed to gain colleague trust and confidence when to the contrary, colleagues themselves acted unprofessionally toward you, in a harassing or demeaning manner.

The Potential Consequences of Preceptor Trouble

When things go poorly and you haven't met your preceptor's expectations, things can go very poorly. What happens when you get in trouble with your preceptor can be much more than simply your hurt feelings. Preceptor trouble can, in the worst cases, derail your nursing education. The point is to take preceptor problems seriously. Don't ignore an unfairly critical and damaging preceptor evaluation. The consequences could be more serious than you at first imagine. Be wise and cautious about those potential consequences. A bad preceptor report could lead to any of the following consequences:

• loss of professional reputation, respect, and standing;
• the termination of your clinical experience before you complete it;
• loss of job opportunities, references, and recommendation letters;
• your transfer to another, less-desirable clinical site;
• your loss of credit for the clinical course;
• the necessity of repeating clinical coursework;
• delay in your progress and delay in your graduation;
• complaint to a nursing licensing board;
• claims of nursing malpractice and civil liability;
• criminal charges for patient abuse or neglect;
• your suspension from the nursing school;
• your dismissal from the nursing program;
• acceleration of school loans; and
• inability to enroll in other educational programs.

What to Do About a Bad Preceptor Report

All hope is not lost with a bad preceptor report. If your preceptor unfairly evaluates your performance in a way that could negatively impact your education and career, then take prompt action. Don't lose hope of completing your nursing education with the sterling record you worked so hard to earn. Don't give up the fight. You have several things that you can and should do to set your academic record straight with the accurate evaluation that you deserve. Attitude is everything. Consider each of the following steps.

Preceptor Communication. The first step in any professional relationship in which a conflict exists is to communicate with the other professional. No matter how you hear of your preceptor's bad report, your best first step may be to talk with the preceptor. How you do so, though, is important. Professionalism requires that you respect your preceptor's own skill and judgment. Instead of challenging your preceptor's opinions and conclusions, first, confirm what evidence the preceptor observed suggesting your inadequate performance. You may be able to show the preceptor that the evidence wasn't as the preceptor assumed it to be. Or you may have other evidence the preceptor would need to consider. Focus on facts and evidence, not judgments and conclusions. Help your preceptor correct misunderstandings.

Professor Intervention. If your communication with your preceptor doesn't cure the unfairly bad report, then promptly communicate with the professor assigned to your clinical experience. Your professor, not the preceptor, has the final say in how well or how poorly you did in your clinical work. Your professor may help you communicate with your preceptor, including holding a conference among the three of you. And if that intervention doesn't work, the professor and school may still have options to help you. When preceptor relationships go unfairly awry for a student, schools can and do reassign students to new preceptors in similar or different clinical settings. If you have a problem preceptor, then your best move may be to get out of there and over to a new clinical experience.

Administrative Intervention. If your clinical professor is unable or unwilling to help you correct an unfairly bad preceptor evaluation, then exhaust your other avenues within the school's administration. That may mean contacting the clinical program manager, a clinical department chair, an assistant dean, or the dean or vice president of academic or student affairs. Schools generally don't want problems, especially with valued professional partners like hospitals, clinics, private practices, and their professionals who act as preceptors. Wise school administrators tend to prefer to make problems go away than to allow them to fester. You won't get relief simply for showing that you have a demanding preceptor. But you could well get relief if you show that your preceptor is unprofessional, unbalanced, or otherwise unfit to supervise nursing students.

Attorney Consultation. If your preceptor, professor, and school refuse to correct an unfairly bad preceptor evaluation, that evaluation looks to adversely affect your education and career. This is not a road to travel alone. The advice and counsel of national academic attorney Joseph D. Lento and the expert team at the Lento Law Firm can increase the odds of a fair resolution. Attorney Lento has helped hundreds of nursing students nationwide to get relief from unfair misconduct allegations and to avoid or correct unfair discipline. Attorney Lento can help you confirm and document the specific problem that you have with your preceptor and then help you advocate with school officials for relief. Schools typically have ombudsman and general counsel offices, helping the school meet its student obligations and avoid unnecessary, expensive, and disruptive disputes, embarrassment, and litigation. They also typically have dispute-resolution and academic-appeals procedures through which students can, with a skilled attorney's advice, gain relief from unfair evaluation and discipline. If Attorney Lento's outreach to and advocacy with the school does not gain you appropriate relief, then a litigation remedy is sometimes available.

Retain a Premier National Academic Attorney

Ultimately, your best move in the event of an unfairly bad preceptor report is to retain a national academic attorney who has the skills and experience to navigate academic procedures. Most lawyers don't have experience in academic administrative matters. A general practice lawyer, even one who handles civil litigation and criminal defense, generally won't do. You need legal representation from a national academic attorney who knows academic norms, procedures, and rules. You also need a committed and confident advocate who knows how to fight effectively for you.

If you have suffered an unfairly bad preceptor report that is holding you back or presents the prospect of holding you back, then promptly consult and retain national academic attorney Joseph D. Lento and the Lento Law Firm. Attorney Lento is ready for your aggressive and effective representation. The right representation can help you correct an unfairly bad record and avoid damaging consequences that could result. If you've already suffered suspension or dismissal, then you especially need a committed legal professional's review. Remember all that you have at stake in your education. Call 888-535-3686 to schedule a consultation with Attorney Joseph D. Lento and the Lento Law Firm or use the online service.