Why Your Preceptor is Failing You as a NP Student

...and Why You Should Think Differently About It 

I had an interesting conversation with a nurse practitioner student the other day. She was disappointed in her assigned preceptor. She felt like her preceptor didn't give her much autonomy in patient care and took little time to explain what she was doing and how she was making decisions. I find that dissatisfaction with preceptors is common among NP students. As an experienced NP helping out new grads, I've also seen the other side of the equation. 

While its true, some nurse practitioners just aren't cut out to be preceptors, there are several valid reasons that your preceptor doesn't seem to be meeting the mark. So, the next time you're feeling low about your clinical placement as a nurse practitioner student, keep these things in mind to gain a little understanding. 

1. Your Preceptor May be Taking a Pay-Cut to Host You 

Many nurse practitioners are paid based on productivity. In a nutshell, this means that the more patients the NP sees, the bigger their paycheck. Hosting a nurse practitioner student takes some time and effort and likely means the NP can't function as efficiently during the workday. So, if your preceptor sees fewer patients by nature of hosting you as a NP student this could translate to lower pay. 

2. Your Preceptor is Also Being Evaluated

While your preceptor may be volunteering to help train you, he or she also has a job to do and demands placed on him/her by an employer. Employers can be stringent when it comes to meeting certain metrics. For example, the emergency department where I work measures how many minutes it takes each provider to greet a patient in the room, the number of minutes it takes to order a test, then, the time from the patient's arrival to discharge. The department closely monitors each of these metrics. Each provider must answer to their own metrics in a performance review. 

Precepting a nurse practitioner student means moving a bit slower in patient care and taking the time to explain, answer questions and the like. So, the preceptor isn't performing as well in their own position, at least to the standards demanded by an employer. This means as a NP student you may not get as much attention or as lengthy of explanations to your questions as you would like because of preceptor is balancing your needs with an employer's expectations.  

3. Legit Liability Concerns 

What happens if you totally mess something up as a nurse practitioner student? Who is responsible? You, your university, the facility in which your working and your preceptor can all be to blame. While you are required to carry medical malpractice insurance as a NP student, a preceptor is responsible for a nurse practitioner student's actions based on the principles of delegation. 

State delegation laws for advanced practice providers require that NPs delegate tasks only to individuals who are properly trained, and that the task is within the individual's scope of practice. In the case of precepting an NP student, the scope of practice considered would be that of nurse practitioners in the state where the clinical site is located. 

Healthcare providers precepting NP students must take care to delegate appropriately. This begins with establishing the competence of the individual student and tailoring the level of supervision and delegation of tasks appropriately. Patients should never be placed in danger by a student's inexperience. 

Your preceptor naturally may have some liability concerns and hesitate to give you free reign as a nurse practitioner student when it comes to patient care. 

The Takeaway?

Having an amazing, mentoring, knowledgeable preceptor is of course ideal. But, given that precepting takes place within the constrains of a normal workday and typically without compensation, the system by which NPs are trained is by no means perfect. No one said the issues above are fair, but they can be the reality of precepting a nurse practitioner student. So, the next time you're disappointed in your clinical placement keep these issues in mind to give you a little perspective. Your placement may not be as bad as you think. Instead, focus on what you have to learn and the experiences you are taking away from the clinical assignment. 

 

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