Mastering the Preceptor Role: Challenges of Clinical Teaching

Catherine Burns, PhD, RN, CPNP, FAAN; Michelle Beauchesne, DNSc, RN, CPNP; Patricia Ryan-Krause, MS, MSN, RN, PNP; Kathleen Sawin, DNS, CPNP, FAAN

Disclosures

J Pediatr Health Care. 2006;20(3):172-183. 

In This Article

Abstract and Introduction

Abstract

This article aims to help both experienced and new preceptors become more effective teachers while maintaining their clinical workloads. A variety of strategies is essential to increase teaching effectiveness and decrease stress for the busy preceptor who juggles the roles of teacher and clinician. The article will begin with a review of role expectations and role strain factors for student, faculty, and preceptor. Principles of clinical teaching will be identified, followed by some strategies for teaching on busy days and concluding with suggestions for dealing with difficult students.

Introduction

Guided clinical learning experiences are essential to nurse practitioner (NP) education. The goal is to prepare clinicians to manage care with optimal health outcomes. The preceptorship has proved to be a highly useful strategy for clinical education. It allows education to be individualized, links classroom knowledge to real patient management problems, and provides for role modeling as the student develops standards and strategies for practice.

In the United States, preceptor-ships involve more than 500 hours of supervised clinical practice in the particular NP specialty with preceptors who are either experienced NPs or physicians in the same specialty. The student and preceptor have a one-to-one relationship. In the typical clinical practice teaching episode, the student does the assessment and presents the case to the preceptor with diagnosis and plan outlined, the preceptor validates the assessment and plan, the student implements the plan with assistance as needed, and the preceptor helps the student reflect on the case and its implications. As the student works with the preceptor over an academic term or more, he or she is expected to increase knowledge and skills, refine practice efficiency and effectiveness, and become increasingly independent in managing patient care. The preceptor provides constant feedback and support to the student and evaluation data to both the student and faculty (National Organization of Nurse Practitioner Faculty, 2000).

This type of teaching is not without problems, however. Irby (1995) noted that teaching in the clinical setting often occurs at a rapid pace with multiple demands on the preceptor; is variable in teaching and learning opportunities as cases vary unpredictably in number, type, and complexity; and has a relative lack of continuity. In a busy setting, there may be limited time for teaching and feedback. In turn, the student may not find learning to be collaborative with the preceptor, may lack opportunities and time for reflection, and may find that independent learning is not at an optimal pace given the student's learning style.

A previous study of the preceptor as mentor (Beauchesne & Howard, 1996) concluded that preceptors may need help in identifying an individual student's learning style and in determining their own leadership style. Preceptor development is worth the time and energy needed because, if it is done successfully, the preceptor, student, and faculty all will benefit from more efficient, less stressful teaching by preceptors in clinical settings.

A survey by Burns (2003) for the Association of Faculties of Pediatric Nurse Practitioner Faculties of 350 preceptors attending the National Association of Pediatric Nurse Practitioners Annual Conference found that 89% preceptored because they felt an obligation to the PNP specialty and 85% did so because they liked teaching. Ninety-four percent said that they planned to continue precepting. Thus, despite the problems, preceptors find this role to be inherently satisfying.

This article addresses several strategies to increase teaching effectiveness while decreasing stress as the busy preceptor juggles the roles of teacher and clinician. It reviews role expectations and role strain factors for student, faculty, and preceptor; identifies some key principles of clinical teaching; suggests a variety of strategies for teaching on busy days; and concludes with suggestions for dealing with the difficult student. The goal is to help both experienced and new preceptors become more effective teachers while maintaining their clinical workloads.

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