Should I Agree to Precept Nurse Practitioner Students?

Carolyn Buppert, MSN, JD

Disclosures

November 28, 2017

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Question

A Request to Precept

A nurse practitioner who frequently receives requests from student nurse practitioners to precept them has a couple of concerns. "I've heard that the preceptor or practice can't bill for a student's work and that I might be held liable if the student makes a mistake. What are the rules on billing student visits, and what is my liability for a student's work?"

Response from Carolyn Buppert, MSN, JD
Healthcare attorney

Students' work cannot be billed. It is the preceptor who is licensed, certified, and credentialed by the payer as a nurse practitioner, not the student. And you can't use the student's documentation, with two exceptions. There are two things the student (or any office staff) can elicit from a patient and document that you don't need to redo and redocument. Those are the review of systems and the patient's medical, family, and social history. Everything else—chief complaint, history of present illness, examination, and medical decision-making—must be performed and documented by the preceptor.

Students can be helpful, in spite of these limitations. It saves time if the preceptor doesn't need to take a review of systems and medical, family, and social history. And students can be enlisted to help with clinical improvement projects and patient education. Essentially, the economic argument for having students is that the practice or facility may find great prospective employees by precepting.

As for your liability for student errors, you have the same responsibility as any supervisor. That is, it's your responsibility to do the following:

  • Ensure that the student is adequately prepared to perform the service you direct the student to perform;

  • Check and correct the student's work often enough that you are confident that the student is competent (at the same level as a nurse practitioner); and

  • Be available when the student needs you.

Whether you or the school's faculty member prepares the student for these activities is between you and the faculty; however, someone needs to provide the training before you let students see patients on their own.

I searched for cases in which a preceptor was held liable for a student's error and patient injury. I haven't found any at the graduate level, although there are some at the undergraduate level. An example is a student who gave an injection in the wrong place in a patient's gluteus, and the patient suffered nerve damage. The host facility was found liable, along with the preceptor. The student had not correctly identified the landmarks for the injection. The court assumed that the student had not been taught about the landmarks or the potential for patient harm if the landmarks aren't identified. The court believed that the student had not been supervised during an injection before doing it on her own.

Your risks for liability for student errors is low if you attend to your preceptor responsibilities. If you think a student is risky, or too much work for you to take on, then notify the school of nursing faculty member or liaison so that the student can get more attention from the faculty. You may ask to be relieved of preceptor duties.

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