The Journal of Continuing Education in Nursing

Teaching Tips 

Maximizing Learning Opportunities in Interprofessional Clinical Environments Through Precepting

Marianne Druva Horner, MS, RN, CNM, CNE®cl

Abstract

Effective precepting requires a separate skill set than being an expert clinician, which is something that is often overlooked. Deliberate preparation should include utilization of effective communication techniques, teaching using powerful questions, developing skills for feedback and evaluation, as well as others. Becoming a highly functioning member of an interprofessional team requires special consideration and preparation that can enhance the nurses' role. [J Contin Educ Nurs. 2018;49(12):545–546.].

Abstract

Effective precepting requires a separate skill set than being an expert clinician, which is something that is often overlooked. Deliberate preparation should include utilization of effective communication techniques, teaching using powerful questions, developing skills for feedback and evaluation, as well as others. Becoming a highly functioning member of an interprofessional team requires special consideration and preparation that can enhance the nurses' role. [J Contin Educ Nurs. 2018;49(12):545–546.].

Learners who have the good fortune to have a clinical placement in an interprofessional setting have rich opportunities that will serve them well as practitioners in the contemporary health care arena. For the preceptor, it is important to possess a baseline teaching skill set, and there are additional considerations that need to be made for an interprofessional team environment. “Preceptors are the essential link between what nurses are taught and what they do, and between what nurses know and what they need to know” according to Ulrich (2012, p. xxv)

Effective precepting requires a separate skill set than being an expert clinician, something that is often overlooked. The assumption is that if a provider or a nurse is highly competent in a clinical sense, it is a given that he or she will be an excellent preceptor. An expert clinician can become an excellent preceptor, but without specific preparation there can be dissatisfaction in the role and a less than ideal clinical experience for the preceptee.

Deliberate preparation for this role is important and should include content on effective communication techniques, particularly having to do with learners, the use of powerful questions in teaching, and discussion regarding why precepting is important for the individual for the agency, as well as some of the nuts and bolts of exactly what is required in the role. This includes things such as identification of the best learning experiences, how to pace the clinical learning experiences, how to know when to push the learner to be more independent, and how to know when more supervision is required. Feedback and evaluation content are important for the novice preceptor to understand. For the vast majority of learners, the feedback comes in the form of specifically identified encouragement. Comments such as “Doing fine” or “Great job!” are welcome but not particularly helpful. The preceptor should be as specific as possible regarding exactly what was observed. For example, it is much more helpful to say “I really was impressed with your interactions with the family. The way you sat down with them and really listened to their concerns went a long way to defusing the tense situation.”

On the other hand, the preceptor is a vital link in the quality control on our clinical units. It is imperative that preceptors accept the serious responsibility of stopping the line in cases where the learner is not successfully bridging the theory–practice gap or when it is clear that there has been a mismatch in placing a new employee in the unit. Open communication must exist between the preceptor and unit leadership such that progress or the lack thereof is readily shared.

Additionally, when preceptors work with students, they need to be thoroughly familiarized with FERPA (Family Educational Rights and Privacy Act), which is essentially the educational version of Health Insurance Portability and Accountability Act, with strict regulations for how information regarding a student and his or her performance is handled. Information regarding compliance to these important regulations should be available from the universities who send students.

The good news is that precepting learners requires a skill set that is similar across several disciplines, whether nursing, medicine, pharmacy, social work, or other health care-related professions, which serves well in an interprofessional arena.

All of the above can be superimposed on the challenges and benefits to novice practitioners when they have an opportunity to work in an interprofessional environment. Placement in such an environment presents rich opportunities for novices to learn not only about their own role and skills but to witness how a whole team is able to function for the benefit of individual patients. Health care has become so complex that the single patient with his or her physician and/or his or her nurse to provide care is not realistic. Addressing complex diseases and comorbidities, as well as the social aspects of health and illness, requires varying and broad skill sets that may include players such as a dietitian, a chaplain, social worker, pharmacy, respiratory therapy, physical and occupational therapists, and others in addition to a physician, the designee or advanced practice nurse, and the nurse. Contemporary health care is no longer an individual pursuit between the caregiver and the patient. To fully address the magnitude of needs that are often present, it is important to harness the skills and knowledge of several professionals to provide the highest quality and safest care.

Without deliberate training and effort, the players caring for a patient will demonstrate overlapping care or, conversely, gaps in care and uncoordinated and sometimes competing actions, all with the best interests of the patient in mind. Merely bringing a group together does not make them a team (Kowalski, 2018). Part of the expertise that goes into being a member and sometimes leader of an effectively functioning team can be learned as a portion of a clinical experience that is supervised by a preceptor.

One of the first and foundational pieces of knowledge has to do with developing a clear understanding of the roles of other team members. Novices can valuably spend time with other disciplines to gain a clearer appreciation of the expertise, the knowledge, the skills, and the scope of practice of each. One of the lessons learned through the interprofessional team projects in Colorado is that students in individual disciplines often have incomplete or even inaccurate notions about other professions and how they can interface with their own. Assigning a new employee or a student to spend time with practitioners in other disciplines can yield excellent learning opportunities if there is careful framing. Merely shadowing another professional is of limited value. For example, if a student is assigned to complete an informal interview with another professional that includes such things as “What is the hardest part of your job?” “What is your biggest frustration?” “How can nurses support you in what you do?”, a good deal of insight can be gained that can serve the developing nurse well. Role clarity is a critical component in effective team functioning (Bittner, 2018).

Another consideration when students are present within an interprofessional team is who can precept whom. In general, it is possible for a nursing student to be precepted by other disciplines but the formal evaluation is generally handled within the same discipline. When a nurse accepts a student from another discipline for clinical experience, it is imperative that the student come with specific learning goals. Sharing the excitement of working in a vibrant, interprofessional team is satisfying and requires some additional careful planning.

Becoming a preceptor beautifully dovetails with the future of nursing recommendation number five: “Promote nurses' interprofessional and lifelong learning” (Goosh, 2014, para. 9). A preceptor will be challenged in a variety of ways to support others in their professional development and as a consequence will develop themselves. Each of us has numerous opportunities to grow in our expertise whether for a new employee, a student, or another professional on the interprofessional team. The patients will be the recipients of the enhanced quality of care that we encourage!

References

Authors

Ms. Horner is Project Director, Coach CTI, Colorado Center for Nursing Excellence, Denver, Colorado.

The project described is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant TOBHP29991, entitled Primary Care Training and Enhancement and had no nongovernmental financial sources. This information or content and conclusions are those of the author and should not be construed as an official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.

The author has disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Marianne Druva Horner, MS, RN, CNM, CNE®cl, Project Director, Coach CTI, Colorado Center for Nursing Excellence, 5290 E. Yale Circle, #102, Denver, CO, 80222; e-mail: marianne@coloradonursingcenter.org.

10.3928/00220124-20181116-04

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