When I enrolled in my nurse practitioner (NP) program several years ago, after working as a nurse for 10 years, I found that it was typical of my fellow students to have had at least 5 years of clinical nursing experience prior to entering the program. As I found, this experience would serve us well when we entered our clinical rotations. Our familiarity with methods and procedures and our experience with direct patient care allowed us to jump in and take more responsibility right from the start, and allowed us to focus our attention on the advanced clinical skills we were there to learn.
In the process, it also established a general level of competence that our clinical preceptors came to expect from the students they mentored. This helped them to structure a balance between supervision and autonomy in the mentoring relationship that allowed students to build confidence in their advanced practice skills and yielded a positive experience for both mentor and mentee.
However, in recent years, I have noticed what appears to be an increasing trend toward students going right into NP programs directly from nursing school or after having worked for only a year or two. This has meant that an increasing number of NP students are entering clinical rotations for which they may not be adequately prepared to quickly assume the level of responsibility that will be expected of them. This can create problems for both NP students and their clinical preceptors.
Nurse practitioner students who lack solid years of nursing experience to fall back on may find themselves feeling overwhelmed and discouraged when given too much autonomy too quickly. In one case, an otherwise promising NP student was so discouraged by her experiences in clinical rotation that she ultimately dropped out of her program. Also, inexperienced NP students may be a source of great anxiety to their clinical mentors, who bear legal responsibility for any mistakes their mentees may make. A mentor used to dealing with more experienced students may tend to expect more than the inexperienced student can handle and may misinterpret inexperience for poor work attitude.
In my own experience, as a clinical nurse practitioner in a busy geriatric outpatient clinic, where I routinely precept nurse practitioner students, I have found that those students with prior patient care experience consistently do better and get more out of their clinical rotations. In addition, these students generally have greater success finding a job after graduation.
To avoid these sorts of problems, it is important for both preceptor and student to discuss up front the student's level of prior experience so that both can adjust their expectations accordingly. I now make a point to talk to the NP students prior to starting their clinical rotation to determine their level of nursing experience as well as their level of confidence in their physical assessment and decision-making. In the same way that my initial assessment interview with a patient determines the treatment plan I develop, I have found that performing an initial assessment interview with each new student helps me better determine a precepting plan that can help that student get the most out of the rotation and control my anxiety level as well.