The culmination of the BSN nursing student’s clinical experience is the immersion experience. In a Midwestern region of the US, the numbers of student placements for immersion experiences has been growing to meet the demand for nurses. Each of these students requires a preceptor. An established cooperative group of nursing school and clinical site representatives determined to collaborate to find more preceptors. The group identified a task force of their peers with equal representation from schools and clinical sites. This Task Force developed ground rules of respect and transparency as they deliberated their purpose and plans.
Preliminary meetings were focused on identifying the barriers experienced by both the schools and the clinical sites in finding preceptors. Three areas were identified within the realm of influence of this group:
- The scheduling process: coordinating the preceptor and student schedules
- Faculty involvement
- The evaluation tool for the immersion experience
The problems identified in these three areas are summarized below:
SCHEDULING: Issues with scheduling were separated into three groups: school issues, student issues, and preceptor/clinical site issues
The school determined the numbers of hours required, the timeframe within which the hours must be completed, and the scheduling of conflicting classes/events. Each of these impacted the scheduling process. The student issues included conflicts in their schedule from a variety of activities, anxiety related to communication, and the pressure of scheduling all their shifts. The clinical site and preceptors were required to work around the school’s schedule, meeting the clinical hours required by each school. The preceptor was in high demand both for students and new hires. The preceptor work schedules were often created up to eight weeks before being contacted by the student.
FACULTY: Faculty involvement varied among the schools represented. There was not a standard of engagement or of numbers of site visits required during the immersion experience. The communication with the students and preceptors both in quality and quantity was also varied. Some schools provided very structured plans for faculty while others did not. The evaluation involvement by the faculty and preceptor was also not standardized among the schools.
EVALUATION: Each school provided their objectives and written instructions to the preceptor based upon their approved curriculum. Again, these were not standardized, having between 5 and 14 objectives which the preceptor and student were expected to meet. The instructions given the preceptors came from the faculty, the school, and/or the students.
The Task Force presented their recommendations in phases. Report out was given firstly to the larger collaborative group. Once approved, the recommendations were placed before the executive clinical leader group and the executive educational leader group for approval. Each of the recommendations were approved and were then implemented as a trial at a large academic medical center.
The recommendations included standardization in all three areas:
SCHEDULING: Once sites were approved, the student would contact the preceptor with the expectation of following the preceptor’s schedule. Conflicts in the student’s schedule were first reviewed by the school then if necessary, the school would request an additional preceptor. This eliminated students and faculty soliciting preceptors, and attempting to accommodate the student’s schedule rather than the preceptor’s schedule. If a conflict arose because of a preceptor absence, the clinical site would locate a substitute preceptor.
FACULTY: Faculty attended an orientation to the clinical setting, its policies and procedures related to student immersion experiences, and to the tools/ guidelines developed with associated expectations. Faculty contact information was collected and provided directly to the clinical site and the preceptor. Expectations to engage the preceptor, student, and preceptor-student dyad during rounds a minimum of 1-2 times/40-50 hours of clinical were made clear.
EVALUATION: An evaluation tool was created, based upon the BSN Essentials (2008) listing four goals with supporting competency statements. A Likert scale was developed using a DASI scale: Dependent-Assisted-Supervised-Independent.
These processes will be implemented city-wide this fall and evaluations collected from students, faculty and preceptors. Evaluations from the pilot are still being processed and will inform the work going forward, in a continuous improvement process.