- Email: [email protected]
Faculty Clinical Site Visits Versus Preceptor Evaluation of NP Students
POINT
counter-point
Roberta Hoebeke
Roberta Hoebeke, PhD, FNP,APRN-BC, is an assistant professor of nursing who teaches graduate students in the family nurse practitioner (FNP) program at the University of Southern Indiana in Evansville. She received a BSN from Michigan State University in East Lansing, an MS in nursing from the University of Wisconsin-Milwaukee, and a PhD in nursing from the University of Wisconsin-Madison. She holds ANCC certification as an FNP, maintains a part-time FNP practice at Family Medicine Associates in Evansville, is a member of NONPF, and a site visitor for the Commission on Collegiate Nursing Education.
Jessica MacLeod
Jessica MacLeod, MSN, FNP, APRN-BC, is an FNP who received a BSN from Fairfield University in Fairfield, Conn, and an MSN from Indiana University, where she is enrolled in the PhD program in nursing science. She teaches in the undergraduate nursing and graduate FNP programs at the University of Southern Indiana in Evansville. She maintains an FNP practice at Family Medicine Associates in Evansville.
Faculty Clinical Site Visits Versus
Preceptor Evaluation of NP Students In 2002, the National Task Force on Quality Nurse Practitioner Education, in the Criteria for Evaluation of Nurse Practitioner Programs, published the mandate to “evaluate students cumulatively based on clinical observation of student performance by NP faculty and the clinical preceptor’s assessment” and that “Direct clinical observation of student performance is essential.” The National Organization of Nurse Practitioner Faculties (NONPF) supports this mandate, including for distance education students. This standard was reaffirmed and endorsed in 2003 by the Commission on Collegiate Nursing Education in their Standards for Accreditation of Baccalaureate and Graduate Nursing Programs. The number of nurse practitioner (NP) programs continues to proliferate, and more options for distance education have become available for students. Fulfilling these obligations and ensuring clinical competence present challenges for academic institutions, faculty, and students who desire quality education. This will require NP programs to review their current practices of clinical site visits, reconsider the geographic region of students they will reach, and examine the burdens of cost and time resources for faculty and students. Can students be evaluated for a degree by preceptors who are not at the academic institutions, or must students visit the campus or be evaluated by a faculty member? To comment on this matter, e-mail section editor Jacqueline Rhoads at [email protected].
Online Poll: What is your view on this topic? Go to www.npjournal.org to register your preference. 316
The Journal for Nurse Practitioners - JNP
May 2006
Support for Faculty Clinical Site Visits
Rationale for Evaluation by Clinical Preceptors
Roberta Hoebeke
Jessica MacLeod
support faculty site visits to evaluate the clinical performance of NP students for three reasons. First, when faculty consistently evaluate student clinical performance by direct supervision, they are more likely to apply and interpret the elements of the clinical evaluation tool reliably. Nonfaculty preceptors who directly supervise NP students may vary considerably in how those elements are interpreted and applied. Does the preceptor understand the student’s learning goals, the clinical experience, and the level of progression that the student has attained? One preceptor may expect too much and another too little. Without prior orientation and good communication, preceptors may not understand the clinical evaluation tool, misclassify a rating, or give inadequate substantive supporting comments for why a rating was given. Second, when a faculty member visits the site, there is an opportunity to evaluate not only the student’s critical thinking ability and progression in the NP role but also the quality of the clinical setting and the student–preceptor interaction. On occasion I have intervened on behalf of a student because the clinical site or the preceptor–student dynamics were not optimal for learning. This is difficult to evaluate from a distance by email or phone. Third, I believe that the student’s degree is granted by the academic institution through the faculty, not through preceptors. I am responsible for evaluating student clinical performance, with preceptor input. Direct supervision evaluation can be accomplished by the faculty going to a distance or local site, or the student can come to campus for the evaluation using local clinics or standardized patients. Ultimately, I believe that I have a responsibility to my profession, to our students, to my academic institution, and to the public to ensure consistency, quality, and rigor in the evaluation standards I apply.
I
believe that requiring direct faculty clinical evaluation of all NP students creates unnecessary barriers that could ultimately decrease the number of competent advanced practice nurses. Universities that offer NP degrees are usually located in urban or suburban areas. Requiring faculty observation of students would necessitate that either clinical practice sites are near campus, students come to campus to demonstrate competency, or faculty travel to clinical sites. All options are problematic for distance students. The cost of obtaining a graduate degree is significant. Asking students to shoulder the additional financial burden of travel may decrease the number of nurses willing to pursue an advanced degree. This burden would be disproportionately felt by nurses living in rural areas—the very areas where NPs are most needed. At a time when our profession wants to increase diversity of practitioners, do we really want to limit an advanced degree to those who either live in proximity to a university or have the personal financial resources for tuition and travel? Sending faculty to clinical sites may offer a solution, but university budgetary restraints may limit the distance that faculty can travel. Limiting the geographic radius of clinical sites means that some students may not be eligible for the program simply because of where they live. With the current shortage of nursing faculty, the travel time necessary for direct clinical observation may not be the best use of faculty resources. With clear guidance from faculty, clinical preceptors can and do provide accurate student clinical evaluations. Data show that NPs go on to provide quality primary care. There is no evidence that NPs evaluated by preceptors while in school go on to have poorer patient outcomes than those evaluated by faculty. Why are we changing our clinical requirements and creating unnecessary barriers when our existing system works?
I
1555-4155/06/$ see front matter © 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.nurpra.2006.03.014
www.npjournal.org
The Journal for Nurse Practitioners - JNP
317
counter-point
Roberta Hoebeke
Roberta Hoebeke, PhD, FNP,APRN-BC, is an assistant professor of nursing who teaches graduate students in the family nurse practitioner (FNP) program at the University of Southern Indiana in Evansville. She received a BSN from Michigan State University in East Lansing, an MS in nursing from the University of Wisconsin-Milwaukee, and a PhD in nursing from the University of Wisconsin-Madison. She holds ANCC certification as an FNP, maintains a part-time FNP practice at Family Medicine Associates in Evansville, is a member of NONPF, and a site visitor for the Commission on Collegiate Nursing Education.
Jessica MacLeod
Jessica MacLeod, MSN, FNP, APRN-BC, is an FNP who received a BSN from Fairfield University in Fairfield, Conn, and an MSN from Indiana University, where she is enrolled in the PhD program in nursing science. She teaches in the undergraduate nursing and graduate FNP programs at the University of Southern Indiana in Evansville. She maintains an FNP practice at Family Medicine Associates in Evansville.
Faculty Clinical Site Visits Versus
Preceptor Evaluation of NP Students In 2002, the National Task Force on Quality Nurse Practitioner Education, in the Criteria for Evaluation of Nurse Practitioner Programs, published the mandate to “evaluate students cumulatively based on clinical observation of student performance by NP faculty and the clinical preceptor’s assessment” and that “Direct clinical observation of student performance is essential.” The National Organization of Nurse Practitioner Faculties (NONPF) supports this mandate, including for distance education students. This standard was reaffirmed and endorsed in 2003 by the Commission on Collegiate Nursing Education in their Standards for Accreditation of Baccalaureate and Graduate Nursing Programs. The number of nurse practitioner (NP) programs continues to proliferate, and more options for distance education have become available for students. Fulfilling these obligations and ensuring clinical competence present challenges for academic institutions, faculty, and students who desire quality education. This will require NP programs to review their current practices of clinical site visits, reconsider the geographic region of students they will reach, and examine the burdens of cost and time resources for faculty and students. Can students be evaluated for a degree by preceptors who are not at the academic institutions, or must students visit the campus or be evaluated by a faculty member? To comment on this matter, e-mail section editor Jacqueline Rhoads at [email protected].
Online Poll: What is your view on this topic? Go to www.npjournal.org to register your preference. 316
The Journal for Nurse Practitioners - JNP
May 2006
Support for Faculty Clinical Site Visits
Rationale for Evaluation by Clinical Preceptors
Roberta Hoebeke
Jessica MacLeod
support faculty site visits to evaluate the clinical performance of NP students for three reasons. First, when faculty consistently evaluate student clinical performance by direct supervision, they are more likely to apply and interpret the elements of the clinical evaluation tool reliably. Nonfaculty preceptors who directly supervise NP students may vary considerably in how those elements are interpreted and applied. Does the preceptor understand the student’s learning goals, the clinical experience, and the level of progression that the student has attained? One preceptor may expect too much and another too little. Without prior orientation and good communication, preceptors may not understand the clinical evaluation tool, misclassify a rating, or give inadequate substantive supporting comments for why a rating was given. Second, when a faculty member visits the site, there is an opportunity to evaluate not only the student’s critical thinking ability and progression in the NP role but also the quality of the clinical setting and the student–preceptor interaction. On occasion I have intervened on behalf of a student because the clinical site or the preceptor–student dynamics were not optimal for learning. This is difficult to evaluate from a distance by email or phone. Third, I believe that the student’s degree is granted by the academic institution through the faculty, not through preceptors. I am responsible for evaluating student clinical performance, with preceptor input. Direct supervision evaluation can be accomplished by the faculty going to a distance or local site, or the student can come to campus for the evaluation using local clinics or standardized patients. Ultimately, I believe that I have a responsibility to my profession, to our students, to my academic institution, and to the public to ensure consistency, quality, and rigor in the evaluation standards I apply.
I
believe that requiring direct faculty clinical evaluation of all NP students creates unnecessary barriers that could ultimately decrease the number of competent advanced practice nurses. Universities that offer NP degrees are usually located in urban or suburban areas. Requiring faculty observation of students would necessitate that either clinical practice sites are near campus, students come to campus to demonstrate competency, or faculty travel to clinical sites. All options are problematic for distance students. The cost of obtaining a graduate degree is significant. Asking students to shoulder the additional financial burden of travel may decrease the number of nurses willing to pursue an advanced degree. This burden would be disproportionately felt by nurses living in rural areas—the very areas where NPs are most needed. At a time when our profession wants to increase diversity of practitioners, do we really want to limit an advanced degree to those who either live in proximity to a university or have the personal financial resources for tuition and travel? Sending faculty to clinical sites may offer a solution, but university budgetary restraints may limit the distance that faculty can travel. Limiting the geographic radius of clinical sites means that some students may not be eligible for the program simply because of where they live. With the current shortage of nursing faculty, the travel time necessary for direct clinical observation may not be the best use of faculty resources. With clear guidance from faculty, clinical preceptors can and do provide accurate student clinical evaluations. Data show that NPs go on to provide quality primary care. There is no evidence that NPs evaluated by preceptors while in school go on to have poorer patient outcomes than those evaluated by faculty. Why are we changing our clinical requirements and creating unnecessary barriers when our existing system works?
I
1555-4155/06/$ see front matter © 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.nurpra.2006.03.014
www.npjournal.org
The Journal for Nurse Practitioners - JNP
317