Advancing education: Nurse preceptors ease the transition from classroom to clinic
by alicia potter, photographs by justin knight
It’s a December morning at Harvard Vanguard Medical Associates in Somerville, and Maureen Gehlenborg, M.S. ’13, is giving a pregnant woman an ultrasound. “You have a busy baby!” she tells her. Cynthia Tefft, M.S. ’82, looks up from her notes and agrees. “Have you been seeing a lot of movement?” she asks. The woman laughs and relays her toddler son’s amazement at how much the baby kicks.
Tefft takes the lead for the rest of the appointment, gently interviewing the woman about her birth plan, while Gehlenborg mostly listens. However, when the woman inquires about exercising post-C-section, Tefft turns to Gehlenborg for the answer. “Maureen has five years’ experience in labor and delivery,” she explains, and steps aside.
Tefft is Gehlenborg’s preceptor, a clinician-teacher who transforms routine exams such as this into opportunities for learning. During their academic year together, she supervises Gehlenborg as she performs Pap smears, breast exams, HPV tests, and other aspects of pre- and post-natal care. She also guides the younger nurse as she further hones a critical skill: interacting with patients.
Skilled nurses have played a role in educating students in clinical settings since the time of Florence Nightingale, and preceptors have augmented nursing education at Boston College since it opened its school of nursing in 1947. Today, approximately 300 preceptors each semester help train Connell School of Nursing (CSON) graduate students as they make the transition from classroom to clinic. They work in internationally renowned hospitals, public school systems, hospices, prisons, and homeless shelters.
As advanced practice nursing programs attract more students, particularly in the Boston area, the demand for preceptors is on the rise, according to nursing experts. But many nurses choose not to teach in the field. Nursing journals describe a “shortage” of preceptors, and a 2009 online poll conducted by the National Association of Pediatric Nurse Associates and Practitioners found that just three percent of respondents planned to “precept” in the coming year. In an age of health care cost containment, when nurses are expected to handle more patients and paperwork in less time than in the past, teaching on the job strikes some as more of a burden than an opportunity. While Boston College preceptors receive benefits—including partial tuition for course work, reimbursement for continuing education, or conference fees—they are not paid.
But for nurse practitioners like Tefft, who has been working with students for 30 years, the rewards of precepting significantly outweigh its drawbacks. As she and several other veteran nurse-teachers see it, precepting isn’t just an added responsibility—it’s an integral part of being a nurse practitioner (NP). What’s more, they say, it’s as crucial to their success in a fast-changing field as it is to that of trainees.
“I precept for the love of the job,” says Tefft, “and for the love of teaching. But I also do it to keep me on my toes.”
Managing the match
As a nursing student, Tefft found her own preceptor, and there was a time when nursing schools left it to students to do so. “I went begging for someone to precept me,” recalls Associate Professor Jane Flanagan, who lines up students and preceptors for the CSON adult gerontological health track.
The Connell School places a premium on what it calls “the match”: the highly individualized process of pairing student and preceptor to meet learning goals. “Making sure we get the right placements for students is huge,” says Flanagan. “We want to give students the clinical transition they need based on their experience.”
CSON faculty members actively recruit new preceptors, often from the school’s alumni ranks. They also work closely with clinics to assess students’ progress, through both written evaluations and on-site visits.
“We’re looking for excellent clinicians who are committed to the profession,” says Flanagan. “But they also must be able to balance, in a very artful way, recognizing when to push a student and when to give gentle direction.” Preceptors, she adds, have to be “patient with the process of translating textbook knowledge to a clinical setting.”