Title
School of Nursing: Standard On Clinical Teaching And Supervision
Unit Standard
Introduction
Purpose
The purpose of this document is to provide guidance to faculty regarding expectation for clinical teaching and supervision.
Scope of Applicability
This Standard applies to both undergraduate and graduate clinical courses, and to courses taught by both direct and indirect supervision. At the undergraduate level, this Standard applies to courses for pre-licensure (BSN and ABSN) students and to the undergraduate courses for RN to MSN students. At the graduate level, this Standard applies to MSN and DNP clinical courses.
Standard
Clinical experiences are an essential component of the education of BSN, MSN, and DNP students. The School of Nursing faculty are committed to providing the highest quality instruction, which includes formal classroom experiences, clinical supervision and mentorship. The students' overall evaluation of their educational experience and their socialization as nurses will, in part, be determined by the degree to which their student clinical experiences are positive. Often students will look to their clinical faculty and preceptors as the role models and mentors who helped to solidify their professional values, role identification and career pathways.
The degree of clinical supervision provided by faculty varies, dependent on whether the student is licensed or unlicensed and whether the preceptor is an RN or another type of health care provider.
Expectations for Clinical Teaching
Clinical teaching and supervision play a vital role in the education of BSN, MSN, and DNP students. Clinical teaching and supervision entails both supervisory and evaluative activities within a specific course.
There are important distinctions between direct and indirect clinical supervision. Direct clinical supervision occurs when a faculty member is providing the actual supervision of the student in the clinical setting. Indirect clinical supervision occurs when a student is supervised directly by a clinical preceptor and indirectly by a faculty member who has responsibility for the clinical section of a course. In situations where faculty are assigned as indirect clinical supervisors, they act as a liaison to a clinical agency on behalf of the School of Nursing and are responsible for evaluating student progress and providing oversight of the clinical learning experience.
The faculty member maintains the ultimate responsibility for the student's learning in a specific course. Frequent contact with the student and the preceptor in the clinical setting is necessary for the faculty member to have a good understanding of how the student is performing. It also facilitates early intervention when a student's performance is not at the level expected for that course. In the end, it is the supervising faculty member who evaluates the students' performance using their own assessment data and input from the preceptors.
It is an expectation that faculty will be present during their assigned undergraduate and graduate direct supervision student clinical experiences. In exceptional circumstances, if a faculty member cannot meet their clinical assignment, the appropriate parties need to be notified. If the absence will be for one day, the faculty member must notify the course coordinator and negotiate a plan for making up the clinical time. If the absence will be longer than one day, the faculty member needs to notify the course coordinator, lead faculty, and Associate Dean so that an appropriate plan for coverage can be negotiated.
Undergraduate Student Supervision
Consistent with Board of Nursing requirements, all undergraduate clinical experiences must occur in a clinical agency that has been reported to the Board. In addition, the School of Nursing must have a signed Clinical Contract or Memorandum of Understanding with the agency before a student can begin a clinical experience in that agency. It is not a faculty responsibility to fulfill these contractual requirements. The Office of Academic Affairs needs to know when an agency is being considered for use and will ensure that the clinical agency meets Board of Nursing requirements and that appropriate contractual agreements are in place.
Direct Supervision
In clinical courses, the ratio of faculty to students for direct supervision is ordinarily 1 faculty member working with 8 to 9 students. At no time should faculty be expected to provide coverage for more than 10 students in a clinical section. Faculty members should not be expected to provide supervision for more than 12 hours per day.
For undergraduate direct clinical supervision, faculty may take breaks and meals just as employees in the clinical agency do. At all other times, faculty are expected to be on the unit with their clinical group. If a clinical faculty member is going to be off the unit, it is essential that unit staff know where the faculty member will be and how to contact them.
Indirect Supervision
In some courses, students will work with preceptors to complete clinical experiences and course objectives. As defined by the North Carolina Board of Nursing, a preceptor is a highly qualified professional with specific clinical expertise and knowledge of the teaching/learning process. She/he agrees to serve as a role model, resource person, and to provide support for the nursing student while supervising the student's clinical experiences. Ideally, this is accomplished in a one-to-one experience. However, depending on the complexity of patient needs, level of the student in the program of study, and the specific learning objectives, the preceptor student ratio may be adjusted (see Board of Nursing guidelines). Faculty should not be assigned to supervise more than 15 pre-licensure students who are working with a preceptor at any one time.
At the undergraduate level, clinical agencies require that faculty be available on call when students are working directly with RN preceptors. Faculty need to be sure that agencies and preceptors know how to contact them when situations arise with students. Generally these are urgent situations so it is essential that faculty be available when agencies and preceptors are trying to contact them.
When students are working with preceptors, the number of site visits made may vary with the type of preceptor, the length of the clinical day, and the progress of the student assigned at the site. Site visits or another form of communication with the student and preceptor should occur weekly when students are working with RN preceptors. If the preceptor is not an RN, then faculty site visits should be made more frequently. With distance education courses, alternatives to site visits may be negotiated with the approval of the program director.
Observation Experiences/Secondary Site Experiences
Some courses at the undergraduate level use observation/secondary site experiences for students. These do not involve the provision of patient care by the student (e.g. physical care, interviewing, counseling, teaching) and are of short duration (a few hours). These activities are scheduled by the clinical coordinator and Lead Faculty at the same time other clinical experiences for the course are scheduled, and are subject to the same requirements for clinical contracts and compliance. Faculty are responsible for evaluating the experience. Site visits are not required.
Graduate Student Supervision
Direct Supervision
For direct clinical supervision, NTF (2016) guidelines recommend that on-site faculty/clinical preceptors to student ratios should be no more than 1:2 if faculty/clinical preceptors are not seeing their own patients and 1:1 if the faculty/clinical preceptors are seeing patients. The guidelines further recommend that IPE and team-based models of care allow for variation in faculty/student ratios for direct supervision while ensuring safety, quality care and the integrity of educational experiences.
Indirect Supervision
All graduate students in off-campus clinical placements must have a minimum of 1 site visit per term to monitor student progress in assuming new roles and responsibilities in an advanced practice area. In situations where a student requires closer monitoring by the faculty, up to three (3) site visits at various points throughout the semester may be required.
In general, it is recommended that site visits be completed during weeks 5 to 9 in the Fall and Spring semesters to assess student progression. This also will permit sufficient time if additional site visits are warranted during that semester.
Written documentation of the site visit is required. The summary of student performance must be signed by the faculty who conducted the site visit and the student. The summary is submitted to the course coordinator at the end of the semester prior to submission of grades. All final evaluations by faculty of student performance must be sent to the Assistant Dean-MSN/DNP after grades have been assigned and will be filed in the OSA.
For courses that consist of a practicum only (not a final capstone), site visits are not mandatory if a student is concurrently enrolled in another advanced practice management course or has successfully passed prior clinical experiences that have included site visits by faculty. However, clinical progress must be monitored periodically with the student throughout the semester and with the preceptor by telephone or email at mid-semester and at the end of the semester.
For clinical management courses (that include site visits), the indirect faculty supervision faculty to student ratio is 1:8 students. During a single semester, the maximum number of students that can be supervised by a faculty member is 18–20 students.
Observation Experiences
Although infrequent, an observational student experience may occur at the graduate level. Observations do not involve the provision of patient care by the student (e.g. physical care, interviewing, counseling, teaching). Students are registered for elective credit and supervised by the faculty who has agreed to supervise the observational experience. These activities are scheduled by the clinical faculty and/or course coordinator and reported to the Associated Dean-MSN/DNP two months prior to the start of a semester. Observation experiences require an agency/SON contract or MOU. Faculty are responsible for arranging and evaluating the experience. Site visits are not required, however this experience should be monitored periodically with the student and with the preceptor by telephone or email throughout the semester, and with the preceptor at mid-semester and at the end of the experience.
Exemplary responsibilities
Responsibilities for faculty who are providing either direct or indirect supervision of students in the clinical setting will vary by course and program level. Specific position descriptions for course coordinators and course team members are available for review for both the BSN, MSN, and DNP program areas. Faculty are expected to comply with those guidelines.
Typical responsibilities may include some or all of the following:
- Meeting all health and safety requirements of the assigned agency, as appropriate
- Collaborating with the course coordinator around student assignments for required clinical experiences
- Coordinating student clinical learning with preceptors
- Ensuring student clinical experiences commence as soon as feasible at the beginning of a course so students will be able to complete the required clinical hours within the time frame of the course
- Evaluating student competencies in the clinical setting using preceptor input as appropriate to ensure that students are providing optimal client care and are adhering to agency expectations, guidelines, and standards
- Documenting student clinical performance and evaluation conferences
- Meeting with or being available to students outside the clinical setting as necessary
- Attending course team meetings
- Assessing the process of student clinical evaluation within a course and recommending improvements when necessary
- Facilitating faculty/student/preceptor problem-solving as necessary, coordinating conferences as appropriate, developing plans for remediation when necessary, arranging for assistance with academic counselors if needed, and communicating with course coordinator
- Notifying course coordinator of student difficulties in meeting clinical objectives
- Conducting site visits for each student and preceptor to assess student progress and preceptor feedback
- Assisting with clinical site and preceptor development
- Informing course coordinator of clinical agency issues which may affect student practice or clinical placement
- Evaluating site and preceptor performance as a basis for recommending future clinical placements
- Submitting final evaluations of student, preceptor and site (as appropriate) to the course coordinator prior to grade submission
- Participating in alternative learning activities, e.g., human patient simulation activities, problem-based learning case studies, and inter-disciplinary training sessions.
Exceptions
N/A
Contact Information
Primary Contact
Peggy Wilmoth, Executive Dean Academic Affairs
Other Contacts
N/A
Important Dates
- Effective Date and title of Approver: 10/2003 approved by the faculty
- Revised: 4/2009 by AAC
- Revised: 3/10 by AAC
- Revised: 4/11 by AAC
Approved by:
Peggy Wilmoth
Executive Dean Academic Affairs