23 minute read
Leadership Through Precepting
The importance of preceptors has never been more evident. The COVID-19 Pandemic has brought greater awareness of our nation’s shortage of healthcare providers. FNU students are primed and ready to help fill these gaps, but they must have clinical hours to complete their course requirements and gain the real-world experience they need to excel.
In the following pages, we take a look at the many different angles of precepting, including the specialties most in need of preceptors, the changes in precepting brought on by the pandemic, and the keys for students to find the right sites and preceptors. We also thank our devoted preceptors who continue to share their time and expertise year after year.
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Telehealth Offers Solutions to Precepting During the Pandemic
Jeff Anderson
Jeff Anderson, DNP, MS, PMHNP-BC, began his role as Regional Clinical Faculty (RCF) in the PMHNP program at FNU in March 2020, just as the COVID-19 Pandemic became widespread throughout the United States. Just like the other RCFs and students, Anderson had to adjust quickly to a new way of work. As clinics began to shut down or reduce on-site personnel due to the pandemic, many students were faced with the prospect of losing their clinical sites. “There have been several instances where either the preceptor or the clinic stopped taking students as the COVID numbers went up,” said Anderson, who resides in Idaho and works with students primarily in the northwestern part of the country. “In those cases, we had to suspend the preceptor relationship because the student was no longer allowed in the clinic. We have had students who,
because a clinical site shut down, had to go on academic hiatus.” Anderson himself faced hurdles connecting with preceptors. Instead of meeting with preceptors face to face, as is the norm, the meetings have largely been held via video.
“In the time I’ve been with Frontier, I’ve only traveled once to meet with a preceptor face to face,” Anderson said. “It’s kind of the way business is done now.” Not only has video conferencing enabled Anderson to meet with preceptors, but it has also enabled many of his psychiatric mental health nurse practitioner (PMHNP) students to continue to progress at their clinical sites. Anderson said that most of the roughly 30 students he has had over the past few terms have transitioned to at least some level of telehealth with their preceptors. “For the students who have found a good situation with a preceptor, it has really been convenient for them to do telehealth from their own home,” he said. “We have had students do clinicals in which they stay at home and they log in to a Zoom type meeting with the patient and the preceptor. We have also have the situation where the preceptor is still going to their office and the student meets them in their office, so the student and preceptor are both in the office but the patient joins via telehealth.” Though there are some drawbacks such as not being able to see a patient’s body language, Anderson said that telehealth provides a viable option, particularly for PMHNP students.
“Mental health is unique compared to the other specialties at Frontier because mental health treatment really lends itself to telehealth,” he said. “I don’t see a big drop in the quality with telehealth versus face to face. In my own practice, when I see patients, it’s 100 percent telehealth now. Because of the jumpstart provided by COVID, telehealth is going to be significantly more prevalent in the future. It is a very important part of the students’ education to participate in and understand telehealth because it may be a big piece of their practices going forward.”
Anderson said that even post-pandemic, telehealth might prove to be the preferred option for many patients who otherwise might have difficulty attending an appointment. In mental health care, virtual visits have not often been an option as insurance companies have been resistant to pay for telehealth. “It is hard to say there’s anything positive coming from the pandemic, but if there was it would be that insurance companies that have in the past have been somewhat reluctant to pay for telehealth now will have a year’s worth of data showing that it is just as effective,” Anderson said. “In some ways, I think telehealth might be more effective because the no-show rates go down. Mental health patients can telehealth right from their home where they are more comfortable.” Most of the PMHNP students who have been able to have face-to-face visits with patients have done so where the patients are admitted and living on-site. Other
students have found telehealth to be a tool to acquire clinical hours with preceptors in other states.
“Telehealth actually opened some doors for precepting in that a lot of states are compact states where an RN license from one state is valid in the other state,” Anderson said. “What that allows is that,
PRECEPTING BY THE NUMBERS
ACTIVE FNU PRECEPTORS:
3,532 preceptors for all programs during the Winter 2021 term
PRECEPTORS NEEDED:
In the Winter 2021 term, FNU has 866 students in clinical courses. The average FNU student needs three clinical sites to complete all required experiences. The need is great and the competition for clinical sites is heavy. The demand for preceptors is constant.
if we have a student in Colorado who can’t find any sites in their state, they can reach out to any other compact state and look for a provider that’s doing telehealth and willing to take on a student. They’re really not limited to their state anymore. I’ve actually had some students who have obtained an RN license in a non-compact state because they had a willing telehealth preceptor in that state.” While an end to the pandemic will surely result in a significant return to in-person healthcare, Anderson said that the past year has shown that telehealth is here to stay. “This is a real-world experience,” he said of the widespread adjustment to and implementation of telehealth. “Telehealth is definitely an important aspect of the psychiatric mental health NP student’s education at this point and moving forward.” PRECEPTORS IN DEMAND
Frontier Nursing University recruits preceptors from the following specialties:
• Certified Nurse-Midwife
• Certified Family Nurse
Practitioner
• Certified Women’s Health Care Nurse Practitioner
• Certified Psychiatric-
Mental Health Nurse
Practitioner
Pandemic Emphasizes Need for Mental Health Practitioners and Preceptors:
Dr. Jess Calohan
Editor’s Note: Dr. Jess Calohan, DNP, is an Associate Professor and Department Chair of FNU’s Psychiatric-Mental Health Nurse Practitioner program. A recent retiree from the United States Army after 20 years of distinguished service, he is a recognized expert in treating combat-related PTSD, presenting nationally and internationally with multiple peer-reviewed publications. He was awarded the prestigious “A” designator by the United States Army Surgeon General in 2013, an honor that is given to less than 5% of Army medical officers in recognition of his expertise and significant contributions to military medicine. He also earned multiple military awards, most notably the Bronze Star and Defense Meritorious Service Medal.
Q&A with Dr. Jess Calohan
How has the pandemic impacted mental health in America?
The pandemic has actually created a mental health crisis in America. One national behavioral health crisis service has seen an 800% increase in calls and internet inquiries over the past four months. This has truly been a national disaster in which there is really no relief at this point. In my professional practice, I’ve hospitalized more patients in the past nine months than I have in the last four years. People are stressed and those with mental health conditions are vulnerable to symptom exacerbation due to the increased stress. Then we have the family and friends of the more than 300,000 individuals that have died due to COVID struggling with grief as many of them didn’t get to say goodbye to their loved ones. This is an unprecedented time for the mental health of our country and the impact may well last a generation.
How have mental health professionals and their patients adapted to conducting visits during the pandemic?
Mental health care was initially seen as routine care during the beginning of the pandemic with the exception of emergency services. Many patients had appointments canceled due to quarantining and social distancing requirements. Many insurance payers along with Medicaid and Medicare did not reimburse for telephone and other types of virtual visits so care was delayed until late March when Congress passed legislation allowing reimbursement for telephone visits with patients. Other payers began to follow suit and care resumed for many patients. Psychiatry, in general, has been a pioneer in telehealth, however, it was not widely used in many practices. Providers had to quickly learn the nuances of providing telehealth services and incorporate those into clinical practice. At FNU we provide telehealth training and allow our students to use telehealth modalities in their clinical practicums.
Do you think anything that has changed in mental health care during the pandemic will persist after the pandemic is over?
Yes, telehealth utilization prior to the pandemic with our student population was about 10%. That number increased to 70% during the pandemic. I believe telehealth utilization for behavioral health services will likely fall somewhere in between. The bottom line is that it will become part of a behavioral health provider’s daily practice.
What challenges have FNU students faced during the pandemic? Have they had difficulty finding preceptors?
Our students have faced multiple challenges related to the pandemic. The two most common things we have seen are increased workload for students in their jobs and adjusting work/life/school balance. From a clinical perspective, we’ve been able to adjust and have increased the number of telehealth hours so that they can stay engaged in clinical. Our department has not had a significant impact on clinical placements.
What do prospective PMHNP preceptors need to know about precepting FNU students? What is required of them and how do they make themselves available to precept?
Even though our program is relatively new, we are becoming one of the top education PMHNP programs in the country. We are much different than other distance programs in that we require students to have face-to-face time with faculty. When the pandemic is contained, our students will resume two on-campus requirements that prepare them for the didactic and clinical portions of the program. We currently have successfully adapted these requirements to the virtual environment, but are looking forward to returning to our new campus. We are not a “death by discussion board” program. Part of what makes FNU unique is our ability to develop a sense of community in the virtual environment and our faculty engage students through a variety of technological platforms. Our faculty have diverse backgrounds and clinical experience. All of our faculty still practice including me. We are one of the few programs in the country that have a telehealth simulation clinic so that students can have faculty-supervised simulated patient experiences before moving on to their clinical practicums. We have dedicated clinical faculty that support preceptors and students during the clinical rotation. The clinical faculty support reduces the administrative burden on preceptors and we offer honorariums for preceptors that precept our students.
Please describe the current and future level of need for mental health practitioners in the U.S.
We have a nationwide shortage of behavioral health providers and 3% of behavioral health providers are providers of color. FNU has a long history of graduating providers to serve in their communities. We also have made a tangible commitment to increasing the diversity of our student population and graduates.
Gain Valuable Training as a Preceptor with Free CE Courses
Participate in free online training courses for new and experienced preceptors: “The Gift of Precepting” and “The Master Preceptor” (.2 CEUs each)
• Promote your profession through the education and guidance of your future peers
• Help expand access to quality, compassionate care, to rural and underserved populations
• Earn an honorarium based on the percentage of time spent precepting students
• Learn more and sign up to be a preceptor at
frontier.edu/preceptor
The Road to Dreams Fulfilled
Nancy Reinhart
Nancy Reinhart, MPH, CNM, Class 155 knew what she was looking for, and was willing to travel as far as necessary to find it. Her journey has taken her from her hometown of Louisville to Hyden, Kentucky; Fort Hood, Texas; Shiprock, New Mexico; and, currently, Gettysburg, Pennsylvania. The common theme behind every choice and step she has made has been her drive to serve rural and underserved communities.
Even with that as her guide, however, Reinhart did not set out to be a nursemidwife. That began to change when she participated in Frontier’s Courier program during the summer between her junior and senior years of college. “My family has always been committed to helping people and giving service,” she said. “But the rural healthcare piece was inspired by my experience in the Courier program. I saw my first birth and it made a tremendous impact on me. I actually chose my master’s program because of that history.” After her Courier experience -- which included meeting current FNU President Dr. Susan Stone, who was the Midwifery Program Director at that time -- Reinhart earned a masters’ degree in public health and began a job in social justice. Soon thereafter she was contacted by Frontier and offered the opportunity to run the Courier program. “I just knew it was a good fit for me,” Reinhart said.
It was also the beginning of her journey to become a nurse-midwife. Like all staff and faculty members at FNU, Reinhart attended Frontier Bound as part of her orientation. That experience convinced her that her dream of becoming a nursemidwife could be a reality. “When I was at Frontier Bound I was so amazed at the diversity of people and ages that were starting this journey,” Reinhart said. “I had been thinking I was too old and too far along in life. I was putting up all these barriers against myself, but that dream just wasn’t leaving me and that really helped me to get over the hump. So I went ahead and started chipping away at the educational requirements while running the Courier program.” One of those requirements -- acquiring clinical hours -- proved to be a bit of a challenge. She found opportunities close to home at the University of Louisville and the Tree of Life Birth Center in southern Indiana. She enjoyed working with Damara Jenkins, MSN, CMN, Class 48, her primary preceptor at both sites, but both sites were in very high demand with other student requests. She also wanted some of her training to be in a rural setting with a strong collaborative physician-midwife model. Determined to find the experience she was looking for, she decided to expand her search. “There was an intense amount of clinical pressure on the sites local to me. As soon as I gave up a spot at both of the sites that I had for brief periods of time in Kentucky, they were taken by other students who needed clinical hours, particularly births,” Reinhart said. “I wanted to be at a higher volume site and one with a rural focus because that is how I envisioned practicing. That was a governing factor in why I chose to travel. It felt like to get what I was looking for, I was going to have to expand my horizons.” That led her to the Carl R. Darnall Army Medical Center in Fort Hood, Texas. There, her primary preceptor was FNU graduate Susan Clapp, MSN, CNM, Class 81. She next went to Northern Navajo Medical Center in Shiprock, New Mexico, where she was primarily precepted by Venay Uecke, CNM, and another FNU graduate, Kerena Satlzgiver, MSN, CNM, Class 91.
“I traveled quite far,” Reinhart laughed. “We took our whole family on a roadshow from July to December in 2019.” Reinhart’s family consists of her husband, Dave Mitchell, who is a therapist, and three children ages 4, 9, and 11. Reinhart expressed her gratitude to all the preceptors who taught her and to all the families who allowed her to participate in their births as a student. She said she learned a tremendous amount from the regional variation in midwifery practices that she saw across four states during clinical. When the successful “roadshow” came to an end, it was time to find a full-time opportunity. Once again, the family had a vision for their desired next step. “My husband and I were pretty clear about what our priorities were,” Reinhart said. “I prioritized rural health as something I was committed to serving. So we looked at what places and locations both had job openings, were rural serving underserved, and were relatively close to home, family, and friends. I had job opportunities in New Mexico and far afield, but we limited our search to Virginia, Maryland, Pennsylvania, and North Carolina. I wanted to serve women in a rural area through a full-scope midwifery position
with a good work-life balance. I also wanted to be in a place with really supportive physicians. I know what it’s like for midwives when they don’t have supportive physicians to work with. Gettysburg fit all those things for us.” Reinhart joined WellSpan OB/GYN in Gettysburg, Pennsylvania, as a fullscope nurse-midwife in July 2020. The practice, which consists of four nursemidwives and four physicians, is the only one in the area that offers 24/7 nurse-midwifery care. “We serve several surrounding, rural counties,” Reinhart said. “We have a largely low socioeconomic class of women and families that we serve. This is an orchard and farming area, so we serve migrant workers and their families as a part of our base. Just like anywhere that you have a diverse population, we have language barriers. One thing I really value about our hospital is that we have inperson Spanish language translators. It is such a nice human touch to have that for someone going through labor and often scary situations.” The COVID-19 Pandemic has only added to the fear and stress of those situations, for both the patients and their caregivers. “One of the things I love about birth is the intimacy that midwives provide before, during, and after labor,” Reinhart said. “The pandemic definitely disrupts that process. Most of our patients are good champs about it, but it is a different experience when you’re in labor and you see your healthcare provider covered from head to toe with protective equipment. I grieve that for my patients and I look forward to a time when we can be more physically connected.” Reinhart went on to point out the mental health impact of the pandemic. Feelings of anxiety and isolation are understandably magnified when loved ones are not able to be as involved in welcoming a new addition to the family as they would like. “Sometimes partners aren’t allowed in the appointments depending on the level of infection we have in our county,” Reinhart
Nancy Reinhart (right) with preceptors Kristyn Leftridge, CNM (left) and fellow FNU graduate Susan Clapp, MSN, CNM, Class 81 (middle) at the Carl R. Darnall Army Medical Center in Fort Hood, Texas. said. “Postpartum, the experience with so many partnerships and families trying to have this source of joy in their home and not being able to share that baby’s life with loved ones because of the pandemic is pretty tough on people.” Even after the pandemic is over, there will be other challenges in healthcare and society in general. While serving as a certified nurse-midwife is enough, Reinhart is determined to do more to help others. Already involved in the American College of Nurse-Midwives (ACNM), she intends to increase her participation and to seek more ways to make a difference in her community. “Frontier curriculum provided a high level of dedication to the aspects of public health, how the social determinants of health underlie our practice, identifying the political and practical trends that impact how we serve our clients,” Reinhart said. “That got me thinking about how I think of myself as a midwife outside of the hospital. What are the things I can be involved with in my community and ACNM to make a difference in the lives of the clients I serve to work to dismantle racism and other obstacles that people face to be able to be well and healthy? Frontier helped me see that bigger picture within the context of midwifery.” Even though she’s only been in Gettysburg less than a year, Reinhart said she is considering applying to the local human relations commission and plans to start a perinatal loss support group. Further on the horizon, she would like to get her doctorate and eventually teach. No matter how long the route, Reinhart has proven she’s willing to put in the work -- and the miles -- to reach whatever goal is in her sights. Editor’s note: Nancy’s father, Philmar Reinhart, a longtime supporter of Frontier who was very supportive of Nancy’s journey into midwifery, passed away during the time it took this story to come to print. We mourn with the family and are thankful for Nancy and her father, who attended many FNU events.
Trio of FNU Students Perform Clinical Hours at the Same Site
Jenn Johnson, Diedre Willer, and Simone Chang Jenn Johnson, Class 178, Diedre Willer, Class 181, and Simone Chang, Class 175, (pictured left to right) are three FNU nurse-midwifery students who are in a clinical rotation at Maimonides Midwifery Practice in Brooklyn, N.Y. The practice, which includes 14 certified nurse-midwives, is a frequent clinical site for FNU students. Maimonides has taken nine FNU CNEP students since 2017. Since its launch in 1993, the practice has been directed by Phyllis Lynn, CNM, who is a shining example of the value of precepting.
Are You Qualified to Be a Preceptor? Let’s Check!
FNU needs preceptors with the following credentials:
• National certification in specialty area • One year of relevant experience in advanced practice role • Master’s Degree or higher in nursing-related field (we do allow
BSN for midwives with significant experience, but an MSN is preferred) • MDs and DOs • For PMHNP students: MSN prepared
LCSWs, LSWs, MFTs, and LDACs.
FNU Sends COVID Kits to Preceptors
As the COVID-19 Pandemic surged into the summer months, FNU distributed 80 COVID relief kits to FNU Regional Clinical Faculty (RCF). RCFs then distributed the kits as a way of saying thank you to those preceptors who continued to accept FNU students in clinical studies during the pandemic.
Each COVID-19 kit included:
• 20 FNU Face Masks
• 20 FNU Bags • 20 Bottles of Hand Sanitizer
The kits also included a thank you letter from FNU President Dr. Susan Stone, who wrote:
“Committing to precepting a student is a wonderful gift of your time and tutelage even under ideal circumstances. Fulfilling that commitment during a pandemic is challenging and remarkably generous. I thank you for staying with us as we all navigated the events of the pandemic, attempting to make the best decisions for the health and safety of all involved. “The COVID-19 Pandemic has revealed what we already knew -- that midwives and nurses are invaluable members of healthcare in the United States. FNU is incredibly proud of our graduates and CONTACT US
To learn more about precepting, contact The FNU Department of Clinical Outreach and Placement. Our staff will be happy to:
• Answer questions about the process to become a preceptor
• Provide support to preceptors when using the online preceptor profile portal
• Provide information regarding our Master and Expert Preceptor programs
You can reach our department via email at ClinicalAdvising@frontier.edu
students who represent all 50 states, providing care to those in need. We are also proud of preceptors like you who continue to give your time and mentorship to help prepare these students who are answering the call to serve.”
Real Talk About Precepting: One Year and a Pandemic Later with RCF Audra Cave
Audra Cave
A year ago, to better explain the role of RCFs and answer questions about precepting, RCFs Audra Cave, DNP, FNP-BC, Class 49 and Cathy Cook, MSN, CNM, CNEP Class 17, agreed to share their experiences as preceptors. Now, one year later, we followed up with Dr. Cave for her perspective on precepting during the pandemic. While Dr. Cook was unable to precept due to the pandemic, Dr. Cave precepted two students in 2020.
“I am in a busy Federally Qualified Health Center (FQHC) practice and we have lots of opportunities to precept,” said Dr. Cave, who practices in Spindale, North Carolina. “There were many unique challenges with precepting during COVID. We had to coordinate protocols for staff and students for how to manage everyone’s safety in the practice, how to manage and create protocols for patients who were exposed and/or positive for COVID, and how to manage the flow of our regular patients. We also had to learn how to manage telehealth. All in all, it was a good learning process for us in the clinic and for students.” While some clinical sites closed or had to limit precepting during the pandemic to reduce the number of people on-site, Dr. Cave said she’s happy she has been able to continue to work with students.
“I want to be a preceptor because I get as much from students as I give,” she said. “I learn from students every time that I precept. The process of watching students grow from nervous initial interactions with patients to managing patients with common and complex medical problems is very uplifting for me. The time that you put into teaching a student is rewarded with all of the ah-ha moments, the positive patient feedback, and the positive interactions with the office staff. The payoff is that I get to see the end result of a long process of student growth and learning.”
WHAT STUDENTS SAY ABOUT FNU’S DEPARTMENT OF CLINICAL OUTREACH AND PLACEMENT
Every student experience has individual considerations, so the Department of Clinical Outreach and Placement strives to meet with students one on one to help them navigate the overall clinical site search process. Here are a few examples of the feedback the Department of Clinical Outreach and Placement has received.
“I have to say I am so happy that Frontier started the clinical advising program, it was really helpful for me to have this touchstone for the stressful
process of site finding.” ~ Kat
“Thanks for checking in. This can be pretty overwhelming and your support makes it less daunting for
sure!” ~ Anastasia
“Thank you for reaching out and for all your help, it was invaluable. I had so much success sending emails with an intro video embedded. I had 20-30 positive responses! Thank you again for
everything!” ~ Sara
“I attended your clinical placement webinar this morning, and am glad I did. I have scheduled an appointment with you first thing
this coming Monday.” ~ Candace
