Things You Need to Know
A. The FNU Student
FNU clinical students have the following characteristics, which, taken together, make them and their needs unique:
- They are adult learners, bringing diverse life experience to practice.
- They have fulfilled over a year of rigorous didactic requirements, by independently structuring their use of time and resources.
- Their interactions, intellectual and social, with faculty and students have mainly taken place in electronic and written formats, not "face-to-face."
- They are intensely eager to be "finally" gaining clinical experience.
- They come to preceptors as beginners following completing Clinical Bound, an intensive faculty-led workshop.
- Their preceptors will teach them to practice in all clinical areas simultaneously.
- They have a didactic academic load concurrent with clinical practice.
- At FNU, didactic courses are “front-loaded” so that students have successfully completed all of their clinical management courses prior to entering clinical.
- They will be completing clincial rotations over 4-6 months.
B. The Role of the Regional Clinical Faculty
Are experienced nurse-midwives or nurse practitioners residing in the region that they coordinate.
- Serve as the liaison between the clinical sites, the Clinical
- Credentialing Coordinator, the Preceptors, the students, and the appropriate Program Director.
- Guide students through the Clinical Practicum, fostering the networking of students in their area.
- Visit sites to assess student progress and to ensure positive learning environments.
- Evaluate clinical performance and assign the clinical grades with input from the Preceptors.
- Qualifications for Regional Clinical Faculty include the following:
- Nationally certified in nurse-midwifery or appropriate advanced practice nursing specialty,
- Active in nurse-midwifery or nurse practitioner community,
- Master's degree or Doctorate in nursing or related field,
- Experience as a clinical preceptor;
- and strong communication, problem solving, management, organization and computer skills
C. How the Program Works
Education for the FNU student is community-based. Coursework is delivered via a distance-learning model in which students learn in their communities with learning activities distributed and completed using web based technology. The design is modular. The FNU faculty is primarily composed of nurse-midwives and nurse practitioners who interact with students virtually and by phone throughout the educational process. During the program, students interact in person with the faculty and with each other as learners on our campus in Hyden, Kentucky during two required on-campus sessions called Frontier Bound and Clinical Bound.
During the clinical experience, with the skillful guidance of our preceptors, students progress from novices to safe beginning level practitioners. This usually takes six to nine months. The duration of the clinical experience is dependent on variables unique to the site, the preceptors, and the student. Students must be in clinical for a minimum of 16 weeks and complete 675 clinical hours and a minimum number of specific visit types (examples: midwifery, women’s health, pediatric, chronic care, antepartum, etc dependent upon their specialty track).
Usually, it is possible for a student to work with a preceptor or a practice near or in their local community during the clinical practicum, but occasionally distant sites need to be arranged. Sites may change due to unforeseen events that occur during the time that the student is working on their didactic prerequisites, but this is the exception rather than the rule. The variation in time for completing the didactic coursework has to do with the students' personal situations as well as learning styles, how they organize time, and their approach to study. During the clinical practicum, site volume and dynamics are additional factors affecting the time needed for completion. Click here for the nurse-midwifery, women’s health nurse practitioner, and family nurse practitioner curricula inCLICKING HERE .
D. Guidelines for the Clinical Experience
1. Working During Clinical
- Students MAY NOT work in any capacity in an out-of-hospital (such as a home birth practice or birth center) birth setting where they are a clinical midwifery student.
- In a hospital or office setting, the students MAY NOT work as a nurse in any unit in which they are also a clinical student. They must practice within the scope of their license, and not assume any additional responsibilities based on their advanced knowledge base.
- A student may not work as a nurse-midwife or nurse practitioner at any time while in clinical unless legally licensed to do so.
2. Clinical Supervision Requirements
The level of direct supervision expected of a preceptor will depend on:
- The student's demonstrated ability and readiness for unobserved practice of a skill or task.
- The comfort level of the patient with the student.
- The negotiated comfort level of both student and preceptor.
- The complexity of the clinical situation.
- Clear, effective communication between the student and preceptor.
- The program and clinical site’s requirement for direct supervision of all student-attended births and all suturing
Progressing from student observation of the preceptor to performing all functions in an encounter will be gradual and will require demonstration and return demonstration of many skills. Seeing patients together provides the student with the opportunity to watch and reflect on the skills, critical judgment, and behaviors of the preceptor. The preceptor can also see the student grow in ability to do "parts" of the visit and try new skills while receiving preceptor feedback.
In the labor setting, CNM direct presence is required for all births. The preceptor level of involvement will vary based upon the circumstances and the skill level of the student. In the event than an emergency requires the preceptor to be unavailable for a birth, the student will step aside and allow nursing personnel to attend the birth.
Time with physician supervision is limited for all FNU students. With prior approval, nurse-midwifery students may work for a limited amount of time with credentialed physicians in the clinic setting; however the student must work with a CNM/CM for all midwifery visits.
The FNP and WHNP students may work with credentialed physicians as their preceptors. Students may spend up to 20% of their spend clinical time working with a physician.
The FNP students and WHNP students are required to have direct supervision by their preceptors for all suturing and or lesion removals. FNU students are prohibited from suturing face and hands due to malpractice insurance restrictions.
Advanced Practice Skills
Many advanced practice nurses regularly perform advanced skills. Students are encouraged to watch these skills, whether performed by physician, midwife, or practitioner--but, as students, they MAY NOT perform them, even if they have expertise from prior roles. The FNU's malpractice insurance does not cover these activities:
- Vacuum-assisted birth
- Repair of fourth-degree lacerations
- "First assisting" at cesarean section or other major surgery
- Insertion or removal of Implanon or Nexaplanon
- Suturing face or hands
- Any other advanced skills not taught within FNU program
4. When The Student Has Multiple Sites
Individual student needs and site concerns may necessitate the student's use of more than one site for clinical experience, although it is strongly recommended to have four or fewer sites. Students will record time spent with each preceptor in clinical care or learning experiences. FNU will use this information to calculate each preceptor’s honorarium. The RCF will be responsible for facilitating a smooth transition between clinical sites.
5. Adverse Events And Risk Management
FNU carries malpractice insurance coverage for students. Coverage begins at Clinical Bound and continues until clinical is completed and the student has taken the Comprehensive Examination. All preceptors must be covered by malpractice insurance in any setting in which the student practices. An Affiliation Agreement must be signed and on file at the School for each setting in which a student practices as well.
Any occurrence involving an incident report, or any situation in which the student has potential liability, must be reported within 24 hours to the Program Director. The Program Director will advise the student and convey the information to the FNU Risk Manager. The Incident Report Form is discussed with the student at Clinical Bound and is available on the FNU website. The student should complete this form with the help of the preceptor. Only information contained in the chart should be included in the Incident Report. It is the student's responsibility to do this reporting; however, preceptors must insure that students recognize reportable events and fulfill the reporting requirement. Incidents should not be discussed in e-mail.
E. Success at the Finish Line
- Declaration of Safety (DOS)
- Feedback to FNU
1. Declaration of Safety
When the preceptor is confident that the student is a safe beginning level practitioner, the RCF will provide a Declaration of Safety (DOS) form. The preceptor should sign it and return it to the student for uploading. Timing of the DOS is at the preceptor's discretion. Regardless of when it is signed, the student needs to complete the clinical numbers and time requirements.
2. Honorarium and Continuing Education Certificate
All honorariums are paid when the verification of hours spent with the preceptor are submitted. Students record the hours they spend with the preceptors by using DDATs and time logs. This documentation is signed by the preceptor for verification purposes. The student sends this documentation to the RCF. FNU then calculates the hours for each preceptor; the honorarium is based on the percentage of time relative to the required 675 hours the student spends with an individual preceptor. Timely distribution of honorariums requires current address and W-9 information. A certificate for continuing education for time spent precepting students is also calculated based upon DDATs and time logs. This certificate will be issued at the time of the honorarium. Please contact the RCF with any address changes or concerns associated with the honorarium or CE certificate. We appreciate your time and want to be sure that you receive both the honorarium and the CE certificate.
3. Feedback To FNU
At the time of the site visit, the RCF will provide the preceptor with a form or email link for evaluation of the visit. FNU welcomes any comments or suggestions the preceptor may offer. Preceptor contribution to FNU is critically important for program and student success. Any program or clinical experience feedback can be directed to the Clinical Director.