nurse practitioner preceptor manual 2019-2020 · post-masters nurse practitioner (pmnp) diploma...

1 September 5, 2019

Nurse Practitioner Preceptor Manual 2019-2020

Masters in Nursing (MN) (Nurse Practitioner Field of Study) Degree Program and Post-Master NP (PMNP) Diploma Program

2 September 5, 2019

Dear Respected Preceptor, Thank you for agreeing to participate as a preceptor or NP Advisor for a student in the Nurse Practitioner program at the Lawrence S. Bloomberg Faculty of Nursing. The preceptor role is fundamental to helping the student learn, experience, and practice in an environment that is supportive and safe for both the student and the patients. We appreciate your time, your professional commitment, and your willingness to share your knowledge. Please find included some useful information in assisting you to become familiar with our faculty and program. The student for whom you are a preceptor or NP Advisor is enrolled either in the MN (NP Field) Degree Program or Post-Masters Nurse Practitioner (PMNP) Diploma Program. Throughout the program, aspects of clinical reasoning will be investigated, critically reviewed and applied to a broad range of clinical case studies as students develop advanced physical assessment skills, knowledge and skill in the collection of data and diagnostic formulation. Practical elements of advanced client assessment, including physical and mental status, psychosocial, family, and cultural and community factors, the implications of social determinants of health and risk appraisal will be addressed in terms of their impact on the child/adolescent/adult/older adult client’s health status. Clinical, theoretical and scientific knowledge will be synthesized in the identification and management of existing and potential client states of health and illness. Approaches to effective written and verbal communication of findings to lay individuals and health professional colleagues as they relate to the client and family will be addressed. Students will have opportunities to apply knowledge and develop advanced skills in assessment, clinical reasoning, therapeutic management, and health promotion. They will also have opportunities to explore the full scope of the nurse practitioner role by engaging in quality improvement, demonstrating leadership to improve client care and facilitating system change The clinical component of the program includes a total of 800 practicum hours divided amongst 4 courses over 2 years. The clinical practicums are designed to facilitate students’ development of advanced skills (interviewing, physical examination, diagnostic testing, interpretation of findings, therapeutic planning and advanced practice/nurse practitioner role development) related to client/family, community and system assessment. Application of the clinical reasoning process is integral to the students’ experiences. It is expected that students will be competent in basic health and physical assessment (HPA) and the associated techniques prior to beginning the nurse practitioner program. They will continue to build on these basic skills to develop an advanced level of assessment, planning and therapeutic management. Kind Regards, Katherine Trip NP-Adult, Interim Coordinator, Nurse Practitioner Programs Lawrence S. Bloomberg Faculty of Nursing 155 College Street, Suite 130 Toronto, ON, Canada, M5T 1P8

3 September 5, 2019

Table of Contents

SECTION 1: FACULTY LIAISONS ________________________________________________________________________________ 4

SECTION 2: NP PROGRAM ____________________________________________________________________________________ 5

Program Overview ________________________________________________________________________________________________ 5

Summary of Clinical Practicum Course Competencies ______________________________________________________________ 7

Detailed Clinical Practicum Course Competencies __________________________________________________________________ 8

SECTION 3: PRACTICUM ROLES & RESPONSIBILITIES ______________________________________________________________ 20

Clinical Education Office _________________________________________________________________________________________ 20

Students ________________________________________________________________________________________________________ 20

NP and Physician Preceptors _____________________________________________________________________________________ 21

NP Advisors ____________________________________________________________________________________________________ 22

SECTION 4: CHARACTERISTICS OF AN EFFECTIVE PRECEPTOR/NP ADVISOR ____________________________________________ 24

Guiding Learners in Clinical Practice______________________________________________________________________________ 25

SECTION 5: ASSESSMENT AND EVALUATION OF STUDENTS _________________________________________________________ 27

Competency Evaluation __________________________________________________________________________________________ 27

Student Behavioural Evaluation __________________________________________________________________________________ 28

SECTION 6: POLICY AND PROCEDURES _________________________________________________________________________ 35

Entry-to-Practice Competencies for Nurse Practitioners ____________________________________________________________ 35

NP Student Conduct _____________________________________________________________________________________________ 35

Accountabilities for Supporting Students _________________________________________________________________________ 36

Student Preparedness Permit ____________________________________________________________________________________ 39

Placement Process (Points of Contact / Escalating Issues) _________________________________________________________ 40

SECTION 8: PRECEPTOR BENEFITS _____________________________________________________________________________ 41

Preceptor Honorarium ___________________________________________________________________________________________ 41

Adjunct Appointments ___________________________________________________________________________________________ 42

4 September 5, 2019

SECTION 1: FACULTY LIAISONS Academic Inquiries

Director, MN Program Martine Puts, RN, PhD Telephone: 416-978-6059 Email: [email protected]

Coordinator, NP Field of Study

Katherine Trip, NP-Adult Telephone: 416-946-7355

Email: [email protected]

Placement Inquiries

Student Placement Coordinator Sharon Lee Telephone: (416) 978-8475 Email: [email protected]

Student Placement Coordinator Kong Ng Telephone: (416) 946-0279 Email: [email protected]

Clinical Evaluation Inquiries

Student Financial Awards, Stewardship & Project Officer Angela Ho Telephone: (416) 946-8165

Email: [email protected]

Graduate Program Assistant Star Yu Telephone: (416) 978-8318 Email: [email protected]

Honorarium Payment Inquiries

Financial Director Stephanie Mack E-mail: [email protected]

mailto:[email protected]






5 September 5, 2019

SECTION 2: NP PROGRAM Program Overview

Approximately 100 NP students’ graduate per year from the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto in one of three NP emphases: NP-Adult, NP-Paediatric and NP-Primary Health Care-Global Health. Students enter either a Master of Nursing (MN) (Nurse Practitioner Field) Degree Program or a Post-Masters Nurse Practitioner (PMNP) Diploma Program. Our NP programs prepare graduates to lead in the comprehensive care of patients through the application of Advanced Practice Nursing and Nurse Practitioner competencies as described by the College of Nurses of Ontario (CNO, January 2018). Students are also accountable for complying with relevant laws as outlined in the CNO Practice Standard (Revised 2017). Students gain population-based experiences in caring for patients with health maintenance requirements, common health problems and/or acute and chronic conditions within their chosen population of Adult (adolescents/adults/older adults) Paediatrics (infant/child/adolescent) or Primary Health Care-Global Health (all ages).

Clinical placements may occur across the health care sector in primary care, long-term care, ambulatory care and acute care settings. Students may choose to concentrate and specialize with a clinical focus through focused course work and targeted clinical placement selection in the final year of the NP program.

Our NP programs are accessible to students across Canada. The student experience in this hybrid education delivery model includes:

• Attendance at on-campus residencies,

• Simulation-based learning,

• Virtual classrooms, and

• Combined asynchronous and synchronous discussions.

Master of Nursing (MN) (Nurse Practitioner Field) Degree Program The NP Field of the Master of Nursing Program is designed to provide students with the skills and competencies required to practice as a Nurse Practitioner (Adult, Paediatric or PHC-GH). This innovative and accessible MN population-based program is completed over 2 years (full time). The course-work is available entirely on-line and the practicums are emphasis focused. In addition to the specialty NP courses outlined in Table 1, MN NP students are required to complete 4 foundation courses: NUR 1094H: Research Design, Appraisal, & Utilization NUR 1095H: Qualitative Research NUR 1096H: History of Ideas in Nursing NUR 1097H: Program Planning & Evaluation

More specific details on individual courses in the MN (NP Field) Degree Program is available on our website: https://bloomberg.nursing.utoronto.ca/programs/post-masters-nurse-practitioner-diploma.

https://bloomberg.nursing.utoronto.ca/programs/post-masters-nurse-practitioner-diploma

6 September 5, 2019

Post-Masters Nurse Practitioner (PMNP) Diploma Program The Post-Master's NP Diploma is an innovative and highly competitive 2-year program (part time) available to students across Canada. It is designed to afford students who have completed graduate education in nursing the opportunity to develop knowledge and skills required to practice as a Nurse Practitioner. The Post-Master's NP Diploma consists of 5 courses (Table 1), completed over a 2-year period. Students will focus their studies in the area of adult, paediatric, or primary health-global health care. Table 1. MN Foundation (red font) and NP Specialty (black font) NP courses.

Fall Winter Summer

NUR 1100H: Pathophysiology and Pharmacotherapeutics

NUR 1101H (Adult) or NUR 1102H (Paediatric):

or NUR 1114H (PHC-GH)

Advanced Health Assessment and Clinical Reasoning 100 clinical hours

(20h SimLab + 80h Practice Setting)

NUR1094 (MN-NP students only)


NUR 1115H (Adult) or

NUR1116H (Paediatric) or

NUR 1117H (PHC-GH) Advanced Health Assessment and

Therapeutic Management I 250 clinical hours Fall


NUR 1215H (Adult) or

NUR1216H (Paediatric) or

NUR 1217H (PHC-GH) Advanced Health Assessment and

Therapeutic Management II 250 clinical hours Winter


NUR 1221Y (Adult) or NUR1222Y (Paediatric) or NUR1223Y (PHC-GH) Nurse Practitioners: Roles and Issues

200 clinical hours

* please note that PMNPD students take only the NP Specialty courses and the MN NP students take both the MN Foundation and NP Specialty courses.

Year 2

Year 1

7 September 5, 2019

Summary of Clinical Practicum Course Competencies

Clinical Course Clinical Competencies NUR 1101/1102/1114: NP Advanced Health Assessment & Clinical Reasoning (20h simulation lab+80h in practice setting)

Following successful completion of 3 OSCE stations, students undertake this course with the goal of developing advanced practice skills in history taking and physical examination on clients/families with common health and illness states. Learning to formulate differential diagnoses is also integral to this practice rotation. A focus on select competencies as outlined in the Entry-Level Competencies for Nurse Practitioners (CNO, 2018) are integral to this course: Competency I Client Care (Client Relationship Building and Communication, Assessment, and Diagnosis), Competency II: Quality Improvement and Research, Competency III: Leadership, and Competency IV Education. Relevant controlled substances competencies are also integrated within relevant CNO Entry-Level Competencies.

NUR 1115/1116/1117 Advanced Health Assessment and Therapeutic Management I (250 hours)

Students undertake this course with the goal of continued development of clinical skills (advanced history taking and physical examination) with the integration of diagnostic testing and treatment planning. Students will continue to develop advanced practice nursing judgment, skill and knowledge in patient/family care scenarios. . Students will also focus on educating clients, the community, and members of the healthcare team during this clinical practicum. Select Entry-Level Competencies for Nurse Practitioners (CNO, 2018) are integral to this course: Competency I Client Care (Client Relationship Building and Communication, Assessment, Diagnosis, and Management), Competency II: Quality Improvement and Research, Competency III: Leadership, and Competency IV Education. Relevant controlled substances competencies are also integrated within relevant CNO Entry-Level Competencies.

NUR1215/1216/1217 Advanced Health Assessment and Therapeutic Management II (250 hours)

This course includes the goals of developing and refining clinical reasoning skills, and skills to critically appraise and synthesize relevant clinical data, research, theory and clinical practice guidelines related to geriatrics or paediatric complex care, pain, end-of-life care and medical assistance in dying, mental health, diabetes, and skin disorders/dermatologic issues. The clinical practicum is focused on professional roles, responsibility and accountability (clinical practice and collaboration, consultation and referral), therapeutic management, and health promotion and prevention of illness and injury. A focus on select competencies as outlined in the Entry-Level Competencies for Nurse Practitioners (CNO, 2018) are integral to this course: Competency I Client Care (Client Relationship Building and Communication, Management, Collaboration / Consultation/Referral, and Health Promotion), Competency II: Quality Improvement and Research, Competency III: Leadership, and Competency IV Education. Relevant controlled substances competencies are also integrated within CNO Entry-Level Competencies reflected in this course.

NUR 1221/1222/1223: Nurse Practitioners: Roles and Issues (200 hours)

Students consolidate learning across the health-illness continuum. Practice settings offer opportunities for students to integrate all NP domains of practice into their advanced practice role with a focus on quality improvement . Select Entry-Level Competencies for Nurse Practitioners (CNO, 2018) are integral to this course: Competency I Client Care (Collaboration, Consultation, and Referral), Competency II Quality Improvement and Research, Competency III Leadership, and Competency IV Education. Relevant controlled substances competencies are also integrated within relevant CNO Entry-Level Competencies.

8 September 5, 2019

Detailed Clinical Practicum Course Competencies Clinical Course Clinical Competencies NUR 1101/1102/1114: NP Advanced Health Assessment & Clinical Reasoning (20h simulation lab + 80h in practice setting)

I. Client Care A. Client Relationship Building and Communication The competent, entry-level nurse practitioner uses appropriate communication strategies to create a safe and therapeutic environment for client care.

1. Clearly articulate the role of the nurse practitioner when interacting with the client. 2. Use developmentally and culturally appropriate communication techniques and tools. 3. Create a safe environment for effective and trusting client interaction where privacy and confidentiality

are maintained. 4. Use relational strategies (e.g., open-ended questioning, fostering partnerships) to establish therapeutic

relationships. 5. Provide culturally safe care, integrating clients’ cultural beliefs and values in all client interactions. 6. Identify personal beliefs and values and provide unbiased care. 7. Recognize moral and ethical dilemmas, and take appropriate action if necessary (e.g., consult with

others, involve legal system). 8. Document relevant aspects of client care in client record.

B. Assessment The competent, entry-level nurse practitioner integrates an evidence-informed knowledge base with advanced assessment skills to obtain the necessary information to identify client diagnoses, strengths, and needs.

1. Establish the reason for the client encounter a. Review information relevant to the client encounter (e.g., referral information, information from

other healthcare providers, triage notes) if available. b. Perform initial observational assessment of the client’s condition. c. Ask pertinent questions to establish the context for client encounter and chief presenting issue. d. Identify urgent, emergent, and life-threatening situations. e. Establish priorities of client encounter.

2. Complete relevant health history appropriate to the client’s presentation. a. Collect health history such as symptoms, history of presenting issue, past medical and mental

health history, family health history, pre-natal history, growth and development history, sexual history, allergies, prescription and OTC medications, and complementary therapies.

b. Collect relevant information specific to the client’s psychosocial, behavioral, cultural, ethnic, spiritual, developmental life stage, and social determinants of health. This includes unique considerations in vulnerable populations (children, older adults, indigenous populations, and clients with a history/risk of mental health conditions/addictions).

c. Determine the client’s potential risk profile or actual risk profile behaviors (e.g., alcohol, illicit drugs and/or controlled substances, suicide or self-harm, abuse or neglect, falls, infections).

d. Assess client’s strengths and health promotion, illness prevention, or risk reduction needs.

9 September 5, 2019

3. Perform assessment. a. Based on the client’s presenting condition and health history, identify level of assessment

(focused or comprehensive) required, and perform review of relevant systems b. Select relevant assessment tools and techniques to examine the client, including specific

assessment/history strategies to identify actual or potential risk of misuse, abuse, addiction and diversion.

c. Perform a relevant physical examination based on assessment findings and specific client characteristics (e.g., age, culture, developmental level, functional ability). This includes unique considerations in vulnerable populations such as children, older adults, indigenous populations, and clients with a history or risk for mental health conditions and addictions.

d. Assess mental health, cognitive status and vulnerability using relevant assessment tools. Highlight to potential role of screening/diagnostic investigations used in monitoring clients receiving controlled substances (for example, toxicology).

e. Integrate laboratory and diagnostic results with history and physical assessment findings.

C. Diagnosis The competent, entry-level nurse practitioner is engaged in the diagnostic process and develops differential diagnoses through identification, analysis, and interpretation of findings from a variety of sources.

1. Determine differential diagnosis for acute, chronic and life-threatening conditions and those related to common indications for the various classes of controlled substances.

a. Analyze and interpret multiple sources of data, including results of diagnostic and screening tests, health history, and physical examination.

b. Synthesize assessment findings with scientific knowledge, determinants of health, knowledge of normal and abnormal states of health/illness, patient and population-level characteristics, epidemiology, and health risks.

c. Generate differential diagnoses. e. Determine most likely diagnoses based on clinical reasoning and available evidence.

2. Explain assessment findings and communicate diagnosis to client. a. Explain results of clinical investigations to client. b. Communicate diagnosis to client, including implications for short- and long-term outcomes and

prognosis. c. Ascertain client understanding of information related to findings and diagnoses.

Competency II: Quality Improvement and Research The competent, entry-level nurse practitioner uses evidence-informed practice, seeks to optimize client care and health service delivery, and participates in research.

1. Identify, appraise, and apply research, practice guidelines, and current best practice. Competency III: Leadership

5. Contribute to team members’ and other healthcare providers’ knowledge, clinical skills, and client care (e.g., by responding to clinical questions, sharing evidence).

7. Utilize theories of and skill in communication, negotiation, conflict resolution, coalition building, and change management.

10 September 5, 2019

IV. Education The competent, entry-level nurse practitioner integrates formal and informal education into practice. This includes but is not limited to educating self, clients, the community, and members of the healthcare team. Continuing Competence

6. Engage in self-reflection to determine continuing education competence needs. 7. Engage in ongoing professional development. 8. Seek mentorship opportunities to support one’s professional development.

NUR 1115/1116/1117 Advanced Health Assessment and Therapeutic Management I (250 hours)


1. Clearly articulate the role of the nurse practitioner when interacting with the client. 2. Use developmentally and culturally-appropriate communication techniques and tools. 3. Create a safe environment for effective and trusting client interaction where privacy and confidentiality




B. Assessment The competent, entry-level nurse practitioner integrates an evidence-informed knowledge base with advanced assessment skills to obtain the necessary information to identify client diagnoses, strengths, and needs.

1. Establish the reason for the client encounter a. Review information relevant to the client encounter (e.g., referral information, information from

other healthcare providers, triage notes) if available. b. Perform initial observational assessment of the client’s condition. c. Ask pertinent questions to establish the context for client encounter and chief presenting issue. d. Identify urgent, emergent, and life-threatening situations. e. Establish priorities of client encounter.

2. Complete relevant health history appropriate to the client’s presentation. a. Collect health history such as symptoms, history of presenting issue, past medical and mental

health history, family health history, pre-natal history, growth and development history, sexual history, allergies, prescription and OTC medications, and complementary therapies.

b. Collect relevant information specific to the client’s psychosocial, behavioral, cultural, ethnic, spiritual, developmental life stage, and social determinants of health. This includes unique


considerations in vulnerable populations (children, older adults, indigenous populations, and clients with a history/risk of mental health conditions/addictions).

c. Determine the client’s potential risk profile or actual risk profile behaviors (e.g., alcohol, illicit drugs and/or controlled substances, suicide or self-harm, abuse or neglect, falls, infections).

d. Assess client’s strengths and health promotion, illness prevention, or risk reduction needs.

3. Perform assessment. a. Based on the client’s presenting condition and health history, identify level of assessment

(focused or comprehensive) required, and perform review of relevant systems b. Select relevant assessment tools and techniques to examine the client, including specific

assessment/history strategies to identify actual or potential risk of misuse, abuse, addiction and diversion.

c. Perform a relevant physical examination based on assessment findings and specific client characteristics (e.g., age, culture, developmental level, functional ability). This includes unique considerations in vulnerable populations such as children, older adults, indigenous populations, and clients with a history or risk for mental health conditions and addictions.

d. Assess mental health, cognitive status and vulnerability using relevant assessment tools. Highlight to potential role of screening/diagnostic investigations used in monitoring clients receiving controlled substances (for example, toxicology).

e. Integrate laboratory and diagnostic results with history and physical assessment findings. C. Diagnosis The competent, entry-level nurse practitioner is engaged in the diagnostic process and develops differential diagnoses through identification, analysis, and interpretation of findings from a variety of sources.

1. Determine differential diagnosis for acute, chronic and life-threatening conditions and those related to common indications for the various classes of controlled substances.

a. Analyze and interpret multiple sources of data, including results of diagnostic and screening tests, health history, and physical examination.

b. Synthesize assessment findings with scientific knowledge, determinants of health, knowledge of normal and abnormal states of health/illness, patient and population-level characteristics, epidemiology, and health risks.

c. Generate differential diagnoses. d. Inform the client of the rationale for ordering diagnostic tests. e. Determine most likely diagnoses based on clinical reasoning and available evidence. f. Order and/or perform screening and diagnostic investigations using best available evidence to

support or rule out differential diagnoses. g. Assume responsibility for follow-up of test results. h. Interpret the results of screening and diagnostic investigations using evidence-informed clinical

reasoning. i. Confirm most likely diagnoses.


2. Explain assessment findings and communicate diagnosis to client. a. Explain results of clinical investigations to client. b. Communicate diagnosis to client, including implications for short- and long-term outcomes and

prognosis. c. Ascertain client understanding of information related to findings and diagnoses.

D. Management The competent, entry-level nurse practitioner, on the basis of assessment and diagnosis, formulates the most appropriate plan of care for the client, implementing evidence-informed therapeutic interventions in partnership with the client to optimize health.

1. Initiate interventions for the purpose of stabilizing the client in, urgent, emergent, and life-threatening situations (e.g., establish and maintain airway, breathing and circulation; suicidal ideation).

2. Formulate plan of care based on diagnosis and evidence-informed practice. a. Determine and discuss options for managing the client’s diagnosis, incorporating client

considerations (e.g., socioeconomic factors, geography, developmental stage). b. Select appropriate interventions, synthesizing information including determinants of health,

evidence-informed practice and client preferences. c. Initiate appropriate plan of care (e.g. non-pharmacological, pharmacological, diagnostic tests,

referral) and discuss the rationale for selecting controlled substances over other treatments. d. Consider resource implications of therapeutic choices (e.g. cost, availability).

3. Provide pharmacological interventions, treatment, or therapy. Summarize pharmacotherapeutics for various controlled substances (e.g., benzodiazepines) and discuss poly-pharmacy risks, including common high-risk drug combinations.

a. Select pharmacotherapeutic options as indicated by diagnosis based on determinants of health, evidence-informed practice, and client preference. Summarize considerations associated with individual client needs, including dosing, various formulations of controlled substances (e.g., long versus short acting, tamper resistant formulations), and quantity prescribed.

b. Counsel client on pharmacotherapeutics, including rationale, cost, potential adverse effects, interactions, contraindications and precautions as well as reasons to adhere to the prescribed regimen and required monitoring and follow up. Ensure the establishment and documentation of a clear treatment plan when prescribing controlled substances.

c. Complete accurate prescription(s) in accordance with applicable jurisdictional and institutional requirements. Use specific evidence-based practice resources and clinical practice guidelines.

d. Establish a plan to monitor client’s responses to medication therapy and continue, adjust or discontinue a medication based on assessment of the client’s response.

e. Apply strategies to reduce risk of harm involving controlled substances, including medication abuse, addiction, and diversion.

4. Provide non-pharmacological interventions, treatments, or therapies. a. Select therapeutic options (including complementary and alternative approaches) as indicated

by diagnosis based on determinants of health, evidence-informed practice, and client preference.

b. Counsel client on therapeutic option(s), including rationale, potential risks and benefits, adverse effects, required after care, and follow-up. This includes a standardized approach for monitoring


of controlled substances, including frequent assessments, treatment agreements, functional improvement, and achievement of treatment goals.

c. Order required treatments (e.g., wound care, phlebotomy). d. Discuss and arrange follow-up.

5. Perform invasive and non-invasive procedures. a. Inform client about the procedure, including rationale, potential risks and benefits, adverse

effects, and anticipated aftercare and follow-up. b. Obtain and document informed consent from the client, including risk for addiction and overdose

with clients. Highlight considerations for client education in relation to controlled substances, including: common side-effects, risk factors, rationale for type and frequency of monitoring, safe storage at home, disposal, adherence to treatment plan (e.g., no crushing, chewing, cutting).

c. Perform procedures using evidence-informed techniques. d. Review clinical findings, aftercare, and follow-up.

6. Provide oversight of care across the continuum for clients with complex and/or chronic conditions. 7. Follow up and provide ongoing management. Discuss common universal strategies for assessing,

managing and monitoring potential or actual misuse, abuse, addiction, diversion or aberrant behaviors (e.g., standardized assessment tools, treatment contracts, standardized monitoring protocols).

a. Develop a systematic and timely process for monitoring client progress. b. Evaluate response to plan of care in collaboration with the client. Discuss possible, or expected,

consequences that may include dependence, tolerance, pseudo addiction, and non-adherence. Highlight strategies to address consequences including discontinuing treatment if therapeutic goals are not met.

c. Revise plan of care based on client’s response and preferences. Competency II: Quality Improvement and Research The competent, entry-level nurse practitioner uses evidence-informed practice, seeks to optimize client care and health service delivery, and participates in research.




IV. Education The competent, entry-level nurse practitioner integrates formal and informal education into practice. This includes but is not limited to educating self, clients, the community, and members of the healthcare team. Client, Community, and Healthcare Team Education

1. Assess and prioritize learning needs of intended recipients. 2. Apply relevant, theory-based, and evidence-informed content when providing education. 3. Utilize applicable learning theories, develop education plans and select appropriate delivery methods,

considering available resources (e.g., human, material, financial).


4. Disseminate knowledge using appropriate delivery methods (e.g., pamphlets, visual aids, presentations, publications).

5. Recognize the need for and plan outcome measurements (e.g., obtaining client feedback, conduct pre- and post-surveys).

Continuing Competence 6. Engage in self-reflection to determine continuing education competence needs. 7. Engage in ongoing professional development. 8. Seek mentorship opportunities to support one’s professional development.

NUR1215/1216/1217 Advanced Health Assessment and Therapeutic Management II (250 hours)


1. Clearly articulate the role of the nurse practitioner when interacting with the client. 2. Use developmentally and culturally appropriate communication techniques and tools. 3. Create a safe environment for effective and trusting client interaction where privacy and confidentiality




D. Management The competent, entry-level nurse practitioner, on the basis of assessment and diagnosis, formulates the most appropriate plan of care for the client, implementing evidence-informed therapeutic interventions in partnership with the client to optimize health.

1. Initiate interventions for the purpose of stabilizing the client in, urgent, emergent, and life-threatening situations (e.g., establish and maintain airway, breathing and circulation; suicidal ideation).

2. Formulate plan of care based on diagnosis and evidence-informed practice. a. Determine and discuss options for managing the client’s diagnosis, incorporating client

considerations (e.g., socioeconomic factors, geography, developmental stage). b. Select appropriate interventions, synthesizing information including determinants of health,

evidence-informed practice and client preferences. c. Initiate appropriate plan of care (e.g. non-pharmacological, pharmacological, diagnostic tests,

referral) and discuss the rationale for selecting controlled substances over other treatments. d. Consider resource implications of therapeutic choices (e.g. cost, availability).


3. Provide pharmacological interventions, treatment, or therapy. Summarize pharmacotherapeutics for various controlled substances (e.g., benzodiazepines) and discuss poly-pharmacy risks, including common high-risk drug combinations.

a. Select pharmacotherapeutic options as indicated by diagnosis based on determinants of health, evidence-informed practice, and client preference. Summarize considerations associated with individual client needs, including dosing, various formulations of controlled substances (e.g., long versus short acting, tamper resistant formulations), and quantity prescribed.

b. Counsel client on pharmacotherapeutics, including rationale, cost, potential adverse effects, interactions, contraindications and precautions as well as reasons to adhere to the prescribed regimen and required monitoring and follow up. Ensure the establishment and documentation of a clear treatment plan when prescribing controlled substances.

c. Complete accurate prescription(s) in accordance with applicable jurisdictional and institutional requirements. Use specific evidence-based practice resources and clinical practice guidelines.

d. Establish a plan to monitor client’s responses to medication therapy and continue, adjust or discontinue a medication based on assessment of the client’s response.

e. Apply strategies to reduce risk of harm involving controlled substances, including medication abuse, addiction, and diversion.

4. Provide non-pharmacological interventions, treatments, or therapies. a. Select therapeutic options (including complementary and alternative approaches) as indicated

by diagnosis based on determinants of health, evidence-informed practice, and client preference.

b. Counsel client on therapeutic option(s), including rationale, potential risks and benefits, adverse effects, required after care, and follow-up. This includes a standardized approach for monitoring of controlled substances, including frequent assessments, treatment agreements, functional improvement, and achievement of treatment goals.

c. Order required treatments (e.g., wound care, phlebotomy). d. Discuss and arrange follow-up.

5. Perform invasive and non-invasive procedures. a. Inform client about the procedure, including rationale, potential risks and benefits, adverse

effects, and anticipated aftercare and follow-up. b. Obtain and document informed consent from the client, including risk for addiction and overdose

with clients. Highlight considerations for client education in relation to controlled substances, including: common side-effects, risk factors, rationale for type and frequency of monitoring, safe storage at home, disposal, adherence to treatment plan (e.g., no crushing, chewing, cutting).

c. Perform procedures using evidence-informed techniques. d. Review clinical findings, aftercare, and follow-up.

6. Provide oversight of care across the continuum for clients with complex and/or chronic conditions. 7. Follow up and provide ongoing management. Discuss common universal strategies for assessing,

managing and monitoring potential or actual misuse, abuse, addiction, diversion or aberrant behaviors (e.g., standardized assessment tools, treatment contracts, standardized monitoring protocols).

a. Develop a systematic and timely process for monitoring client progress. b. Evaluate response to plan of care in collaboration with the client. Discuss possible, or expected,

consequences that may include dependence, tolerance, pseudo addiction, and non-adherence.


Highlight strategies to address consequences including discontinuing treatment if therapeutic goals are not met.

c. Revise plan of care based on client’s response and preferences. E. Collaboration, Consultation, and Referral The competent, entry-level nurse practitioner identifies when collaboration, consultation, and referral are necessary for safe, competent, and comprehensive client care.

1. Establish collaborative relationships with healthcare providers and community-based services, rehabilitation, home care.

2. Provide recommendations or relevant treatment in response to consultation requests or incoming referrals.

3. Identify need for consultation and/or referral (e.g., to confirm a diagnosis, to augment a plan of care, to assume care when a client’s health condition is beyond the nurse practitioner’s individual competence or legal scope of practice).

4. Initiate a consultation and/or referral, specifying relevant information (e.g., client history, assessment findings, diagnosis) and expectations. Discuss strategies for identifying client-populations, or findings that may require specialized services.

5. Review consultation and/or referral recommendations with the client and integrate into plan of care as appropriate.

F. Health Promotion The competent, entry-level nurse practitioner uses evidence and collaborates with community partners and other healthcare providers to optimize the health of individuals, families, communities, and populations.

1. Identify individual, family, community and/or population strengths and health needs to collaboratively develop strategies to address issues.

2. Analyze information from a variety of sources to determine population trends that have health implications.

3. Select and implement evidence-informed strategies for health promotion and primary, secondary, and tertiary prevention.

4. Evaluate outcomes of selected health promotion strategies and revise the plan accordingly. Competency II: Quality Improvement and Research The competent, entry-level nurse practitioner uses evidence-informed practice, seeks to optimize client care and health service delivery, and participates in research.






1. Assess and prioritize learning needs of intended recipients 2. Apply relevant, theory-based, and evidence-informed content when providing education 3. Utilize applicable learning theories, develop education plans and select appropriate delivery methods,

considering available resources (e.g., human, material, financial) 4. Disseminate knowledge using appropriate delivery methods (e.g., pamphlets, visual aids, presentations,

publications) 5. Recognize the need for and plan outcome measurements (e.g., obtaining client feedback, conduct pre-

and post-surveys) Continuing Competence

6. Engage in self-reflection to determine continuing education competence needs. 7. Engage in ongoing professional development. 8. Seek mentorship opportunities to support one’s professional development

NUR 1221/1222/1223: Nurse Practitioners: Roles and Issues 200 hours

I. Client Care A. Client Relationship Building and Communication The competent, entry-level nurse practitioner integrates formal and informal education into practice. This includes but is not limited to educating self, clients, the community, and members of the healthcare team.

1. Clearly articulate the role of the nurse practitioner when interacting with the client.

E. Collaboration, Consultation, and Referral The competent, entry-level nurse practitioner identifies when collaboration, consultation, and referral are necessary for safe, competent, and comprehensive client care.

2. Establish collaborative relationships with healthcare providers and community-based services, rehabilitation, home care).

3. Provide recommendations or relevant treatment in response to consultation requests or incoming referrals.

4. Identify need for consultation and/or referral (e.g., to confirm a diagnosis, to augment a plan of care, to assume care when a client’s health condition is beyond the nurse practitioner’s individual competence or legal scope of practice).

5. Initiate a consultation and/or referral, specifying relevant information (e.g., client history, assessment findings, diagnosis) and expectations. Discuss strategies for identifying client-populations, or findings that may require specialized services.

6. Review consultation and/or referral recommendations with the client and integrate into plan of care as appropriate.


II: Quality Improvement and Research The competent, entry-level nurse practitioner uses evidence-informed practice, seeks to optimize client care and health service delivery, and participates in research.

1. Identify, appraise, and apply research, practice guidelines, and current best practice. 2. Identify the need for improvements in health service delivery. 3. Analyze the implications (e.g., opportunity costs, unintended consequences) for the client and/or the

system of implementing changes in practice. 4. Implement planned improvements in healthcare and delivery structures and processes. 5. Participate in quality improvement and evaluation of client care outcomes and health service delivery. 6. Identify and manage risks to individual, families, populations, and the healthcare system to support

quality improvement. 7. Report adverse events to clients and/or appropriate authorities, in keeping with relevant legislation and

organizational policies. 8. Analyze factors that contribute to the occurrence of adverse events and near misses and develop

strategies to mitigate risks. This includes identifying misuse, abuse, addiction, overdose and diversion as risks when using controlled substances.

9. Participate in research. 10. Contribute to the evaluation of the impact of nurse practitioner practice on client outcomes and

healthcare delivery. III. Leadership The competent entry-level nurse practitioner demonstrates leadership by using the nurse practitioner role to improve client care and facilitate system change.

1. Promote the benefits of the nurse practitioner role in client care to other healthcare providers and stakeholders (e.g., employers, social and public service sectors, the public, legislators, policy-makers).

2. Implement strategies to integrate and optimize the nurse practitioner role within healthcare teams and systems to improve client care.

3. Coordinate interprofessional teams in the provision of client care. 4. Create opportunities to learn with, from, and about other healthcare providers to optimize client care. 5. Contribute to team members’ and other healthcare providers’ knowledge, clinical skills, and client care

(e.g., by responding to clinical questions, sharing evidence). 6. Identify gaps and/or opportunities to improve processes and practices, and provide evidence informed 1. recommendations for change. 7. Utilize theories of and skill in communication, negotiation, conflict resolution, coalition building, and

change management. Reinforce the leadership necessary to ensure clients receive appropriate treatment, while also managing expectations and dealing with the pressure to prescribe.

8. Identify the need and advocate for policy development to enhance client care. 9. Participate in program planning and development to optimize client care.



1. Assess and prioritize learning needs of intended recipients 2. Apply relevant, theory-based, and evidence-informed content when providing education 3. Utilize applicable learning theories, develop education plans and select appropriate delivery methods,

considering available resources (e.g., human, material, financial) 4. Disseminate knowledge using appropriate delivery methods (e.g., pamphlets, visual aids, presentations,

publications) 5. Recognize the need for and plan outcome measurements (e.g., obtaining client feedback, conduct pre-

and post-surveys) Continuing Competence

6. Engage in self-reflection to determine continuing education competence needs. 7. Engage in ongoing professional development. 8. Seek mentorship opportunities to support one’s professional development.


SECTION 3: PRACTICUM ROLES & RESPONSIBILITIES Individual NP students are placed in a clinical practicum to work with either an NP or a physician (Preceptor Model). The student works under the guidance and direction of the preceptor and is expected to take on a portion of the workload. Student supervision is integrated within the role of the NP or physician preceptor and supported by the course instructor and the NP program coordinator. The preceptor's roles include those of a coach, teacher, facilitator, resource person, and clinical evaluator. In most cases, the preceptor is a NP (with at least one year of clinical NP experience). In some situations, students may have a physician preceptor. In this case, students are also assigned a NP Advisor. Students may complete no more than 50% of program practicum hours (400 hours maximum) with physician preceptors. Students generally have one placement and preceptor for each practicum course. This is to ensure each student has adequate time to develop in the role of a NP and to allow the preceptor adequate time to assess the student and provide a reliable and valid student and clinical experience evaluation.

Clinical Education Office The staff in the Faculty’s Clinical Education Office identify potential NP placements, in collaboration with the student and the NP program faculty. They recruit suitable preceptors and use a placement matching system to coordinate placements. The staff in the Clinical Education Office are normally the initial point of contact for students and agencies related to placements. The staff are also responsible for formally notifying agencies when students have been matched to preceptors and informing students of necessary agency orientation requirements.

Students The primary objective of practicum experience is to gain knowledge and expertise from working with the preceptor and within the practice setting in preparation for a career as a knowledgeable, competent nurse practitioner. Professional demeanor as would normally be expected of one working in the role of an RN is expected to continue in all practicum experience situations. Respect, collegiality and privacy of information will be upheld at all times by the student. Any breach in conduct should be reported by the preceptor to the instructor immediately.

Before Beginning a Clinical Rotation

• Analyze and determine what they want to gain from the experience (please reflect on course competencies and individual learning needs)

• Complete online practicum information form

• Ensure that all required documentation for student preparedness permit is valid and complete (immunization, CNO or comparable registration, mask fit testing results, vulnerable sector police record check)

• Complete any agency-specific orientation and/or documentation requirements (e.g. agency ID, secure system access, etc.)

• Develop a draft learning plan; consider the self-reflection piece of the clinical portfolio and the specific course competencies when formulating the learning plan


At the Outset of every Clinical Rotation

• Discuss your consolidated clinical portfolio and draft learning plan with the preceptor/submit to course instructor as required

• Discuss with the preceptor reciprocal expectations and devise a schedule of activities to meet learning competencies During the Clinical Rotation

• Maintain an updated clinical portfolio and learning plan

• Seek supervision and feedback from the preceptor on a weekly basis

• Perform within the administrative framework of the practice facility

• Progress toward achievement of all course competencies for a successful clinical evaluation

• Abide by PHIPPA requirements; students will not view any records that they are not authorized to see and will not copy, scan or remove any patient documents from the clinical setting

• Communicate with course instructor if issues arise during practicum placement (e.g. challenges with meeting course competencies, issues with preceptor access or availability, concerns re: clinical supervision, etc.)

After Completion of every Clinical Rotation

• Review the clinical portfolio and learning plan with the preceptor to determine if competencies have been successfully achieved

• Discuss student self-evaluation with the preceptor

• Submit a preceptor approved clinical portfolio to instructor verifying hours of on-site clinical practice experience

• Submit a completed learning plan as directed to instructor

• Keep a copy of the clinical portfolio for submission to the instructor in the next clinical course (i.e. keep 1101 [or 1102 or 1114] for submission at beginning of 1115 [or 1116 or 1117]), etc.

• Complete online preceptor and placement evaluations

NP and Physician Preceptors The preceptor role is fundamental to helping the student learn, experience, and practice in an environment that is supportive and safe for both the student and the patients. All NP preceptors and NP Advisors must be entitled to practice as an RN (EC) in Ontario (or in their province where placement occurs) with no restrictions. All physician preceptors must be in good standing with the College of Physicians and Surgeons of the province where placement occurs. All NP students must have valid RN registration in their province.

Prior to the Beginning of the Clinical Rotation

• Communicate with the student in order to discuss the clinical environment

• Information such as start times, dress code, reporting of sick time etc. should be communicated prior to the beginning of the practicum experience

• Additional learning opportunities such as rounds, journal clubs etc. can be suggested at this time as well


At the Outset of the Clinical Rotation

• Review the learning plan, clinical portfolio, and practicum competencies with the student

• Assist the student to identify strategies for achieving competencies

• Communicate with the course instructor to establish initial contact (the course instructor typically initiates this contact via email within the first 2 – 3 weeks of the course.)

• Complete the honorarium request sent via email by the Financial & Payroll Administrator Note: Honoraria requests will be processed once the practicum evaluation has been completed, and final grades have

been submitted by the course instructor and approved by Committee on Standing. Honorarium payments are issued September, January, and May each year for the previous term. For more details, visit https://bloomberg.nursing.utoronto.ca/faculty-staff/clinical-instructorspreceptors/nppreceptor.

During the Clinical Rotation

• Facilitate student's introduction to the clinical setting

• Act as a clinical expert and role model sharing experiences and knowledge

• Provide clinical supervision and consultation to the student during their practicum experience

• Meet with the student regularly to discuss progress towards achievement of learning competencies (as outlined in the student’s learning plan)

• Inform the course instructor of any problems arising from the student placement as soon as these are suspected or identified (Early intervention and faculty support helps to ensure student success and decrease preceptor burden in difficult situations)

• Complete all required evaluations* via the online evaluation tool - Linking Health Professionals (watch for an email link from [email protected]), and discuss the evaluation with course instructor if unsatisfactory. If you have not received an email, please notify the course instructor.

After Completion of the Clinical Rotation

• Review the course competencies with the student to determine if successfully achieved. Meet and discuss evaluation of performance with the student. Complete the required final evaluation* online via Linking Health Professionals, (watch for an email link from [email protected]), and discuss the evaluation with course instructor if unsatisfactory.

• Review the clinical portfolio for accuracy *If you are a physician preceptor, please discuss evaluation of performance with the NP Advisor prior to completing the online form.

NP Advisors All students with a physician preceptor in any semester must also have a NP Advisor. A NP Advisor will provide feedback via on line evaluation to the course instructor about a NP student’s progress towards their clinical competencies as they relate to NP practice. The NP Advisor will work together with the student and their physician preceptor to ensure the student has the opportunity to learn and be assessed by an Advanced Practice Nurse with NP competencies. NP Advisors may participate in the students learning through direct observation in the clinical setting, or via indirect methods including face-to-face meetings, video room chats, telephone calls or email correspondence.

https://bloomberg.nursing.utoronto.ca/faculty-staff/clinical-instructorspreceptors/nppreceptor




The student will provide the NP Advisor with details of her/his individual learning plan. Students are also asked to provide the NP Advisor with a plan for communication and identify strategies for illustrating progress towards meeting the course and clinical competencies. NP Advisors will communicate with their NP students weekly during the semester. The student is expected to negotiate a schedule with the NP Advisor at the beginning of the course. At any point in the semester, the NP Advisor is encouraged to contact the course instructor, if there are any concerns about the student's placement or progress or if contact is limited. Some examples of how NP Advisors have assessed student progress include:

Indirect:

• review sample clinical documentation, discuss student documented case studies and analysis of exemplars describing clinical encounters. Discuss experiences related to the NP role with students.

Direct

• carry out direct observation of a student in the clinical setting

The NP Advisor is required to document their feedback about the students’ progress and clinical competence online via online evaluation. This feedback will be used together with that provided by the physician preceptor to determine if a student has met the competencies for the clinical practicum component of their course.


SECTION 4: CHARACTERISTICS OF AN EFFECTIVE PRECEPTOR/NP ADVISOR

Characteristic Description

Knowledge • understanding entry-level NP course competencies and advanced practice models of care

• assisting students in how to demonstrate entry-level NP course competencies and advanced practice

models of care

• being up-to-date on NP standards of practice, organizational policies, and evidence-based guidelines

• using this knowledge to help students demonstrate entry-level NP course competencies

• knowledge of students’ backgrounds, previous NP clinical experiences (clinical portfolio) and clinical

learning goals (clinical learning plans)

Clinical Competence • experts in their clinical specialty

• have maintained their advanced practice clinical skills/competence

• can guide NP students in demonstrating entry-level NP course competencies

• have developing / developed skill in clinical teaching

Skill in Clinical Teaching • ability to assess students’ learning goals, plan instruction / clinical experiences that meet student learning

goals and foster achievement of entry-level NP course competencies, and evaluate learning (objective

evaluations with constructive feedback)

• understands adult learning theories and knows how to teach (being an expert clinician is not enough)

• good organizational skills; keeping students challenged; good role model

Interpersonal Relationship

with Students

• genuine, direct and honest in relationships with students; willing to express own feelings and mistakes /

limitations

• trust and respect for diversity (age, background, abilities, gender, ethnicity, race, sexual orientation,

learning styles, etc.); nonjudgmental; showing confidence in students

• empathetic understanding, supporting students and demonstrating caring behaviours

• being approachable, encouraging students to ask questions and seek guidance when needed

Personal Characteristics • enthusiasm and enjoyment in working with students

• major factor in keeping students motivated and interested in learning

• sense of humour, willingness to admit limitations and mistakes honestly, patience and flexibility

• friendly, provide students with opportunity to share feelings and concerns about patients

• integrity, perseverance, courage

• professional nursing identity

• well prepared and confident

(Adapted from Gaberson et al., 2015; Hanson & Stenvig, 2008, Melrose et al., 2015)


Guiding Learners in Clinical Practice (Adapted from Gaberson et al., 2015)

This is the instructional phase of the clinical teaching process – the actual teaching of students in the clinical setting. Guiding learners is a process of coaching students to acquire the essential knowledge, technological and other skills, and values for practice. This is where students develop their clinical reasoning skills and learn to think like a nurse practitioner.

Skill in Observing Clinical Performance

Preceptors/NP Advisors need to be skilled in observing/discussing/evaluating clinical performance, arriving at sound judgments

about that performance, and planning/suggesting additional learning activities as needed.

Guidelines for Observing Students in Clinical Practice

• Examine your values and biases that may influence observations

of/conversations with students and judgments about clinical performance

• Do not rely on first impressions… these often change significantly with further

observations of/discussions with the student

• Make a series of observations or have several discussions before drawing

conclusions about student knowledge/clinical performance

• Share observations/insights regularly with students and judgments about

whether they are meeting entry-level NP course competencies

• Focus observations/discussions on the entry-level NP course competencies

• Use observations/discussions as a way of providing both positive and

constructive feedback to students

• When discussing observations/clinical experiences with students, obtain their

perceptions of performance and be willing to modify judgments when a

different perspective is offered

(Modified from Gaberson, Oermann & Shellenbarger, 2015)


Skill in Questioning Students

Preceptors/NP Advisors also need to be skilled in questioning students to promote critical thinking and clinical judgment. This

includes the ability to ask thought-provoking questions without students feeling that they are being interrogated. Open ended

questions about students’ thinking and the rationale they used for arriving at clinical decisions foster development of critical thinking

skills. It is important to assess students’ understanding of relevant concepts and theories and how they apply to patient care.

Questions should encourage learners to think beyond the obvious.

“Situated coaching” has been described by the Carnegie National Study of Nursing Education (Benner, Sutphen, Leonard & Day,

2009) as focusing questions within specific clinical situations (McNiesh, Benner & Chesla, 2011). In this study, an example of

excellent clinical teaching by Lisa Day encourages use of the following questions:

1. What are your concerns for this patient?

2. What are you planning to do to cope with these concerns (do you need additional information? what diagnostics will you

order? What are your differential diagnoses? What pharmacologic treatments will you prescribe? What non-pharmacologic

interventions might be useful? Do you need to consult/refer? Is additional education needed?)

3. What are the patient’s concerns?

4. Who/where are your resources?

5 Principles on Providing Feedback in the Clinical Setting

1. Feedback should be precise and specific 2. For procedures, use of technologies, and any psychomotor skills, the preceptor should provide both verbal (by

describing observations of performance and explaining what to do differently) and visual feedback (by demonstrating correct performance)

3. Feedback about performance should be given to students at the time of learning or immediately following it 4. Students need different amounts of feedback and positive reinforcement 5. Feedback should be diagnostic – after identifying areas in which further learning is needed, the preceptor’s

responsibility is to guide students so they can improve performance

(Adapted from Gaberson, Oermann & Shellenbarger, 2015)


SECTION 5: ASSESSMENT AND EVALUATION OF STUDENTS

One of the important roles of the preceptor is to formally provide students with an assessment of their competencies. These are specific to each clinical course (see previous descriptions in Section 2). The following section describes the student assessment methods used at the Lawrence S. Bloomberg Faculty of Nursing. ** For students with physician preceptors, a student’s clinical evaluation cannot be considered complete until all required NP Advisor feedback has been submitted via Linking Health Professionals. Watch for an email link from [email protected].

Competency Evaluation Preceptors provide ongoing feedback on their student’s clinical progress throughout the clinical practicum. It is encouraged that preceptors and NP Advisors keep notes on student progress throughout the term. These notes will assist in providing students with individualized and meaningful verbal and written evaluations on their progress. It is helpful to include specific clinical examples to support your observations of the students’ progress. Two types of student assessment methods include midterm clinical progress updates with the course instructor and final evaluations using Linking Health Professionals. Midterm Clinical Progress Update The clinical instructor will send an email requesting information regarding student progress at the midpoint of the practicum experience. The midterm clinical progress update takes place at the mid-way point for each clinical practicum (~week 5-6). At the midterm point, the preceptor meets individually with the student during the clinical day to provide them with a verbal evaluation of their progress. The midterm evaluation is the perfect time to conduct a ‘check-in’ with the student. In preparation for the midterm evaluation, it is helpful for the preceptor to review the course competencies and their notes. During this meeting, the preceptor reviews the student’s clinical portfolio and clinical learning plan and discusses how their practicum has progressed to date, how the student believes their goals are being met, how the student is progressing towards meeting the course competencies, and suggested areas for growth. If preceptors are concerned that students are not on track to meet all required competencies by the end of the course, instructors must be informed. Preceptor concerns are discussed with the course instructor and/or NP program coordinator, please refer to page xx for further information on working with a struggling student. NP Advisors also meet with students who have physician preceptors at the mid-way point. During this meeting, the NP Advisor reviews the student’s clinical portfolio and clinical learning plan and discusses how their practicum has progressed to date, how the student believes their goals are being met, how the student is progressing towards meeting the course competencies, and suggested areas for growth. NP Advisor concerns are discussed with the course instructor and/or NP program coordinator, please refer to page need a page # here for further information on working with a struggling student.



Final Competency Evaluations Submitted On-Line via Linking Health Professionals Completed by Student All student evaluations are completed online through our online evaluation system – Linking Health Professionals (LHP). LHP hosts a community of students and preceptors affiliated with the Lawrence S. Bloomberg School of Nursing. Students carry out self-

assessments (competency evaluation) and provide feedback on the clinical experience. All information is private and confidential. Individual evaluations of the preceptor and site are never released to the preceptors. In order to provide constructive feedback, evaluation results are anonymized, collated and shared with the site only after at least three separate evaluations have been provided and a request from the preceptor or site has been made. Completed by Preceptor As a preceptor, you are required to complete a clinical competency evaluation and a student behavioral evaluation. At completion of your student’s placement you are required to complete these online evaluations via LHP. You will receive an email link from LHP requesting you to do so. The student must complete their evaluation first, and then you will be prompted to complete your evaluation. As a part of the evaluation you will be required to verify your student’s on site hours. Preceptors are invited to build their profile on LHP, and are encouraged to share a photo, which helps build recognition as part of the Lawrence S. Bloomberg Faculty of Nursing. Minimum posting to the profile should include your name, area of practice and contact details. We will set up your account with LHP (if not currently a member) and the LHP system will email you an access password. If you have used LHP previously, you may sign on with your current login name and password. Most common issues related to LHP evaluations: Students must complete their evaluation first. This step is needed in order for the LHP system to prompt the preceptor to complete their part

• Students or preceptors click “save” instead of “submit” (evaluation is not submitted to the system, but saved instead)

Student Behavioural Evaluation Completed by Preceptor As a preceptor, you are required to complete a clinical competency evaluation and a student behavioral evaluation. At completion of your student’s placement you are required to complete these online evaluations via LHP. You will receive an email link from LHP requesting you to do so. The student must complete their evaluation first, and then you will be prompted to complete your evaluation. As a part of the evaluation you will be required to verify your student’s hours. See below for a screen shot of a behavioural evaluation.


How to Navigate the Evaluation System: 1. Once your student has completed their evaluation you will receive an email prompt from the LHP system. The message

will state that a Competency Evaluation and Student Evaluation are waiting for you to complete. Watch for an email link from [email protected]. Sign in to Linking Health Professionals using the link provided or through (www.linkhealthpro.com).

2. On the left menu, select “Application” and select “Clinical Evaluation in the drop-down menu 3. Click Start to proceed with the evaluation. You can view the Student’s self-evaluation by clicking the magnifying glass icon. You

will start the evaluation by confirming the number of hours spent with the Student. You can either confirm the number of hours the student has documented, or if different, enter the number of hours spent with the Student.


http://www.linkhealthpro.com/


4. Proceed with the Competency Evaluation.


5. Once you are finished with the evaluation, click on the Submit button


6. A summary screen displays the selections you made. The continue button takes you back to the evaluations screen.


7. Submit the evaluation when complete.

8. A summary screen displays the selections you made. The continue button takes you back to the evaluations screen.


SECTION 6: POLICY AND PROCEDURES Entry-to-Practice Competencies for Nurse Practitioners Competency evaluations are course-specific and based on the entry-level competencies for Nurse Practitioner practice in Ontario. These competencies are the benchmark for the knowledge, skill and judgment a student must demonstrate for safe, ethical and effective NP practice. The entire Entry-to-Practice Competencies for Nurse Practitioners can be accessed using this link: http://www.cno.org/globalassets/docs/reg/47010-np-etp-competencies.pdf.

NP Student Conduct It is an expectation that NP students demonstrate a high degree of respect towards others as a fundamental aspect of professional conduct. Nurse Practitioner practice is grounded in the values, knowledge and theories of nursing practice (CNO, Entry-to-Practice Competencies for Nurse Practitioners, 2018). Nurse practitioner students in our program must understand and enact this professional standard:

• in their actions and interactions with patients and family members,

• in their communications about patient care and other issues with colleagues,

• in their conduct, manner and demeanor in the practice environment,

• and generally, as a student member and representative of a professional organization. The Regulated Health Professions Act, 1991 (RHPA) and Nursing Act, 1991 set the legal framework for the practice of nursing. This includes a scope of practice statement and a number of controlled acts NPs are authorized to perform. For additional guidance please refer to:

1. The University of Toronto’s Standards of Professional Practice Behavior for all Health Professional Students (2008): http://www.governingcouncil.utoronto.ca/Assets/Governing+Council+Digital+Assets/Policies/PDF/ppsep012008i.pdf

2. Practice Standard - Ethics, College of Nurses of Ontario (2009): http://www.cno.org/globalassets/docs/prac/41034_ethics.pdf 3. Nurse Practitioner Practice Standard (2018): https://www.cno.org/globalassets/docs/prac/41038_strdrnec.pdf 4. Confidentiality and Privacy – Personal Health Information Practice Standard (CNO, 2017):

http://www.cno.org/globalassets/docs/prac/41069_privacy.pdf

Guidelines for NP Clinical Performance The practice of nursing students is guided by the principles of Competence, Client Safety, and Authority as per legislation and/or agency policy. Instructors and students are expected to be familiar with and follow agency policies in relation to student practice. Regardless of what is authorized through legislation or policies, students must provide care only in circumstances where they have the necessary knowledge, skill, and judgment to perform safely, effectively, and ethically. The nursing student is expected to:

• Identify situations where he/she requires assistance

• Seek appropriate assistance, direction, and supervision

http://www.cno.org/globalassets/docs/reg/47010-np-etp-competencies.pdf

http://www.governingcouncil.utoronto.ca/Assets/Governing+Council+Digital+Assets/Policies/PDF/ppsep012008i.pdf

http://www.cno.org/globalassets/docs/prac/41034_ethics.pdf

https://www.cno.org/globalassets/docs/prac/41038_strdrnec.pdf

http://www.cno.org/globalassets/docs/prac/41069_privacy.pdf


Accountabilities for Supporting Students “Nurses have a professional obligation to support learners to develop and refine the competencies needed for safe, ethical and effective practice, and to support the development and socialization of colleagues who are learning”. Please refer to handout of CNO Practice Guideline: Supporting Learners http://www.cno.org/en/learn-about-standards-guidelines/educational-tools/ask-practice/supporting-learners/

Expectations of Students in Clinical Practice The primary objective of practicum experience is to gain knowledge and expertise from working with the preceptor and within the practice setting in preparation for a career as a knowledgeable, skilled nurse practitioner. Professional demeanor as would normally be expected of one working in the role of an RN is expected to continue in all practicum experience situations. Respect, collegiality and privacy of information will be upheld at all times by the student. “Nurse practitioners are expected to comply with relevant laws and other College of Nurses of Ontario standards and guidelines (http://www.cno.org/en/learn-about-standards-guidelines/standards-and-guidelines/). Nurse practitioners are authorized to diagnose, order and interpret diagnostic tests, and prescribe medications and other treatments for clients. NP practice includes health promotion with the aim of optimizing the health of people, families, communities and populations. This enables NPs to practice with diverse client populations in a variety of contexts and practice settings such as acute care, primary care, rehabilitative care, curative and supportive care, and palliative/end-of-life care” (CNO NP Practice Standard, 2018). Minimal and acceptable characteristics for safe clinical practice for NP students are described according to the following standards: 1) health assessment, 2) diagnosis, 3) therapeutic management, 4) collaboration, consultation and referral, 5) conflict of interest, and 6) discontinuing the NP-client relationship. Further details are found in the CNO NP Practice Standard (2018) at: http://www.cno.org/globalassets/docs/prac/41038_strdrnec.pdf. Unsafe Performance in the Clinical Setting Unsafe performance is defined relative to course expectations and competencies. Unsafe performance in clinical practice includes behavior that reflects a lack of knowledge, skill, or judgment, or disregard for the welfare of the client. Unsafe performance indicates that the student is unfit to continue in a course or courses or to continue as a student in the program. If you are concerned about your student’s practice, please contact the clinical instructor and or NP program coordinator immediately so that they can ensure timely and appropriate action is taken. Student Injury If a student injures themselves while at clinical (i.e. needle stick injury, fall), it is important that certain steps be followed to ensure that the student receives appropriate follow-up. Students should also complete an online clinical incident reporting form. This new form must be completed along with the accompanying paperwork for all WSIB injuries. For non-WSIB incidents, reporting is optional and anonymous. This form assists the Faculty in tracking injuries and incidents that occur during practicum placements. The form can be located at https://bloomberg.nursing.utoronto.ca/current-students/student-forms#content4

http://www.cno.org/en/learn-about-standards-guidelines/educational-tools/ask-practice/supporting-learners/

https://bloomberg.nursing.utoronto.ca/current-students/student-forms#content4


In the event of a student injury during practicum placement, please follow the instructions below:

1. The student notifies the preceptor as soon as incident/ injury occurs. The Course Instructor must be notified as well. 2. The preceptor sends the student to the organization’s Occupational Health Department (or the ER if the organization does

not have Occupational Health or if OH is closed). The preceptor tells the student to request a blood test during assessment/examination if this is a needle stick injury or bodily fluid exposure.

3. The student should request a copy of the completed assessment form from the Occupational Health Nurse or ER physician to

provide the Faculty of Nursing. 4. On the same day as the incident, the preceptor must send an email to the Course Instructor and the Clinical Education Office

[email protected].

5. Within 48 hours of the incident, the preceptor and student complete the following forms: a. University of Toronto Students on Unpaid Work Placements Accident Report b. Postsecondary Student Unpaid Work Placement Workplace Insurance Claim c. Letter of Authorization to Represent Employer forms (please refer to the WSIB Responsibility Matrix).These three forms

can be found on the Faculty’s website at: https://bloomberg.nursing.utoronto.ca/current-students/student-forms#content4 (use Internet Explorer as your web browser to open these forms, for sample document “Postsecondary Student Unpaid Work” please see appendix)

6. Please note that students/preceptors to submit WSIB documents using the University of Toronto's secure file transfer system

UTSend https://send.utoronto.ca/. UTSend file transfers can be directed to [email protected] on the UTSend system.

7. Upon receipt of the completed forms, the Clinical Education Office will submit all the completed documentation to the University of Toronto’s Office of the Vice-Provost, Students on behalf of the Faculty of Nursing.

8. If a student is advised to take time off from the clinical placement, the student must obtain a note from his/her family physician before returning to clinical practice. The note should state “May return to regular duties” or the student will need to register with Accessibility Services for any accommodations.




https://send.utoronto.ca/



WSIB Responsibilities Matrix

Student Preceptor Clinical Education

Office

University of Toronto Students on Unpaid Work Placements Accident Report

complete middle two sections on page 1 "Student Trainee Information" and "Reporting Information"

complete the top portion of page 1 i.e. indicate appropriate option "No Injury" vs. "Injury/Illness", in most cases "No Lost Time" is indicated (only indicate Lost Time if student is not able to return to their placement for a significant amount of time and therefore is unable to graduate on time), complete "Incident Information" bottom of page 1 and continued on page 2, complete "Confirmation of Placement Employer" and sign bottom of the form with date

send to Office of the Vice-Provost, Students

Postsecondary Student Unpaid Work Placement Workplace Insurance Claim

complete sections A, B and C and sign

complete section D and sign complete section D and send to Office of the Vice-Provost, Students

Letter of Authorization to Represent Employer

complete section where it says Placement Employer Complete section where it says Training Agency and send to Office of the Vice-Provost, Students


Clinical Attendance Expectations

Clinical practice is central to nursing and mandatory in the Nurse Practitioner Program at the Lawrence S Bloomberg Faculty of Nursing. If students cannot attend clinical practicums, they are required to follow the process below. Failure to act responsibly regarding absences constitutes non-compliance with the University of Toronto’s Standards of Professional Practice Behaviour for All Health Professional Students and will impact the student’s professionalism assessment and overall clinical evaluation. Breach of these standards may be cause for failure in a course. Students are expected to arrive with all onboarding/orientation completed. Students should ensure they have signed and returned all the necessary documentation to the agency’s Professional Practice, if applicable.

Absences In the case of absence due to illness, students must notify: (1) their Preceptor and (2) Course Instructor and (3) the Clinical placement site. Course instructors should be notified by email as soon as an absence occurs; the clinical placement site and preceptor should be notified by phone prior to the beginning of the shift. Lateness Students are expected to arrive at the time agreed with the primary preceptor. If student arrival at the clinical placement site will be delayed due to extenuating circumstances, students must notify the Preceptor and the clinical placement site as soon as possible. Ongoing issues with lateness, and/or failure to provide appropriate notification will negatively impact the student’s clinical evaluation. Vacations Students are expected to attend course required activities within the course start and end dates. Vacations should be planned around these dates. Commitments which may affect students’ attendance in clinical practicums must be discussed with and approved by the course instructor and/or NP program coordinator prior to the beginning of the term.

Student Preparedness Permit Students need to meet the requirements of a student preparedness permit prior to the fall term of each academic year, including CNO (or equivalent) registration, immunization, CPR, N95, and a police record check. For more information on additional requirements, visit https://bloomberg.nursing.utoronto.ca/current-students/placements/graduate/graduate-program-practicum-requirements Vulnerable Sector Police Check All MN and Post-Master’s NP students are required to comply with the Lawrence S. Bloomberg Faculty of Nursing Police Record Check Guidelines https://bloomberg.nursing.utoronto.ca/current-students/placements/graduate/graduate-program-practicum-requirements#content2

https://bloomberg.nursing.utoronto.ca/current-students/placements/graduate/graduate-program-practicum-requirements

https://bloomberg.nursing.utoronto.ca/wp-content/uploads/2012/07/Police-Records-Check-LSBFON-Guideline-August-30-2017-removed-named-officer.pdf



https://bloomberg.nursing.utoronto.ca/current-students/placements/graduate/graduate-program-practicum-requirements#content2






Placement Process (Points of Contact / Escalating Issues) Notes: This flowchart is simplified and does not represent every scenario that can arise during placement. When a concern is raised the process really changes from a linear process to bidirectional. There should be ongoing communication between the preceptor, student, course instructor +/- NP program coordinator and this is in-keeping with UofT and CNO standards for supporting students.

Student begins placement

Clinical Education Office staff member sends a placement

confirmation email message to all preceptors with a copy of

the Preceptor Manual

Course Instructor sends an introductory email message to all preceptors with a copy of

the course syllabus

During placement, the preceptor acts as the clinical

expert ond role model for the student

Throughout the term, students, preceptors, and or course

instructors may consult with the NP Program Coordinator

for guidance

Course Instructor sends a mid-term email to prompt the

preceptor to discuss with the student his/her progress and

learning goals

When needed, preceptor and/or student may identify to

Course Instructor and NP Program Coordinator any

difficulties with placement

When appropriate, NP Program Coordinator can resolve issues

If warranted, the NP Program Coordinator can request that staff in the Clinical Education

Office find an alternative placement for the student

(occurs early in term)

If necessary, the matter is discussed with the MN

Program Director and Associate Dean Academic Student completes placement,

reviews the clincal portfolio and clinical learning plan with

preceptor

Preceptor completes a final evaluation of the student's placement experience and course instructor reviews

Course insructor determines pass/fail grade for student

Student completes an evaluation of preceptor,

evaluation of site, and self-evaluation


SECTION 8: PRECEPTOR BENEFITS

Preceptor Honorarium The Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto provides a modest honorarium to preceptors of NP students except where prohibited. All preceptors who complete clinical practice hours with a student and who complete the evaluation will receive an honorarium. Honoraria are not provided for NP Advisors. The honorarium can be designated to the individual preceptor or the site. Preceptors must complete the student evaluation and instructors must review, confirm and submit final grades. Final grades must be approved by Committee on Standing. This subsequently triggers the honorarium payment process. Typically, the payroll process occurs at the start of the subsequent term. Maximum honoraria provided per course

NUR 1101, 1102, 1114 (spring/summer) $500.00 per 80 hours (maximum 80 hours)

NUR 1115, 1116, 1117 (fall) $1,250 per 250 hours (maximum 250 hours)

NUR 1215, 1216, 1217 (winter) $1,250 per 250 hours (maximum 250 hours)

NUR 1221, 1222, 1223 (spring/summer) $1,000.00 per 200 hours (maximum 200 hours)

Note: Honoraria payments can only be processed after the receipt of honorarium payment forms by the stated deadline, the completion of students’ practicum evaluations, and the approval of final grades submitted by the course instructors. If preceptors arrange for additional preceptors for a student in any given term, these arrangements must be communicated to the course instructor. Also, any additional preceptors must receive the necessary honorarium payment forms to complete so that they are able to receive a portion of the honorarium payment. All honorarium payment forms are pro-rated based on the number of hours. Returning preceptors who have no changes to their previously submitted information (i.e., address, name, banking information) do not need to submit the forms and will be paid using the existing information. We request, that at the start of each term only new preceptors and returning preceptors who have changes to their information (name, address, bank, etc.) complete the Honorarium Payment forms, which can be found at https://bloomberg.nursing.utoronto.ca/faculty-staff/clinical-instructorspreceptors/nppreceptor and return via email to the Financial & Payroll Administrator at [email protected] .We also suggest returning preceptors re-submit their information if they are unsure that their information in UofT’s financial system is current and correct. In addition, preceptors are required to identify if the payment is paid either to the preceptor or the organization.

https://bloomberg.nursing.utoronto.ca/faculty-staff/clinical-instructorspreceptors/nppreceptor



Adjunct Appointments NP Preceptors are invited and encouraged to apply for an Adjunct Appointment at the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto. Adjunct appointments are granted to preceptors who do not currently hold an appointment at the University of Toronto and are employed elsewhere in a position that is not primarily academic in nature, who have special skills or learning of value to the Bloomberg Faculty and who may provide services for which recognition is desirable. For more information please visit: http://bloomberg.nursing.utoronto.ca/staff/clinapptprocess.htm Privileges of Adjunct Faculty The following privileges are associated with an Adjunct academic appointment at the Lawrence S. Bloomberg Faculty of Nursing:

1. Opportunities for professional development. 2. University of Toronto Library privileges including access to paper and electronic library holdings (for the duration of the

appointment). In order to obtain a card please send your request to [email protected] 3. University of Toronto email account. 4. Reduced rates on courses offered at the Centre for Professional Development. 5. Reduced rates on licensed software: http://sites.utoronto.ca/ic/software/ 6. Adjunct appointees may be a co-investigator on a grant held by appointed or status-only faculty at the University of Toronto

but cannot be the principal investigator on research funds administered by the University. 7. Regular communication and updates of issues and events associated with the Lawrence S. Bloomberg Faculty of Nursing.

Duties and Obligations of Adjunct Faculty

1. Adjunct faculty are expected to acknowledge their affiliation with the Lawrence S. Bloomberg Faculty of Nursing in all publications and scholarly works resulting from the adjunct appointment.

2. Adjunct faculty who teach or engage in research are bound by all University of Toronto policies governing academic conduct. 3. Adjunct faculty must complete the Annual Academic Activity Profile on or before June 30th each year of their academic

appointment in order to continue to be considered for ongoing adjunct status.

http://bloomberg.nursing.utoronto.ca/staff/clinapptprocess.htm


http://sites.utoronto.ca/ic/software/

nurse practitioner preceptor manual 2019-2020 · post-masters nurse practitioner (pmnp) diploma...

Documents