Part 2: Nuts and Bolts 101-Facts, Rules and Other Structures

A. The Basics 

1. Time and Schedules

Students are responsible for establishing, at the initial preceptor interview, when they expect to begin clinical. If there are factors in a student's progress that affect the anticipated clinical start date, the student must inform the preceptor as early as possible, in order to determine whether this will affect the ability to precept.

2. Pre-clinical Meeting between the Student and Preceptor

The preceptor will be contacted in advance of arrival at the clinical site to confirm availability and readiness. Plans need to be made for the student and preceptor to meet together to discuss the following: 

1. The student's background, progress through the program, and any special areas identified as needing the attention of the preceptor.
2. A plan for orientation to each clinical setting and any documentation and credentialing that the site requires, such as copies of the nursing license, proof of immunity to rubella or other diseases, hospital ID badge, keys, etc. Directions to each site and parking information are also helpful.
3. The Practice Guidelines for the practice. It is desirable for the student to make or purchase a copy to review and carry. If there are no specific written guidelines the protocol or resources that the preceptor uses should be identified for the student.
4. Appropriate professional attire for the settings. The student must wear a FSMFN picture ID badge at all times.
5. How to communicate with the preceptor if ill or unable to attend clinical for another urgent reason.
6. Introduction to or description of other providers in the practice, and any relevant issues concerning their needs and availability.
7. Any expectations for attending staff meetings, case reviews, grand rounds, etc.
8. Any special considerations in dealing with clients or with hospital, office, or clinic personnel.
9. You should also design a clinical schedule and discuss expectations for how you will work together at the start).

3. Schedule and Assignments

As the student begins in each new clinical setting or role, a period of observation is recommended, both for orientation and for role and skill modeling purposes. It is often preferable that:

• Students begin in the setting with a single preceptor.
• Some observation time should be built in to the first few days of clinical. As the student progress the need for observation time should diminish but may be required for complex clients.
• Nurse-midwifery students spend no more than three full days a week in the clinical setting until academic coursework is completed or nearly completed. The FNP students may spend up to five days a week in clinic if approved by the preceptor.
• Preceptors bring a clinical schedule to the first meeting, show it to the student, and plan the first 3-4 weeks.
• Review the student's "timeline" for Level IV at this time and keep a copy.

4. Length of Clinical Experience

Students are encouraged to plan at least 20-30 weeks in clinical. This allows time for finishing course work, together with adequate time to integrate didactic material and clinical skill practice. The marriage of practice and theory is the essence of the clinical experience and students must demonstrate ability to do this in order to graduate from the program.

The minimum duration of clinical experience is 16 full clinical or call weeks for the nurse-midwifery students and 675 clock hours. Students must remain in clinical until they have completed the academic work for their clinical courses.

Students who are experienced Certified Nurse Practitioners, Certified Nurse-Midwives, or Physician's Assistants may be eligible to "challenge" 50% of the required clinical experiences in the area/s in which they are certified. This may result in a shorter duration of the clinical practicum, but the minimum of 16 weeks is still required. Minimum hours may be adjusted in this situation by the Department Chair. The Clinical Challenge is available only if students meet established criteria. Preceptors of these students will receive detailed information about the Clinical Challenge mechanism from the RCC and clear guidance through the process.

5. "Doing the Numbers": Clinical Experience Requirements

Minimum numbers of experiences are required for all FSMFN students.

Sometimes the specified categories of visits overlap for individual patients; therefore, a single visit may count in more than one category.

Nurse-Midwifery Students

The Division of Accreditation of the American College of Nurse-Midwives sets minimum criteria for clinical experiences for nurse-midwifery programs, including numbers and types of experiences. The FSMFN requires a greater number of experiences in most areas than the minimum.

CNEP Clinical Experience Requirements

In Level IV the student is expected to master, at a safe beginning level, the Core Competencies of the ACNM. These competencies are included in the NM601 course.

The following are the requirements for clinical experiences in all areas of practice:

• 10 preconception care visits
• 30 new antepartum visits
• 140 return antepartum visits
• 40 labor management experiences
• 40 births  (4 observations)
• 40 newborn assessments
• 20 breastfeeding support visits
• 40 postpartum visits (2 hours to 14 days)
• 30 postpartum visits (2 to 8 weeks)
• 40 common health problems
• 30 family planning visits
• 25 non-postpartum gynecologic visits
• 25 perimenopausal/postmenopausal visits

Some of these categories overlap and a single visit may therefore count in more than one category. These numbers must be completed before the RCC assigns clinical grades.

rev. 3/15/05

CFNP Clinical Experience Requirements

In Level IV the student is expected to master the clinical skills necessary to become a safe beginning level Family Nurse Practitioner.

The following are the requirements for clinical experiences in all areas of practice:

• 10 new antepartum visits
• 30 returning antepartum visits
• 50 speculum/bi-manual examinations
• 10 newborn exams   
• 30 infant/toddler exams
• 30 school age exams
• 10 adolescent exams
• 300 client visits for episodic or wellness care
• 150 client visits for chronic illness care

Some of these categories overlap and a single visit may therefore not count for more than 2 categories. These numbers must be completed before the RCC assigns clinical grades.

Students are expected to master SOAP charting as a way to integrate critical thinking. Each month students will chart 2 SOAP notes on each type of patients seen. RCC will review these at the time of the clinical site visit. Students are required to send their RCCs 10 SOAP notes representing different types of pvisits for the first month.  The Rcc willl then use their own judgement regarding continued submission of SOAP notes based on the student's progress.

rev. 3/15/05

Note: Not all clinical sites will be able to provide the required number of clinical experiences. Many students may need to work with additional preceptors to gain the required clinical experience. If you anticipate difficulty meeting any of the required number of visits at your clinical site, please discuss this with the student, the regional clinical coordinator and or the department chair.

rev. 2/23/04

“When trying to remember hand maneuvers during birth she made it easier to understand by stating 'pinkys to the perineum'”. - Irene M. Meyers, CNM, Central Maine OB/GYN, Lewiston, Maine

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