Nurse Practitioner Programs Practicum Manual for the Master of Science in Nursing (MSN) and Post-Master’s Certificate:

Section 3: NP Practicum and Program Information

The practicum experience helps students transition from the role of learner to that of scholar-practitioner. To achieve this transition, students develop and engage in a relationship with a Clinical Instructor and an approved preceptor, focusing on roles and role functions and the achievement of individualized Learning Objectives. The primary objective of the practicum is to provide students with the basic skills necessary to serve as providers of primary care to selected populations and to prepare students to take the appropriate national certification exam.

Note: Students who changed specializations through enrollment and/or had to reenroll after a break in enrollment are readmitted under a newer catalog than the original catalog of admission. To confirm which catalog you are enrolled under, please contact Student Success Advising.

Walden wants all students to be aware of the costs associated with practicum, which may vary depending on a number of factors. Generally, students will incur and are responsible for paying costs associated with completing practicum. Examples of costs include, but are not limited to, the following: travel to/from practicum site; relocation costs; living costs during practicum; books; course materials; professional liability insurance; onboarding/administrative fees required by practicum sites; health insurance; costs associated with completion/renewal of onboarding requirements (e.g., immunizations, physical exam, CPR certification, HIPAA and OSHA training, etc.); state licensing fees; photo ID badge; additional onboarding requirements of practicum site; lab coat, if required by practicum site; stethoscope (NP courses); additional equipment costs; etc.

Note: Walden does not expect students to pay preceptors, practicum sites, or site placement agencies and discourages students from doing so, due to conflicts of interest that can arise. Students who enter into payment arrangements with preceptors, practicum sites, or site placement agencies do so at their own risk. 

Students who have questions about costs associated with practicum should contact Nursing Field Experience Office.

All NP practicum courses are offered through two courses, which includes a didactic and clinical course. The didactic course (NRNP) includes the coursework and instruction to develop fundamental knowledge of the content area. The clinical course (PRAC) includes the opportunity for students to complete the hands-on clinical experience in which students develop applied skills and integrate professional knowledge in providing advanced practice nursing care.

Practicum Courses: Students must successfully complete both the NRNP and PRAC of each practicum course number.

• NRNP = Didactic component of the practicum course. This course is equal to 3 credits.
• PRAC = Clinical component of the practicum course. This course is equal to 2 credits and requires practicum hours. Students must have an approved practicum application in order to be registered for a PRAC course. PRAC courses do have clinical related course assignments along with clinical hours.

Students must log in to Canvas for both NRNP and PRAC courses as they are separate courses and have different course assignments, requirements, and Instructors.

Students should refer to the course content section of this manual for further guidelines regarding course sequence and prerequisites. Students must contact their student success advisor to plan their program of study. If students receive financial assistance, students are advised to contact the Office of Financial Aid to understand how course registration affects their financial aid package.

Prerequisite Notes: Prior to beginning the practicum component, students must have satisfactorily completed NURS 6501: Advanced Pathophysiology, NURS 6512:Advanced Health Assessment and Diagnostic Reasoning, and NURS 6521: Advanced Pharmacology. PMHNP students must also complete NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology prior to beginning any practicum class. PNP students must also complete NURS 6800: Advanced Pediatric Development and Behavior prior to beginning any practicum course.

Students enrolled in NURS 6512: Advanced Health Assessment and Diagnostic Reasoning and the practicum courses must have access to the following tools to develop their assessment skills in their use of this equipment.

• Otoscope and ophthalmoscope
• Stethoscope
• Reflex hammer and tuning fork (256 cps)
• Penlight and monofilament tool

Note: If students drop a NRNP course during the term, students must also drop the corresponding PRAC course because NRNP must be taken prior to or concurrently with the PRAC course.

If an approved preceptor is sick, on leave, serving jury duty or would like the student to log hours with another practitioner to gain additional relevant experiences, students may log hours with another practitioner at the site under the direction of the approved preceptor. The approved preceptor must give approval of this additional practitioner assignment to the student and agree to sign off on these hours in Meditrek®. Students are permitted to log up to a total of 25% of the total practicum hours with other practitioners at the practicum site. If the approved preceptor does not sign off on these hours in Meditrek, the hours will not count towards the hour requirement for the course. Procedures for this additional assignment option are as follows:

• Students are only permitted to log up to 25% of the total practicum hours with other practitioners at the practicum site. Examples as follows:
  • Students required to log 144 hours may log up to 36 hours with practitioners at the practicum site
  • Students required to log 160 hours may log up to 40 hours with practitioners at the practicum site
• The practitioner must be employed by the approved practicum site.
• The practitioner must see patients and provide services that meet the course requirements.
• The hours must be related to the course learning objectives and course requirements.
• Students must document the hours in the daily time log in Meditrek as follows®.
  • Select the approved preceptor’s name in the preceptor field
  • Name of the practitioner in notes section of the daily time log
  • Role of the practitioner in notes section of the daily time log
  • Reason for the assignment in notes section of the daily time log
• Students must communicate this additional assignment with another practitioner with their clinical instructor.
• The approved preceptors must sign off on these practicum hours in Meditrek for them to be valid.

The following activities count toward required practicum hours:

• Direct patient care
• Note: shadowing the preceptor (maximum of 8 hours per quarter); shadowing is defined as following and observing preceptor with no direct patient care. These 8 hours are utilized as orientation to the facility and practice.
• Attendance at rounds or meetings that specifically discuss patient care and coordination (multidisciplinary or interdisciplinary teams).
• Documentation in the patient’s medical record

The following activities are NOT included as practicum hours:

• Travel time to and from practicum activities
• Continuing education offerings or staff meetings
• Extensive chart review
• Requirements such as orientation or required training mandated by health care agencies
• Communication (e.g., emails, phone calls), unless conferencing about patients
• Assignments related to the didactic portion of the course
• Meal breaks
• Preceptor directed reading, research, or assignments
• Entering patient encounters or time logs into Meditrek®

Preceptors Who Are Not Available Short-Term

If an approved preceptor is not available to precept for 1–2 days, (e.g., sick, on leave, serving jury duty) or would like the student to log hours with another practitioner to gain additional relevant experiences, students may log hours with another practitioner at the site under the direction of the approved preceptor. The approved preceptor must facilitate and give approval of this additional practitioner assignment to the student and agree to sign off on these hours in Meditrek®.

• Students are permitted to log up to a total of 25% of the total practicum hours with other practitioners at the practicum site. For example:

• Students required to log 144 hours may log up to 36 hours with practitioners at the practicum site.
• Students required to log 160 hours may log up to 40 hours with practitioners at the practicum site.

Note: If the approved preceptor does not sign off on these hours in Meditrek, the hours will not count towards the hour requirement for the course.

• Procedures for this additional assignment option are as follows:

• The practitioner must be employed by the approved practicum site.
• The practitioner must see patients and provide services that meet the course requirements.
• The hours must be related to the course Learning Objectives and course requirements.

• Students must document the hours in the daily time log in Meditrek®, as follows:
  • Select the approved preceptor’s name in the preceptor field.
  • Put the name of the practitioner in notes section of the daily time log.
  • Add the role of the practitioner in notes section of the daily time log.
  • Include the reason for the assignment in notes section of the daily time log.
     
• Students must communicate this additional assignment with another practitioner with their Clinical Instructor.
   
• The Walden-approved preceptors must sign off on these practicum hours in Meditrek® for them to be valid.

Students may be allowed to register for two practicum course (PRAC) classes in the same quarter if the following criteria are met and an approved petition is on file with Student Success Advising:

• The two PRAC classes are the only classes taken in that quarter. Note: An NRNP class is not allowed to be taken concurrently with the two PRAC classes.
• Student has taken and passed the NRNP section of the corresponding PRAC classes.
• Student must have a minimum GPA of 3.0 in the NP core and specialty classes
• Student is not working full time during the quarter when registered for the two PRAC classes. A statement from the student’s immediate supervisor must be included with the petition. Students who are not currently employed must submit a copy of their leave of absence papers, separation paperwork, or signed attestation they are not working during the quarter.
• There must be separate preceptors for each PRAC class. One preceptor may not be utilized for both clinical sections. Students may complete practicum at the same field site, but the preceptors must be different for the two courses.
• There are some restrictions on PRAC sections that can be combined. See below.
• Petitions addressing all of the above criteria should be submitted to Student Success Advising for a decision by the program director.

Notes:

• Students must consult directly with their Student Success Advisor to with program of study to assist course planning and course sequence.
• Students must consult with the Financial Aid Office to discuss the impact of course enrollment of future terms on financial assistance.

Restrictions on PRAC Sections That Can Be Combined With Other PRAC Courses.

Note: See the course sequence guidelings for NRNP and PRAC guidelines.

Students must identify a potential preceptor and determine if the individual is interested in working with them. If so, students must find out whether this individual meets the qualifications to serve as preceptor. Instructions on how to nominate a preceptor are provided in Section 6: Practicum Approval Process. Students should contact the nursing field experience coordinators as soon as they identify a possible preceptor, and no later than the start of their second term, to nominate the individual to serve as their preceptor. Students should evaluate potential preceptors early by emailing [email protected] to obtain feedback about whether the nominee is an acceptable preceptor candidate.

Note: Walden discourages students from paying preceptors, practicum sites, or site placement agencies, due to conflicts of interest that can arise.

Preceptor Requirements

Prior to approval, the nominated preceptor’s licensure and certification (if applicable) is verified and reviewed along with the Preceptor Commitment Form by the Office of Field Experience. The specialization coordinator gives final approval of preceptor nominees. Approval of the preceptor is based on the following criteria:

• General Requirements:

  • The preceptor has a minimum of one year of postgraduate unsupervised experience, based upon the original date of licensure for licensed practitioners. Their current job role relevant to the NP specialization. 

  • The preceptor is able and willing to commit to the preceptor role for the practicum experience.

  • The preceptor is employed at the field site where practicum takes place.

  • The preceptor is not the student's relative, family member, fiancé, roommate, significant other, personal friend, or primary care provider.

  • The preceptor is not the student's direct or immediate supervisor and dose not report directly to the student.

  • The preceptor must not be a current Walden nurse practitioner student.

  • The preceptor has not reached the maximum number of approved students for the 1:1 preceptor to student on-site direct supervision ratio. Preceptors will only be approved to precept up to three Walden University nursing students.

• Educational Level Requirement:

  • AGACNP, AGPCNP, FNP, PNP: holds a master’s or doctoral degree in nursing.
  • PMHNP, Psychiatrist: holds a master’s or doctoral degree in area of practice and licensed to practice in their specialty.
  • MD or DO: holds an earned doctoral degree.
  • PA: holds a master’s or doctoral degree
  • Psychiatrist: holds an earned doctoral degree in area of practice, licensed and board-certified in psychiatry
  • Psychologist: holds an earned doctoral degree
  • Licensed Clinical Social Worker; Licensed Mental Health Counselor/Professional Counselor; or other appropriately licensed/certified mental health professional: holds a master’s degree in the area of mental health
• Licensure & Certification Requirements: Preceptors must have an active, unencumbered license to practice in the particular area of specialization and in the specific state where practicum will occur. If the student is eligible and approved to complete practicum via telehealth, the preceptor must be licensed in the state where the patients/clients are located and meet all state board requirements for telehealth.
• Licensing and certification preceptor requirements include:
  • Nurse Practitioners: The preceptor is currently a registered nurse to practice as an NP in the particular area of specialization. The preceptor has national certification in an area of advanced practice nursing specialization (i.e., FNP; AGACNP; AGPCNP; PMHNP; certified nurse midwife [CNM]; adult, women’s health, or pediatric NP).
  • MD or DO: The preceptor is licensed as an MD or DO to practice medicine in the particular area of specialization.
  • PA: The preceptor is licensed as a physician’s assistant.
  • Psychiatrists: The preceptor is licensed as an MD to practice medicine and is board-certified in psychiatry.
  • Psychologist: The preceptor is licensed as a psychologist.
  • Licensed Clinical Social Worker, Licensed Mental Health Counselor/Professional Counselor, or other appropriately licensed/certified mental health professional: The preceptor is licensed by the appropriate state board in the particular area of specialization.

More information: Preceptor to Student Ratio

If it is found that a student’s preceptor is a supervisor, direct report, relative, family member, fiancé, roommate, significant other, personal friend or primary care provider, the practicum hours will be rejected and not counted toward the practicum hour requirement. If a student utilizes a preceptor inappropriately as noted above, this may lead to an academic integrity violation up to and including dismissal from the university. Students are responsible for nominating preceptors that fully meet all requirements for preceptors.

Note: Please refer to the “Course Specific Requirements” section for more course-specific requirements for preceptors.

Important Note for Preceptor Requirements

To learn the role of the nurse practitioner, it is required that at least two preceptors be NPs in an area of practice clearly relevant to meeting the objectives of the NP program/specialty. The two different NP preceptors must cover two separate practicum courses. Having two NP co-preceptors for one course does not meet this requirement. Following are additional preceptor requirements:

• Students may only use the same preceptor for two of their four practicum courses.
• Students cannot use the same preceptor at the same field site when they are doubling up practicum courses during the same quarter.

• Physicians (MDs, DOs) and physician assistants (PAs) may serve as preceptors but also must be credentialed and licensed to practice in the population-focused and/or specialty area of practice in the state where the practicum will occur. In addition, this area of practice should be clearly relevant to meeting the course objectives of the student’s NP program and meet the course specific guidelines. Students are not allowed to use MDs or PAs for all four courses as at least two preceptors must be NPs.
• Special notes about Physician Assistants (PAs) as preceptors:
  • PAs do not count as meeting the requirement of having two NPs as preceptors.
  • PAs may not serve as preceptors in the PMHNP program.
  • PAs may not serve as preceptors in some states due to specific state board of nursing regulations. Students should verify with their state Board of Nursing for requirements. Examples are as follows:
    • Alaska Board of Nursing does not permit certain professions, including PAs, to precept NP students (starting May 2018).
    • Florida does not permit PAs to precept.
    • Alabama does not permit PAs to precept.
  • Preceptors who are an APRN or MD/DO are the best options. However, if you are considering using a PA or other professional as a preceptor, it is helpful to reach out to your Board of Nursing and the Office of Field Experience to determine whether the preceptor is acceptable.

  Note: Approval of the preceptor must occur prior to the student starting the practicum course and logging hours. Students cannot begin logging practicum hours until their practicum application is fully approved, and they have been registered for the course.

Because circumstances change, sometimes students need to change preceptors before or during their practicum course. Students must receive practicum application approval in Meditrek® for any change of preceptor prior to logging practicum hours.

For Students Who Need to Change Their Preceptor Before Course Begins: Students are required to notify the Office of Field Experience as soon as possible if their approved preceptor becomes unavailable for any reason prior to the beginning of the course, Students must submit a new application in Meditrek® and nominate a new preceptor, who must meet all preceptor requirements. The nominee must be approved before the practicum begins. If the change in preceptorship requires relocation to a new practicum site, then a new Affiliation Agreement will also be needed (if one is not already in place), which will delay the practicum experience until a later term.

For Students Who Need to Change Their Preceptor After Course Begins: Students whose approved preceptor becomes unavailable for any reason after their course begins must notify the Office of Field Experience and faculty member who is teaching the practicum course as soon as possible. Students must submit a new application in Meditrek® and nominate a new preceptor, who must meet all preceptor requirements. The nominee must be approved before the student can continue to log hours. If the change in preceptorship requires relocation to a new practicum site, then it is likely the practicum experience will be delayed.

Students are not permitted to request a change of preceptor or supplemental preceptor if students are dismissed from their preceptor or field site for performance or comportment concerns.

The College of Nursing NP programs allow for students in select specializations and courses to complete practicum experience via telehealth to meet course requirements. Telehealth is the provision of healthcare services remotely by means of electronics and telecommunications technology.

Telehealth for this purpose is defined as synchronous services that occurs when the provider and the patient are interacting with each other in a live real-time manner (e.g., video conferencing). Students may utilize telehealth as a method to deliver patient care under the supervision of their approved preceptor when approved for telehealth. Students must be active participants in the patient visits demonstrating assessment, diagnosis, and treatment planning. Telehealth practicum may be conducted onsite or remotely.

Telehealth Requirements

Telehealth for practicum experience is defined as the use of video conferencing with audio support as a means for interacting with preceptors and patients. All students must submit a practicum application for telehealth, even if they will be conducting telehealth with a previously approved preceptor. Students must not log hours via telehealth until the application for telehealth is fully approved in Meditrek®. Practicum hours will not count if the preceptor is not approved for telehealth in Meditrek® with a submitted Telehealth Questionnaire Form. Applications for telehealth go through the standard review, Affiliation Agreement review, and approval process.

Preceptor requirements include:

• Preceptors must be providing the same type of services and serving the same type of patients as required by the course as outlined under the “Course-Specific Requirements” section of the application. 
• Preceptors must be physically or virtually present during telehealth visits. Students cannot be involved in telehealth sessions without the presence of the preceptor.
• Preceptors must meet all standard preceptor requirements outlined in this manual.
• Preceptors providing telehealth must be licensed in the state(s) where the patients/clients are located.
• Preceptors must be providing telehealth services via a HIPAA approved system.
• Preceptors must be meeting their state Board of Nursing regulations for telehealth.
• Preceptors must complete a Telehealth Questionnaire Form, which students upload to their application in Meditrek®.

Student requirements include:

• Students are not allowed to conduct telehealth visits without the virtual or onsite presence of the approved preceptor. 
• Students must be licensed in the state(s) where the patients/clients are located. Students must NOT log hours via time logs or patient logs for patients that are not located in the state where the student is licensed.
• Students must have audio and video on their device and turned on for all video telehealth sessions.
• Students must identify their type of clinical as telehealth and upload the Telehealth Questionnaire Form completed by their preceptor when they submit a practicum application in Meditrek®.
• Students must have an approved practicum application for telehealth in order to enter logs correctly for telehealth in Meditrek®. Practicum hours and patient sessions completed via telehealth without an approved practicum application for telehealth in Meditrek® will not count as approved for telehealth. If students are unable to enter time logs via telehealth in Meditrek®, they must contact the Office of Field Experience immediately.
• Students must have HIPPA approved software platform for joining video telehealth session from physical locations separate from their preceptor.
• Students must maintain confidentiality during video telehealth sessions from physical locations separate from their preceptor (no household interruptions from family/children/pets, not conducted in public places, etc.).
• Students much NOT conduct personal business or use personal cell phones during telehealth practicum hours. Cell phones may only be used to communicate with their preceptor during the practicum telehealth video time.
• Students must have access to electronic medical records for the patients they are participating with in appointment sessions, through telehealth modalities, for purposes of learning through chart review, documentation practices, etc. If the field site does not permit student access to electronic medical records, the student documented patient encounters may be rejected.

Practicum Hour Limits and Requirements for Telehealth

If approved for telehealth, the following are acceptable levels of telehealth activity by specialization program and course(s):

• Physical in-person practicum experiences are the preferred experience, as they provide a better-quality learning experience (to be physically in the same location of the preceptor), as this experience encompasses the office experience with EMRs, multidisciplinary teams, etc. If approved for telehealth, though, the following are acceptable levels of telehealth activity by specialization program and course(s):

• AGACNP clinical hours/patient encounters: 0%
• AGPCNP clinical hours/patient encounters: 25%
  • 6552
  • 6565
• FNP clinical hours/patient encounters: 25%
  • 6552 (All OB patient encounters MUST be complete in non-telehealth visits.
  • 6568
• PMHNP clinical hours:
• 6635: 25%
• 6645: No telehealth is accepted
• 6665: 75%
• 6675: 75%

Note: The percentage of telehealth hours is based on the total percentage of the course hours. Also, if students have multiple preceptors for one course, they are still only able to log the percentage of hours for the total hours of the course, NOT by individual preceptor.

Also Note: The recommended format for telehealth is the student at the field site with preceptors together seeing patients through video and audio platforms. Students joining telehealth session from their individual homes away from preceptors does not provide optimum learning experiences and is not recommended as students lack access to electronic medical records, multidisciplinary team experiences, etc.

Students must satisfactorily complete all the requirements of their practicum courses in accordance with the information provided in the course syllabi. Students complete the didactic portion of the track online. Please note that there has been an increase in clinical hours from 144 hours per course (576 hours total) to 160 clinical hours per course (640 total hours), effective Spring 2018.

Go to NP Practicum Courses by Specialization for Students With Catalog Years Before Spring 2018

NP Practicum Courses by Specialization for Students With Catalog Years Beginning Spring 2018

The following are suggestions, listed by specialization, for students to consider when choosing a preceptor and site for each required practicum course. Students can also consult the course descriptions in the catalog and at the end of this manual as a guide.

Note: For all courses, students are not allowed to complete practicum hours in operating rooms, surgeries, or labor and delivery, or do home visits.