Christine Guelcher, MS, PPCNP-BC: Chris Guelcher is a Pediatric Nurse Practitioner and Program Coordinator for the Hemostasis and Thrombosis Treatment Center at Children’s National Health System, a role she has held for over 20 years. Prior to this position, Ms. Guelcher was a Registered Nurse IV in the Hematology/Oncology/Bone Marrow Transplant Clinic at the Children’s National Health Center, where she worked on the inpatient unit and in the outpatient clinic. Before specializing in hemophilia care, Ms. Guelcher worked on an inpatient Hematology/Oncology unit at Children’s Memorial Hospital in Chicago, Illinois, as well as at Mott Children’s Hospital in Ann Arbor, Michigan. She was a member of the National Hemophilia Foundation Nursing Working Group for three years, and served as an active member of the Region III/Mid-Atlantic Regional Executive Committee. She has also served on the Board of the American Thrombosis and Hemostatis Network (ATHN) since 2009, and presently holds the position of Secretary on the Board.
Ms. Guelcher has served as an officer in the National Capital Chapter of the Association of Pediatric Hematology/Oncology Nurses (APHON) and is an active member in APHON nationally. She was a co-editor of the recently published combined Scope & Standards of Pediatric Hematology/Oncology Nursing Practice. She also helped to develop tools for patients and families for APHON including Hematology Drug Information Sheets and the Hemophilia Patient Brochure. She is also co-author of the hemophilia brochure for patients and families at the request of APHON. She also serves on the Certification and Continuing Education Committee and the Programming Subcommittee of the American Society of Pediatric Hematology Oncology (ASPHO). In 2016, Ms. Guelcher was elected to represent the United States on the World Federation of Hemophilia Nursing Work Group.
Ms. Guelcher earned her Bachelor’s of Science in Nursing from Georgetown University in 1989 and her Masters of Science in Nursing with a concentration in Pediatric Nurse Practitioner from the University of Maryland in 1997.
[OnlineFNPPrograms.com] May we please have an overview of your academic and professional background in registered nursing and advanced practice pediatric nursing?
[Christine Guelcher, MS, PPCNP-BC] I received my Bachelors in Nursing from Georgetown University. After graduating I worked on the inpatient Hematology/Oncology unit at Children’s Memorial Hospital in Chicago. Next, I worked at Mott Children’s Hospital in Ann Arbor, Michigan on the inpatient hematology/oncology/BMT unit. When I returned to Washington DC I came to Children’s National where I have worked ever since. I started on the inpatient hematology/oncology/BMT unit and then moved to the outpatient clinic. Eventually, I went back to get my Master’s in Science from the University of Maryland. As I completed my graduate education and became ANCC certified as a Pediatric Nurse Practitioner I transitioned into the role of Program Coordinator for the federally funded Hemostasis and Thrombosis Treatment Center at Children’s National–the position that I have held for the last 20 years.
[OnlineFNPPrograms.com] Could you please describe your past and current responsibilities as a preceptor? How do you collaborate with your students to set learning objectives for the academic term, what kinds of tasks/responsibilities are your students expected to take on, and what kinds of guidance do you provide them with?
[Christine Guelcher, MS, PPCNP-BC] I have always enjoyed precepting students and new hires. Over the last 20 years I have collaborated with a colleague to coordinate the placement of graduate NP students in the Center for Cancer and Blood Disorders at Children’s National. We facilitate scheduling and experiences to meet the goals and objectives of the courses that are provided by their program. We are the liaison between the graduate programs and our nursing education department. In addition to coordinating the overall experience, we enjoy working with the students as preceptors. Students who set up clinical experience at Children’s National must complete required paperwork, evaluations and competencies before they can start working with a preceptor. As they complete these requirements, we work to identify preceptors and set up a schedule. When I am precepting, I focus on providing opportunities to use information discussed in the classroom setting in a real-world patient setting. Not every student who comes through Hematology will go on to work in the sub-speciality, but they leave our clinical experience understanding the role of the cellular components of blood, common hematologic disorders that they may identify in their own practice, how to begin a basic evaluation and when to refer a patient to a specialist.
[OnlineFNPPrograms.com] For current and prospective MSN students, what advice do you have for them in terms of making the most of their clinical placements? What are the challenges that students encounter when trying to obtain clinical placements, and how do you recommend they address these challenges?
[Christine Guelcher, MS, PPCNP-BC] It can be hard to find the right clinical placement, but sometimes timing is just as important as location. Most programs encourage NP students start with primary care placements in well-child settings so that they can focus on physical exams skills and routine well-care. As a specialty clinic, students who are ready to get the most out of a rotation in our Department tend to be further along in their program. The variety of diagnoses that a student may encounter during a rotation in the Center for Cancer and Blood Disorders can be overwhelming to a newer student unless they have a background in hematology and oncology. In order to find the right clinical placement I encourage students to use their resources. Graduate programs often have relationships with local clinical sites and preceptors. Additionally, nurses who are working while in graduate school may have professional contacts that they can tap into for suggestions. We work with each graduate program to make sure that we will be a good fit for a particular student.
I would also encourage students to try something new during graduate school. Even if they think they know what they want to do next, it can be enriching to broaden their experience. They may find that what they learn comes in handy in their future practice.
[OnlineFNPPrograms.com] In your opinion, what is the ideal working relationship between preceptor and student? Is it more collegial or is it structured more like a mentor-mentee relationship? How frequently do you typically interact with your students on a daily and weekly basis, and for what span of time during students’ clinical placements?
[Christine Guelcher, MS, PPCNP-BC] The ideal preceptor/student relationship combines experiential learning that provides hands-on opportunities that allow the student to reinforce the pathophysiology and pharmacology that they learn in the classroom with real-world experience. As a preceptor, I like to reinforce this learning with evidence from the literature that, in turn, allows students to build a reference library that they can refer to in their own practice going forward. I also like to provide ample time for questions and discussion so that students can get a sense of the big picture. In a specialty clinic like ours, providers develop expertise with a specific patient population, which provides a depth of experience, but may not provide a broad enough exposure. Therefore, we structure each student’s schedule to make sure that they see a variety of diagnoses with different preceptors. We work hard to strike the right balance of variety without losing continuity for the students. Most students spend between 90 and 135 hours during their semester-long clinical rotation with us.
[OnlineFNPPrograms.com] What are some of the primary questions and concerns your students have when preparing for and completing their clinical placements? How do you help your students address these concerns?
[Christine Guelcher, MS, PPCNP-BC] When students start in clinic they have the opportunity to shadow with their preceptor who can model interactions and examination skills with families and patients of different ages and developmental levels. Students take on more responsibility for intake, examination and planning over the course of their clinical experience.
[OnlineFNPPrograms.com] How do you recommend students prepare for the presentation of their cases to colleagues and their supervisors? What components should be included in this presentation to make it thorough, effective, and actionable?
[Christine Guelcher, MS, PPCNP-BC] Students are often intimidated by having to present a patient to colleagues in the clinical setting. We work on organizing thoughts, creating differential diagnosis lists and determining next steps systematically so that the presentation becomes second nature over time. I can remember one particular student who was very anxious about presenting patients, but she focused on this skill and developed an intake sheet that she found helpful during her clinical experience. She would use this template to organize the information as she was presenting her patient and it helped her to be more confident with this necessary skill. At the end of her rotation we asked if she would share her tool and we now provide it as a resource to other NP students. It is so nice to see the growth of students during a clinical experience.
The key to presenting patients is being thorough and organized. If students are consistent in taking a complete history and doing a good physical exam, it makes it easier to present the patient in an organized fashion.
[OnlineFNPPrograms.com] How do you recommend students prepare themselves for the increase in the length of their shifts as they transition to more advanced nursing roles? When you were a student, was this transition difficult for you? How do you help the students you precept to manage this part of their clinical rotations?
[Christine Guelcher, MS, PPCNP-BC] One of the toughest adjustments for graduate nursing students is the transition into the advanced practice role. For many nurses, they are used to eight to twelve hour shifts with a hand-off to the next nurse at the end of their shift. It can be hard to adjust to a role where hours are more fluid and roles involve a lot more independence. A good clinical experience provides an opportunity to observe the preceptor as they model the advanced practice role. The most important message that I try to convey to graduate nursing students is knowing what they do not know and never being afraid to ask questions. As a life-long learner, I am always open to opportunities to expand my knowledge. I hope that I am successful in sharing this perspective with the students.
[OnlineFNPPrograms.com] What have been some of your most educational and/or rewarding experiences thus far as a preceptor? On the other hand, what challenges have you encountered as a preceptor, and how have you managed these challenges?
[Christine Guelcher, MS, PPCNP-BC] One of the toughest things that I have experienced as a preceptor is when a student is not dedicating appropriate time and effort to prepare for clinical given the investment of time involved in precepting. When this has come up, I have worked hard to be forthcoming and transparent. If a student is not ready to fully participate in the clinical experience, it is in everybody’s best interest to address the issue, take a step back and make concrete goals with close monitoring. This is when having the relationship with the faculty in the graduate schools is paramount. I have been most rewarded by following the careers of former NP students. I am fortunate to work with a number of them here at Children’s National.
[OnlineFNPPrograms.com] What advice do you have for nurse practitioners who would like to become preceptors, in terms of preparing for this role? Why did you decide to become a clinical preceptor, and what steps did you have to take to become a preceptor?
[Christine Guelcher, MS, PPCNP-BC] I think that some nurse practitioners worry that they don’t have enough time to precept. It can be hard to think about going through a busy clinic explaining everything that we do, but I have found that precepting keeps me energized and enthusiastic about hematology nursing and advanced practice. I realize how many things that I know now that I take for granted and students are so motivated to absorb the information. Moreover, precepting keeps me on my toes because I focus on evidence in the literature that I can share with students during their clinical rotation. I love nursing and I enjoy sharing my experience, but I find that I continue to grow and learn as I precept students which makes me a better nurse and preceptor.
Thank you Ms. Guelcher for participating in our preceptor interview series!