About Jen Wiles, FNP-BC: Jen Wiles is a Family Nurse Practitioner at Minute Clinic, where she provides primary care services to patients across the age spectrum, and also trains staff and new employees. Before her role at Minute Clinic, Ms. Wiles worked at UNC Healthcare as a Nurse Practitioner, delivering inpatient nursing care in pre-, post-, and perioperative contexts at UNC’s Neurosurgical step-down unit and on the neurosciences floor. Ms. Wiles was also a nurse practitioner at St. Vincent Indianapolis Hospital, where she provided inpatient and outpatient care in the Trauma and General Surgery departments, and at Indiana University Health within the pediatric and adult emergency care divisions.
Ms. Wiles received her Bachelor of Science in Nursing in 2008 from Gardner-Webb University, and earned her Master of Science in Nursing in 2010 from Vanderbilt University. She is currently an MBA candidate at North Carolina State University, where she is taking classes on healthcare management, innovation, and leadership.
[OnlineFNPPrograms.com] Could you please describe your past and current responsibilities as a clinical preceptor at Indiana University Health, St. Vincent Indianapolis Hospital, and UNC Health Care? 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?
[Jen Wiles, FNP-BC] I have worked as a preceptor in every position since becoming a registered nurse over eight years ago. I have had the opportunity to precept paramedic, nursing, and nurse practitioner students as well as nursing and nurse practitioner new hires. It was at UNC Healthcare and at my current position with the Minute Clinic that I have precepted Family Nurse Practitioner students. All of the students have worked with me over the course of a semester, one-on-one, and during their last rotation before graduation. I feel that the easiest way to collaborate with the students on learning objectives is to simply ask them. I will generally wait until after a few days on the floor or in the clinic so they have a general idea of what I do and what patients I see. I will then have them give me a few goals of where they feel weak or where they see a large potential to dive in deep given the work setting. Having them give me five or more objectives allows me to narrow them down to three that are reasonable given my work environment, the number of hours the student will have with me, and my areas of expertise. However, if they have a really great objective that doesn’t fit my professional experiences or areas of expertise, I strongly recommend them to nevertheless write up a brief summary of the topic and present it to me at some point during the rotation. This way we can both learn!
I have only had students in their last semester so I do give them a lot of tasks and responsibilities. I have always been a person who learns best by doing, and I get extremely bored if I am just standing around watching someone work all day. I don’t want the student to dread their time with me, and I want them to learn as much as they are capable of learning during the short time. I will generally use the first two to three days to gauge how assertive they are in their learning process. Many students want to jump right in, and I will give them the space to do so, stepping back and only interjecting when needed. However, some students are more passive. After the three days, it is a perfect time to set objectives and collaborate on concrete ways to meet these goals. I continually reiterate that I am always there if they get stuck or have questions and that I will always stop them from doing or saying anything harmful. I believe there is a lot of strength in asking questions and I want them to practice doing this. I still consult with colleagues on a daily basis and there is a lesson in learning that you don’t know everything. However, I do want them to start doing and thinking on their own. Sometimes the more timid practitioners need to do this slowly; having them take on an extra patient each day or a different part of the visit until they feel that they can do everything comprehensively can be a good approach in these instances. Most students will end up stepping up to the responsibility and appreciate that I trust their experience and education.
[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?
[Jen Wiles, FNP-BC] The relationship is both at different times. However, I strongly advocate preceptors to put the most emphasis on a collegial relationship. I learn from the students every time they are with me. In fact, on several occasions, I have referred to their knowledge in an area that has recently changed in medicine or that they have recently studied as they are learning the most up-to-date information we have. I always give them permission to challenge me and to teach me something new. That being said, I feel like mentorship is extremely important in nursing. I can’t adequately mentor every student I precept, but I feel like it is vital to be open to being a mentor where that relationship clicks. I have a handful of people who have truly mentored me during my career, and their support is invaluable. I try to give students advice that goes beyond patient care. I talk to them about their careers and work-life balance and families and education goals. I try to answer all of their questions about my experiences honestly and openly. While I only have them for one semester, which is typical for clinical preceptors, many of them I still keep in touch with and would always answer any questions they have or write any recommendations they need.
I think it is important to have varied experience in your clinical placements, but I also think you gain a lot from spending a significant amount of time with a single preceptor. The longer a student is with a preceptor, the more the relationship and trust grow. When this is maximized, a professional and personal relationship can certainly take root. This is also the most likely way to gain that mentor-mentee relationship that can carry well on into the future.
[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?
[Jen Wiles, FNP-BC] Their first concern is always related to passing clinical. I try to relieve this fear by starting off telling them that they will all pass if they show up and are truly present while there. However, I think it is important to also let them know upfront that this doesn’t mean you will praise everything they do or never have constructive criticism for them. Clinicals are truly the best time to evaluate your skills and see where you are proficient or need improvement. However, as promised, if they show up every day and are truly present to the learning process, they always improve and do great. Secondly, students tend to be concerned about messing up or doing things differently from how I would do them. I am very honest with students about my past mistakes in my career. I will generally tell them stories, not to scare them, but to teach them that mistakes happen and that they will benefit from knowing mine and not making the same ones.
I am also very adamant from day one that there is no one right way to do anything. I don’t want students to copy how I do everything. I have many times witnessed a student say or do something that completely changed the way I practice. We all steal tidbits from our colleagues while maintaining our own personality and process. I feel you are more prone to errors if you do anything in a way that doesn’t feel comfortable. Therefore, I stress for students to practice the way it makes sense to them as long as they are practicing standard of care.
[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? How will you translate what you have learned into your work as a preceptor in the future?
[Jen Wiles, FNP-BC] One of my most rewarding experiences is one I am having currently at Minute Clinic. The student is in her last year of the program and has experience as an ICU nurse. She is about the same age I was when I started as a nurse practitioner. It has been such an easy relationship because she is so similar to me in a lot of ways. She is a go-getter with a ton of great acute care experience but a real interest and passion for how much you can help patients as a primary care provider. She jumped right in on day one, and I have already learned so much from her as she educates and evaluates patients. It is very rewarding when the preceptorship is mutually beneficial for both the student and preceptor.
Challenging experiences for me are generally when students need a lot of structure. I am far from a micro-manager, and I’ve had new-hires tell me that my teaching style just didn’t work for them because they needed structure and close management to feel comfortable. This can be difficult when you are employed in a busy and fast-changing environment. I’ve learned that I have to adapt my style to what is best for the student because this is ultimately their educational experience. This is what led me to implementing the 3-day objective-setting policy. By this time, students have seen how I work and understand the environment, and they are able to say either “I need more rules” or “I need to go slow” or “I want to jump right in.” I then have to be supportive of those needs with the ultimate goal of growing them to be a fairly autonomous practitioner by the end of the time. I will also screen my students to make sure that their wants and needs can be served in my environment. If they really want to see children and I am at a clinic that mostly serves adults, it probably isn’t a good fit. They will be much happier elsewhere.
[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?
[Jen Wiles, FNP-BC] If the student is excited to be there, is flexible from day to day, and is willing to take constructive criticism, I feel that half of the clinical battle is won. We can learn a lot from places we never want to work or from people we never want to work with. I feel being open to whatever learning can be achieved will allow you to get the most out of the experience. While I do recommend students attempt to find clinical placements in their area of interest, I think a lot can be learned from taking a placement or two that is vastly different from where you want to work. I would have never found the emergency room as a nursing student if I hadn’t given it a shot. I never imagined that I would be a new graduate nurse in the ER, but I fell in love with that clinical setting. I think the goal should be trying to see a diverse range of patients wherever you go initially. Then if you know that you love dermatology or cardiac, you can find a more focused setting near the end of your education that could filter into a job offer or great training for wherever you do find employment.
I also always advocate for volunteer work. I volunteered during most of my schooling just a couple times a month at free clinics and learned so much about the worth of a great physical examination when you are lacking the ability to perform diagnostics. Finally, I always encourage students to consider shadowing. If you are interested in an area but don’t know if you want to devote an entire clinical placement there, call and see if you can come in and shadow the doctors or practitioners on your own time. The medical community is really open to teaching because it still closely mimics apprenticeships in a lot of ways. Most of us want to give back to students because of how much we were given when we were students. I would be happy to have someone come a day or two and follow me around to just see what I do, even if neither of us receives continuing education or class credit for it. It is a great way to see if an area of interest is really worth pursuing.
[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?
[Jen Wiles, FNP-BC] First, I truly believe that everyone should consider being a preceptor. It enables you to keep your skills sharp as the ability to teach someone something is the greatest indicator of proficiency. There is also so much that you will learn from your students that will improve your own practice. In most of my positions, the requirement to precept was just working in that position for at least a year. I believe this is a good standard. I would also suggest having at least a year if not two of nurse practitioner experience in general. You want to be confident in your own practice because navigating a full time job and a teaching assignment can be hectic. You really need to be at a place in your position where you can take on more work or your routine can slow down and you will still be able to accomplish all of your daily tasks.
It is also imperative to allow students to work in a way that makes sense to them. I feel that preceptors who micro-manage can confuse students or make them feel uncomfortable as they may be getting variable instructions every place they go. I advise every preceptor to take the time to make a list of the qualities of your favorite preceptors and teachers and your least favorite preceptors and teachers and then maximize these strengths and minimize these weaknesses in your own style. It may be helpful to create a short questionnaire that you give each student on day one to help you better assess their learning needs and objectives. Just like the student, show up excited for the day and excited to have them there. They will either feel your stress and perform worse for it or feel your excitement and be more engaged because of it.
Thank you Ms. Wiles for participating in our Nursing Preceptor interview series!