1. Sherman, Rose O. EdD, RN, NEA-BC, FAAN
  2. Prestia, Angela S. PhD, RN, NE-BC

Article Content

Advancing the education of the nursing profession is an essential priority in meeting our nations' growing healthcare needs. The expected nursing shortage is well documented, as is the need for a robust nursing leadership pipeline.1 A critical step in the translation of education into practice is the practicum experience. Nurse managers may be asked to serve as preceptors for both RN-to-BSN and graduate students in nursing administration. There's often hesitation because frontline leadership roles are demanding, leaving managers little time for coaching students. Yet, research indicates that practicum experiences with nurse managers are powerful learning opportunities.2

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Well-designed practicums can be a win-win for the student and nurse manager preceptor. Students can bring a fresh perspective to work environment challenges and provide nurse managers with insights that contribute to better unit outcomes, and working with students often leads managers to reflect on their leadership practices and philosophy. This article focuses on how to design practicum experiences that are meaningful for both students and nurse managers.



Leadership practicums are incorporated into academic curricula to provide opportunities for students to translate what they learn in the classroom to practice settings. Practicum experiences are a required part of both BSN and MSN curricula, according to national accrediting bodies.3 Students spend a certain number of hours in healthcare settings, with outcome objectives that may include an evidence-based project. Although expectations vary by program, organizations such as CGEAN, formerly the Council on Graduate Education for Administration in Nursing, have established recommended criteria for the types of activities that should be included in practice hours.4


It's rare that students understand their professional goals clearly enough to independently craft an exceptional experience. This then becomes a joint responsibility with the faculty advisor and the leadership preceptor. When working with nurse managers, students are often provided with a set of leadership competencies, such as the American Organization of Nurse Executives Nurse Manager Competencies.5 Initial leadership practicums usually focus on understanding the role of the manager, budgeting, and performance management.6 The most meaningful practicum experiences are those in which the student is able to both accomplish his or her goals and conduct a project that's of value to the organization.


The engaged preceptor

The role of the nurse manager preceptor is one of an engaged academic partner. Depending on the academic institution, the nurse manager preceptor may be selected either by the student or the faculty. Preceptors are usually asked to sign an agreement and provided with some orientation to the academic program. Ideally, there's a good fit between student needs and the activities that a nurse manager can provide.


Best practice includes meeting with the student to review his or her current nursing experience, practicum objectives, and evaluation criteria, and to clarify mutual responsibilities. Encouraging words from the preceptor at the outset of the experience can be powerful. An example of this may be, "My goal is to help make this a successful practicum experience for you" or "I realize that parts of this practicum may seem challenging, but I'm here to help guide you." These words can be the difference between a mundane experience and an exceptional one.


Crafting high-value experiences

Leadership practicums aren't designed to be observational experiences. Ideally, students are asked to apply their ideas from the leadership literature to activities and assist the nurse manager in following up on problems when appropriate. An initial experience may include spending a full day with the nurse manager, with the goal of seeing the variety of leadership activities. The preceptor and student then debrief on what the student observed, what surprised him or her, and what he or she would like to learn more about. Students should also review the organizational chart and the nurse manager position description to achieve a full understanding of role expectations and placement in the organization.


Communication is a critical part of the leadership role. Students should attend a unit or department staff meeting conducted by their preceptor to observe and analyze how the nurse manager communicates with his or her staff, and engages/empowers them in the achievement of unit goals. Debriefing with the preceptor before and after the meeting is an important part of learning. Students can often offer interesting insight into staff behaviors that they observe. Accompanying the preceptor on patient rounds is another important learning experience. Students observe what the nurse manager is assessing during these rounds and can assist with follow-up on any problems that are found.


Many practicum experiences now include an administrative microsystem assessment of a unit, designed to have the student look at administrative processes, staffing, payer mix, top admission Diagnosis-Related Groups, average length of stay, average admission numbers, discharges and transfers, usual procedures conducted, care delivery model, staff assignments, and achievement of performance goals. Such microsystem assessments can be invaluable to busy nurse managers who may not have time to do them on a regular basis.


Although leadership students are exposed to budgeting in their coursework, this is really best learned when content is applied in a practice setting. Ideally, the nurse manager or someone in finance will do a line-by-line budget review. Students should review organizational policies on capital budgets and equipment purchases. They can also attend a products evaluation committee meeting or a pharmacy and therapeutics meeting where cost versus product efficacy is discussed. The student can assist the nurse manager in researching and evaluating the cost of different products or equipment.


A critical skill for nurse leaders in today's environment is the ability to effectively manage staff performance. Although students often can't observe these crucial conversations, nurse leaders can debrief situations and discuss how they manage them. It's also valuable for students to sit in on interviews that nurse managers hold with prospective staff to learn how candidates are viewed through the leadership lens.


Developing meaningful projects

Most practicum experiences involve the design and completion of a project. Projects done by RN-to-BSN or graduate students as part of leadership practicums are generally less complex than those expected of DNP candidates. Students ideally select a practice project with their preceptor that contributes to their leadership growth and is of value to the unit or department.7 These can be simple, such as presenting a practice change to the staff in a group forum to enhance executive presence, researching the evidence on a unit challenge, or reviewing staffing and the budget to reduce variances. More complex projects may involve evaluating multiple data points to assess patient throughout, surveying staff to determine causes for unit turnover, redesigning a shared governance strategy, or revising a unit orientation plan.


A last word

Students are often surprised by the complexity of leadership roles in today's healthcare environment and the challenges experienced by nurse managers. Leadership practicum experiences offer a real world perspective and are an essential part of grooming our future nurse leaders. Done well, they can be a win-win for both the student and nurse manager preceptor.




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3. American Association of Colleges of Nursing. Commission on collegiate nursing education. [Context Link]


4. CGEAN. Criteria for practice hours in master's and professional doctoral programs for nurse executives and leaders. [Context Link]


5. American Organization of Nurse Executives. Nurse manager competencies. [Context Link]


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