Get the free N874A Preceptor Agreement Form - nursing psu

The Pennsylvania State University SCHOOL OF NURSING Preceptor Agreement Form N874A: Adult Gerontology Primary Care Nurse Practitioner Integrative Practicum Date: Semester: Year: Student's Name: RN

How to fill out n874a preceptor agreement form

How to fill out the n874a preceptor agreement form:

1. Fill in the personal information section: Provide your full name, contact details, and any other requested information about yourself as the preceptor.
2. Indicate your qualifications: State your professional qualifications, including your licensure, certifications, and any relevant experience that makes you suitable to serve as a preceptor.
3. Specify the student information: Fill in the details of the student for whom you will be serving as a preceptor, including their name, contact information, and any relevant academic details.
4. Describe the clinical setting: Provide a brief description of the clinical setting where the preceptorship will take place, including the name and address of the facility, the type of facility, and any special notes about the setting.
5. Outline the objectives and goals: Clearly articulate the objectives and goals of the preceptorship, including what the student is expected to achieve and learn during their time with you.
6. Establish the schedule: Set the dates and times for the preceptorship, including the specific hours and days the student will be present, as well as any anticipated breaks or time off.
7. Discuss the responsibilities: Outline the roles and responsibilities of both the preceptor and the student during the preceptorship, including expectations for attendance, performance, and professionalism.
8. Address liability and confidentiality: Specify any liability waivers or agreements, as well as the importance of maintaining patient confidentiality and adhering to HIPAA regulations.
9. Sign and date the form: Both the preceptor and the student should sign and date the agreement form to signify their agreement and understanding of the terms outlined.
10. Retain a copy: Make sure to keep a copy of the completed and signed agreement form for your records, and provide a copy to the student and any relevant institution or organization involved in the preceptorship.

Who needs the n874a preceptor agreement form:

1. Nursing schools and educational institutions: Nursing schools and other institutions offering healthcare-related programs may require their students to complete a preceptorship as part of their clinical education. Therefore, the preceptorship agreements are necessary to ensure the proper evaluation and supervision of students during their clinical training.
2. Preceptors: Healthcare professionals who serve as preceptors, including registered nurses, nurse practitioners, physicians, and other licensed healthcare providers, may need to fill out the n874a preceptor agreement form to formalize the terms and conditions of their mentorship role.
3. Students: The n874a preceptor agreement form may also be required for students who are entering into a preceptorship. They need to understand and agree to the terms set out in the agreement before beginning their clinical training under a preceptor's guidance.

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What is n874a preceptor agreement form?

The n874a preceptor agreement form is a document used to formalize the relationship between a preceptor and a student in a clinical setting.

Who is required to file n874a preceptor agreement form?

Preceptors and students are required to file the n874a preceptor agreement form before the start of the clinical rotation.

How to fill out n874a preceptor agreement form?

The n874a preceptor agreement form can be filled out by providing the required information about the preceptor, student, clinical site, and objectives of the rotation.

What is the purpose of n874a preceptor agreement form?

The purpose of the n874a preceptor agreement form is to clarify roles and responsibilities, set expectations, and ensure a successful clinical experience.

What information must be reported on n874a preceptor agreement form?

The n874a preceptor agreement form must include details about the preceptor, student, clinical site, objectives of the rotation, and signatures from both parties.