CRITERIA FOR AGREEMENT BETWEEN STUDENT, PRECEPTOR AND
FACULTY FOR ALL CLINICAL PRACTICUMS

Before any practicum in which an NP student enters a preceptorship relationship, the student will collaborate with the preceptor and faculty to plan and implement an instrument of agreement that is signed by the student, preceptor, and faculty member responsible for the evaluation of the student. The device is kept on file by the faculty member, and copies are distributed to all other parties of the agreement. The written agreement will contain, but is not limited to, the following:

1. Student's responsibilities for attendance and participation in agency activities and evaluation instill the values and attitudes required to preserve supervision, guidance, and assessment of the student and collaboration with student and faculty.
3. Faculty member's role in orientation and collaboration with student and preceptor, evaluation of classroom and clinical performance, and determination of course grade.
4. A statement providing for the confidentiality of information related to the agency, patient, institution (college of nursing), and student affairs

PRECEPTORS: Review: Benner, P. (19) From Novice to Expert.

Criteria for Preceptor:

1. Leader, researcher, manager, expert practice role.
2. Accessible.
3. Role model.
4. Change agent.
5. Articulate communicator.
6. Professionally active.
7. Proficient to expert in interviewing, history taking, physical examination skills, diagnostic reasoning, planning, and managing.
8. Interested in teaching and working with nurse practitioner students.
9. Objectively assesses, critiques, and validates the learner's competencies.
10. Facilitator for professional advanced practice socialization.
11. Holds a trusting, confident relationship with students and treats students as professional colleagues.

The purposes of the clinical preceptorships are to:

1. Integrate the student into the role of the nurse practitioner.
2. Assist the student in applying theory to practice.
3. Assist the student in increasing skills, competence, and expertise.


STUDENT - PRECEPTOR – FACULTY AGREEMENT

The nurse practitioner student enrolled in the Master of Science in Nursing or DNP program, or Post Master’s Certificate Nurse Practitioner program, will commit an average of agreed hours weekly participating in clinically sanctioned activities. The student will share in the evaluation of the preceptor and course content.

Priority Medical Group preceptor will serve as a role model and provide adequate opportunities for practice and success. The preceptor will provide support, encouragement, and professional feedback in difficult and complex situations. The preceptor will share various tools and references to assist me in transitioning to the nurse practitioner role.

The preceptor agrees to review the student's weekly activity log and provide supervision and guidance to facilitate the student's goals and expectations for the clinical experience. The preceptor also agrees to collaborate with the student and professor to evaluate the student’s needs and clinical experiences.

The preceptor agrees that a copy of their licenses and national certifications are current and available at the clinical site.

Payment: a fee of 10.00 per hour will be paid by the student for each clinical hour of preceptorship and is due before the start of the clinical preceptorship. Payment shall be paid by ACH or cashier’s check made out in the preceptor's Name or LLC.

The student agrees that all information concerning the agency, patients, or School of Nursing Assigned to the Preceptee/College of Nursing will be confidential. The student also agrees that the preceptor will evaluate the student's activities, professionalism, goal attainment, etc.

This AGREEMENT aims to guide and direct the parties respecting their affiliation, working arrangements, and agreements to provide high-quality clinical learning experiences for
APRNs and PMHNPs DOING CLINICAL ROTATION (S) WITH MDVIP365 LLC DBA PRIORITY MEDICAL GROUP IN BENEFIT OF THE PRECEPTEE IN COLLABORATION WITH THE PRECEPTEES SCHOOL OF NURSING.

WHEREAS this AGREEMENT is intended and shall be interpreted to meet the PMGS obligations ASSIGNED TO THE PRECEPTEE’s accreditation standards related to affiliation agreements with clinical affiliates, which require, at a minimum:

IF APPLICABLE, PMG Staff will provide APRNs, PMHNPs, and faculty access to appropriate resources for APRN and PMHNP education.

The School OF NURSING ASSIGNED TO THE PRECEPTEE is ultimately responsible for the medical education program, academic affairs, and the assessment of APRNs and PMHNPs.

The School OF NURSING ASSIGNED TO THE PRECEPTEE is primarily responsible for appointing and assigning faculty members responsible for APRN and PMHNP teaching.

Specification of the responsibility for treatment and follow-up when an APRN or PMHNP is exposed to an infectious or environmental hazard or another occupational injury,

The shared responsibility of the School OF NURSING is ASSIGNED TO THE PRECEPTEE and PMG for creating and maintaining an appropriate learning environment.

WHEREAS, neither party intends for this AGREEMENT to alter in any way its respective legal rights or its legal obligations to any third party.

NOW, THEREFORE, in consideration of the mutual covenants and agreements contained herein, the parties identified in the Uniform Preceptorship Clinical Training Affiliation Agreement Implementation Letter agree as follows:

Responsibilities of the School OF NURSING ASSIGNED TO THE PRECEPTEE

The School OF NURSING ASSIGNED TO THE PRECEPTEE will plan and determine the adequacy of the student's educational experience in theoretical background, basic skills, professional ethics, attitude, and behavior. It shall assign to PMG Staff only those students who have satisfactorily completed the prerequisite didactic portions of the School OF NURSING ASSIGNED TO THE PRECEPTEE’s curriculum.





The School OF NURSING ASSIGNED TO THE PRECEPTEE will retain ultimate responsibility for the education and assessment of its students. The School of Nursing Assigned to the Preceptee’s representative for this Agreement shall be a faculty member appointed and assigned by The School of NURSING ASSIGNED TO THE PRECEPTEE, who will be responsible for APRN, PMHNP teaching, and assessment provided according to this Agreement.

The School OF NURSING ASSIGNED TO THE PRECEPTEE will advise all students assigned to PMG Staff facilities regarding the confidentiality of patient/client records and patient/client information imparted during the training experience. The School OF NURSING ASSIGNED TO THE PRECEPTEE will also advise all students that the confidentiality requirements survive the termination or expiration of this AGREEMENT.

The School OF NURSING ASSIGNED TO THE PRECEPTEE will require all participating students to maintain health insurance and provide proof of health insurance to the School of Nursing Assigned to the Preceptee. PMG Staff may request that the student provide evidence of health insurance before the beginning of the training experience.

The School OF NURSING ASSIGNED TO THE PRECEPTEE will require all participating students to have completed an appropriate criminal background check and documented appropriate immunizations on file with the School OF NURSING ASSIGNED TO THE PRECEPTEE. If applicable, PMG Staff shall notify the student of any requests for evidence of a criminal background test or immunization. The School OF NURSING ASSIGNED TO THE PRECEPTEE will inform the student of their responsibility to provide proof to PMG Staff of any required criminal background checks or immunizations when requested. PMG Staff shall notify the School OF NURSING ASSIGNED TO THE PRECEPTEE of its requirements for an acceptable criminal background check and required immunizations. The School OF NURSING ASSIGNED TO THE PRECEPTEE will also inform students that they may be required to undergo a drug test or other similar screening tests under PMG Staff’S policies and practices and that the cost of any such examination will be paid by the student if not PMG Staff.

The School OF NURSING ASSIGNED TO THE PRECEPTEE will advise students that they are required to comply with PMG rules, regulations, and procedures.

If requested by PMG Staff, the School OF NURSING ASSIGNED TO THE PRECEPTEE will provide instruction to PMG Staff’s staff concerning the School OF NURSING ASSIGNED TO THE PRECEPTEE’s expectations regarding the assessment of the School OF NURSING ASSIGNED TO THE PRECEPTEE'S students at PMG Staff.

The School OF NURSING ASSIGNED TO THE PRECEPTEE warrants and represents that it provides occurrence-based liability insurance or self-insurance for its students with limits of at least $1,000,000 per occurrence and $3,000,000 annual aggregate.






However, suppose the School OF NURSING ASSIGNED TO THE PRECEPTEE is a public entity entitled to governmental immunity protections under applicable state law. In that
Case, the School OF NURSING ASSIGNED TO THE PRECEPTEE shall provide.

Occurrence-based liability coverage by any limitations associated with the applicable law. Still, the School OF NURSING ASSIGNED TO THE PRECEPTEE shall provide such insurance with limits of at least $1,000,000 per occurrence and $3,000,000 annual aggregate in the event.

Government immunity protections are determined by a court of competent jurisdiction not to apply. If requested by PMG Staff, the School OF NURSING ASSIGNED TO THE PRECEPTEE shall provide a certificate of insurance demonstrating coverage for students completing clinical training at PMG Staff.

However, suppose the School OF NURSING ASSIGNED TO THE PRECEPTEE is a public entity entitled to governmental immunity protections under applicable state law. In that case, the School OF NURSING ASSIGNED TO THE PRECEPTEE shall provide occurrence-based liability coverage by any limitations associated with the applicable law. Still, the School OF NURSING ASSIGNED TO THE PRECEPTEE shall provide such insurance with limits of at least $1,000,000 per occurrence and $3,000,000 annual aggregate in the event.

Government immunity protections are determined by a court of competent jurisdiction not to apply. If requested by PMG Staff, the School OF NURSING ASSIGNED TO THE PRECEPTEE shall provide a certificate of insurance demonstrating coverage for students completing clinical training at PMG Staff.

Responsibilities of PMG Staff

1. PMG is responsible for maintaining a positive, respectful, and adequately resourced learning environment so that good educational experiences can occur. Therefore, PMG Staff will provide students and faculty access to appropriate resources for APRN and PMHNP education.

a) access to patients at PMG facilities in an appropriately supervised environment, where students can complete the School OF NURSING ASSIGNED TO THE PRECEPTEE’s curriculum.
b) student security badges or other means of secure access to patient care areas.
c) access and required training for APRNs and PMHNPs in using electronic medical records or paper charts, as applicable.
d) computer access.
e) secure storage space for APRN and PMHNPs’ items when at PMG Staff; and
f) access to all rooms, if necessary.



PMG Staff will retain full authority and responsibility for patient care and quality standards and maintain a level of care that meets generally accepted standards conducive to good instruction. While in PMG’s facilities, students will have the status of trainees, are not to replace PMG staff; and are not to render unsupervised patient care and/or services. All services rendered by students must have educational value and meet the goals of the medical education program. PMG and its staff will supervise the academic and clinical activities as is reasonable and appropriate to the circumstances and the student’s training level.

PMG Staff will, upon request, assist the School OF NURSING ASSIGNED TO THE PRECEPTEE in the assessment of the learning and performance of participating students by completing assessment forms provided by The School of NURSING ASSIGNED TO THE PRECEPTEE and returning to the School OF NURSING ASSIGNED TO THE PRECEPTEE in a timely fashion.

PMG Staff will provide for the orientation of the School OF NURSING ASSIGNED TO THE PRECEPTEE’s participating students as to PMG Staff’s rules, regulations, policies, and procedures.

PMG Staff agrees to comply with applicable state and federal workplace safety laws and regulations. In the event a student is exposed to an infectious or environmental hazard or another occupational injury (i.e., needle stick). In contrast, at PMG Staff, PMG Staff, upon notice of such an incident from the student, will provide such emergency care as is provided to its employees, including, where applicable: examination and evaluation by PMG’s emergency department or another appropriate facility as soon as possible after the injury; emergency medical care immediately following the injury as necessary; initiation of the HBV, Hepatitis C (HCV), and/or HIV protocol as required; and HIV counseling and appropriate testing as necessary. If PMG does not have the resources to provide such emergency care, PMG will refer such students to the nearest emergency facility. The School OF NURSING ASSIGNED TO THE PRECEPTEE will define, for its APRN, PMHNPs, who bear financial responsibility for any charges generated.

To the extent PMG Staff generates or maintains educational records related to the participating student, PMG Staff agrees to comply with the Family Educational Rights and Privacy Act (FERPA) to the same extent as such laws and regulations apply to the School OF NURSING ASSIGNED TO THE PRECEPTEE and shall limit access to only those employees or agents with a need to know. For this Agreement, under FERPA, the SCHOOL OF NURSING ASSIGNED TO THE PRECEPTEE at this moment designates PMG as a School of Nursing Assigned to the Preceptee official with a legitimate educational interest in the academic records of the participating student(s) to the extent that PMG requires access to the School OF NURSING ASSIGNED TO THE PRECEPTEE’s records to carry out the Program.

Upon request, PMG Staff will provide proof that it maintains liability insurance in a Commercially reasonable amount.




PMG Staff will provide written notification to the School OF NURSING ASSIGNED TO THE PRECEPTEE promptly if a claim arises involving a student. PMG Staff and The School of NURSING ASSIGNED TO THE PRECEPTEE agree to share information to protect such disclosures from discovery to the extent possible under applicable federal and state peer review and joint defense laws.

PMG Staff will resolve any situation in favor of its patients’ welfare and restrict a student to the role of the observer when a problem may exist until the incident can be determined by the staff in charge of the student or the student is removed. PMG Staff will notify the SCHOOL OF NURSING ASSIGNED TO THE PRECEPTEE’S course director if such an action is required.

PMG Staff shall identify a site coordinator from among its medical staff who will communicate and cooperate with the School OF NURSING ASSIGNED TO THE PRECEPTEE’s clerkship director to ensure faculty and APRN, PMHNP access to

Health Insurance Portability and Accountability Act.

According to this Agreement, students participating in clinical training are members of PMG Staff’s workforce for purposes of the Health Insurance Portability and Accountability Act (HIPAA) within the definition of “health care operations.” Therefore, they may have access to patient medical information as provided in the Privacy Rule of HIPAA. Therefore, additional agreements are not necessary for HIPAA compliance purposes. This paragraph applies solely to HIPAA privacy and security regulations applicable to PMG Staff and, as stated in paragraph E above, does not establish an employment relationship with appropriate resources for the clinical training experience.

Mutual Responsibilities

Representatives for each party will be established on or before the execution of this AGREEMENT.

The parties will work together to maintain an environment of high-quality patient care. At the request of either party, a meeting or conference will promptly be held between the School OF NURSING ASSIGNED TO THE PRECEPTEE and PMG representatives to resolve any problems or develop any improvements in the operation of the clinical training program.

The School of NURSING ASSIGNED TO THE PRECEPTEE will provide qualified and competent individuals in adequate numbers for the instruction, assessment, and supervision of students using the School of NURSING ASSIGNED TO THE PRECEPTEE facilities. PMG Staff will provide qualified and competent staff members in adequate numbers to instruct and supervise students using PMG Staff facilities.




The School of NURSING ASSIGNED TO THE PRECEPTEE and PMG Staff will not discriminate against any employee, applicant, or student enrolled in their respective programs because of age, creed, gender identity, national origin, race, sex, sexual orientation, or any other basis protected by law.

The School of NURSING ASSIGNED TO THE PRECEPTEE, including its faculty, staff, APRN, PMHNPs, and residents, and PMG share responsibility for creating an appropriate learning environment that includes both formal learning activities and the attitudes, values, and informal "lessons" conveyed by individuals who interact with the student. The parties will cooperate in evaluating the learning environment (including on-site visits) to identify positive and negative influences on maintaining professional standards and to conduct and develop appropriately.

Strategies to enhance the positive and mitigate the negative influences. PMG shall require its faculty and staff who interact with students to adhere to the expectations outlined in Exhibit A and communicate student violations to The School of NURSING ASSIGNED TO THE PRECEPTEE. The school OF NURSING ASSIGNED TO THE PRECEPTEE agrees to require its students to adhere to the expectations outlined in Exhibit A.

PMG may immediately remove from the premises and retains the right to suspend or terminate any student’s participation at PMG Staff. PMG Staff will immediately notify the appropriate office of The School of NURSING ASSIGNED TO THE PRECEPTEE if such an action is required and the reasons for such action. The School of NURSING ASSIGNED TO THE PRECEPTEE may terminate a student’s participation when, in its sole discretion, it determines that further involvement by the student would no longer be appropriate. The School of NURSING ASSIGNED TO THE PRECEPTEE will notify PMG Staff if such action is required.

Term and Termination

This AGREEMENT is effective upon execution of the Implementation Letter by both parties to the covered clinical training experience(s) and will continue indefinitely or until terminated. This AGREEMENT may be terminated at any time and for any reason by either party upon at least ninety (90) days prior written notice to the other party. Should notice of termination be given under this Section, students already scheduled to train at PMG will be permitted to complete any previously scheduled clinical assignment at PMG.

Any Honorarium paid in advance is forfeited upon termination by PRECEPTEE.







Employment Disclaimer

The students participating in the program will not be considered employees or agents of PMG Staff or the School OF NURSING ASSIGNED TO THE PRECEPTEE for any purpose. Students will not be entitled to receive any compensation from PMG or School OF NURSING ASSIGNED TO THE PRECEPTEE or any benefits of employment from PMG or School OF NURSING ASSIGNED TO THE PRECEPTEE, including but not limited to health care or workers’ compensation benefits, vacation, sick time, or any other benefit of employment, direct or indirect. PMG will not be required to purchase any form of insurance for the use or protection of any student of The School of NURSING ASSIGNED TO THE PRECEPTEE.
No Agency Relationship Between the Parties.

Nothing in this Agreement is intended to or shall be construed to constitute or establish an agency, employer/employee, partnership, franchise, or fiduciary relationship between the parties, and neither party shall have the right or authority or shall hold itself out to have the right or power to bind the other party, nor shall either party be responsible for the acts or omissions of the other except as explicitly provided to the contrary herein.

Assignment
Either party will only assign this AGREEMENT with the prior written consent of the other.
Governmental Immunity

Suppose The School of NURSING ASSIGNED TO THE PRECEPTEE is a public entity entitled to governmental immunity protections under applicable law. In that case, it is expressly understood and agreed that nothing contained in this paragraph or elsewhere in this AGREEMENT will be construed as an express or implied waiver by The School of NURSING ASSIGNED TO THE PRECEPTEE of its governmental immunity or of its state governmental immunity; an express or implied acceptance bySchoolOF NURSING ASSIGNED TO THE PRECEPTEE of liabilities arising as a result of actions which lie in tort or could lie in tort more than the weaknesses allowable under the applicable governmental immunity laws; or, a pledge of the full faith and credit of a debtor contract; or, as the assumption by The School of NURSING ASSIGNED TO THE PRECEPTEE of a debt, warranty, or liability of PMG Staff.

No Special Damages

In no event shall either party be liable hereunder (whether in action in negligence, contract, or tort or based on a warranty or otherwise) for any indirect, incidental, special, or consequential damages incurred by the other party or any third party, even if the party has been advised of the possibility of such damages.




Notices

All notices provided by either party to the other will be in writing and deemed duly given when delivered personally or deposited in the United States mail, First Class, postage prepaid, addressed as indicated in the Uniform Clinical Affiliation Agreement Implementation Letter.

Payments
Every hour a student is precepted, they will be charged $ 12.00. This payment is due upon signing this agreement and the agreed number of hours. This payment is due and does not guarantee a passing grade for clinical precepted hours. It is mutually agreed upon that this fee is earned for the additional time and consideration of the preceptor in teaching the student and meets the requirements for fair market value for professional services from the preceptor.
The clinical Agreement is signed as attachment A for payment terms.
Severability
The invalidity of any provision of this AGREEMENT will not affect the validity of any other provisions.

Entire Agreement

This AGREEMENT contains the parties' entire AGREEMENT related to this subject matter. It may be modified only by additional written provisions in an adequately executed Uniform Clinical Affiliation Agreement Implementation Letter.
Severability
The invalidity of any provision of this AGREEMENT will not affect the validity of any other provisions.
Headlines
Headlines in this AGREEMENT are for convenience only.
Entire Agreement

This AGREEMENT contains the parties' entire AGREEMENT related to this subject matter. It may be modified only by additional written provisions in an adequately executed Uniform Clinical Affiliation Agreement Implementation Letter.

PMG ADMINISTRATION AND CLINICAL STAFF ASSIGNED TO THE PRECEPTEE holds professional behaviors and attitudes in high regard, including altruism, integrity, respect for others, and a commitment to excellence. Effective learning is best fostered in an environment of mutual respect between teachers and learners. In medical education, the “teacher” includes peers, resident physicians, full-time and volunteer faculty members, clinical preceptors, nurses, ancillary support staff, and others students learn from.

GUIDING PRINCIPLES:

Duty: Medical educators must convey the knowledge and skills required for delivering the profession’s standard of care and instill the values and attitudes needed to preserve the medical profession's social contract with its patients.

Integrity: Learning environments conducive to conveying professional values must be integrity-based. Students and residents learn professionalism by observing and emulating role models epitomizing authentic professional values and attitudes.

Respect: Respect for every individual is fundamental to the ethic of medicine. Mutual respect is essential for nurturing that ethic. Teachers are obligated to ensure that students and residents are always treated respectfully.

RESPONSIBILITIES OF TEACHERS AND LEARNERS:
Teachers should:

Treat students fairly and respectfully

Maintain high professional standards in all interactions.

Be prepared and on time.

Provide relevant and timely information.

Provide explicit learning and behavioral expectations early in a course or clerkship.

Provide timely, focused, accurate, and constructive feedback and thoughtful and timely evaluations at the end of a course or clerkship.

Display honesty, integrity, and compassion.

Practice insightful (Socratic) questioning, which stimulates learning and self-discovery, and avoid overly aggressive investigation, which may be perceived as hurtful, humiliating, degrading, or punitive.
Solicit feedback from students regarding their perception of their educational experiences.
Encourage students who experience mistreatment or witness unprofessional behavior to report the facts immediately.





Students should:
Be courteous to teachers and fellow students.

Be prepared and on time.

Be active, enthusiastic, curious learners.

Demonstrate professional behavior in all settings.

Recognize that not all learning stems from formal and structured activities.

Recognize their responsibility to establish learning objectives and to participate as active learners.

Demonstrate a commitment to life-long learning, a practice that is essential to the profession of medicine.

Recognize personal limitations and seek help as needed.

Display honesty, integrity, and compassion.

Recognize the privileges and responsibilities coming from the opportunity to work with patients in clinical settings.

Recognize the duty to place patient welfare above their own.

Recognize and respect patients’ rights to privacy.

Solicit feedback on their performance and recognize that criticism is not synonymous with “abuse.”

Relationships between Teachers and Students
Students and teachers should recognize the unique nature of the teacher-learner relationship, partly defined by professional role modeling, mentorship, and supervision.

Because of the unique nature of this relationship, students and teachers should strive to develop their relationship into one characterized by mutual trust, acceptance, and confidence. They should recognize the potential for conflict of interest and respect appropriate boundaries.