Dear Psych Providers, Have a Vetting Process!

Someone recently asked me to precept and I swiftly declined. I’m already pushed to the maxed. Hence, I use this website to help people and ramble. To give a more honest reason, when the person contacted me, my first impression was just irritation. Clearly, these psych programs need to stop accepting student if they can’t find preceptors… I’ve also precepted residents and PAs but at least they don’t have to worry about not completing their programs. The person went to an online school, which is quite a common problem… so take precautions future NPs! this is still unacceptable, especially if you’re paying tens of thousands of dollars and in general.

My second thought was, since I have my own practice this isn’t like a teaching hospital that already has a system for students, therefore, I really needed to put some thought into this or have my own standards, which my brain cells simply don’t feel like doing right now. Furthermore, the expectations in psych/the demands, lack of preceptors is a relatively new issue in the profession that I didn’t deal with in school. Thus, this post is for the many providers out there in my boat and need additional guidance…

It’s also currently like a forbidden topic of discussion, but it’s no excuse…I usually have a system and didn’t think about sharing it with others until I’ve heard a few horror stories. I’ve also recently saw a story where an NP precepted someone who was bad fit, spoke poorly of their practices, that resulted in the school reporting the NP and getting their license flagged, which basically impacted everything… Yes, it’s more sides to the story, but the point is in YOUR practice, YOU (the provider) will assume ALL responsibility. Therefore, for the sake of your sanity, license, finances and livelihood.. Have a vetting process before accepting a student or decline like I did until you’re able to handle the extra obligations:

Considerations Before Accepting a Student

Before committing to be a preceptor, consider the following practical, legal, and professional factors to ensure a smooth experience.

1. Your Time & Availability

✅ Do you have the bandwidth? – Precepting requires extra time for teaching, documentation review, and feedback.
✅ How many students can you manage? – Some preceptors limit to one student per semester to avoid burnout.
✅ Does their schedule align with yours? – Ensure their required clinical hours fit your availability and workload.

🚩 Red Flag: A student who needs a highly flexible schedule that disrupts your workflow.

2. School & Program Requirements

✅ Does their school provide a contract? – Some universities require a formal affiliation agreement.
✅ Are you required to submit evaluations? – Some schools demand frequent progress reports, adding to your workload.
✅ What type of setting do they need? – Ensure your practice meets their clinical requirements (e.g., outpatient vs. inpatient experience).
✅ Does the school offer compensation? – Some programs pay preceptors, while others expect students to arrange payment.

🚩 Red Flag: A school with excessive paperwork or unrealistic expectations.

3. Student’s Experience & Competency

✅ What is their background? – Do they have prior psych experience as an RN, case manager, therapist, etc.?
✅ Have they completed foundational coursework? – Ensure they understand basic psychopharmacology, assessment, and DSM-5 criteria.
✅ Do they have strong clinical reasoning? – A vetting interview can help assess their critical thinking skills.
✅ Are they professional and open to feedback? – Look for good communication skills, willingness to learn, and adaptability.

🚩 Red Flag: A student with no mental health experience, poor communication skills, or who is resistant to feedback.

4. Legal & Liability Considerations

✅ Are you covered by malpractice insurance? – Some preceptors require personal or employer-provided coverage.
✅ Does the student have liability insurance? – Many schools require students to carry their own malpractice coverage.
✅ Will they be charting under your license? – If so, you must carefully review their documentation.
✅ Are there state regulations on NP student supervision? – Some states require specific supervision ratios or physician oversight.

🚩 Red Flag: A student without malpractice coverage or who expects too much autonomy too soon.

5. Patient & Workflow Impact

✅ Will patients be comfortable with a student? – Some may decline, especially in sensitive psych cases.
✅ Will it slow down your workflow? – Initial training can increase visit times, so plan accordingly.
✅ How independent will they be? – Decide when they can lead assessments vs. observe.

🚩 Red Flag: A student who expects full autonomy before demonstrating competency.

6. Compensation & Benefits

✅ Will you charge for precepting? – Common rates range from $500–$1,500 per semester.
✅ Does the school compensate preceptors? – Some programs offer stipends or faculty titles.
✅ Are you doing this for professional development? – Teaching can be rewarding but should not become a burden.

🚩 Red Flag: A student expecting free preceptorship when it’s too demanding on your time.

Bottom Line:

✔ Assess if you have time and patience to mentor a student.
✔ Clarify school expectations (paperwork, evaluations, contracts).
✔ Vet the student (experience, professionalism, ability to take feedback).
✔ Ensure legal and liability protections (malpractice coverage, supervision rules).
✔ Decide if you’ll charge for your time.

Some Drawbacks to Precepting

Precepting a student can be rewarding, but there are definitely challenges to consider. First, make sure you’re able to take care of yourself, the main job and tasks, and personal responsibilities… before adding more obligations. Obligations = Stress, even if you’re like me and love to teach and train, take precautions. Here are some common negatives to consider and ways to navigate them:

1. Time-Consuming

Teaching and supervising a student slows down workflow, especially in a busy clinical setting.
Solution: Set aside structured teaching moments rather than trying to teach during every patient encounter.

2. Variable Student Skill Levels

Some students may be overconfident or underprepared, making it hard to find the right balance between guidance and independence.
Solution: Assess their baseline skills early and tailor your approach accordingly.

3. Increased Liability & Risk

Letting students conduct interviews, make assessments, or suggest medications increases legal risk.
Solution: Always review their clinical decisions and double-check documentation before signing off.

4. Resistance to Feedback

Some students may struggle with constructive criticism or appear defensive.
Solution: Use a coaching approach—frame feedback as a learning opportunity rather than a critique.

5. Disruptions to Patient Flow

Patients may be less comfortable with a student present, leading to longer visits or refusals.
Solution: Introduce the student properly and allow patients to opt out if necessary.

6. Emotional Toll

Students may have strong emotional reactions to difficult cases (e.g., suicide risk, trauma).
Solution: Encourage self-care, debriefing, and supervision to help them process challenging cases.

7. Student Dependence

Some students may rely too much on the preceptor instead of thinking critically.
Solution: Push them to develop clinical reasoning by asking questions rather than giving immediate answers.

8. Unclear Boundaries

Some students may overshare personal issues or struggle with professionalism.
Solution: Set firm boundaries and expectations from the start.

Bottom Line: Precepting requires patience, structure, and clear expectations. While it can slow things down initially, a well-trained student can eventually become an asset to the team.

Some Practical Tips for Training Students

Let’s say everything checked out well and you’re ready to start the training. I usually start off by sending the student a chart to review of a simple patient and ask questions about it for next session… Depending on their experience, it can be more than one chart like a kid/adult, male/female, or a complicated case, but don’t give too many chart reviews to not overwhelm yourself or the student. From there, I’ll do mock intakes or encounters, I don’t just immediately send anyone to a patient because even if they don’t say it, yes the student is scared or intimidated. I also don’t blindsight patients, make sure they’re stable, you have permission and their comfortable with having a student, it is their right to know and/or declined.

I treat every student the same, whether they’ve been in the healthcare field for a year or 10 years, I start with a chart review… and pace the training until the student is more comfortable to be on their own. Precepting can be a wonderful journey but it also requires a structured approach to ensure they gain both the knowledge and confidence. Here are some additional key tips to make the experience effective:

1. Establish Clear Expectations Early

Discuss goals, scope, and level of independence at the start.
Clarify documentation standards and workflow expectations.
Define the balance between supervision and autonomy based on their experience level.

2. Encourage Critical Thinking

Instead of giving answers right away, ask:
- “What do you think is happening?”
- “What are possible differential diagnoses?”
- “What evidence supports this treatment plan?”
Push them to justify their clinical decisions.

3. Gradually Increase Responsibilities

Start with mock patients and shadowing → move to co-assessing patients → eventually let them lead visits with supervision.
Encourage them to develop their own treatment plans before discussing.

4. Provide Constructive Feedback Regularly

Offer specific feedback after sessions:
- What went well?
- Areas for improvement?
- Strategies for growth?
Use the “compliment-suggestion-compliment” method to keep it balanced.

5. Teach Practical Documentation Skills

Help them master SOAP notes, risk assessments, and psychotropic medication rationales.
Emphasize concise and clear charting that meets legal and billing requirements.

6. Role Model Professionalism & Patient Interaction

Demonstrate therapeutic communication and boundary-setting with patients.
Guide them in handling difficult conversations (e.g., suicidal ideation, medication refusal).

7. Integrate Evidence-Based Practice

Encourage the use of clinical guidelines (APA, AACAP, SAMHSA).
Discuss recent research or case studies to reinforce learning.

8. Expose Them to a Variety of Cases

Ensure they see a diverse mix of disorders (e.g., mood disorders, psychosis, PTSD, personality disorders, substance use).
If possible, provide multidisciplinary exposure (therapy teams, case managers).

9. Support Clinical Decision-Making with Medications

Walk them through pharmacological and non-pharmacological treatment plans.
Discuss medication side effects, monitoring, and patient education.

10. Foster Confidence & Independence

Reinforce positive progress and encourage self-reflection.
Let them know it’s okay to not have all the answers—the key is knowing how to find them.

What About the Money?

I don’t charge students because I believe it’s unethical. I know not everyone agrees, but if a provider is being paid, there’s an expectation that the student will pass—even if they shouldn’t—simply because money was exchanged. There are times when I felt like the student wasn’t good fit and didn’t precept even if they did wanted to pay…. For my practice or future reference, I probably would make some kind of contract with the school to pay or make it a tax write off (with the rates below for example).

To future students, I urge you to have a vetting process when choosing a school. Ask if they provide a preceptor or consider the costs of securing one yourself. If you have to find your own, it might be worth attending a school that offers that support. I’ve seen students fall behind by a year or two, and some never graduate because they can’t complete their clinical placements. However schools, should pay NP’s to precept because it’s their responsibly provide the student’s education:

How Much to Charge?

💰 Common Rates for PMHNP Preceptors:

$500 – $1,500 per semester (flat rate)
$10 – $25 per clinical hour (hourly rate)
$50 – $100 per week (if charging weekly)

📍 Higher rates may apply if:
✔ You work in a private practice or specialized setting (e.g., forensic psych, addiction).
✔ The student requires more intensive supervision.
✔ Schools do not offer any stipend and expect students to pay out-of-pocket.

📍 Lower or no charge if:
✔ The student’s school compensates preceptors directly.
✔ You’re doing it for professional development or networking benefits.

How to Set Up Payment?

✅ Student Pays Directly – If the university doesn’t provide preceptors, students often expect to pay.
✅ University Pays You – Some schools offer a stipend or honorarium. Ask the student if their program provides compensation.
✅ Written Agreement – If charging, ensure you outline the fees, payment schedule, and refund policy in writing.

Alternative Benefits (Instead of Charging)

If you prefer not to charge, you might negotiate:
🔹 Continuing Education (CEUs) from the school.
🔹 Letters of recommendation or faculty titles (e.g., Adjunct Clinical Instructor).
🔹 Networking opportunities with the university for future teaching/precepting roles.

Bottom Line

🔹 Charging is reasonable, especially given the time and effort required.
🔹 Rates vary, but $500–$1,500 per semester is typical.
🔹 Always clarify payment expectations upfront (with the student or their school).

In Conclusion

When I precepted people, I generally had an understanding what to do, information about the person, or had the support of my facility. However, this post is related to people who got their own practice or encountering people/strangers, which will cause more risks and liabilities. Therefore, I’m glad I didn’t blindly go into the situation like I was working in a hospital or had some legal protections. What’s funny is how some of my patients are in the medical field, so I’m still somewhat precepting for free lol but to wrap this post up, I wanted to mentioned some more key points:

Here’s a Great Tip or Mindset

Treat this like a future employee! Ask for their resume, CV, and a time to interview them. This is also good for professors to practice with their students. We need to keep the standards high. Do not blindly accept anyone. Good luck everyone!

Key interviewing questions to help you determine if a student is a good fit for preceptorship. These will assess clinical knowledge, professionalism, critical thinking, and adaptability. Here’s 15 questions and a score card below (I don’t use one, but this is just for educational purposes):

🧠 Clinical Knowledge & Experience

1️⃣ “Tell me about your experience working in mental health.”
✅ Good Answer: Prior experience in psych as an RN, crisis worker, case manager, therapist, etc.
🚩 Red Flag: No psych background, unrealistic expectations.

2️⃣ “What are the most common psychiatric conditions you expect to treat, and how would you approach them?”
✅ Good Answer: Can name major disorders (MDD, GAD, Bipolar, Schizophrenia, PTSD, etc.) and describe basic assessment & treatment.
🚩 Red Flag: No real understanding of psych conditions.

3️⃣ “What are your thoughts on using medications vs. therapy for mental health treatment?”
✅ Good Answer: A balanced view that considers both options based on patient needs.
🚩 Red Flag: Either over-reliance on meds or anti-medication stance.

🧐 Critical Thinking & Clinical Judgment

4️⃣ “A patient tells you they are suicidal. What are your next steps?”
✅ Good Answer: Immediate risk assessment, safety planning, hospital referral if needed, collaborative care.
🚩 Red Flag: No clear safety plan, lack of urgency.

5️⃣ “How do you differentiate between Bipolar Disorder and Borderline Personality Disorder?”
✅ Good Answer: Discusses mood cycling vs. emotional instability, duration of symptoms, and treatment differences.
🚩 Red Flag: No real distinction, overly simplified answer.

6️⃣ “What would you do if you suspect a patient is drug-seeking?”
✅ Good Answer: Screening tools, reviewing PDMP (if applicable), alternative treatments, team consultation.
🚩 Red Flag: Quick to dismiss the patient without a thorough assessment.

🗣️ Communication & Patient Interaction

7️⃣ “How would you handle a patient who is non-compliant with medication?”
✅ Good Answer: Motivational interviewing, patient education, addressing concerns rather than forcing compliance.
🚩 Red Flag: Dismisses the patient’s concerns or gives up easily.

8️⃣ “A patient becomes agitated and verbally aggressive toward you. How do you respond?”
✅ Good Answer: De-escalation techniques, calm tone, ensuring safety, involving support staff if needed.
🚩 Red Flag: Reacts emotionally, lacks a clear de-escalation plan.

9️⃣ “Tell me about a time you had to deliver difficult news to a patient.”
✅ Good Answer: Example of empathy, clear communication, and professionalism.
🚩 Red Flag: Avoids tough conversations or lacks patient-centered thinking.

📚 Learning Style & Adaptability

🔟 “What are your biggest strengths and weaknesses as a student?”
✅ Good Answer: Honest self-reflection, shows willingness to improve weaknesses.
🚩 Red Flag: No weaknesses or defensiveness.

1️⃣1️⃣ “How do you handle constructive feedback?”
✅ Good Answer: Open to learning, values mentorship, applies feedback in practice.
🚩 Red Flag: Defensive or argumentative.

1️⃣2️⃣ “How do you manage stress and avoid burnout in a high-stress field like psych?”
✅ Good Answer: Self-care strategies, good boundaries, debriefing with colleagues.
🚩 Red Flag: No clear plan, history of quitting under pressure.

📅 Logistics & Fit

1️⃣3️⃣ “What are your availability and scheduling needs?”
✅ Good Answer: Clearly communicates availability, aligns with preceptor’s hours.
🚩 Red Flag: Unreasonable scheduling demands.

1️⃣4️⃣ “What are your top learning goals for this clinical rotation?”
✅ Good Answer: Has specific goals (e.g., improve diagnostic skills, gain confidence in med management, etc.).
🚩 Red Flag: No clear goals, expects too much hand-holding.

1️⃣5️⃣ “Is there anything you expect from me as a preceptor?”
✅ Good Answer: Looks for guidance, structured learning, feedback.
🚩 Red Flag: Unrealistic expectations (e.g., expecting constant supervision).

🚦 Decision-Making Guide:

✔ Green Flags (Great Fit!)

Has prior psych experience or at least a strong understanding of psych concepts.
Can think critically and safely assess/treat patients.
Professional, open to feedback, and eager to learn.
Flexible and respects boundaries & workflow.

🚩 Red Flags (Not a Good Fit!)

No clinical reasoning, expects to “wing it.”
Poor understanding of psychiatric meds & diagnoses.
Defensive, resistant to feedback, lacks professionalism.
Unrealistic scheduling needs or excessive paperwork from their school.

Here’s a Interview Scoring Rubric to help you objectively evaluate candidates. You can rate each category on a 1-5 scale (1 = Poor, 5 = Excellent), then total the score to determine the best fit.

📝 A Student Interview Scoring Rubric

(Score each category from 1-5, with 5 being the best. Total score at the bottom.)

Category	Criteria	Score (1-5)
1. Mental Health Experience	Has relevant psych experience (e.g., psych RN, case manager, therapist) OR demonstrates strong foundational knowledge.	____
2. Understanding of Common Diagnoses	Can describe and differentiate MDD, GAD, Bipolar, Schizophrenia, PTSD, etc.	____
3. Approach to Suicidal Patients	Knows how to conduct a risk assessment, safety plan, and determine hospitalization needs.	____
4. Medication vs. Therapy Approach	Understands the role of both medication and therapy in treatment.	____
5. Differentiation of Bipolar vs. BPD	Can explain differences in mood cycling vs. emotional instability.	____
6. Handling Drug-Seeking Patients	Knows how to assess for substance misuse and respond appropriately.	____
7. Response to Agitated Patient	Demonstrates knowledge of de-escalation techniques.	____
8. Handling Non-Compliant Patients	Uses motivational interviewing and problem-solving instead of dismissing them.	____
9. Ability to Receive Feedback	Accepts constructive criticism professionally, shows willingness to improve.	____
10. Professionalism & Communication	Well-spoken, respectful, and maintains professional demeanor.	____
11. Adaptability & Critical Thinking	Can apply clinical reasoning to problem-solving situations.	____
12. Availability & Scheduling Fit	Their schedule aligns well with your availability.	____
13. Learning Goals & Motivation	Clearly articulates specific learning goals and is proactive about learning.	____
14. Liability & Documentation Awareness	Understands malpractice insurance, supervision requirements, and documentation rules.	____
15. Overall Gut Feeling	Do they seem like a good fit for your practice & teaching style?	____

Total Score: ____ / 75

🔍 Scoring Guide

✅ 60-75: Excellent fit! Highly motivated, competent, and professional.
⚠ 45-59: Decent fit, but may need extra guidance. Evaluate if you have time to mentor them.
❌ Below 45: Probably not a good fit. Consider passing.