taking students, precepting - page 4

I do not precept and I do not take students. At one time I thought I would never say this. However, students deserve better. I want you to learn and do well and have good experiences. ... Read More

  1. by   Agnus
    Perhaps, I did not tell you that I used to precept. I took students eagerly and loved it. I still enjoy seeing students learn and often informally teach these students that I no longer precept. I love to hear what they are learing thier plans and dreams.

    I really have not had bad experiences so to speak that have turned me off. The vast majority (actually I believe all) were there to learn.

    Would you beat up or pass judgement on a beloved professor who decided to cut back and only teach occasionally because they had developed physical limitations? I am guessing, no.

    As far as "blaming" students for the added stress. I don't believe I am blaming anyone. Stress is. I simply stated the fact that students do add to that and I challege you to demonstrate that a student adds no stress what so ever. Part of the stress is that I care very much about what they learn and how they learn. This is not blaming it is a simple statement of fact as I see it. There are numerous stressors thoughout the day and this is one more period. I do not need one more.

    Even the student who just watches and needs to be prompted at every step is a gem. We call this student as being in observation mode. He is attentive but tenative in taking action himself. He is just so awed and unsure about his abilities and well it is pretty darn scarry for the new student to get in there and do things himself.

    Students hit this point not just at the beginning but at various points though out thier education process and then it hit again after they graduate. This is normal. Some are just afraid to ask questions or even more important do not know WHAT to ask. These are normal human reactions.

    Let me tell you a story. I loved where I worked and loved my employer. I eageryl stayed late when asked or took an extra shift when asked because I knew it was apreciated and I was respected.

    Then something started happening. I did not recognize it at first. EVERY single time I worked a few hours extra or an extra day I ended up calling in sick after I did this. After a while I saw the pattern.

    I went to my employer an told them the pattern that I saw. I said that I would not work extra anymore because if I was calling in sick after doing this then I was not doing my employer nor myself any favor, infact I was doing us both a diservice.

    That employer and every one since has agreed and been very respectful of this.

    It was hard for me. There are still times I would like to help out.

    I also hate it when I see nurse much older with the physical endurance that I once had. I used to be very high energy.

    I used some examples of student behavior as a means of demonstrating some of the minor stress that was added by taking a student. The student who did not want to do meds did some other really wonderful things for my patient that really needed it. He was not a bad student. I did not have the energy to address what he chose not to do. I believe that (especially since he was graduating in 6 weeks) that he had a responsibility for his own education. He knew enough to accept or decline a task. However, I feel he did not take the free oportunity to practice and that is a loss. I can not save the world. I don't know if he would have understood if I explained it the significance of the oportunity that he had that day and passed up. And I did not have the time or energy that day to do it.

    For the record that student was given to me with out my being asked. I really was not up to taking him but he apeared at my side when I was getting report and that was that. Later his part time clinical instructor who also happened to be a staff nurse on our unit came to me and apologized that she had not asked first and thanked me. (NO I had not complained or indicated in any way that this was a problem) She was just courtious I am sure, as people generally do ask first there.

    As far as payment goes. If you choose (yes it is voluntaiY) to precept for 12 weeks you get paid $1 extra. After the 12 weeks you get nothing extra. If another nurse takes the person that you are precepting for you one day that other nurse gets nothing.

    Some hospitals pay a bit extra for precepting or taking students some do not.

    Taking students where I am does not pay more.
    The precepting pay is for new graduates that are going to work on the unit, or for senior year students who are employed (paid) on the unit for the purpose of gaining additional clinical experience with a preceptor. Some places call these apprentices.

    The paient load for the preceptor sometimes is only slightly adjusted up or down due to the precenses of the apprentice. However, the apprentice and preceptor have a long term relationship and get to know each other very well.

    The student coming to the floor for the occasional clinical rotation does not have this. I assess as best as possible where a student is at in the beginning and try to find out what he can and can not do and what he wants from this day's experience. Then we go from there. In other words the student directs his own learning to an extent;remember these are adult students. Then when I see oportunities especially unusual ones I will direct the student to them.

    Some hospitals pay nothing to precept period. Some require you take students, new grads, new nurses to the unit etc.

    It IS NOT part of my job description. It is my decision if it becomes a part of my job description where I work, and the nurse who has agreed to this can change her mind.

    I hear a lot of shoulds. I HATE the word should. Should is a very judgemental word that comes from what we preceive others expect, whether we say you should, or I should. Should is a finger pointing word. When I point my finger at you and say "should" three more fingers are pointing back at me.

    Should is what is not and never will be. It is a fantacy word.

    Please join me in the real world with real people and acknowlege our individual and unique limitations. It is ok to hate our limitations. It is not ok to confuse that limitation with the person who has it.

    To the angry students who have posted here. I have been where you are and I am here now. You have not been were I and other nurses are do not be so hasty to pass judgement.

    If it scares you away from the profession to see nasty nurse then that is a good thing IMHO. Because if that turns you away you do not belong here. The sad truth is we do get pretty cranky. And you will have to deal with that your whole career. Though hopefully not all the time every second of every day.

    I hate to see people scared away because we need nurses so badly. And at the same time I am glad that you learn early on what you may be up aganist and make a decision early to get out rather than be just a warm body in the profession. It is sad and disapointing for you who are scared away. But reality is this is not a NICE NICE profession. Some times people come into nursing with an idea that is unrealistic.

    From the angry students that posted here, I hear tones and words written by you that suggest you are pretty contentious yourself. This does not help the profession. If you come in angry what is it going to add to the profession that is already over stressed and over stretched?

    You were treated badly by a nurse so you now have your dukes up. Not a good start.

    I was a student. I had classmates complaining on a daily basis about 'bad" nurses and recieving bad treatment. I had those same nurses sometimes work with me and I precieved the experience quite differently. Sometimes the same nurse on the same day as the other student who complained.

    Late on I did have a nurse that it was very obvious even to me the nurse did not want a student. My instructor could see it and aproached me. I verified that the nurse was physically avoiding me. We agreed that I would stay out of her way as much as possible and not make this any worse. I went to my instuctor with my concerns rather than tax this nurse any more than necessary.

    Some of it is our own attitude as a student. Recognizing a stressed nurse rather than a nurse who was "mean to me." As nurses we are grown ups. Please, recognize that everytime someone snaps or seems grouchy it is not about you. It is about that person's level of stress.

    Some of us are actually human. Stressors are not limited to the obvious ones we see others having at work. Though we don't necessairly bring our home life to work with us the stress we are feeling in other aspects of our life does not magically disapear when we choose not to bring the problem associated with it into the work place.

    I am under numerous stressors away from work as I am sure you are as studens, wives, moms, daughers (subsititues sons, husbands) breadwinners, living on own etc.

    You do not know where another person is at EVER. Please, do not compare their stress to yours. Perhaps you are under more stress but are handling it better. Perhaps the other person has less stress but has cumulitive effects from past stressors. Perhaps you have better coping mechanisms.

    However, if you are feeling angy and need to lash out pass judgement and or saying "should" then I would surmise that you aint doing so well you're self and maybe need to acknowledge that you and they both have limitations.
    Last edit by Agnus on Nov 3, '05
  2. by   HeartsOpenWide
    I think it is sad that you have had bad experiences with nursing students. However, I think it is great that you are able to recognize that a student would be better off having some one else as a preceptor. I have had teachers that I have though "They have no business being here!" Why do they assume that just because some one is a nurse they should have the duty to teach people what they do. Some people are good and teach/explaining things and others are not!
  3. by   tencat
    I understand where Angus is coming from. I think when you are young (early 20's) you want to devote as much time and energy as possible to your new career. Often that means that these new employees don't realize that they need to take care of themselves, too. I am student for the second time around, and this time I realize that I have limits and need to stick to them to survive long term in this new career. For example, yesterday in clinical a young student spent 8 hours straight on the floor and skipped lunch because she had so much to do. Admirable, yes, but she's headed for burn out if she keeps doing that in her job. I could have easily skipped lunch and kept working, as there's always a lot that needs doing. But as long as my patients are stable, I have reported to the nurse, and meds have been given, I see no reason to skip lunch, especially since I get really irritable and tend to be prone to mistakes if I'm too hungry. Some of the nurses who precept me do have the attitude that you should only think of your patients, and you don't matter. I disagree. If I am not taking care of myself, how can I adequately take care of others?
  4. by   Agnus
    Just an added thought. I do not see student bashing going on here. I do see bashing by (a few) students toward nurses who, for what ever reason, choose not to take on students. Unfortunately some are not in a position to refuse students.

    I also see a sense of entitlement on the part of those students. Are you aware that you are in our hospital as a guest? You are entitled to very little here. You do not pay tuition to the hospital. Your tuition and entitlement comes from your school and even that entitlement is limited. Your school is dependent on us to furnish you clincal experience. Not the other way around.

    There are hospitals that do not take students. Yet are able to staff thier hospitals with well educated nurses. One does not poop in the living room of a place where they are a guest even if the host is not what the guest wants.
  5. by   AuntieRN
    I laugh at myself now...but...I was a CNA and unit clerk for over 20 years. I hated when students came onto my unit. You know the ones...the ones who already knew everything but really knew nothing at all. Then I hated it when they would first graduate and come work the night shift and you had to actually train them to do things like put on a restraint etc. Now I am the student nurse. I feel bad for the staff on the floor and try my hardest to not add any more stress. I know the stress the presence of nursing students on an already busy floor that is short staffed is already running high. I have to admit though that in the program I am in...we have 7-8 students in clinicals each time and our instructor is right there on the same floor with us at all times. If we need any help or have any questions we are supposed to go to her first. Some of the nurses like us being there and some dont. I have to add one thing though..the only nurse I have ever had a "problem" with so to say was a new grad from my program. She only graduated in December and already has a problem with students being in her way so to say. I want to say thank you to all the floor nurses who have to put up with students. I know we are not easy...some of us are lazy...others are over eager...and some of us are just plain scared...but I do not think anyone should be put down or chastized for not wanting to precept. I would rather have a nurse be honest and tell up front that they do not want a student then to be pushed on one and have hard feelings and more stress added to the day. Nurses work very hard and their jobs are extremely stressful. In my book they are not appreciated nearly as much as they should be. We as students should be thankful for any experiences or lessons we can be taught from any nurse and not put one down because they do not want to "teach" us. We are like having another patient. We are not competent enough to be sent out on our own to do most tasks...after all...why should they put their license on the line for us...we do take longer to do tasks that probably only take them seconds to do....I do not want to be on a soapbox and I am sorry...I just want to say thank you again to all the nurses out there.
    Last edit by AuntieRN on Nov 3, '05
  6. by   fergus51
    I think it's sad when we start to point out that students aren't entitled to be precepted. If you work in a teaching hospital, this is a part of your job plain and simple. I would hope people could do that with kindness and compassion if they are not able to simply refuse or else find a different work environment where this is not a part of the job.
  7. by   Curious1alwys
    All this talk about preceptors has me wondering.......

    Is it appropriate to give something to a preceptor nurse? I don't want to try to "buy" anyone's niceness, but like I said, I do understand the position they are in. However, there is not much I, as a student, can do to change that. So...........wondering if you can get them something or send them a card? I suppose unless you did it with every single one it would not be appropriate? I just thought of this the other day when I had this one nurse who was really not happy to see me in the AM and was VERY dissapointed when I told her I was a Block 1 student (can't do much). Even still, she warmed up and ended up being very nice and a super teacher.:icon_hug: I wondered if I could do anything other than saying "thank you" to show my appreciation??

    I just think that these nurses who are nice to you despite all their stress deserve something. I am usually 10x more scared of the nurse I am assigned to for the day than my patient!!! Funny, but true!

    Any thoughts???:uhoh21:

    Edited to add that I have asked my preceptor nurse if she would like anything from the cafeteria but I don't think that counts, LOL
  8. by   grinnurse
    Agnus-

    I totally respect your point of view and candor on the subject. Too bad there aren't that many other nurses that will be that honest and decline. I think the ones that don't have the guts to decline are the ones that we hear about by the students as being the ones that "Eat their young".

    I personally am looking forward to that aspect of nursing once I myself know what I am doing but I think that it takes all kinds to make the nursing world what it is!!
  9. by   grinnurse
    Quote from thrashej
    All this talk about preceptors has me wondering.......

    Is it appropriate to give something to a preceptor nurse? I don't want to try to "buy" anyone's niceness, but like I said, I do understand the position they are in. However, there is not much I, as a student, can do to change that. So...........wondering if you can get them something or send them a card? I suppose unless you did it with every single one it would not be appropriate? I just thought of this the other day when I had this one nurse who was really not happy to see me in the AM and was VERY dissapointed when I told her I was a Block 1 student (can't do much). Even still, she warmed up and ended up being very nice and a super teacher.:icon_hug: I wondered if I could do anything other than saying "thank you" to show my appreciation??

    I just think that these nurses who are nice to you despite all their stress deserve something. I am usually 10x more scared of the nurse I am assigned to for the day than my patient!!! Funny, but true!

    Any thoughts???:uhoh21:

    Edited to add that I have asked my preceptor nurse if she would like anything from the cafeteria but I don't think that counts, LOL
    Here's what I did last spring for the nurse and the department that precepted me. I took my actual preceptor to dinner at a Mexican Food Restaurant that she liked that was close to the hospital (way after the "grading" part had been done by her) and then I baked several different kinds of muffins and got a card for the whole department to thank them for the experience as a whole. You might also send a nice letter to her/his nurse manager recognizing their kindness!!

    Hope you find something that works for you!!
  10. by   Thunderwolf
    Excellent posts, folks.
  11. by   blueiwahine
    Agnus,
    I understand where your coming from but there is also a flip side. I am an older student about to graduate. Our instructors tell us we can not do a skill the first time until they are there with us. Needless to say I missed alot of skill opportunities waiting on her. I also feel that I am in the nurses way, because what school says we can do or can't do without them around or do not say at all. I know my experience in nursing school has not been the greatest. I feel from day one they have just let us out in clinicals on our on and feel we are suppose to jump into running. Some days I wouldn't see my instructor until post conference that afternoon. I don't know if they felt like I was older and thought I had it all under control or what (Yeah right!)...My instructor this last semester was awesome to take the time with us all and make sure to see us during clinical days to explain, etc needed info. I love nursing and enjoy caring for patients.. Again, I understand you are use to your routine and don't have time to deal with teaching a student and your workload...but experienced nurses is where we learn most of our real world nursing experiences...it's not from our teachers or the books...If we don't have nurses willing to be inconvenienced and put out...we won't have new graduate nurses coming into the field...which will lead to more nurse's having to work long hours and getting burned out. So all you nurses's out there...we need you guys to teach us your experiences...I know I appreciate every thing I learn from the nurse I am with that day.
    Deb
  12. by   lisamc1RN
    My own experience has been that there are a couple of nurses on the floor I'm on now who grin and bear it when working with students. I take the attitude that I am going to be the least amount of burden on them as I can possibly be. I don't blame them for not wanting to work with students, no matter what their reasoning may be. Not everyone wants to do that. It's ok. I think it is the responsibility of the student to have their ducks in a row as much as possible. Go in prepared and informed! Seek out information from more than one source. We have an instructor, books, the computer, and many more resources at our disposal. Also, I think it's a good idea to let the nurse know that you know she is very busy and you do not want to be a burden to her and ask how best you can be of help. Where I am, if there is an invasive procedure such as an IV or foley, I have to get my instructor to observe, which can be frustrating if she is busy with another student. Sometimes that foley can't go in right away if it is dependant upon me. We can ask the nurse how much time leeway do we have for the procedure. If it has to be done asap and the instructor is not available, I just offer to observe or assist.

    Kudos and many thanks to all those wonderful preceptors out there who are willing to teach students. It is much appreciated. For those who find themselves stuck in the position but would rather not be there, thank you too. You all deserve extra praise (and pay) for your efforts!
  13. by   kim0190
    I am a student, and wondering--where is the clinical instructor in these cases when the nurse is bombarded with questions from the students? In my clinicals, I have been lucky so far with the nurses on the floor. However, we generally notify them in the morning that the students are assigned to these certain patients, and will be passing meds, doing am care, etc... and then we basically just report off to the nurse at the end of our time there. We may ask a question about something, or report something sooner that we feel the nurse should know, but we use our clinical instructor for the bulk of our questions. I would also get very frustrated if I was told to take someone under my wing for a day and then had to babysit them the whole time. I thought that was the purpose of the clinical instructor, to be there on the floor with the students, helping and assisting with procedures that we are unsure of. I will also say that I do tell the other nurses that if any patient needs anything else, please let me know and I'd love the experience of doing whatever I can. The hospital I am at now-Fairview-has been exceptional. The nurses on the acute rehab floor were actually so glad to have students, they came looking for us to show us all sorts of new things as they came up, that was wonderful. It is very nice to have nurses glad to see students-and also nice when the student lives up to the nurses expectations of them.

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