Bad preceptors and the demotivated state of nursing.

[Axmann, RN, BSN, NREMT-B]

Why do nurses who obviously have absolutely no interest in the education or development of their students bother to volunteer to be preceptors?

Is it recognition? Feelings of importance? Standing within an organization?

Almost all of my clinical preceptors (bar a couple) have been so uninterested and so disengaged that my nursing education has suffered severely.

I graduate from my BSN program in May (which my preceptor knows) and my preceptor asked me yesterday whether I knew how to put an SCD on. How is someone allowed to teach students if you have absolutely no ability to roughly estimate their skill level and educate them accordingly?

The level of disengagement and lethargy permeating the nursing profession is really astonishing. How do people "fall in love" with a profession that, for the most part, devoid of the passion it probably used to have?

Severe micromanagement, liability and HIPAA concerns, disrespect from superiors, strict protocols disallowing any attempt at innovation... Why do it? To help people? Really? What about ourselves?

[tlc2003]

I'm an ADN nursing student graduating in May, so congratulations! I'm going to show my ignorance by saying upfront that my understanding of the role of preceptor is to be a teacher or mentor once we are employed to bridge the gap between nursing school and actual nursing, or when we're moving from one specialty unit to another. In my nursing school experience we pretty much surprise our nurses at 0700 with the fact that they will be followed by one or more students that day. We preplan the day before on however many patients our clinical instructor tells us to and bring our care plan, list of meds, etc...with us. I personally always carry the list provided by my college stating what I can or cannot do at my level of education in the event my nurse asks and my nerves have me stumbling all over myself. And I've been asked repeatedly what I know how to do and what I'm allowed to do and I can't find it in me to be offended that my nurse asked me if I could feed a patient or put on SCD(which BTW, I don't have a knack for so if asked I'll admit sure, I can, but it won't be pretty. Show me your trick!), because they've been dealing with different students over weeks and months, all at different levels. It's understandable for them to double check with us before throwing something at us that we're not pros at. I've only had two negative experiences out of countless nurses I've encountered where I felt they resented my following them. One nurse refused to speak to me, would not reply when I said hello and introduced myself, just turned on her heel and walked away. Informed my instructor and was told to try again. I waited until she came back to the desk and introduced myself again and asked if I could follow her or if her patient load would be such that I'd be in the way. No response, turned in her chair and clicked away at the keyboard. Informed my instructor that I'd listen to report and I could either do another quick and dirty preplan on another patient or I could act as a tech that day because there was no way for me to effectively learn or the nurse effectively teach in this situation and it wasn't fair to the patient. The other nurse would speak but was a bit condescending when I couldn't always pronounce generic drug names correctly. Nerves, lawd my nerves, I got tongue tied and I'd butcher the name. She was a new BSN grad and didn't feel ADN's should be allowed to practice. I smiled, nodded, thanked her, and finished my day. Why get bent out of shape? On the whole I've had the opportunity to work with a ridiculous number of nurses who were happy to baby step me through some skills that I should have no problem with but my confidence wasn't there, multiple times. Some have anticipated me for the following week and recommend patients for me so I'd get more practice. Their, and soon our, jobs are really difficult and draining. Unless they're abusive or teaching unsafe practices use the experience as an example of what you don't want to do in your practice, an example of how you want to treat future students. No matter how much education we have we know NOTHING, we may have noble and lofty ideals but we're not in the trenches yet and still have the luxury of those ideals. Give our future colleagues an itty bitty break! And, truly congratulations and I hope you have a wonderful career!

[Janetnzrn]

In my hospital, senior nurses are expected to take students and new grads. We aren't asked, we don't get paid more and there is no "recognition" some of us enjoy it and some do not. Some are good at it and some aren't. Asking what you can or can't do is practising safe nursing, get over yourself and don't expect a nurse to know what skills you have. Frankly, you sound like the type of student I don't enjoy teaching. On my unit we don't eat our young, we help and support, but the expectation is that you learn the job by asking questions and seeking out experiences. And as for strict protocols, they are there for a reason! They are based on best practice research and should not be open to a student nurse's "innovation"!

[rlwood1]

I hate to see the amount of comments to your thread that reiterate why you feel how you feel about preceptors. I had a similar experience and had to step back and ask myself if I wanted to work in a profession that we were told was great and wonderful but in real life was a lot of negativity and even sometimes a hostile work environment. If I can share anything Ive learned with you its this: first take a step back and put it into perspective...if your preceptor doesn't have time to teach you ask to be reassigned because it's vital that you LEARN while you can! Once you're on the floor it's all on you, take every opportunity you can to learn a new skill, follow different nurses and learn different ways of doing things. Also, don't be discouraged by bad attitudes...keep your head up and be confident!

[Jenniscorp84]

I think it depends on a couple of things 1). the area you are in and 2). the hospital you are at.

Idk how people are defining preceptorship but I think this may be a source of confusion.

The way my school does it is from the beginning of nursing school until your last semester you attend 'clinicals' - where you go to a specific facility/hospital/unit that corresponds to the lecture class you are taking (med surg 1/2, peds, mental health, etc.). There your clinical instructor will take you to a floor and ask the charge nurse if she knows of any nurses who are willing to let students follow them. Charge will then reach out to nurses who can either say yes or no (most usually say yes out of politeness even if they don't want to) and then the student will 'shadow' them for however long they have clinical. For us we had a different nurse to shadow every day.

PRECEPTORSHIP for us at least was during our last semester of nursing school where my nursing school reached out to a hospital and saw what various units were available and which ones had preceptors. These preceptors (I was at a rather large hospital and my friends at other big hospitals in the area confirmed this as well) had gone through training to become one and get an additional yearly bonus for being preceptors for assisting nearly grad-nurses. And I can honestly say I'm not making any assumptions because in nearly every unit employee bathroom is a flyer from the hospital's HR talking about the preceptor program and what benefits nurses who go through it get.

So while nurses you may SHADOW during your clinicals may not have a choice on taking students, PRECEPTORS are usually given a head's up because of the contract the hospital has to make with your school.

If my school's different/if I've got the whole definition thing wrong please let me know; but this has been my experience.

This is EXACTLY how my BSN program was in GA. And I agree, as booth looking back as a nursing student then and an almost 5-year experienced RN now, most new grads and students do not communicate enough with their preceptors and nurses they shadow. It is very logical for that question to have been asked, and for that matter, Any question regarding assessment /treatment /intervention /skill, etc. As a preceptor to a student or new nurse, I would definitely want to ask if they know how than assume and pay for it later. Calm, effective and productive communication lines between students /new grads/nurses need to be open and respected because that is how we can best learn in this field and possibly prevent mistakes.

[Queen_of_Cardiology]

I think I should start by saying I'm a UK nurse, so things are somewhat different here. We don't have many academics in practice (I've met one in a career lasting over a decade) and when they are there they do not work clinically, they're there to support nursing students. So nurses attend university based training on both teaching & assessing, and are responsible for all teaching in practice.

In all the years I've nursed, I've never known anyone take students for glory or any of the other daft things you list! Frankly in my experience nurses don't get any choice about taking students, it's merely expected they will do their training and take them, so your way off.

The thing which strikes me the most is your attitude! As a nurse my priority is, and always will be my patients! I've not got the time or the interest in spoon feeding students, if students are interested it's far easier to teach and you opportunities for teaching present themselves far more often. As an adult learner, it's your responsibility to push for your development! Why do you think it should be anyone else to remember what you can and cannot do? Do you remember the clinical abilities, strengths and weaknesses of all those you work, probably not, so why should they do the same for you?

If if you change your attitude and appear more keen and motivated, your mentor may be motivated to teach more! And as for being micromanaged- I'm sorry but until you've proved your competence I'm not surprised your kept on tight leash! Your mentors responsibility is to keep patients safe above and beyond fluffing your ego, so checking your competence is good practise in my opinion.

[APRN., DNP, RN, APRN, NP]

Dearest OP:

Did you take a class in your nursing program to •••••••teach you how to precept others•••••••••?

.........Please keep that in mind when you put down others for not being stellar preceptors. Nursing skills are one thing. Teaching skills are something else. Please do not confuse the two.

Most nurses precept because they enjoy helping others learn, but are given very few tools with which to be a perfect preceptor right off the bat.

There are as many varied and different ways to precept a student as there are nurses.

Unlike nursing school where you learn a standard way of doing things, precepting a student is learned on the fly AFTER graduation. Usually after trial and error.

Rejoice when you get a good preceptor.

As far as berating a preceptor goes, you may very well be giving a new-to-precepting nurse a reason to Never venture in those waters again

[HeySis, BSN, RN]

I have been an LPN for over 20 years and decided it was past time to go back and get my RN. I'm in my last semester of an ASN program and am precepting. I was told that our preceptors would be volunteers form the hospitals that our university has contracts with, but that turns out not to always be true. When I contacted my preceptor for the first time, she let me know that she had not volunteered but has been assigned. She said she use to precept years and years ago and didn't know her name was "still in the system".

My instructor for my precepting class comes to meet with the preceptor and student three times, at the beginning, at 65 hours and at the end (135hours). She has the preceptor sign a contract with the university at the first meeting making my preceptor an "adjunct professor" and it gives her six free credit hours if she wants to return to school and advance her degree.

Even though my preceptor didn't volunteer, she's been great. I went over my goals with her and she let me know what would and wouldn't be possible to do and gave ideas for other goals. If we have a critical situation (we are in the ICU) she'll let me know that she needs to jump in and just get some things done, but I should watch. When it's resolved she gives me a chance to ask questions and then the next time she assigns me some of the tasks. She lets me do skills every shift. At half way, I do the bulk of the patient care because she has watched me and is more confident that I am doing things correctly. The other nurses on the unit also are looking out for me to see new things, I just had to speak up at first to let them know I was interested and willing to do things for them... so will trade running for linens, passing dinner trays, helping with double bagging or doing bed baths (which the RN's on ICU do anyway) for a chance to be taught!

[Purple_roses]

I don't understand how asking you about skills your familiar with is a bad thing. I also don't understand how this would make your preceptor a complacent one. Take charge of your learning. Ask questions. Your preceptor isn't a mind reader. And where is your instructor?

[pedseraprn]

As former faculty, I can tell you there is money paid to the hospital and no, the poor staff rn's or the floor never see the money. Staff rn's usually have little choice in student or not. They are busy and yes, some don't like students at all . Thankfully, some do and are helpful. Precepting is different. Probably no money to the nurse again, but prestige of being picked , service to the floor, and noted to be skilled on the unit and with education. Looks good on an annual review!

Other posts are correct. They don't feel it is their job to teach you, it is the schools. Be open and willing to learn. Take any and all opportunities to watch or do. Be respectful even when they aren't.

in my unit, new rn's are precepted and it's about the extra preceptor pay. Doesn't matter whether you can teach or not.

[gemmsrn]

I've been a nursing instructor for almost 40 years and when I am in the clinical area with my students, I am their preceptor. I graduated from a BSN program that had very active clinical faculty until the last 7 weeks of my undergraduate education. I learned from those faculty, what I feel is the best way to be a clinical instructor. I have NEVER pushed my students on any of the nurses on any of the units I am on. It is my responsibility to make sure that the student is safe and knows what he or she is doing at all times. If they don't then they are asked to leave and receive an "Unsatisfactory" for the clinical day. In my almost 45 years of nursing, preceptors were only used to help orient the new nurse to the unit, not to do clinical teaching while the student is in school. Using overworked nursing staff to do the job that nursing faculty are supposed to do is the problem, and the reason many nursing students become very poor nurses. They learn bad habits and bad attitudes from those nurses, overworked and burned out as many are. Reading the comments, I can understand why new nurses are demotivated and hate being preceptors because they feel very taken advantage of. I can only hope and pray that in the future, those schools that push their students off on nursing staff see the error in doing this and return to the clinical faculty being responsible for the student's performance, leading to a change in the motivation of future new nurses.

[nursekittycat39]

I have spent 4 months precepting a BSN student during her finally semester and had a wonderful time. She had great respect for me, she worked up to taking over my patient load by the end of her term. I didn't get compensated for it but got a lot of satisfaction from it. We also have junior year clinical students that are in and out more frequently. I was not asked to take these students. They were observing me...pelting me with hundreds of questions...wanting to know all medication side effects and so on... I finally handed them a drug book. It got to be such a drain and I was dreading going to work. Not all students were a burden but some were really aggressive and obtrusive. I think that gave me a bad taste for teaching even though I have loved it in the past.

[katdan1026]

I work in a Specialty Physicians Office that is part of a hospital. My practice manager decided to stick me with my THREE nursing students! In a one physician office! All 3 followed my every step, crowding the small triage and exam rooms, and making the my pediatric patients and their parents very uncomfortable and doctor upset! There wasn't enough work for all of them so they just stood around bored or on their cell phones most of the time, or fighting over what little work I had for them to do. It was a total mess! After a few days of this I dismissed all 3, called their schools and told them,why they were dimissed so the girls wouldn't get in trouble, told the practice manager 1 student or none! Fortunately we now have one student and it's much more manageable and she actually gets to practice her skills.