Dear Nursing Students/Orientees: A Love Note from the Preceptor from Hell

[CheesePotato]

Warning: The following post is rife with brutal honesty and frustration. Read at your own risk.

Memorandum from the desk of Your Friendly Neighborhood Sociopath

Dear Nursing Student/Orientee:

Allow me to start my letter with a brief aside. Yes, I know there are things you are not taught at nursing school. I know that this may not apply exactly to your set of circumstances. I know that there are evil, vindictive individuals out there that will purposefully set you up, hold you down, and delight in making your every morning something to dread and your every evening a nightmare.

But I am not one of those individuals. I do not, under any circumstances, condone their conduct.

Nor am I some fluffy feel-good nurse that will hold your hand, coddle your mistakes and spout sayings freshly garnered from those horrid encouragement posters seen in every middle management office. You know the ones...they normally feature a humpback whale tale flipped above the water, inked on black with the word "Perseverance" splayed in white type beneath it. No. I am not that nurse.

Normally this is where I would insert some words of acknowledgement and a word, dare I say, an apology for who I am.

No.

Wrong.

I am not sorry.

I am not sorry for who I am. And more importantly, I am not sorry for who I am trying to help you become.

And if that makes me the sharp toothed thing lurking under your bed, poisoning your dreams, then so be it.

Let me be frank....well, more frank: It is not my job to be your friend. It is not my job to be your nanny, your partner, or your teacher.

I am your preceptor.

I am not paid to like you. I am not obligated to think you are amazing, or clever, or the greatest thing to grace the floor. You were admitted to nursing school. Maybe you've already passed the NCLEX. So did I as well as the rest of the nurses around you. Get over yourself.

I am not here to swap stories of what we did over the weekend or invite you out to drinks after work. To be clear, you are but one more individual whom I must monitor throughout my shift and what a dangerous individual you are as you practice under my license and tutelage. I am not blown away that you remembered to put on gloves or to put the bed low and make sure the call light is in place. That is your job. By the time you round with me, that should be second nature.

So let's pause for a second and smooth all the hackles I know I just raised.

Allow us, for just a moment, to be honest together, yes? Nursing school often paints a pretty picture of perfect working environments frosted with therapeutic communication, dollops of hand holding, smiling, radiant preceptors for everyone and delightful nurse to patient ratios. Rainbows sold separately.

It's not that I crush dreams so much as get the lovely job of escorting you out of Wonderland and into reality. And reality bites.

I may not be your friend, but I will be professional with you and you have the right to expect nothing less. Perhaps in time we may develop an understanding which my lead to friendship. But that time is not now. Stop taking it so personally.

If you have done your research, if you have made your phone calls, if you have come to me and we have agreed upon a solution that turned out to be wrong, I will never throw you under the bus. I will defend you even to the DON and the MD's if we followed protocol, proper skilled nursing practice and physician orders. You may take a fall, but it will not be alone.

But I will not own your foolishness or your negligence. Expecting me to sacrifice my career, my rapport, my dignity for you is simply not realistic. Even in our little corner of the working jungle, natural selection, AKA survival of the fittest, still applies.

On that note, I will do everything in my power to be damn sure you never, ever manage to make such a grievous error. Why? Not because of patient care (though it should be a no brainer that such a thing is part of it). Because I want you to succeed. I want you to be safe. Because I know those mistakes destroy futures.

Not on my watch.

I promise you that my knowledge is yours to access any time, day or night. Even when I've stolen a precious few seconds in the bathroom or are snarfing down a sandwich. If you have a question, for the love of all things sacred and delicious, ask. Yes, even the "stupid" questions.

Though I firmly stand by the reasoning that the only stupid questions are the ones not asked.

I also promise to tell you when I don't know. What's this? A preceptor without an answer? Absolutely. Look, it's been...well...a while since nursing school and there is only so much room in the mental hard drive, alright? It's either remember the exact dosing of Colace or remember how to make a Denver Omelet. Sacrifices must be made for the greater good.

But we'll relearn/learn it together.

You worry about asking me questions as you fret over my answers and thus ask none. Pray tell, how shall I guide you if you do not ask?

I may not have the answer, but I know someone who does. Pay attention to who I talk to in order to get that information. Guess what? I'm showing you my sources. They will become your sources too when you are out on your own. And don't forget, I'm around. It's not like after the orientation is over I'm going to vanish with a nod and a plume of purple smoke to a magic lamp.

Silence means just as much as speech. Kindly note when I hold my tongue and when I talk and more importantly, who I talk to. (Yes, I know, ending a sentence with a preposition. - 10 points from Gryffindor) I'm giving you hints on who to trust and who to watch as well as your Reliables, those fine folks that always seem to be Johnny on the spot with whatever strange thing you need.

Speaking of speech, communication is a two way street. If you need my attention, if you need something different, if you need me to back off because, trust me, it is harder than nothing else to sit on ones hands and watch someone struggle when it is just so much easier to do it oneself, say something! Just....not in front of a patient. Or my charge nurse. Let's talk privately, quietly, as two adults ought.

Be sure that I am fully aware of the tone I use. You know. The. Tone. I have it in my orificenal for a reason. That is my "Some serious !@#% is about to go down and I need you to do exactly as I say" tone. Never argue with the tone. Pay attention and make mental notes. Ask me later what I saw that you didn't. I'll happily tell you.

Should that tone ever come out while you are performing a task: freeze. I am trying to keep you from causing unwitting harm. More to the point, I am working to guard you from making the same mistakes either myself or others have made. And yes, I will tell you the story later.

Again, don't take it personally. In those moments it's not about you. It's about the patient.

However, there is nothing in this world more frustrating, more gut churningly irritating, than someone wrapped in indifference and swaddled in ego. Nothing makes me angrier, quicker, than an orientee that does not see their own potential and is more than happy to just settle. I see so much ability just lying dormant, waiting for the right chance to break free and yet when it is ignored, when you gloss over it in favor of the easy way out, I seriously just want to kick a squid. In the face. Hard.

So I'm going to push you. Relentlessly. When you could do something better, I will tell you. I do not hand out compliments liberally for a reason. Your best today is simply not good enough tomorrow. It's not good enough for me and it definitely shouldn't be good enough for you. Your momentary failings are disappointing and just as you question what you are doing wrong, I am wondering the same thing about myself. When you ask questions, I'm going to ask you questions in return to make you think, not because I enjoy watching you squirm.

Remember: a great nurse is a thinking nurse.

And never be afraid to admit you don't know something. Ever. See points mentioned above about sources and help. I am going to push you. I am going to make you struggle and stumble. I will not let you fall.

In honesty, there are going to be good days. And there are going to be bad. The bad may outweigh the good for a bit. Sometimes it can get to be a tad much and I know, heaven help me, I know there are some criers out there. As an aside, I bid you, with utmost sincerity, to please don't cry. Don't cry. Not over a doctor yelling, or another nurse be snarky, or because you are overwhelmed, or because you thought I was harsh to you. Don't cry. Not one of those things is devastating enough to have earned that much power over your emotions.

But, as I realize that it is easier said than done for some, if you need to have it out, tell me. Tell me so I can find you a place to let it all hang out in private, even if it means covering your patients so you can go to your car. Because I want to protect you from committing what, for some, becomes a moment they cannot live down and stains their repertoire on the floor.

Because medical personnel are predatory pack animals. When you cry, they scent blood and bay for their pack mates to take notice. They watch. Stalking. Lurking. Marking you as weak, ready to cast you aside to larger predators, or, more readily, pick the psychological meat from your bones themselves.

When you have found your composure, we'll talk, brainstorm, and fix the situation. Even if it has something to do with me--scratch that--especially if it has something to do with me. But for that one moment, let me protect you.

And lastly, keep in mind that I'm human. I have bad days. I have a life outside of work and sometimes there is a lot going on that you may not know about. And on top if it all, I have my own workload, work drama, etc, on top of what is going on with you. So before you start gossiping to other orientees about your "!@#% of a preceptor" remember two things: 1) I will find out. I have eyes and ears you don't know about. 2) One day, you will look back and realize that your crazy preceptor may have had a point and you are stronger for it.

And you didn't even have to be coddled.

Wishing you best of luck and kindest regards,

~~CheesePotato~~

P.S.

I owe everything I am, every moment of clarity, success, and moment of feeling capable to my preceptor of many years ago who just so happened to be a nightmare on two tennis toned legs. Without him, I would never have survived running my first trauma alone nor would I have found a home in nursing. Thank you, my friend, for breaking me down so I could be built stronger.

[joanna73, BSN, RN]

We used to joke, some of us that nursing school was like the army. I appreciated the kick butt instructors, and even more so after I became a nurse. Sometimes they were brutal. However, I know that my "pass with distinction" from clinicals MEANT something, as does my degree. They are doing no favours by sugar coating. Students need to be prepared for the realities they will face. Great article!

[Ntheboat2]

Nurses are such a diverse group. There are tons of nurses who become nurses later in life and plenty of 2nd or 3rd career nurses who have been successful in their professional and personal lives before nursing.

When I read the original post....it sounds like it's directed at a 20 year old kid who those kind of antics might work with.

However, if that kind of "breaking down" had been attempted on me or the majority of my classmates, I'm sure the preceptor would've been in for a surprise.

Little kid games don't work on grown ups.

[joanna73, BSN, RN]

I'm a second career nurse. Still appreciate the post. Even second career nurses still need to learn the world of nursing.

[Majestas]

Thanks for posting, MusicalCoffee. I'm a new nurse in orientation myself, and first thought that being more emotionally sensitive is a weakness. In actuality, it can be a great strength if you know how to avoid taking certain things personally. This is challenging at times, but having a strong preceptor makes all the difference. One like SweetPotato can teach you this.

My only recommendation to SweetPotato is to keep this mind, that some people have a more sensitive nature. Not because they are weak, but because it's just part of who they are. I believe you touched on this a bit in your article. And please, no arguments about how perhaps these people are not cut out for nursing, because I know that I can be a great nurse!

[Ntheboat2]

I'm a second career nurse. Still appreciate the post. Even second career nurses still need to learn the world of nursing.

Of course every new nurse needs to learn the "world of nursing."

However, most older nurses who often have more life experience than many preceptors don't need to be taught how to handle their emotions, or what your non-verbal cues mean, or be told that "no question is a stupid question."

They generally just need you to do your job so that they can watch and learn the requirements/routine of the job vs. being praised for "putting the bed low" or learning what their preceptor's tone of voice really means. They definitely don't need to be told that real life is not like a text book.

It just seems a little juvenile so I assume those are the antics that work with people less experienced at life and work in general vs. the world of nursing.

[CheesePotato, BSN, RN]

Wow....didn't expect to see this thread still alive with active dialogue. Interesting. :)

So many great thoughts and responses. I appreciate each and every one of them.

You know, on the topic of those that are second career nurses, would it strike you all as strange to know that some of the folks that have the hardest time adjusting to the idea that nursing is not the glorified field they thought it was were second career nurses?

I would never have suspected something like that to be the case, but ::shrugs:: these are things I have seen and even experienced as a second career nurse, myself. Former Candy Stripper. Oh yeah. I went there.

Other thoughts about modifying the manner of precepting are very valid and absolutely should be practiced. No preceptor worth their salt tries to do things the same way every time with every new individual that orients with them. Such a thing would be foolishness. There is no one size fits all. Take it from the girl that firmly believes such sizing tags lie to your face and are the mark of the devil.

But just as those labeled articles of clothing, one can only stretch so much within their own personality and style. As I stated in my second reply, if a mismatch occurs (and it does), a proper fit must be found.

Incidentally, one can be both congenial and direct. I find it fascinating that a direct approach is immediately associated with various feelings which conjure, to my addled mind, images of combat boots and riding crops.

::quirks eyebrow::

Thank you, again, all for your various vehement replies and thoughts. Lovely, yummy things which will keep my brain busy on this night rotation. Ick.

Have a safe night and a fine tomorrow.

Regards,

~~CP~~

[echoRNC711, BSN]

I have precepted for close on 20 yrs. At first I was a woman on a mission and was dubbed "the General". Yes, orientees learned and were well trained. I had sheets made out to have them account for time and compete with themselves until they could be 1 hr ahead of schedule (to always make room for a potential code )

However, I do cringe now when I look back on it. My heart was in the right place but honestly it need not have been that difficult for either of us. Perhaps I have softened . I now look at orientees and ask myself more often "what does this nurse need right now " and I try to facilitate that. Mostly I tried to encourage them to step out that I am on their side. The very first words I tell a new nurse is "I am not here to judge you but to facilitate learning. I welcome mistakes because it means you are stepping out and making decisions.I will be behind you .I want you to feel safe to tell the truth and that way we can figure out where you feel weak and strengthen those areas " I also give honest feedback if they are slacking I tell them. I tell them they set the pace,if they want to learn I will tell them everything I know but if they want to skate then that is their choice. I precept because I love both teaching and nursing. I do privately hope that they will go on to do this for other new nurses and raise the profession higher where we take care of each other better.

OP I don't doubt your sincerity or passion and you sound like an entertaining teacher. There is room for all types of nurses including tears. Most nurses have cried somewhere in their career.Making it a teaching moment. Everyone is teacheable if they are helped to find confidence the rest is simply experience and developing organizational skills. Thank you for taking the time to teach ,we need to do it more in our profession.

[Ntheboat2]

You did say in your post that you know it may not apply to "our" exact set of circumstances. That didn't go unnoticed.

I was just saying, in my opinion, most of the things you mentioned would be relevant to someone with little to no working experience or life experience in general. On the other hand, I've seen 50 somethings (new nurses) who act like nervous lost puppies so there are always exceptions of course.

Assuming that most new nurses need as much guidance and/or praise as your article suggests would be as naive as believing every preceptor does a good job or even knows what they're doing. My preceptor, for example, was younger than me and had only been a nurse herself for 2 years. She was constantly using her acrylic nails (uh, no) to text on her iPhone.

But it was a good article overall when applied to the type of students/new nurses it represents.

[foggnm]

Hmmm. I have to say this post annoyed me in its self-righteousness. Take a break from precepting and nursing.

[neverbethesame]

A LOVE NOTE FROM THE PRECEPTOR FROM HELL

I'll bet her bark is worse than her bite!! Errrrr.....

Memorandum from the desk of Your Friendly Neighborhood Sociopath~~

Wouldn't you love to meet her former preceptees?? Actually, when someone self-identifies as a sociopath then I really want to meet everyone around them and get the whole story!!

Because medical personnel are predatory pack animals. When you cry, they scent blood and bay for their pack mates to take notice. They watch. Stalking. Lurking. Marking you as weak, ready to cast you aside to larger predators, or, more readily, pick the psychological meat from your bones themselves.

Why do I get the feeling that the OP is more than ok with seeing a little blood spilled in the name of caring??

[Piggles]

Wow, what a great read! I plan to read this at least three more times. I am 3 weeks away from my first preceptorship and I want to make the most of it. I have a background in education and I think what preceptors do is so vital to this profession that I am so proud to becoming a part of.

[daverika]

I pray that one day your preceptee becomes your charge nurse or manager. I pray your colleagues have the guts to report your abusive behavior to your current manager. But most of all I pray you give up nursing and find another profession. We don't need your brand of self-righteous nastiness propagated any further than this generation. You are known by how you treat the least and most vulnerable. And you don't treat them with any kind of respect whatsoever. Shame on you.