Unsolicited Advice From A Preceptor

[Izzy11]

I'm an FNP and I want to share some advice that I assumed was obvious, but apparently is not. I started precepting students this fall and I had four over the semester. Two were rock stars - one is just graduating and I recommended her for a job with my practice and she was hired, the other is graduating in May and I told her that I would love to recommend her for a job as well.

Student 3 was very good, and I would have been happy to recommend him as well, until his last day. I see patients in nursing homes and assisted livings and go to several facilities each day. On his last day, we made the morning rounds, and then I told him to meet me at the last place after lunch. About a half hour later, he texted me and asked if he could skip the afternoon since it was going to be a light load, and he had a lot of studying he wanted to get done.

You do not ask a preceptor if you can leave early or skip a day etc. unless it is for something urgent (a sick child or such). Right there my opinion of him changed and I wouldn't recommend him for a job now.

Then there was student 4. She's been a psych NP for five years and is getting her FNP certificate, so you'd think she'd understand the basics of professionalism. First, she was late every day except one, often over 30 minutes. She had a long commute, so I even told her to meet me at my second stop instead of my first (about 45 minutes later) to make it easier for her. She was still always late, and usually never notified me at all.

Then on her last day, she went to the skilled unit at the facility, even though we always started on the assisted living side, and saw a patient without me even knowing she was on-site. It was a new admission who I had never seen, which makes it even worse. She finally came over to find me an hour and 15 minutes after her scheduled start time. She did not contact me at all to tell me she would be late or that she was at the skilled unit. This was so far out of line. I was tempted to fail her for the rotation, but I'm probably too nice and passed her with a poor evaluation.

5 STEPS ON BEING A GOOD PRECEPTEE

STEP 1 Your preceptors are doing you a favor. They usually do not get paid for this. You need to respect their time.

STEP 2 Show up on time. And that means early. Allow time for traffic. Think about how you feel sitting in the waiting room when your provider is running late. It sucks. So be on time.

STEP 3 Do not go off on your own unless your preceptor tells you to. It is completely unprofessional to see patients without permission from your preceptor.

STEP 4 Treat every rotation as an extended job interview. At a minimum, you want your preceptors to be willing to provide references for you, and you might find it's a place that you would like to work. If you leave a bad impression, you will definitely lose your chance of working there, and will likely lose your reference as well.

STEP 5 When a preceptor has a bad experience with a student, they are less likely to take students in the future. I know how hard it is to find preceptors, and if providers stop offering because they have bad experiences, it makes it harder for everyone.

I'm not going to stop precepting (although now I definitely understand why providers do stop), because I had some great preceptors who really went out of their way to help me, so I'm going to keep paying it forward. But I'm really frustrated right now.

Please, I ask everyone to be professional on their rotations - show up on time, follow professional standards and norms, work hard, and generally act like you want to be there.

[Daisy4RN]

I think it is sad that you would have to tell people they need to behave as professionals in that situation. We used to learn this in even our first jobs (fast food etc). Maybe its society in general or maybe these people have never learned this, sad either way because it should also be, to a certain extent, common sense. If necessary the Preceptor can and should set the boundaries from the very beginning for those who lack the "professional" skills.

[SHGR, MSN, RN, CNS]

In my MSN program it was so difficult for any of us to find preceptors. It was easier for me as a CNS/educator student than those who were in the FNP track, for sure, but still difficult to find someone willing to have me tag along for hundreds of hours of their time. I did indeed want to pay it forward.

My MSN/Ed preceptee was so unprofessional that I will never do it again unless it is mandatory for some reason. I won't go into details here, but I was really surprised at how difficult it was to help someone else for no reward.

[chiromed0]

Wow...let's see now that I am graduated and practicing. I found some (certainly not all) of my preceptor candidates to be the most unprofessional people I've ever met! Multiple preceptors bailing on me after the semester started. One made me drive in ice & snow to their location (2 hours each way) just to tell me they were going to close the clinic down and she wanted to tell me in person. Are they nuts! Others would take weeks & weeks just to electronically sign off on evals I needed to get credit (literally 2 minutes of time). Another forgot I was coming and never called me (long 1 hr each way commute, over 100 miles), showed up and clinic closed. Still another emails me 2 weeks after the semester started to tell me she quit! I can't tell you how many flaky mid-levels and physicians offices I had to go through to get my clinicals done. I swore I'd never do a student that way if I ever did precept one. I think we need to remember also that the schooling, clinical time, commute is costing these students tons of money too!

Personally, I loathed the preceptors that really just wanted to "show" me how much they know instead of "teaching" me what I need to know. The ol' "grand rounds" type of teaching was a waste of time and I realize some docs only know this type of teaching. For NP's that is not the model that works.

On the other hand, yes-some students are just bad...bad people, bad students, bad employees. It really doesn't matter what job/profession they are training for. NP programs can't teach you basic professionalism or courtesy. They know what they are supposed to do but I'd say look at their profile. If they are young--teach them. If they are older--correct them. If they are annoying--let them go b/c you got enough on your plate without being annoyed for months on end.

[sunny time]

Put your ego back in the drawer. This is not your right. You took this all so personally

Did you bother making a phone call? Did you talk to the 2 offenders before the last day of precepting? I think you are the one with a big ego, next time talk to your preceptees before you start precepting Give them a list of dos

and don'ts. Stop whining and take control.

[PANYNP]

Put your ego back in the drawer. This is not your right. You took this all so personally

Did you bother making a phone call? Did you talk to the 2 offenders before the last day of precepting? I think you are the one with a big ego, next time talk to your preceptees before you start precepting Give them a list of dos

and don'ts. Stop whining and take control.

Whaaaat??!

OP is not exhibiting ego; s/he is sharing observations on both ideal and problematic student behaviors. A preceptor's first responsibility is to patients, not chasing around after students and making phone calls to try to locate them.

As noted, preceptors generally precept out of the goodness of their hearts; it is relatively rare that they are monetarily compensated. Some institutions may offer a small tuition waiver or opportunities for CE, but preceptors are willingly allowing students to tag along on their advanced practice credential.

As a classroom faculty member, I let students know, in no uncertain terms, that preceptors and patients alike don't *have* to allow students to *practice* on them. Having an opportunity to do so is a privilege, and it is incumbent on students to conduct themselves in a professional manner at all times, from communication to appearance to preparation to promptness.

Don't even get me started on students who show up to clinical in short skirts, low-cut tops, and spike heels. Club wear in clinical: a whole other story.

[Skippingtowork]

I worked in an office where we loved having students. No one was paid to precept, but we learned to make it work. You see a patient, while I see a patient. I finish my patient, then come see your patient with you. Usually, you have secured quite a bit of information so I could anticipate plan. I see patient with student, let patient go, then talk with student. Find out student has information that is up-to-date. Learn from student. Win-win situation. Student needs to study, looks anxious, allowed to go home, come back on time next day. Everything's going to be ok.

I agree, students must be given some guidelines about expected behavior and dress from schools. But this can also be given on a one sheet of paper from the clinical site, as each site operates differently. Some preceptors get upset if student is at site and is at the end of rotation, but did not proceed to see patients because preceptor was not there. Students shouldn't be seeing patient without preceptor, but every preceptor sees things differently. The psych NP might of thought she was being helpful, although the lack of communication is unacceptable.

[sunny time]

These are preceptors that should not.

[subee, MSN, CRNA]

Why are schools that are not providing their own preceptors even open. If I am chairman of the department and graduating students under the imprimatur of XYZ University, I'd want to be aware who is precepting my students andthrow them a little money as adjunct faculty. The students are paying tuition, lots if tuition. Our standards are soooo low..

[PANYNP]

I teach in a new AGPCNP program in a college in a rural location. The need for NPs to provide primary care in rural settings is particularly high. Our students travel to our weekly classes from the eastern, western, and central areas of our state, as well as the northern tier of a neighboring state. We are located 60 miles from one major academic health science center, and 55 miles, in another direction, from another academic health science center.

Within the first year of existence of our program, we have admitted a total of 48 MS students and 20 Post-Master's students. All are on schedule to graduate in August 2017.

Because the NP role is new to this geographic area, faculty have had to beg, bribe, and poach NP and MD preceptors from surrounding areas, as we build what we hope is a renewable pool of preceptors who are willing to work with our students. We have asked our students to help us network to identify potential preceptors; however, we do not expect that students go out and track down their own preceptors.

All of our preceptors and their practice settings are thoroughly vetted by us in relation to education, certification, and credentialing, as well as indemnification, before our students begin their clinical hours.

We have budgeted to pay each preceptor a small stipend for their efforts, and have applied for state funding focused on rural health that will help us to continue to provide these stipends.

So, no, our standards are not "so low" - - because we are new and building our base of preceptors. We are doing remarkable work preparing the next generation of primary care providers who will be available to care for our vulnerable and underserved rural population.

And we will be proud to graduate these advanced practice students under the imprimatur of our college which has a long history of serving our geographic area with well-educated and dedicated baccalaureate-prepared nurses.

Generalizations, such as are contained in the above message, are not only broadly inaccurate, but also are damaging to the profession.

[subee, MSN, CRNA]

PANYNP said:

I teach in a new AGPCNP program in a college in a rural location. The need for NPs to provide primary care in rural settings is particularly high. Our students travel to our weekly classes from the eastern, western, and central areas of our state, as well as the northern tier of a neighboring state. We are located 60 miles from one major academic health science center, and 55 miles, in another direction, from another academic health science center.

Within the first year of existence of our program, we have admitted a total of 48 MS students and 20 Post-Master's students. All are on schedule to graduate in August 2017.

Because the NP role is new to this geographic area, faculty have had to beg, bribe, and poach NP and MD preceptors from surrounding areas, as we build what we hope is a renewable pool of preceptors who are willing to work with our students. We have asked our students to help us network to identify potential preceptors; however, we do not expect that students go out and track down their own preceptors.

All of our preceptors and their practice settings are thoroughly vetted by us in relation to education, certification, and credentialing, as well as indemnification, before our students begin their clinical hours.

We have budgeted to pay each preceptor a small stipend for their efforts, and have applied for state funding focused on rural health that will help us to continue to provide these stipends.

So, no, our standards are not "so low" - - because we are new and building our base of preceptors. We are doing remarkable work preparing the next generation of primary care providers who will be available to care for our vulnerable and underserved rural population.

And we will be proud to graduate these advanced practice students under the imprimatur of our college which has a long history of serving our geographic area with well-educated and dedicated baccalaureate-prepared nurses.

Generalizations, such as are contained in the above message, are not only broadly inaccurate, but also are damaging to the profession.

Since your program provides the students with vetted preceptors, my comments don't even apply to your program.

[PANYNP]

We still are asking students to "help" us identify preceptors.

Not sure of the context behind your original comment.

[subee, MSN, CRNA]

PANYNP said:

We still are asking students to "help" us identify preceptors.

Not sure of the context behind your original comment.

I see you are talking about BSN students. I thought thus thread was about NP students who often gave to find their own clinical preceptors.