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.

[PANYNP]

My post was about our AGPCNP program and identifying preceptors.

In response to your assumptions about programs that do not provide preceptors, be assured, that in order to maintain CCNE accreditation, all NP programs vet their preceptors and clinical sites, regardless of whether faculty or students identify them.

As well, CCNE and NONPF require a minimum of one site visit, preferably two, with the student and preceptor every semester, whether in-person or virtually, via Skype, FaceTime etc

Although it may appear that there are NP students out there flapping on their own, accredited programs will keep close tabs on preceptor-student relationships in order to provide an optimal learning experience and to maintain accreditation.

[subee, MSN, CRNA]

How can they vet preceptors that the students haven't even found yet?

[Skippingtowork]

Although it may appear that there are NP students out there flapping on their own, accredited programs will keep close tabs on preceptor-student relationships in order to provide an optimal learning experience and to maintain accreditation.

NP students are out there flapping in the wind, whether you want to believe it or not. The amount of time spent trying to secure a preceptor is ridiculous. Also, some preceptors are just not acceptable. If you surveyed students in the programs are graduated, how many do you think have seen a faculty at their clinical site? It is well known that some of the faculty do not even live in the same state. The lack of support for students is quite disturbing.

[annie_m]

I would have given student three a break. As a current student I would rather make up a day of clinical because I needed to pass a course and had to have study time then to have spent a semester wasting a preceptors time because I did poorly on a test. I have been told that I do really well in the clinical setting but I have horrible scores on my test's. Its not that I don't study or know information its that I test poorly. Should #3 have known that this was not acceptable for your after having spent many days with you? Maybe but maybe not. Also he was honest with you and could have just lied with a family emergency and you would have never known the difference. As for a previous poster that stated that test schedules come out at the beginning of the semester yes they do but I had my instructor change all of our dates all semester long. It made for a very stressful semester that I have no desire to repeat. Your student likely weighed the benefit of one hours worth of clinical learning versus the 4 or 5 hours of study time and what would help him most in the semester.

[aok7, NP]

Thank you for taking the time to share your experience. I am a third semester NP student and am committed and hungry for insight from preceptors about expectations. I am shocked by the behavior of the students who were late and disrespectful, and appreciate that you are obviously still willing to support students.

I would love to hear more about what you recommend for students. Sadly, I go to PA sites (and the profession even has a book for PA clinical students for guidance) for insight about preparing for my clinical time. It's a struggle to find in-depth information from NPs about this topic. Thank you.

[Palliative Care, DNP]

During my pediatric rotation my preceptor was the one that was unprofessional. Not once but twice she was gone for a week at a time and never said a word to me. Luckily, another provider took pity on me and took me on. One of these weeks was also when my faculty came to observe and evaluate me. Sometimes, professionalism needs to be revisited by students and working NPs alike.

[subee, MSN, CRNA]

Palliative Care, DNP said:

During my pediatric rotation my preceptor was the one that was unprofessional. Not once but twice she was gone for a week at a time and never said a word to me. Luckily, another provider took pity on me and took me on. One of these weeks was also when my faculty came to observe and evaluate me. Sometimes, professionalism needs to be revisited by students and working NPs alike.

Was that person an employee of your university or randomly selected? You have options when they are program affiliated.

[Palliative Care, DNP]

subee said:

Was that person an employee of your university or randomly selected? You have options when they are program affiliated.

My program provided zero assistance with finding preceptors unless you were located in Louisiana where the school is located. I found all of my preceptors some good and some not so much. This is my biggest argument for students finding their own preceptors. We are so desperate that we end up taking whoever says yes. Begging is not networking nor professional. I would not advise my own children to go the NP route but to choose another path or healthcare career due to this.

[TriciaJ, RN]

On 12/16/2016 at 12:14 PM, sunny time said:

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.

These preceptees are already licensed professionals. They should not have to be spoken to like teenagers getting their first job. With as difficult as it apparently is to find preceptors, why on earth would anyone think they could show up late, cut out early, or run their own program altogether?

[SpaceCadet77]

I don't normally post replies that could be construed as negative or critical, however...I am a little stunned by this post and most of the follow-up comments. I assume that you "oriented" these preceptees to your particular expectations, otherwise, it is unreasonable to expect the level of subordination you've suggested in your post. An FNP student already has a professional license (as an RN) and is an educated, independent clinician. It is neither necessary nor appropriate for you to assess and judge their professionalism. None of the issues you cited are within your purview as a preceptor. While I respect that you have personal values and a standard operating procedure or methodology while working, those standards are your own. I suppose you can communicate your expectations and hold preceptees to them as you see fit, but your role as a preceptor is clinical guidance and oversight. Please consider sticking to evaluation of their clinical competence.