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Discussion

Abusive preceptor

I'm in the final weeks of my CNM/WHNP MSN. My entire clinical experiences at 3 different practices have been riddled with abusive preceptors, but none compare to what my preceptor did this afternoon. I haven't cried in months over anything, but I broke down (after shift) today and WEPT. We were in the middle of a precipitous delivery and 1. she was completely taking over when there was no reason to. I've caught plenty of babies so far - I'm only a handful away from meeting requirements to graduate. She has made this move several times in the last few months - taking over completely low risk, normal births that I should be managing and catching. ANYWAY, the birthing person is really losing control and my preceptor is coaching her well, and I'm taking the cue that I guess I should hang back as not to overwhelm her with other people talking.

But I'm at the perineum, hands poised, just watching and assuming I'm catching (you know, like I'm supposed to do as a student. . .). Preceptor asks for more gel so I take initiative and try to be involved and start to put gel on the perineum where head is crowning (a VERY tight lady parts and larger head - not looking like a shoulder but more just like maybe even an episiotomy). . .she SLAPS my hand away and literally YELLS at me in front of NICU nurses, a nurse intern, a tech, the dad, a Dr., baby nurse and maternity nurse - "DO NOT TOUCH HER". 

She then angrily tells me she can feel EVERYTHING and HANDS OFF. Which incidentally I am the mother of four term babies born utterly unmedicated, one at home, one with a two day IOL, I've had a manual exploration unmedicated - I for one, can totally empathize. YET, she then goes on to do exactly what I was trying to do - lubricate the perineum. 

I felt belittled, small, guilty, confused, and abused. No one said anything. Preceptor took over everything and I didn't participate in any of the birth nor third stage, with no real reason not to. I have been in integration with her for 4 months. She makes it a point to always say 'anyone can catch a baby, THAT'S the easy part' yet acts as if I'm not to be allowed to do that. There are so many other instances of just plain bad preceptorship (imo) but I was really shook by this. I mean, total disrespect in front of a whole room. I would be more understanding if I were doing something totally unacceptable, but I was doing WHAT SHE WAS ABOUT TO DO. In my psychoanalysis of her, she is desperate for power as she has a long history of abuse and trauma, but for god's sake, don't bring that into birthwork or teaching! I'm sorry you've been in terrible relationships and aren't respected by some of the physicians, but also don't volunteer to precept if you're just going to use your student as a poor coping outlet via abuse - I mean, have some passion and respect for your career!

I didn't get a chance to talk with the other people there about that, to ask their opinion, but is this just one of those things I should just 'put up with' - so many other posts on this site give such advice - 'well, you have to just learn to deal with those people'. . .why are there so many fragile egos and so much emotional baggage brought into medicine? 

Thanks for reading this, I just feel better venting already. Not sure how I'll address this since I can't afford to lose this placement mere weeks from graduating, but dang.

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    I have no idea what it is like to be a student in your position, not to mention I have no experience (nor any interest) in L&D, so my reply might not be as helpful but I figured "hey, lets try some thought experiments" and see if that helps. 

    It's OK to vent. Reading this makes me want to vent. Nursing is hard and honestly for me it is the preceptors / co workers / managers that create the most stress for me. I will take a super ill patient attached to a tree of pressors and paralytics and continuous sedation on a vent in severe septic with A-lines + Central lines + Swan Catheters who also requires some sort of advanced therapy machine - CRRT, Impella, you name it. I will be on top of medications / labs / therapies / speaking with family / oral care / turning. If my patient or someone else's patient codes, I'll be there totally cool calm and collected. 

    If you give me a crap preceptor, or a clique (my so called "team mates") that won't help but rather just gossip amongst eachother, or play on their phones at work, or give me a belittling supervisor or charge nurse that believes they're better than everyone else, or someone that takes advantage of me: you can expect to receive my notice to leave from me as soon as feasibly possible. 

    Now... taking it back a notch... and please know this is coming from a place who has gone through absolutely ridiculous situations (like the kind of thing that I only thought existed in medical TV shows but not in real life). Still, every situation and every person is different, so I try to do the very best that I can to try to see things from the other person's perspective. If you're not sure what is up, then why not ask? Prepare yourself, don't care about "how she might react" and just ask to talk privately. Then, state what you've noticed (calmly, professionally, appropriately - and have it be coming from a curious position. It's OK to state your perception of what happened and share that you felt like you were doing something wrong and then ASK for her insight. Don't go on the defensive). When she replies, or asks you questions back, be prepared to have some humble replies/answers no matter if your preceptor gives you constructive feedback or just says really bad things about you. I like to have scripts ready. It helps to keep composure and stay professional and keep all emotions out of it. After that, seek counsel from the superiors. Come to them with a wanting to know how I can be better attitude. If/ when they ask where that's coming from, share specific examples of your experiences with your preceptor. Don't over dramatize it because that would turn them off. Humble humble humble. Cant stress it enough. 

    My only question for you is why you state that you feel that throughout your experiences that you have been riddled with abusive preceptors.  There is a concern there. Like, why have so many preceptors in your eyes been considered abusive? Please remember that when I ask about this that I have also been there, and by no means is this coming from a judgemental place. I am just curious because if we had some more information about how those situations went, we could probably give you better advice on how to deal with those situations so you don't have those experiences in the future. 

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