Bad preceptors and the demotivated state of nursing.

Newbie_RN17 · Mar 9, 2016

Not everyone has a choice. Lots of people are just told they will be precepting someone and we don't get recognition or standing or ANY of the things you mentioned. There's lots of threads on this on this forum. I personally like having students and when I have the time will gladly show them skills or let them perform them when cleared with their instructor, but a lot of the time my day is spent just trying to get the 18 hours of work accomplished in the 12 hours I have to do it. We are not educators of students, we are there for our patients first and foremost and that's something that students need to remember. And for the record, I thought the exact same thing as you when I was a student just one year ago.

It's hard to still love the profession when you are pressured to take unsafe patient loads with higher acuity, patients that were in ICU years ago are now considered med-surg patients and some facilities have 1 to 7 or 1 to 8 ratios. I can barely get everything accomplished with a 1 to 6 ratio so I can't imagine a 1 to 7 or 8. We are expected to not only take care of our patients medical needs but also to be customer service specialists, make sure families are updated, keep up with doctors who may or may not communicate with us or each other, and now clinical instructors push students into the already busy day (not talking about precepting, but just basic clinical experiences with the instructor present).

As the student, you should TELL the nurse the skills you can perform. Take the initiative. It goes a long way and with those precepting students who have done that on my unit they have seen a lot and done a lot because all of the nurses pull them in for skills or to watch procedures.

Jensmom7, BSN, RN · Mar 9, 2016

Your first logic error is in assuming that nurses always "volunteer" to be preceptors.

I'm also still a bit fuzzy as to when it became the staff nurse's responsibility to teach students. When I was a student, we were assigned patients, we relied on our Clinical Instructor to teach us, and we stayed the Hell out of the way of the floor staff.

"Precepting" back then was reserved for those who had graduated, passed Boards and were actually ready to learn how to be nurses. School just teaches you how to take NCLEX. As a student, you are actually a drain on the staff if they are expected to do the CI's job.

To expect the staff to carry a full patient load plus teach students (while the CI is God knows where) has always seemed to me to be the height of arrogance.

ETA: After reading some of your past posts, you come across as feeling that your nursing knowledge should have been spoon fed to you. At the college level, you are considered an adult learner, and are expected to take more initiative and learn more independently.

This is a shock that many have difficulty overcoming, as they are no longer in the high school environment, where everything is laid at your feet and you're pretty much told exactly what you need to regurgitate back for exams.

NurseGirl525, ASN, RN · Mar 9, 2016

Your first logic error is in assuming that nurses always "volunteer" to be preceptors.
I'm also still a bit fuzzy as to when it became the staff nurse's responsibility to teach students. When I was a student, we were assigned patients, we relied on our Clinical Instructor to teach us, and we stayed the Hell out of the way of the floor staff.
"Precepting" back then was reserved for those who had graduated, passed Boards and were actually ready to learn how to be nurses. School just teaches you how to take NCLEX. As a student, you are actually a drain on the staff if they are expected to do the CI's job.
To expect the staff to carry a full patient load plus teach students (while the CI is God knows where) has always seemed to me to be the height of arrogance.
ETA: After reading some of your past posts, you come across as feeling that your nursing knowledge should have been spoon fed to you. At the college level, you are considered an adult learner, and are expected to take more initiative and learn more independently.
This is a shock that many have difficulty overcoming, as they are no longer in the high school environment, where everything is laid at your feet and you're pretty much told exactly what you need to regurgitate back for exams.

This is how it is for us. We are assigned patients. The nurses are asked if it is ok ahead of time if a student can follow them. If there is a procedure the nurse is comfortable with students doing, we can grab our instructor who watches us do it. I have had a couple of nurses this semester allow us to do simple things under their supervision, like giving injections or pushing iv meds, but like the other day there was a central line dressing to be changed and my instructor was present for that, not the nurse.

When the graduate and pass my boards, I will get a preceptor on my job. That is how it works at my school anyway.

elkpark · Mar 9, 2016

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?

There are a kazillion threads here about this topic. Most student "preceptors" are not asked or compensated for "precepting" student nurses. They show up for work and find out that they're expected to take a student and do their own job plus the student's clinical instructor's job for the day. Like it or lump it. If these nurses wanted to be teaching students, they would have applied for teaching jobs.

Also, the state of nursing education is such these days that I assure you the fact that you are a senior nursing student in no way guarantees that you know how to apply SCDs, or do any other typical nursing skill. IMO, the nurse was smart to ask rather than assume (you know what they say about assuming ...)

Most of us feel that it is your school's responsibility to provide your nursing education, not the poor working stiffs on the floors, who have more than enough to do already. I don't understand why hospitals put up with this, and don't just refuse the schools that persist in this practice clinical placements.

Jax94 · Mar 9, 2016

At my school we were told that the preceptors for synthesis (our final course/preceptorship) had to volunteer to take us. During all of our previous classes we just showed up at the hospital in our groups and were assigned to nurses for the day. I understand that having a student thrown at you when you go to work one day is a shock, and not fair to the nurse. However, if preceptors have to volunteer to take a student for 8 weeks of synthesis (which is what I have been told over and over by every instructor at my school) then they should certainly be willing to work with that student and teach them.

If they are forced into being preceptors for our last 8 weeks, then my school is severely uninformed...

As for asking if you could put on SCDs, I agree with "better to ask than assume". I would just say yes and hope they weren't thinking when they asked.

AesthesiaSeeker · Mar 11, 2016

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.

AesthesiaSeeker · Mar 11, 2016

And just a little tip/piece of advice regarding your nurse asking you about SCD use/wanting to know what skills you can do:

Bring a nursing skills check-off sheet/packet with you. If your school hasn't already given you one I'm sure you can find one on the internet that you can download and fill out.

It's good for multiple reasons:

It lists all the basic nurse a student is expected to know by the time you graduate.

You can demonstrate them in front of a nurse faculty member who can sign you off that you can complete the skill and that you're competent to perform it in the field.

Your nurse who you shadow only has to look at the packet to see what you're able to do and has clarity about where you are as a student.

Any future employer can look at the list and be confident that you're competent.

jbird57 · Mar 12, 2016

I am an LPN of 20 years who decided not to bridge after the treatment my fellow students and I received from the RNs who were in charge of us. It is interesting to see the old cliche, "Nurses eat their young" is still going strong. How can things for students and aspiring RNs progress if these conditions prevail? I work under difficult conditions, as well as being among the "redheaded stepchildren" of the nursing field, yet this article lets me know I made the right choice to stay where I am.

cupcakeluver · Mar 12, 2016

In my program, you only do stuff with your instructor during clinicals. You are assigned a patient and I may watch the nurse do her assessment while we're both in the room but that's about the extent of my interactions with the nurse during clinicals. If a skill comes up that the nurses are willing to share, they ask the instructor if we can take care of it. The instructor either says yes or no, depending on what all is going on that day, and then selects the student who will perform the skill. That student then goes with the instructor to complete the skill.

I have never had a nurse show me anything during clinicals. They are busy with their own work.

During preceptorship, which is during our final 2 clinical rotations in our final semester, we are assigned to a nurse to get a more in depth view of the nurses day. We are expected to set up our own times and provide our preceptor with a list of objectives regarding skills we may need to accomplish. These skills must also include things other than tasks, such as time management or organizational methods. The assigned preceptor takes a class to become a preceptor and receives additional incentive to precept (although it's not very much).

In reading how all these other schools are set up, I'm so glad my school does things this way. Although it is a bummer to only have 60 hours of hands-on time with a working nurse, that nurse does have the choice to work with a student. It must be terrible to just be shoved in someone's lap for the day....for all involved.

This sounds like an issue with the schools. The arrangement is not fair for either the student or the nurse. My advice is to make the best of it. Be kind and willing. If your assigned nurse still hates you, keep your head down and move on. Maybe the next one will be different. There are many situations in nursing school, and in life, that require you to just put your head down and move forward. If nothing else, it's teaching you how to cope in difficult situations which I'm sure will prove useful when you begin working as a nurse. Difficult people are present in many situations. Sometimes you just have to make the best of it.

Good luck to you OP.

mendi65 · Mar 12, 2016

And this is the problem....new grad BSN and MSN with no experience think they know all!! You have worn us out and this is why we no longer enjoy precepting. It use to be you were humble as a new grad or student. The new culture seems to think they know more than the senior nurses. When I was learning 20 years ago I kept my mouth shut and respected my senior nurses. B

sarose611 · Mar 12, 2016

I am a little confused by your post. Granted, I graduated long ago, but my clinical instructor was expected to.teach me. We did patient care to.the levelwe had been taught and checked off my an instructor. Preceptorship was for after graduation, and was mostly designef to.familiarize us with the areas in which we were hired an were usually only a few weeks long. ICUs go longer, 3-6 months. It was our responsibility in both cases to.know what our goals were and to.work toward accomplishing them. Our teachers assigned patients, not nurses. And none of those nurses were given so much as a by your leave for risking her license and patient to.a student. Grow up.