Bizarre NP Preceptor Experience!

[All4NursingRN]

Hey all! It seems my preceptor doesn’t want me... long but good!

So I’m going into my last 2 semesters of an acute care program. This summer I have my first clinical rotation and I landed my dream rotation right off bat... cardio thoracic ICU at a world renowned institution. My school matches students with preceptors and since I work nights I was matched with an NP in CTICU nights. I contact her via email and we arrange our first night, she seems nice over email. I was extremely nervous and super excited for this rotation... I was literally beaming as I walked through the doors as I love cardiology and critical care.

So I show up, knock on the door of the office, she opens the door and I explain that I’m all4nursingrn from x school. I’m on time but it seems she had started sign out with the day NP already. That’s fine. So I walk in the room, she continues talking with her colleague and I stand there looking for a place to put my stuff down ... when she finally swings around says oh yeah you can put your stuff anywhere it’s just us and another NP tonite. She turns back and keeps talking to her colleague. I put my bag down, grab a chair and just sit there unsure of what to do trying to follow along with sign out. She then turns to me and says check the printer for the H&P sheets she just printed.

She prints out the H&Ps of our 6 patients for the night and then asked me how I wanna do this. In her words “like do you want to shadow me for a day and then see patients on your own for the rest.. or ??”

I mention again (as I did in the initial email) that this was my first rotation and that I have no CTICU only SICU/MICU experience and that I was willing to do things however she liked. I find her question and disposition a bit odd but I sit there waiting for us to start our night while she is venting with another NP over how much they dislike some of the other NPs and providers. Awkward.

She then motions for us to leave the room and start rounds and were walking towards the nurses station. As I try to hold back my sheer excitement over getting my dream rotation...I casually ask her some general questions about the unit and patient population as she doesn’t really say, explain, or introduce me to much about anything. I just wanted a general introduction to the unit as I wasn’t given any information other than her name, email address and the service she was on by my instructor. She vaguely answers my questions.

She then sits at the desk in the nurses station... talks and laughs with the nurses and the attending then and starts looking stuff up on the computer, doesn’t say much to me, doesn’t introduce me to anyone except the attending as he’s walking away... go figure..smh and also doesn’t tell me her plan for the night. I also log in to epic (which I’ve never used) and just try to mimic what she’s doing because honestly she’s not saying much to me.

She gets up without warning and walks off, I jump up and just trail her everywhere she goes... she rounds with the nurses, laughs and greets coworkers in the hallway but doesn’t give me much attention. I casually questions and honestly I’m so overwhelmed by the complexity of the surgeries and just how different they do things at that hospital it’s hard for me to follow along without her explaining things to me.

Patient after patient she rounds.. me trailing behind her, she asks me nothing, explains nothing ,doesn’t even really talk to me much but I’m still trying to squeeze in a question or two because it’s becoming so awkward. The nurses and patients are staring at me like who is this??... before I could introduce myself to the patient she starts talking to them. I just feel awkward.

She looks up a chest X-ray of a patient that just got out the OR post a mitral valve repair, she sees one of the attending in the hallway and runs a portable computer over to him to check the X-ray out. They’re both blocking the computer so I struggle to see what she’s showing him. They confirm that it’s a pneumothorax, she then goes in the room and adjusts the patients vent settings, talks to the nurse then walks out, me of course running behind her because she’s just running from room to room, again barely interacting with me. She explains nothing. I tell her that I’d like to learn how to read X-rays and ask her how she determined the pneumothorax, she quickly pulls it up the X-ray again but doesn’t give a very clear or thorough explanation of why she thought it was a pneumothorax or what she would do to manage it.

This scenario repeats itself for the next 3 hours as she rounds, she goes in the rooms, talks or examines the patient. I trail her closely but she isn’t interacting with me at all. She discusses the patient with the nurses, plays with the lines, vents and then just walks out while I’m attempting to assess the patient (I’m just trying to mimic what she’s doing) so I drop everything and go running behind her again.

After we’re done rounding we go back to the call room and she like ok so are you ready to go? Confused... I’m like well it’s only 11pm and I have a few questions and some stuff I’d like to go over. She then says “oh most students just want to leave early, I’ll sign you off for the entire night”. I politely tell her that I also work nights so I don’t mind staying as much of the shift as possible. She seems like she doesn’t want me to stay for long, so I ask her a few questions about the patients and their surgeries, she suggests a book I should use and I pick up my bags, thank her and tell her I’d see her Wednesday.

I come back Wednesday, still excited. But same scenario, she’s very detached, vague when answering questions. At this point I’m pretty much doing all the talking because she’s either talking to her colleagues or on the computer checking patient stuff. She interacts a little but not very much. She asks me if I had questions, I told her I had a ton but she doesn’t seem interested in reviewing a whole lot with me. I was honestly fighting back tears during rounds and in the call room. She randomly asks one of the PAs if he wants to share a student which I take is her way of saying she doesn’t want me. Again she suggests we wrap up the night early. I go home after 4 hours. Honestly I fought back the urge to grab my stuff and leave earlier on.

I have another 8+ shifts with her as we were instructed that we may keep the same preceptor through the fall before we are assigned a new service.

I don’t want to complain as A. My first preceptor I was matched with fell through (she couldn’t be contacted) so my instructor had to find me a new site and preceptor at the last minute. B) this is my dream rotation. C). She has to give me grade of pass/fail for clinical.

As an unrelated note it’s even more awkward because this woman is from the same country as my parents (I picked up on her accent lol) so I thought we would’ve bonded, and thought she could be a great resource-possible mentor as there are very few of us in the specialty and our situations are so similar. We’ve both been RNs for over 10 years and transitioning into advance practice (which I’m so nervous about). I told her I remembered when she came to orientation at our school (she’s a graduate of the same program) to speak with us and she pretended to not remember. I remember her distinctly because of her familiar accent.

Ive asked her how comfortable she feels now working as an NP and she says she not really comfortable (read as not confident), I also asked her about how she got the job there to which she was vague... sigh.

Im honestly feeling dejected right now. I’m dreading going there and feel as if I’ve failed somehow. I bought a few cardiac surgery books and I’m studying ferociously just so I can appear to be abreast of what’s going on.

Not sure if she’s just not wanting to teach, not comfortable enough to teach or doesn’t want me as I student.

I plan on going in next time and politely asking her to slow down and explain things to me and ask if we could spend some time reviewing the patient plan she assigned me for tricuspid repair (well that was one thing she gave me to do.. homework) I doubt she’ll remember to review it with me though.

any advice? It’s awkward and bizarre. She doesn’t have to take a student, it’s purely optional.

[DTWriter]

Your preceptor is being inappropriately passive aggressive.

Based on how yours is progressing, she is going to look for an excuse to get you dismissed, or, at the very worst, fail you; either way, you would be forced to repeat the semester -

You do not have time for that, and your pockets do not have time for that.

If I were you, I would be looking for another preceptor, like yesterday. Don't wait to the last minute to discuss your concerns with the school. Yes, this preceptor is at your dream location but, honestly, it is not worth risking a fail.

While your school looks for a new one, you should also look for an alternative preceptor; there are amicable preceptors out there - being willing to relocate. Reach out to former preceptors. If you have to have multiple preceptors to meet your hours, then do so.

Do not feel one bit guilty about asking the school for an alternative preceptor. I would not surprised if they pressured this preceptor into mentoring you, and hence this situation; if so, then all this drama is really on them as well.

In the meantime, definitely document your interactions with her (date, time, witnesses, location, etc). Being objective; no feelings or speculations.

[DTWriter]

EDITS:

Based on how *your situation* is progressing...

-"be" willing to relocate. Reach out to former preceptors...

[Oldmahubbard]

Being a student anything is always a little awkward, but this is way past that.

She was obviously hoping that you would agree to follow her for just one night and after that, see patients on your own, which is entirely ridiculous.

I don't know where to start. I really hope she is not signing people off on clinical hours they didn't do.

She was apparently railroaded into precepting. She has so little confidence in her skills, she doesn't feel comfortable teaching others.

None of this is in any way personal to you.

Some 20 years ago, I had a nightmare preceptor that I ended up filing a formal complaint against her with the BON. And she failed me.

I would ask her very frankly how she thinks you are doing. Are you on track to pass? If not, what needs to change?

I know preceptors are very difficult to find, but this one is unacceptable.

[AnnieNP, MSN, NP]

I am so sorry. Did your school set this up? If so, I would go to them and let them know you need a new site ASAP.

[Oldmahubbard]

Just as an FYI, my crazy preceptor called the school to say what a horrible student or person I was. Don't remember the details.

That is what I call true psychotic initiative.

[USPHS retired RN]

Many years ago I was in a FNP Program. I had an experience that was identical to yours. I mentioned it to my instructor, and he intervened on my behalf. I was also working nights like you.

My instructor had some ideas as to why my preceptor acted this way, and we found ourselves laughing. I remained in the clinic I was assigned to, and everything went well.

I don’t think I could have changed clinics, because none of the other students were willing to work in a clinic in a homeless neighborhood. I had no problems with the area of assignment as I had worked in this neighborhood early in my nursing career.

I wish the best for you. You seem to be on top of the madness.

[BgreenRN]

@All4NursingRN May I ask what school you attend/ed? The fact they help with clinical placement definitely has me intrigued.

[NoelRN]

Bump, interested in what school this is?

[Med Surg RN, BSN, RN]

Please update us on your situation! Did you wind up staying with her or finding another preceptor?

[All4NursingRN]

This is an acute care program in NYC, fairly well known. I’ll fill in more when the semester is over.

[All4NursingRN]

Hi thanks for the replies, this is a formal update on the situation. It was a horrible experience and I did go to the clinical placement manager who is also the program director (smh) to ask for a new placement which she refused to give me. This program has notoriously been strapped for preceptors so I stayed in this rotation for nearly 5 months. Nothing changed the preceptor continued to ignore me and not teach me much, even getting agitated with me at some points when I was trying to place the appropriate post op orders and told me that I didn’t make the most of the rotation and that plenty of other students would’ve been happy to take my place.

Although I don’t know this woman and it shouldn’t be personal, I think it was somehow. She also seemed like a really miserable person and a few of the nurses told me that her behavior had changed recently and they’ve been reporting her as well. This experience has somewhat traumatized me and I lack confidence with each new clinical rotation but the preceptors I rotated with after were professional and wanted to teach me something.

I don’t want to mention the school because that might give me away but it is an very prestigious university in NYC, expensive too so that should point you in a specific direction. Although this school finds your preceptors it has been disastrous with many students getting less than ideal placements to be brief. Not worth the stress honestly.