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Discussion

Clinical Experience Thoughts

As most nurse practitioner students know, it is very difficult finding preceptors. I secured this preceptor in September/October last year. Paperwork was sent back and forth and approved by all parties involved (school faculty, office manager, and preceptor). Last weekish-when I called to get my hours set for my rotation, I was told the days to come and that was that. However, I caught pneumonia and had to call out. I notified my preceptor that I was unable to come only to be somewhat shocked that she had no idea who I was. She stated that she had no paperwork from me. I told her my full name (as I go by my middle name) yet she was very adamant that there was no paperwork from me or my school and she always saved the paperwork.

Fast forward to this week, on the clinical day she told me to come.

This is where my 'clinical experience' begins...

I am going to list my concerns I had that day.

1) I brought my copy of the paperwork which at first, even after meeting her, she still said she never received. However, after flipping through the paperwork, she suddenly remembered completing it.

2) While in her office going over said paperwork, I was quizzed on why I traveled so far to this particular clinical site. Why her office? Why couldn't I do rotations closer to home? How long had I been practicing? What type of nurse was I? On explaining how my school had cancelled the contract with my hospital (which owns the area I live in plus several surrounding areas), that only brought more questions. Why wasn't I willing to pay honorariums? And it seemed she did not approve of my answer of the school not wanting us to pay honorariums (even though I am more than willing).

3) There was another student there. And apparently there was supposed to be a third. All with the same preceptor. Upon discovering that she was going to have three students, she turned to me and the other student and stated that one of us was going to have to leave (even though the other student had yet to show up). Me and the other student decided to see if the other student would show up, which they never did.

4) I was out for a week due to illness, so I am already playing catch up when I came to clinical. My school wants us to do at least 16 hours a week. And I explained this to my preceptor; however she just directed me to her calendar which was already full of student's names...til mid March. And explained that she only takes two students a day. And when I expressed concern over how I would be able to get hours, it was my problem and she was not willing to work with me.

5) The name badge issue. I lost my school name badge over break-this is my fault as I must have misplaced it after my summer simulation course. I ordered another one as soon as I realized it was missing. However, I did bring my work ID badge as it has my picture and name on it as a form of identification. But my preceptor refused me to wear it.

6) Calling me the wrong name. As I stated previously, I go by my middle name. My preceptor continuously introduced me to patients by the same wrong name every time we went into a room. The other student there and other office staff members called me by my middle name. Looking back on this, I am inclined to believe she was doing this out of spite of me not having a name badge.

7) 'Refusing' to look at patient. This one was actually brought to my attention by my school advisor. Supposedly, I refused to look at a patient's throat when this is not the case. I clearly stated I wished to observe her perform one more examination. And yes, I know this is a case of he said she said. But I was keeping notes on all the patients I saw with my preceptor, and the first two I observed her doing an assessment. I consider the first one as the 'breaking the ice' /'first day nerves' patient. The second one, even though there were things I actually tried to observe or do, she told me the details were too minute for me to see/feel. All other patients I did skills on.

Again, sorry for the long post. As you can see, I am somewhat upset. Mostly due to this preceptor contacting my school advisor. Who then contacted me. I was 1) Going by a different name, 2) Did not have a name badge, and 3)Refused to look at a patient. I understand the legal implications of the name badge, school issued or my own work issued. However, my nurse license has my full name on it and again, I did not refuse to look a patient.

Due to the issue of already being behind one week in clinical hours and having to wait until my school name badge comes in, I was forced to withdraw from my clinical course for the sake of saving my grade and standing in my school. I will be taking this course again in the fall but not with this preceptor as I believe she did not want to precept me from the beginning. Whether it was she took on too many students or I just happened to be the weakest link at the right time, I do not know.

Has anyone else ever experienced anything similar? Or even just 'normal' clinical experiences-what should I expect going forward?

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    It may have been a series of major miscommunication. I usually recommend student prepare for clinicals by speaking/emailing directly with the preceptor to discussed clinical preparedness and expectations. Seems a bit chaotic, especially if the preceptor has 3 students. That's A LOT. It's a lot of work having only 1 student. Maybe she's a negative Nancy and embittered...Unfortunately, there are bad preceptors out there. Sorry you've had a hitch in your clinical journey. Hopefully, next rotation will be better and it may be better to go above and beyond to prepare for your clinical journey. I've also seen school programs not prepare student adequately for clinicals. It's not a place to relecture on fundamentals in class or lab, but to actually execute and put into practice what was learned. It is absolutely fair to ask to observe once or twice certain exams if you are not comfortable; however, if a student asked me to do a lot of observations, I won't mind, so long as they are willing to put in more clinical time as it may take a bit longer to achieve a level of confidence and competence. Try not to give the impression of 'counting down hours". It's not the quantity, but quality. If you encounter another ill fitting preceptor, let your coordinator know immediately as to move you to an appropriate one. It's not fair to either party and certainly not the patients.

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    sorry you've had such a bad experience. Fortunately, my clinical preceptors have been great. Hang in there.

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    Has anyone used a preceptor(s) anywhere in Colorado for the FNP that I can contact? Thanks.

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    I think there are also websites that help guild and prepare for clinicals but more for beginners or those without much RN experience. Sometimes PA's are accepted. Like jumpstartnp.com

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    Although this has produced quite a bump in the road, it is an opportunity to secure a better placement. This has/had disaster written all over it. This person sounds like someone who makes others' lives hell in attempt to distract everyone from their own incompetence.

    Of note, though: You should not be wearing your work badge in this capacity for any reason - that is why she refused to let you wear it. It's not simply a piece of plastic that has your name and likeness on it, it represents your affiliation with your employer and, without your constant clarification to the contrary, informs others that you are carrying out duties through a relationship with that employer. Not cool when you are operating as a student in a capacity unaffiliated with your employer's business. If you work in a L1 TC, you likely work for an employer that would have something major to say about this.

    Best wishes finding a preceptor who enjoys working with students and who will support your learning in a positive way ~

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    • Author

    Thank you everyone for your responses.

    As the initial soreness and shock of the experience of it has worn off I can look back on this experience and agree with all of you.

    Yes, there were some miscommunication errors here. I had met my preceptor face to face before I had initiated the preceptor/student agreement. I did not know, however, that she takes on more than one student at a time- if I had known this, I would have continued to look for another preceptor. When I walked into clinical that day, it took me by complete surprise. And I don't mean this as in I refuse to work with a preceptor that takes on more than one student. But she had 2 students a day completely booked all of this month and into March. 6 days a week, Monday through Saturday. And there were at least 5 to 6 different student names listed that I saw, not counting mine.That in my opinion is way too many students to take on. She has one office staff member that does her scheduling-which should change (in my opinion), so situations like having too many students does not happen again.

    In regards to the name badge, again this is my fault. I told her that day I had lost my name badge. I only offered to wear my facility's name badge as a form of identification, nothing more and nothing less. Little side note that I find kind of humorous looking back on this: my name badge actually doesn't have the name of my facility on it, just a symbol behind my name/picture. But again, I understand the implications, it was just an offering and a thought of 'Oh no, I can't find my school name badge, I need to bring some form of ID with me' that I brought my work badge with me.

    Since this experience, I have been contact with a several other offices, all of which seem better able to handle students. Please read this as: MUCH better able to handle students. I am looking forward to hearing back from these in the following weeks. I can say I have learned a lot from this experience and also what to expect and what to look for in a preceptor, as well as my clinicals in general.

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    My program requires all preceptors to have a maximum of 2 students at any time, and I'm thankful for that stipulation. I am currently trying to secure a preceptor for my first practicum in the fall, and am having a very hard time as well. So many students and organizations don't respond half the time. I get zero help from my school.

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    Please I need help finding a preceptor in Austin, San Antonio area for my FNP adult-Gero course. Has anyone ever used a good preceptor out here. Any help will be appreciated. Thanks

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