Dear Nursing Students/Orientees: A Love Note from the Preceptor from Hell

[CheesePotato]

Warning: The following post is rife with brutal honesty and frustration. Read at your own risk.

Memorandum from the desk of Your Friendly Neighborhood Sociopath

Dear Nursing Student/Orientee:

Allow me to start my letter with a brief aside. Yes, I know there are things you are not taught at nursing school. I know that this may not apply exactly to your set of circumstances. I know that there are evil, vindictive individuals out there that will purposefully set you up, hold you down, and delight in making your every morning something to dread and your every evening a nightmare.

But I am not one of those individuals. I do not, under any circumstances, condone their conduct.

Nor am I some fluffy feel-good nurse that will hold your hand, coddle your mistakes and spout sayings freshly garnered from those horrid encouragement posters seen in every middle management office. You know the ones...they normally feature a humpback whale tale flipped above the water, inked on black with the word "Perseverance" splayed in white type beneath it. No. I am not that nurse.

Normally this is where I would insert some words of acknowledgement and a word, dare I say, an apology for who I am.

No.

Wrong.

I am not sorry.

I am not sorry for who I am. And more importantly, I am not sorry for who I am trying to help you become.

And if that makes me the sharp toothed thing lurking under your bed, poisoning your dreams, then so be it.

Let me be frank....well, more frank: It is not my job to be your friend. It is not my job to be your nanny, your partner, or your teacher.

I am your preceptor.

I am not paid to like you. I am not obligated to think you are amazing, or clever, or the greatest thing to grace the floor. You were admitted to nursing school. Maybe you've already passed the NCLEX. So did I as well as the rest of the nurses around you. Get over yourself.

I am not here to swap stories of what we did over the weekend or invite you out to drinks after work. To be clear, you are but one more individual whom I must monitor throughout my shift and what a dangerous individual you are as you practice under my license and tutelage. I am not blown away that you remembered to put on gloves or to put the bed low and make sure the call light is in place. That is your job. By the time you round with me, that should be second nature.

So let's pause for a second and smooth all the hackles I know I just raised.

Allow us, for just a moment, to be honest together, yes? Nursing school often paints a pretty picture of perfect working environments frosted with therapeutic communication, dollops of hand holding, smiling, radiant preceptors for everyone and delightful nurse to patient ratios. Rainbows sold separately.

It's not that I crush dreams so much as get the lovely job of escorting you out of Wonderland and into reality. And reality bites.

I may not be your friend, but I will be professional with you and you have the right to expect nothing less. Perhaps in time we may develop an understanding which my lead to friendship. But that time is not now. Stop taking it so personally.

If you have done your research, if you have made your phone calls, if you have come to me and we have agreed upon a solution that turned out to be wrong, I will never throw you under the bus. I will defend you even to the DON and the MD's if we followed protocol, proper skilled nursing practice and physician orders. You may take a fall, but it will not be alone.

But I will not own your foolishness or your negligence. Expecting me to sacrifice my career, my rapport, my dignity for you is simply not realistic. Even in our little corner of the working jungle, natural selection, AKA survival of the fittest, still applies.

On that note, I will do everything in my power to be damn sure you never, ever manage to make such a grievous error. Why? Not because of patient care (though it should be a no brainer that such a thing is part of it). Because I want you to succeed. I want you to be safe. Because I know those mistakes destroy futures.

Not on my watch.

I promise you that my knowledge is yours to access any time, day or night. Even when I've stolen a precious few seconds in the bathroom or are snarfing down a sandwich. If you have a question, for the love of all things sacred and delicious, ask. Yes, even the "stupid" questions.

Though I firmly stand by the reasoning that the only stupid questions are the ones not asked.

I also promise to tell you when I don't know. What's this? A preceptor without an answer? Absolutely. Look, it's been...well...a while since nursing school and there is only so much room in the mental hard drive, alright? It's either remember the exact dosing of Colace or remember how to make a Denver Omelet. Sacrifices must be made for the greater good.

But we'll relearn/learn it together.

You worry about asking me questions as you fret over my answers and thus ask none. Pray tell, how shall I guide you if you do not ask?

I may not have the answer, but I know someone who does. Pay attention to who I talk to in order to get that information. Guess what? I'm showing you my sources. They will become your sources too when you are out on your own. And don't forget, I'm around. It's not like after the orientation is over I'm going to vanish with a nod and a plume of purple smoke to a magic lamp.

Silence means just as much as speech. Kindly note when I hold my tongue and when I talk and more importantly, who I talk to. (Yes, I know, ending a sentence with a preposition. - 10 points from Gryffindor) I'm giving you hints on who to trust and who to watch as well as your Reliables, those fine folks that always seem to be Johnny on the spot with whatever strange thing you need.

Speaking of speech, communication is a two way street. If you need my attention, if you need something different, if you need me to back off because, trust me, it is harder than nothing else to sit on ones hands and watch someone struggle when it is just so much easier to do it oneself, say something! Just....not in front of a patient. Or my charge nurse. Let's talk privately, quietly, as two adults ought.

Be sure that I am fully aware of the tone I use. You know. The. Tone. I have it in my orificenal for a reason. That is my "Some serious !@#% is about to go down and I need you to do exactly as I say" tone. Never argue with the tone. Pay attention and make mental notes. Ask me later what I saw that you didn't. I'll happily tell you.

Should that tone ever come out while you are performing a task: freeze. I am trying to keep you from causing unwitting harm. More to the point, I am working to guard you from making the same mistakes either myself or others have made. And yes, I will tell you the story later.

Again, don't take it personally. In those moments it's not about you. It's about the patient.

However, there is nothing in this world more frustrating, more gut churningly irritating, than someone wrapped in indifference and swaddled in ego. Nothing makes me angrier, quicker, than an orientee that does not see their own potential and is more than happy to just settle. I see so much ability just lying dormant, waiting for the right chance to break free and yet when it is ignored, when you gloss over it in favor of the easy way out, I seriously just want to kick a squid. In the face. Hard.

So I'm going to push you. Relentlessly. When you could do something better, I will tell you. I do not hand out compliments liberally for a reason. Your best today is simply not good enough tomorrow. It's not good enough for me and it definitely shouldn't be good enough for you. Your momentary failings are disappointing and just as you question what you are doing wrong, I am wondering the same thing about myself. When you ask questions, I'm going to ask you questions in return to make you think, not because I enjoy watching you squirm.

Remember: a great nurse is a thinking nurse.

And never be afraid to admit you don't know something. Ever. See points mentioned above about sources and help. I am going to push you. I am going to make you struggle and stumble. I will not let you fall.

In honesty, there are going to be good days. And there are going to be bad. The bad may outweigh the good for a bit. Sometimes it can get to be a tad much and I know, heaven help me, I know there are some criers out there. As an aside, I bid you, with utmost sincerity, to please don't cry. Don't cry. Not over a doctor yelling, or another nurse be snarky, or because you are overwhelmed, or because you thought I was harsh to you. Don't cry. Not one of those things is devastating enough to have earned that much power over your emotions.

But, as I realize that it is easier said than done for some, if you need to have it out, tell me. Tell me so I can find you a place to let it all hang out in private, even if it means covering your patients so you can go to your car. Because I want to protect you from committing what, for some, becomes a moment they cannot live down and stains their repertoire on the floor.

Because medical personnel are predatory pack animals. When you cry, they scent blood and bay for their pack mates to take notice. They watch. Stalking. Lurking. Marking you as weak, ready to cast you aside to larger predators, or, more readily, pick the psychological meat from your bones themselves.

When you have found your composure, we'll talk, brainstorm, and fix the situation. Even if it has something to do with me--scratch that--especially if it has something to do with me. But for that one moment, let me protect you.

And lastly, keep in mind that I'm human. I have bad days. I have a life outside of work and sometimes there is a lot going on that you may not know about. And on top if it all, I have my own workload, work drama, etc, on top of what is going on with you. So before you start gossiping to other orientees about your "!@#% of a preceptor" remember two things: 1) I will find out. I have eyes and ears you don't know about. 2) One day, you will look back and realize that your crazy preceptor may have had a point and you are stronger for it.

And you didn't even have to be coddled.

Wishing you best of luck and kindest regards,

~~CheesePotato~~

P.S.

I owe everything I am, every moment of clarity, success, and moment of feeling capable to my preceptor of many years ago who just so happened to be a nightmare on two tennis toned legs. Without him, I would never have survived running my first trauma alone nor would I have found a home in nursing. Thank you, my friend, for breaking me down so I could be built stronger.

[NursieNurseLPN, LPN]

Looking back on nursing school, the instuctor who everyone loved was not my favorite. Yes i liked her and respected her knowledge, but she was more just trying to get through the day. When i recieved a 100 on a paper i spend days on and another student received a 100 on their paper (some of which was just blank) i kind of lost my respect for her. OTOH, my other instructor, who almost everyone dreaded (i admit to also dreading her before i ever even knew her), is by far the one i respected and whose knowledge i admired. When i received a 100%, (only once) i knew i had earned that grade and she was proud of how far id come. I learned more from her then i realized at the time.

I think its more about having respect for your students, preceptee, instructor, etc at all times. There is no reason to be cruel. But sometimes we learn the best from someone who we respect, not someone we "like". Its a huge responsibility to mentor someone at the beginning of their nursing career. Im not sure i could do much better, but i know ill always treat them with respect. If someone is not getting it, or acting out of line, there are better ways to handle it.

I read this here on all nurses and its something i will never forget: Praise in public, critique in confidence. Or something along those lines! (Sorry to the original poster of that quote if i messed it up)

[whitebunny]

this article is (1) bitter, (2) harsh, (3) full of stereotyle, negative energy and hostility.

Although it has some points, but at the end i disagree. If OP wants to say "everything im doing is to make a student a better nurse" then i would like to say "there are others ways to make students better nurses. Definately not your destructive ways."

Management has different styles: (1) authrotative (2) deplomatic (3) in between.

I cannot picture OP being a good manager, a supportive manager to help nurses grow. In fact I dont even picture OP has decent leadership skills. All I see is (1) abrasive (2) over the top (3) power, power, power.

All these "nature selection" "I have eyes and ears" shows me OP should be a businessman----because you talk exactly like my father----bitter, hate---"no pain no gain" "the best fit survives" theories----yes, my dad is old school----and he lives a very unhappy life.

Just a little introduction of myself: young, immigrant, senstive, emotional, cry----I WOULD BE DAED ON DAY 1 IF I HAVE YOU AS MY PERCEPTOR---DEAD DEAD DEAD

in fact i did have a instructor like you during the 2nd year of university. She failed me just like you, she screamed at me, she told other students to pass on negative messages to me, she insults me she humiliates me---im slow, im behind----not because im not harding working, because i have a language barrier. i was always top way back at home, now im bottom in another country, i was only 18. But guess what, i went to DON. She had a different type of personality, patient, sweet, and understandable. DON followed me one day during clinical, she said i was fine. Guess what, i passed. Ever since then i worked extra extra extra hard, cuz i know, there are a lot of bitter people like OP in this world, will eat me alive at any single moment. They want me dead but I have to defend myself!

Lots lots good professors helped me. After graduation, i started at nursing home, i told myself i dont have the advantages like native born people so i will start somewhere else less acute, then work my way up. I started with 28th patients, then 18 patients, then I moved into the biggest hospital of the city and started on subacute medicine, 5-6 patients. 2 months later I moved onto medicine, 4-5 patients. I love my managers, doctors, my peers. They help me I help them. We learn together. We forgive each other. I grow because people love me, forgive me and help me. Im stronger now, but I wont be stronger if you destroyed me.

I always remember the manager told me "i always see you a very young girl with lots potentials." She told NP "With lots support she will be fine." I am happy now and i tell myself i do not want to be a negative depressed person like my father ever. Your post made me think of what happened when i was 18, and yes, your post made me upset.

If everyone think like you in this world, all immigrants are dead. They cannot survive in North America.

Thank god, not everyone is like you, tearing, and breaking people down!

[tinyonern]

I'm sorry whitebunny, but I think you missed the satire. This may be related to your language issue. I'm guessing that, if you are as good as you think you are, the OP would have seen your potential. To make assumptions that OP is a depressed, negative person like your father is just wrong. I'll make an assumption (which leaves me open to the old adage; making an ass of you and me), you have a chip on your shoulder.

[whitebunny]

Hi Tinyonern:

Thank you for your reply. I just went out for a quick walk to calm myself down. I read the rest of the thread and saw OP stated that breaking down/rotten students was never her intention. I saw other people's replies were good summaries: (1) not every students work well with OP's style (2) how OP writes make people feel she is full of ego, and certain words are just logically wrong. I have to admit that OP writes 90% as the way my dad talks. I got very defensive. My emotion was a mixture of personal experience. I did take it personally. I guess OP's point was simply "dont gossip about perceptors cuz perceptoring is a hard job too " when she used words "I have ears and eyes".

I never think of myself good. In fact, my low self esteem probably will be my sister for the rest of my life. First several years of immigration were just rough. Low self esteem is just another thing with immigrants, generally speaking. I might present myself tough from outside but my inside was just tears and scars. I have been looking for that piece of serenity since i was 15, and have been practicing throughout work. Still far far away from it.

But thank you for calming me down, pulling me away from going extreme =)

[weluv3]

Um, this article seems a bit over the top to me. Medical professionals are predatory, smell blood, etc.? I've been a nurse for over twenty years. That is way over the top.

As many other posters have said, the way you precept, and your attitude, your leadership style may be a great match for some orientees.

But not for me.

I don't think anyone needs to be "broken down" in order to reach their full potential.

And it's kind of condescending to think all new nurses need to be petted and coddled, and it is your job to toughen them up and show them how the real world is.

I, and many others, were well equipped with enough innate intelligence that we already possessed some pretty good critical thinking skills before we ever even started nursing school, and also realize we have an intrinsic responsibility for our own professional growth and development.

I look at new grads and nursing students as colleagues. I do not try to intimidate them. I get to know them as a person on some level; i.e., ask them when they are graduating, their future career goals, etc. I respect them, and they respect me. I freely tell them everything I know. I assure them there are no stupid questions. That knowing what one does not know is a cornerstone of safe practice.

Positive, healthy interactions with all coworkers go a long way in making tough shifts bearable, even enjoyable.

Support, teamwork, respect, sharing of knowledge, modeling leadership, and yes, KINDNESS. Despite whatever else is going on in my personal or work life.

So I don't worry about my orientees speaking about their experience with me as a preceptor with other staff.

Nice post!

[tinyonern]

Whitebunny, I can't begin to understand how difficult it must be to leave everything you know and then try to learn in a new language, new culture, etc. so, my hat is off to you!!! Take credit for calming yourself down, good job!! Do remember though that English is a very quirky language, and when you are upset by something, give yourself a minute to calm down. It maybe be that the person really is being nasty, so get mad, but it maybe a language issue. Keep up the good work!!

[Rensoul]

This article nails it. Having just come out of a 3 month orientation period with some awesome preceptors, this is really close to home. Some observations:

1) I didn't see the OP as being harsh. The goal is to assess what the preceptee knows and to work from there, regardless of the teaching method. Case in point, if you make me watch everything and then do it, I will bomb every time. However, if you show me once, walk me through it once, and then let me do it on my own, I'll get it every time. We are all familiar with the teach back method, it works.

2) I would much rather have someone be upfront and honest about their intentions/personality in the beginning rather than feel like that person is being fake and get blindsided by it later. At least OP is being honest about how they are and what they expect. Expectations are part of every relationship, and both sides are responsible for stating what theirs are.

3) A smart student/orientee should be watching their preceptor to see what the resources are. You never know when you will need said resources. IMHO this is not the expectation of reading minds. It is the expectation that we learn from experiences. If I see my preceptor consistently go to specific people for things, it tells me that my preceptor values their opinion for a reason.

4) Different strokes for different folks. If you know that OP's precepting style wouldn't work for you, Kudo's. It means you have the self-knowledge to realize what works for you & that is part of being an active learner.

To the new grads/orientees:

Yes, orientation is overwhelming as a new grad. There will be days when you feel you can't do a *&^% thing right. It will pass, you will gain confidence & skills. It will click. Hopefully sooner than later.

Life begins outside of your comfort zone. Seek out new knowledge/skills as you master the older stuff. Don't take thing's personally. Criticism (constructive or not) can be hard to digest and it takes some time to learn the art of stepping out of the situation to look at things objectively.

You will never run out of new things to learn. EVER. If you do, you'll be 6 ft under.

Thank you OP for a great article. I was lucky enough to have not one, but 2 preceptors like you that kept me from making some serious missteps as a student & new hire.

RenSoul

[angie1114]

Thank you for sharing this very blunt statement. I am a first semester nursing student and hope to have a preceptor such as yourself to be as candid as you are. No sugar coating and right to the point. That is who I want to learn from because it shows that you are a "Great nurse".

[passion4people]

Thank you........Well said. You have my upmost respect. You are needed.....Thanks

[SleeepyRN]

Greetings!First of all, thank each and every one of your for a reply and a point of view. I find the spectrum of answers interesting, to say the least and, sadly, it would take me ages to reply to each.A few points, however, that I feel merit mentioning:~~ I most certainly do not have the goal of making anyone cry or otherwise engaging in sabotage, mud slinging, etc etc etc. Participating in any of this behavior would defeat the purpose and render the whole process of preceptorship completely useless. And as someone who was set up....repeatedly...by a preceptor (No, not the one I acknowledge), I can tell you first hand that it's just miserable. I would never do such a thing to someone. That's just....rotten.~~ I do not tear down my orientees or students. Ever.~~ Please remember that any over the top prose are meant to be tongue in cheek and most assuredly taken with a grain of salt.~~ No one should ever, ever be subjected to bullying or feeling fearful of their co-workers.. You have the right to a safe work environment.~~ I have yet to master the whole plume of purple smoke disappearing act. To date, I keep getting my thighs stuck on the entrance to the magic lamp thus spoiling the effect. No, slathering them with Crisco does not help.~~ Preceptor/Orientee mismatch does happen. When it does, it is in everyone's best interest that a proper match be found.~~ Although I may be mistaken, I did not say that I do not enjoy precepting. Some of my favorite times are seeing the moments of "ah-ha!" when it all just clicks. I acknowledge and appreciate all of the various opinions and feedback. The passionate responses were simply awesome. This field is blessed to have individuals willing to take a stand in what they view and what they believe. Sincerest regards,~~CP~~

It was a potentially great initial post. What I believe to be lacking are examples to really understand where you are coming from. What behaviors have you specifically seen that you are responding to. I find it very hard to believe that new grads have walked out of a patient room after making sure a "call light is in place " and came to you for praises for doing such. Your preceptees may understand your post, but you posted it here where we do not know the situations. I don't know this "tone" you are referring to. Based off others posts, I have already seen different interpretations of what this tone is, and I suspect they are off base, but do not really know. Maybe some specific examples and a word of advice to students /new grads on some of your biggest pet peeves would be helpful. Again, a potentially wonderful post, but more clarity could really drive home your point.

[LabGirl77]

I am a nursing student and I am NOT interested in being coddled, or being friends with my instructors. I get more use out of constructive criticism than pats on the back- if I'm doing something wrong, I WANT to be told about it so that I don't do it again. I come to school and clinicals prepared, and I ask questions when I'm unsure because I am not interested in harming anyone. I work hard, with humility, and I treat my instructors, hospital staff, classmates, patients and this profession with RESPECT.

Including the ones that don't have respect for me.

There are MANY serious, hard-working, responsible, mature, kick-ass nursing students out there that many preceptors would be proud to have. We're the ones who remain respectful and professional even when we get stuck with preceptors who hate teaching.

To my fellow nursing students: keep working your ***** off, keep coming prepared, keep putting your big girl/boy underpants on every morning. Keep at it, and don't let people like this stop you from achieving your goals. AND when you're preceptors, remember what it was like to be a student -be the nurse that you want your students to become.

[Ruby Vee, BSN]

a little abrasive I thought, although there were some concepts that are generic to all preceptors. Reducing a student to tears is not acceptable. Your job is not to show how much you know, but to elevate the other person's knowledge. Learning is better achieved in less stressful situations, so if you are stressed at even having the student then you pass that along to them and they endure, but don't learn. Waste of time.

What I don't understand is why is it always someone else's fault when an orientee with no emotional self-control breaks down and cries at work? Why do we always blame whoever it was she was interacting with when she lost control? Why don't we blame the crier for not having the emotional maturity to accept feedback without crying?