Drama w/ Preceptor

[bkdamfino]

Hi,

I'm looking for good advice with some issues I'm having with my preceptor.... I'm in my 3rd of 4 semester rotations in my ARNP program. It's a Distance Learning one so I've not met any instructors face to face but do my clinical hours in my local area with a contract via the school and clinic. My current preceptor has openly said "I hate teaching." Though I've done patient care as a student provider (CC, HPI, ROS, PA, Dif Dx, Dx, and Treatment plan) she has had me do grunt work which I won't go into detail about but basically CNA or MA type things, when I have been in the room, she does about 90% and maybe lets me listen to someones heart. Over the midterm, I received a call from my DL instructor saying I got some concerning feedback that I needed to put forth more initiative and she said she may need to hold me back a semester. I told her what was happening from my side and wrote a very non-emotional, objective needs based letter to my preceptor and cc'd it to my instructor for a plan to be successful. Yesterday, my preceptor did an impromptu 'quiz' for STDs, and other things and I semi froze. She said to study up the info again and she'd ask me after lunch. Lunch came and I passed all the questions beautifully. I came home to find a message on my home phone from 10:30am my time, clearly before the post lunch quiz. Talked with my instructor today, to hear that my preceptor wrote 'concerns' that I'm unprepared and not ready. I was told I may need to take an 'in progress' vs passing, all based solely on my preceptors feedback. My prior 2 preceptors gave high praise about my skills and performance but I am feeling the pressure and am intimidated with the one I have now because of all of this. Should I write the program coordinator to advocate for myself? I don't want to rock the boat but I feel that I was swept under the rug from the beginning of the semester and now it's all turning into a nightmare. I am so depressed over all of this right now.... Please help

[BostonFNP, APRN]

First off, I am sorry you are going through this. If your preceptor truly "hates teaching" then your school should have never assigned you to her, as it is a disservice to you, so you can and should talk to the coordinator about that. That is the schools fault, provided they assigned the preceptor.

On the other side, you are in a difficult place right now because you didn't air these concerns until after you had negative reviews.

Taking what I said above into account (that perhaps the preceptor is not the best for you) you need to do a bit of self-evaluation. Do you honestly feel you were prepared each day? Did you perform the duties you were assigned correctly and without complaint/with enthusiasm?

I can tell you from my experience precepting/teaching (which I enjoy) that first clinical semester I expect students to be able to accurately and efficiently perform basic tasks (rooming a patient, getting vitals, taking a basic history) then move into performing a basic provider-level physical exam and a directed history then be able to distinguish between normal and abnormal. Sometimes students get that in the first two days, sometimes it takes most of the semester. I also expect students to be able to answer very basic questions to prove they are prepared before being allowed to see patients and conduct a visit (BP guidelines, lipid guidelines, diabetes guidelines, screening guidelines, etc). Being prepared isn't knowing all the answers, it's being able to provide some of the answer and demonstrate your thought process.

Remember you are moving into a role with a serious level of responsibility. Sometimes the best thing for your future (and your patients) is to hold back a semester until you are fully prepared.

Best of luck.

Sent from my iPhone.

[zmansc, ASN, RN]

What kind of support does your school offer for these types of situations? Have you kept your faculty apprised of the situation? Is there a process in place for poor placements and how they are dealt with? The fact of the matter is that poor placements happen, and each school should have a mechanism for dealing with this type of issue when it arises. Unfortunately for you this happened to you.

I'm sure that delaying your graduation when you are so close is a frustrating and painful idea. However, if you assess the situation from a neutral perspective, I'm sure you would come to the conclusion that you are not getting everything you need to get out of this term's clinical preceptorship. Irregardless of who's fault that is, with what is at stake, delaying your graduation one term in order to be able to complete your clinicals with sufficient experience to be safe is not the end of the world. Yes, it's painful, but it falls into one of those buckets labeled "unforeseen circumstances".

How long is this term, when did it start? If this happened in the first week or two, I have known my school to offer to help the student find another preceptor immediately and they have been able to catch up and complete the requisite hours. Usually, that has required travel, sometimes several states away even. But it has been done. The more common thing is to find another preceptor and then complete the clinicals one term later. In fact, my school will tell you that it may take an extra term to complete your clinicals due to unforeseen circumstances like these, it's in fine print mind you, but they have seen it enough to know it's possible. That doesn't make it any easier when it happens to you!