FNP Clinical Experiences can be great - or ROUGH

[MultipNP, BSN, MSN, APRN, NP]

I'm not sure if this is a helpful way to encourage my fellow FNP students or more of a vent.  But here goes...

I am an FNP student who is a bit older - I became a registered nurse after a fairly successful first career (have my bachelor/master degrees in another field that wasn't family friendly).  I am married to someone just like me - we met in grad school the first time around.  Then we both chose 2nd careers in the medical field.  He is successful in his chosen field (he has his doctorate).  We've had all of our children - and enjoy being a big family.

When my youngest started school I knew it was time to get back at it.  I had long wanted to become a practitioner, and chose to go the FNP route since it is broad and I can expand on it more easily than some other degrees (I'm leaning toward psychiatry at this point)...

Anyway, I began clinical rotations after putting in a lot of grueling hours of classwork and showing that I "still have it" as a good student.  My first rotation went really well, with my preceptor being someone who had 20+ years experience, and had taught students in the past (both as a preceptor and as a college professor).  She was fantastic, and gave me extremely encouraging feedback and told my professors she had no doubt I would be a good FNP.

I went into my 2nd clinical, excited that I would continue learning.  This time, things were different.  My preceptor was MUCH younger than me (I had been a registered nurse for a good deal longer than she had), but seemed super nice when she accepted me as a student.  It ended there.  

My first day, she began grilling me with questions about obscure health conditions that are not in the FNP scope of practice, and would not allow me the time to think about an answer before saying, "Didn't you learn *anything* in your pathophysiology and pharm classes?!"  I was humiliated and went home in tears.  

Long story short, after that first day, I studied hard and knew my stuff about common conditions, explaining when she asked about obscure things that "since that is not within our scope, I would refer that on to a specialist."  She asked many other questions to which I knew the answers.  When I knew them, she kept asking things until I didn't know something - then would belittle me every time this happened.  I asked for resources to help me be better and asked for information about the next day's patients so I could prepare in advance.  I even asked if there was a list of things she might want me to memorize.  I begged for direction. And I got none.  I did keep hearing her say, "I don't have time for this."  Anytime I had something I knew was good insight to add, she shrugged it off and said, "Well, maybe."  It didn't make it any easier that roughly half of the patients we saw were people who knew me and spoke highly of me. "You're so lucky she's your student!"  This seemed to aggravate her.

After a week, she told me I wasn't cutting it and that she wanted to talk with my clinical professor.  She said, "If you continue with me, I will recommend that you not pass - you will fail for sure."  

I spoke directly with my professor that afternoon - he was dumbfounded at her description of me (I'm an A student - have a really good record thus far).  He said, "In this case, I will be describing her as a 'poor fit' for you.  I do have to discuss this with the higher ups in the school since this person did voice serious concerns about your performance, but I will go to bat for you since I always find it suspicious when someone develops such a strong opinion after just one week with a student they've never met before."

I was emotionally ruined at the time.  As an FNP student, I constantly feel like I am an idiot (something I have learned is quite common), and this preceptor knew that.  She chose to run with that and stomp on any shreds of confidence I had, forcing me to question whether I could cut it as a nurse practitioner.  

Since then I was able to obtain another preceptor in that specialty.  So for the semester, I had 3 preceptors total.  Two of the preceptors evaluated me as "exceeds expectations" across the board.  They were also open to me sharing insights with them - AND with their patients.  One of them went so far as to tell some of her patients, "This is so-and-so, she is a very experienced nurse, and I trust her judgment, so if she has something to add, it's probably excellent advice."  She would then turn to me and ask if I wanted to say anything else.

I actually sought professional counseling over this - and chose to go to the same one who knows me from counseling a couple of my children.  He was surprised that I would be treated this way, so encouraged me to ignore the bad and focus on the fact that I had gotten good feedback from all my other teachers before.

Fast forward to the end of the semester.  A couple weeks before the end, I received a notification that I had evaluations to fill out.  So I did.  I am not one to lie - I evaluated all three preceptors honestly.  With that first one who belittled me and said I was worthless, I honestly described her as below my expectations, that she would not help me when I asked for it.  I also recommended the school not send any more students to her.  I didn't go overboard - I just told the truth.

A few days later, I received notification that I had an eval to review.  I've never received such a notification.  This person had probably seen what I wrote about her.  The eval she wrote about me was packed FULL of lies.  I couldn't believe my eyes.  She fabricated specific situations, telling my professor I didn't know basic anatomy, describing me as a student who "doesn't know nearly what she needs to know, nor does she care to learn."  Holy. Freaking. Cow.  Lie much?  She also described me as "awkward with patients."  It was weird, because I remember thinking she had a somewhat cold demeanor with patients - especially our patients who admitted to struggling with depression or other mental health problems.  

Thank goodness I was given the opportunity to respond to her eval.  I did, explaining that I found it strange that she remember specific situations when they didn't even happen.  

I spoke with my counselor about this, telling him I couldn't understand this from a student perspective, and that I am not a mental health professional yet, but that it *seemed* to me that I was chosen to be a victim of gaslighting by someone who exhibited signs of narcissistic personality disorder.  He almost laughed, and said, "That is exactly what I thought when you first described the situation to me."  Apparently, when seeing my preceptor evaluation of her, she was filled with rage, retaliating with outright lies, trying to devalue my worth as a student.

I'm so glad I have a week off before starting next semester, because I have a lot of emotional junk to work through, trying to get past this.  I know I only have a tiny glimpse of what people married to someone with this disorder must endure.....  But man, it'll do a serious number on a person.

I want to encourage my fellow students that it is important NOT to base your worth on what your preceptor thinks of you.  If they provide you with feedback such as, "You should know this - study it!" then of course study!  But that feedback is constructive.  Do NOT allow anyone to make you feel like you will never make it.  It's hard as a nurse practitioner student because most of us feel like idiots already - so just hold on to that knowledge and do the best you can.  I have been treated poorly by senior nurses in the past - which is rather common.  But I never in a million years could have seen this thing coming!  Maybe I'm naïve, but I didn't even imagine it being as bad as it was.

If any of you has an experience like this, please know it is NOT NORMAL.  My therapist told me that while this was an awful thing for me to go through, he felt this would be an excellent experience to have in my pursuit of the mental health profession. ?  

PS - My clinical professor gave me an "A" and reassured me I was a good student. ? 

[bigmama23]

Yikes that sounds like a rough placement! I hope your university does not use your nightmare preceptor for other students in the future. 

I know what you mean about feeling like you know nothing as a grad student. When I've gotten feedback lately, it's usually that I need more confidence because I know more than what is expected of me and I appear to have impostor syndrome (this is from colleagues and informal feedback/encouragement). I am glad your nightmare preceptor's attempts to sabotage your clinical grade were fruitless for her. Here's to hoping she gets the help and reality check she sounds like she is in need of. She's no longer an issue for you going forward.

[JKL33]

She is a miserable person. She doesn't feel good about herself.

I think there is a way to make good on this unfortunate experience by gaining insight to be able to recognize this in the future. These people are clearly miserable, as evidenced by their need, even as a so-called professional, to prove that they know more than a student. Right? That's kind of sad/lame isn't it? They only feel good when they can convince themselves that they are better or know more than at least one other person (in this case, you, a student).

I know we are all different but this kind of thing can't be allowed to wreak such havoc in one's life. I mean this in a tough love kind of way: There were two problems here: Her behavior and your internalization of it.

Keep moving forward. ??

[MultipNP, BSN, MSN, APRN, NP]

7 hours ago, JKL33 said:

She is a miserable person. She doesn't feel good about herself.

I think there is a way to make good on this unfortunate experience by gaining insight to be able to recognize this in the future. These people are clearly miserable, as evidenced by their need, even as a so-called professional, to prove that they know more than a student. Right? That's kind of sad/lame isn't it? They only feel good when they can convince themselves that they are better or know more than at least one other person (in this case, you, a student).

I know we are all different but this kind of thing can't be allowed to wreak such havoc in one's life. I mean this in a tough love kind of way: There were two problems here: Her behavior and your internalization of it.

Keep moving forward. ??

??????

[valandria75, ASN, BSN, MSN, LPN, RN, NP]

Pardon my French, but your preceptor sounds like an a hole and probably barely made it out of school herself.  It would be interesting to know what the age range of her other students were, I'm almost betting anyone older or who she perceived as a threat received a hard time from  her.  Do not stress it, you have enough to worry about getting through the program, one bad experience does not define the rest of your program.

[MultipNP, BSN, MSN, APRN, NP]

Update: Graduated with honors!  Just received clearance to take board exams, and was offered a job by my psychiatric preceptor during clinical.  He told me my office is ready and waiting. ❤️

[MultipNP, BSN, MSN, APRN, NP]

Update 2: I have had patients asking for referrals to pediatricians during appointments.  Finding it a bit odd that they were seeking advice from the NP at a psychiatric appointment, of course I asked why.  One mom said, "The NP we see there just rubs me the wrong way - she seemed nice at first, but, she is not.  She really is a mean person at heart."  Guess who these patients want to get away from?  You guessed it - the person described above who treated me so badly.  Of course one has to act professionally, saying nothing other than giving requested referrals ... but on the inside?  Oh, so deliciously vindicated.

[SopranoKris, MSN, RN, NP]

On 12/18/2021 at 6:47 AM, MultipNP said:

Update 2: I have had patients asking for referrals to pediatricians during appointments.  Finding it a bit odd that they were seeking advice from the NP at a psychiatric appointment, of course I asked why.  One mom said, "The NP we see there just rubs me the wrong way - she seemed nice at first, but, she is not.  She really is a mean person at heart."  Guess who these patients want to get away from?  You guessed it - the person described above who treated me so badly.  Of course one has to act professionally, saying nothing other than giving requested referrals ... but on the inside?  Oh, so deliciously vindicated.

I love it when we we get to see Karma apply some justice ? Good for you for standing up for yourself, taking appropriate action, and not letting a toxic person trample on you. I think being a bit older & wiser in life helps a great deal during clinicals. Could you imagine experiencing this as a younger version of yourself? Think of the emotional trauma this preceptor could have caused. It was bad enough what you went through now. People like this give NPs a bad name!

Wishing you much success and happy patients in your new career ? 

[Sam121]

On 12/21/2021 at 10:09 AM, SopranoKris said:

I love it when we we get to see Karma apply some justice ? Good for you for standing up for yourself, taking appropriate action, and not letting a toxic person trample on you. I think being a bit older & wiser in life helps a great deal during clinicals. Could you imagine experiencing this as a younger version of yourself? Think of the emotional trauma this preceptor could have caused. It was bad enough what you went through now. People like this give NPs a bad name!

Wishing you much success and happy patients in your new career ? 

Great post!

[blenderbottle]

On 9/4/2021 at 8:59 AM, MultipNP said:

Update: Graduated with honors!  Just received clearance to take board exams, and was offered a job by my psychiatric preceptor during clinical.  He told me my office is ready and waiting. ❤️

OMG congratulations.