taking students, precepting

TweetiePieRN · Nov 5, 2005

Most of the time, I'm left charting or finishing up long after the students leave, precisely because I took time with them.

I love working with students, but time is the main problem. At my facility...management wants us out of there (charted and all) as soon as the shift ends. If we are sticking around charting late too often, we get called into the manager's office and get a nice lecture on time management. :angryfire

Also, at my hospital (we are NOT a teaching hospital) students are assigned to certain patients. I have no say in whether or not a student will end up with one of my patients.

I love working with nursing students because I am still really excited about my job and I love sharing that with people. I love watching the lightbulb go on in their head when they learn a new thing!!

On the flipside, I can also understand why some nurses don't want to work with them. My personal pet-peeve is the nursing student who thinks she/he knows everything...then charts an assessment inaccurately (or performs a shoddy assessment) and then I have to go through and write a huge nurse's note to counter what they "discovered". I tell my students to please come get me when they are done with assessment so we can talk about what we found...then if something is different we can go back in the room and figure out what is actually going on. Good learning experience for both of us!

mrscurtwkids4 · Nov 5, 2005

I have a lot of respect for Agnus speaking her true feelings on the precepting students matter. It's better to know yourself and how you handle certain things. As I know students can be quite trying. It's like when my children were 3 and asking all the "why" questions constantly. At first you are patiently trying to explain things in a fashion they can understand. Then after about 30 "why" questions, you start getting impatient and just can't handle hearing "why" one more time...lol. I'm a 33 yr old junior nursing student. I only just started our first clinical rotation at a nursing home last week. And my experience was one of mixed feelings. When I went to the nursing home in advance of clinical day to review over the chart of my client, I chatted with a couple nurses on the floor about their experiences in that facility and their knowledge of my client I'd been assigned to. And those nurses were very friendly and helpful. On the first clinical day, my partner (another student) and I were given directives to take care of the client and weren't really even checked on again. I knew pretty much what I had to do, and when I had a question, I generally went to my instruction and asked her rather than bother the nurse who was quite busy the morning routine. I completely understood that she was quite busy and is used to the routine and I didn't want to disrupt that routine. I just kind of felt like I was taught to doggy paddle and tossed into the deep end of the pool. Especially since my client is completely dependent, it just made me a bit nervous. But I jumped in and did what was asked and I think the shift went pretty well. Aside from my partner being one of those students that was wary of jumping in and getting to work. But I'm not discouraged. Now that I know what is expectd of me for clinical, I'll be able to do it much better on the next clinical day.

It's much better that you know yourself and what you can handle than to end up in over your head. This wouldn't be helpful to anyone. I would hope that if I became a problem for my nurse that she would let me know so I could have an opportunity to change whatever she may not like. Then I could benefit her by taking some of her workload off of her and I would benefit by becoming a better self-sufficient nurse. But I still have a long year and a half to go...LOL :)

SFCardiacRN · Nov 5, 2005

Well said Cutie! We really do need to train our own. As an aside, My community college instructors make less than the nurses they teach!

Tamerius · Nov 5, 2005

I am currently a preceptee and I cannot agree more that if you don't want to teach don't. When I started rotations in the hospitals people asked me if the doctors were rude. I had to tell them the doctors are nice, its the nurses that are evil. Many nurses seem upset that students don't know what they are doing, but that is why we are there, TO LEARN. I know some students are annoying because I have classes with them, but the majority of us are humble and eager to help you or keep out of your way. We are so incompetent in the hospitals because we spend most of our time studying in classrooms, the only chance we have to learn to hang meds and chart is when we are with you. I have found the majority of nurses very unsupportive. I hearby pledge, that when I am a nurse I will be kind not only to my patients and coworkers, but also to those that are learning, because they need support.

sjrn85 · Nov 5, 2005

Perhaps, I did not tell you that I used to precept. I took students eagerly and loved it. I still enjoy seeing students learn and often informally teach these students that I no longer precept. I love to hear what they are learing thier plans and dreams.
I really have not had bad experiences so to speak that have turned me off. The vast majority (actually I believe all) were there to learn.
Would you beat up or pass judgement on a beloved professor who decided to cut back and only teach occasionally because they had developed physical limitations? I am guessing, no.
As far as "blaming" students for the added stress. I don't believe I am blaming anyone. Stress is. I simply stated the fact that students do add to that and I challege you to demonstrate that a student adds no stress what so ever. Part of the stress is that I care very much about what they learn and how they learn. This is not blaming it is a simple statement of fact as I see it. There are numerous stressors thoughout the day and this is one more period. I do not need one more.
Even the student who just watches and needs to be prompted at every step is a gem. We call this student as being in observation mode. He is attentive but tenative in taking action himself. He is just so awed and unsure about his abilities and well it is pretty darn scarry for the new student to get in there and do things himself.
Students hit this point not just at the beginning but at various points though out thier education process and then it hit again after they graduate. This is normal. Some are just afraid to ask questions or even more important do not know WHAT to ask. These are normal human reactions.
Let me tell you a story. I loved where I worked and loved my employer. I eageryl stayed late when asked or took an extra shift when asked because I knew it was apreciated and I was respected.
Then something started happening. I did not recognize it at first. EVERY single time I worked a few hours extra or an extra day I ended up calling in sick after I did this. After a while I saw the pattern.
I went to my employer an told them the pattern that I saw. I said that I would not work extra anymore because if I was calling in sick after doing this then I was not doing my employer nor myself any favor, infact I was doing us both a diservice.
That employer and every one since has agreed and been very respectful of this.
It was hard for me. There are still times I would like to help out.
I also hate it when I see nurse much older with the physical endurance that I once had. I used to be very high energy.
I used some examples of student behavior as a means of demonstrating some of the minor stress that was added by taking a student. The student who did not want to do meds did some other really wonderful things for my patient that really needed it. He was not a bad student. I did not have the energy to address what he chose not to do. I believe that (especially since he was graduating in 6 weeks) that he had a responsibility for his own education. He knew enough to accept or decline a task. However, I feel he did not take the free oportunity to practice and that is a loss. I can not save the world. I don't know if he would have understood if I explained it the significance of the oportunity that he had that day and passed up. And I did not have the time or energy that day to do it.
For the record that student was given to me with out my being asked. I really was not up to taking him but he apeared at my side when I was getting report and that was that. Later his part time clinical instructor who also happened to be a staff nurse on our unit came to me and apologized that she had not asked first and thanked me. (NO I had not complained or indicated in any way that this was a problem) She was just courtious I am sure, as people generally do ask first there.
As far as payment goes. If you choose (yes it is voluntaiY) to precept for 12 weeks you get paid $1 extra. After the 12 weeks you get nothing extra. If another nurse takes the person that you are precepting for you one day that other nurse gets nothing.
Some hospitals pay a bit extra for precepting or taking students some do not.
Taking students where I am does not pay more.
The precepting pay is for new graduates that are going to work on the unit, or for senior year students who are employed (paid) on the unit for the purpose of gaining additional clinical experience with a preceptor. Some places call these apprentices.
The paient load for the preceptor sometimes is only slightly adjusted up or down due to the precenses of the apprentice. However, the apprentice and preceptor have a long term relationship and get to know each other very well.
The student coming to the floor for the occasional clinical rotation does not have this. I assess as best as possible where a student is at in the beginning and try to find out what he can and can not do and what he wants from this day's experience. Then we go from there. In other words the student directs his own learning to an extent;remember these are adult students. Then when I see oportunities especially unusual ones I will direct the student to them.
Some hospitals pay nothing to precept period. Some require you take students, new grads, new nurses to the unit etc.
It IS NOT part of my job description. It is my decision if it becomes a part of my job description where I work, and the nurse who has agreed to this can change her mind.
I hear a lot of shoulds. I HATE the word should. Should is a very judgemental word that comes from what we preceive others expect, whether we say you should, or I should. Should is a finger pointing word. When I point my finger at you and say "should" three more fingers are pointing back at me.
Should is what is not and never will be. It is a fantacy word.
Please join me in the real world with real people and acknowlege our individual and unique limitations. It is ok to hate our limitations. It is not ok to confuse that limitation with the person who has it.
To the angry students who have posted here. I have been where you are and I am here now. You have not been were I and other nurses are do not be so hasty to pass judgement.
If it scares you away from the profession to see nasty nurse then that is a good thing IMHO. Because if that turns you away you do not belong here. The sad truth is we do get pretty cranky. And you will have to deal with that your whole career. Though hopefully not all the time every second of every day.
I hate to see people scared away because we need nurses so badly. And at the same time I am glad that you learn early on what you may be up aganist and make a decision early to get out rather than be just a warm body in the profession. It is sad and disapointing for you who are scared away. But reality is this is not a NICE NICE profession. Some times people come into nursing with an idea that is unrealistic.
From the angry students that posted here, I hear tones and words written by you that suggest you are pretty contentious yourself. This does not help the profession. If you come in angry what is it going to add to the profession that is already over stressed and over stretched?
You were treated badly by a nurse so you now have your dukes up. Not a good start.
I was a student. I had classmates complaining on a daily basis about 'bad" nurses and recieving bad treatment. I had those same nurses sometimes work with me and I precieved the experience quite differently. Sometimes the same nurse on the same day as the other student who complained.
Late on I did have a nurse that it was very obvious even to me the nurse did not want a student. My instructor could see it and aproached me. I verified that the nurse was physically avoiding me. We agreed that I would stay out of her way as much as possible and not make this any worse. I went to my instuctor with my concerns rather than tax this nurse any more than necessary.
Some of it is our own attitude as a student. Recognizing a stressed nurse rather than a nurse who was "mean to me." As nurses we are grown ups. Please, recognize that everytime someone snaps or seems grouchy it is not about you. It is about that person's level of stress.
Some of us are actually human. Stressors are not limited to the obvious ones we see others having at work. Though we don't necessairly bring our home life to work with us the stress we are feeling in other aspects of our life does not magically disapear when we choose not to bring the problem associated with it into the work place.
I am under numerous stressors away from work as I am sure you are as studens, wives, moms, daughers (subsititues sons, husbands) breadwinners, living on own etc.
You do not know where another person is at EVER. Please, do not compare their stress to yours. Perhaps you are under more stress but are handling it better. Perhaps the other person has less stress but has cumulitive effects from past stressors. Perhaps you have better coping mechanisms.
However, if you are feeling angy and need to lash out pass judgement and or saying "should" then I would surmise that you aint doing so well you're self and maybe need to acknowledge that you and they both have limitations.

Any time anyone wonders why there's a shortage of nurses working in the clinical setting, the above post should be used as a point of reference.

One of my least favorite expressions is the old "Nurses eat their young." This thread has shown some excellent examples of the reverse (which happens more than people think). Heck, people who aren't even nurses yet are judging Agnus with a level or harshness usually reserved for drug dealers and theives.

Agnus has given and is more than entitled to back down. It's absolutely sickening to see posts pummelling her just for doing something as simple as taking care of herself. (The nerve! For a nurse to have needs of her own! How audacious!)

Some people really need to get a clue. Just because we're nurses doesn't mean we have to be all things to all people all of the time. I think it takes a great deal of courage (and caring) for someone to admit that he/she has limits.

SFCardiacRN · Nov 6, 2005

Part of my motavation for welcoming students is the poor treatment I received as a student. However, that does NOT make a nurse a bad nurse, just a bad teacher. Our unit is careful to assign students where they will be welcomed but it is not always possible when we get 6 or 8 on the same day.

MajorAl · Nov 6, 2005

Okay, I precept, both students and new Nurses at my facility, because I enjoy it. I find students to be very challenging, especially when they ask: "Why did you do that that way?" The easy answer usually isn't (and shouldn't be) accepted. (I did it that way because I've been doing it that way for the past 30 years) This keeps me on my toes and helps me stay sharp in a field that I've been working in since 1967. Precepting isn't easy, because we are put on the spot to answer questions. But I remember what it was like back in the dark ages when I began my career. There was no such thing as a preceptor back then. I got a week or so of orientation to the hospital after graduation and then was on my own. I well remember working as a NA (no CNAs in those days) with a Nurse who was as close to retirement as I am now (3 years but who's counting) She hated having students on the floor because then she had to do things right! :uhoh3: I guess that's one of the big reasons I look for students because I want to be able to explain why what I'm doing is the right way. Anyway I guess what I'm trying to say is that I think everyone should precept once so that you can "pay back" the Nurse who precepted you and also you will know if precepting is something you should be doing. I agree that Nurses who are not comfortable precepting should not be doing it.

GEMINI06 · Nov 7, 2005

WOW! Great post! As a student in an entry level master's program, we don't always have the warmest welcome from staff nurses. So not only are we student nurses, we are resented for our program from the get-go. This is usually a common topic brought up at post-conference. Besides the fact that there is a nursing shortage, there is a nursing faculty shortage in my town. So our clinical groups are maxed out. Some of the ways our school has tried to deal with this is that we spend a lot of time with instructors in a lab first semester, and have competency check-offs on skills such as foleys, I.V., injections, even charting. That way, when we get into clinical, our instructors know that we have performed the skills before. Many still like to go with us the first time on the floor so if we have a "freeze" moment, they are there to help. The only thing we can not do is IV pushes and pull meds from the med-cart, so often our instructors end up chained to the med-room and is not available to help. I have had clinical days where the nurse I was working with made me nervous and anxious because she was too involved, and others where I was literally left on the floor with her entire patient load for over two hours (found her in the break room surfing the net :angryfire) There are many aspects to this situation that have been addressed in this post. I can see why people would want to be paid more to precept, and I am all for compensation for their time. My only concern there would be that people may want the incentive, but not the experience...not a good reason to take on students! But to address the original post...More important than teaching is providing safe, compentent care to our patients. Recognizing your limitations is important to meet that goal. And it takes a lot of guts to stand up for yourself. As students, it is our job to learn, and I think we can learn a lot from someone who has the courage to stand up and say "I can not take students because I want to focus on my patient and provide them with the best care I can". I don't think of it as "eating our young" but promoting self-care, advocating for you patient, and reminds us that we can not extend our actions any further than what we feel comfortable with. Thanks! :rolleyes:

newhome · Nov 9, 2005

I do not precept and I do not take students. At one time I thought I would never say this. However, students deserve better. I want you to learn and do well and have good experiences.
Taking students is very taxing and time consuming and frankly at times frustrating, when we are not on the same sheet of music.
It takes a lot of energy and patience and teaching to take on a student. I don't have it. And when I have a day when the demands are already high I do not need to spend extra time and energy with a student.
I will accept a student occasionally but not as a matter of routine. Ask me first. Perferably ask me after I know what I am up against for the day. If I have a patient go real sour very fast I need people I can rely on around me not a student.
I will galdly allow you to do proceedures on my patients when you are with another nurse. However, if I say this patient needs cathed and you waite several hours until you get around to it don't bother. I saw this done when anouther nurse offered to let a student do a cath. The student was with a diffrent nurse and both accepted the offer. Yet more than 2 hours passed and they made no move toward doing it. The patient was suffering. The student with her nurse was not that busy. The nurse who had the patient continued to waite after reminding the student because another hour passed. Finally she did it herself. I am not here to waite until it suits the student to do a procedure. If you want the experience take it now or not at all. Life moves fast in a hospital. Be pro active.
Be willing to jump on an oportunity when it presents itself. Waiting does not cut it. True you may not be able to jump on every oportunity if you can't because you are taking advantage of another opertunity say so. Say when you will be free and keep that commitment or at least tell the nurse you will not be able to keep it.
I found myself a few weeks ago trying to explain something to a student and I realized that because it is so ingrained in me by now I do it automatically and could not explain it. For many of us it gets to be that way. I do not want to go back to where I have to think about every detail so I can explain to a student. I want to just do it and be done with it.
Because you deserve better than what I am willing to offer I will not accept you on. If you are a pia (pain in the tush) for what ever reason I don't want to react to that in an unkind or unfriendly way. You deserve better. I deserve to choose to just do my job without the added stress and challenge of teaching, and being a textbook example because that is what you need right now.
I did have a student last week for one day. He was within 2 months of graduating. I tried to get him to do the meds. He told me he, "has the procedure down and does not need to do it." He watched me. HELLO. I am not the student. I really do have it down. Either you are here to practice your clinical skills or you are not. I did not respond it was his loss. He watched me do assessments. I had to push him to do assessments and they were incomplete. Why was he even there. What a waste of both my time and his.
I guess he had that down too. So why tell me why did he even show up if he had everything so down pat that he did not need to do anything. He lef tsaying he would ask to work with me again. I think not. I know this is not every student. But no matter how good you are you take energy that I am not willing to give as mine has become limited as I age.
You may find that unfriendly but I can assure you you will see more unfriendly if I take you on. You need and deserve much more than I have to give.

I am just ending my preceptorship in SICU, and I absolutely agree with what your saying and how you feel! I've been a nurse for 10 years, a hospital nurse for 6 of those years. During that time, I've been a student and have had students. As you stated, it takes alot of time to teach someone what you know and do on a daily basis in the ultra-fast pace found in the hospital setting. I have been truely blessed to have the preceptor I was given to help me aclimate to the intensive care setting. She's "Younger and Faster" and more thorough than most. You're probably a great nurse and a great role model. Students on the floor will still benefit from 'seeing' you professionalism. Thanks for sharing! :)

rrepass · Nov 11, 2005

I am a nursing student scheduled to graduate in May 2006. I understand that having a student with you adds to your work load and stress and I am sorry for that. BUT, there is only so much we are able to learn from the textbooks and we need that "hands on" experience. I would like to think that the nurses that YOU are today has a little something to do with your preceptor when you were a student nurse. We all want kind, compasionate AND competent nurses taking care of us and our loved ones when we/they are in need. What a wonderful feeling to know you had a hand in developing and shaping and teaching another great nurse.

I am very nervous and need guidance when performing procedures with minimal practice and I appologize if this upsets you. I would appreciate any tips you could offer me. Please remember, you were a student nurse once also! :)

mstigerlily · Nov 11, 2005

I do not precept and I do not take students. At one time I thought I would never say this. However, students deserve better. I want you to learn and do well and have good experiences.

Agnus, I fully support you and understand. I had an absolutely fantastic preceptor on the oncology floor when I was a student nurse. We did 10 12 hr shifts together. I never felt like a burden to her. She was friendly to me, but always professional.

She got there early, she had "battle plan" written out for the evening, she gave me her "brain sheets" so I could copy/modify them. Everything she did, she kept a running narration. She called ahead to ask the charge nurse for patients that might interest me. She constantly sought out challenging patients and pushed me to do them, even if I was afraid. She taught me a skill, watched me do it, then pushed me out the nest to fly alone. When I made mistakes (and I did) she was quietly patient, never got angry, went over what went wrong, asked me how "we" could make it easier for me to remember next time or thought up tricks or mnemonics for me to remember. She took the blame for any mistakes, if they required an incident report we wrote them up together and she signed them. She CHOSE to be a preceptor and took a preceptor class to prepare and did it in spite of the fact that she didn't get paid extra - you need something like 250 hours precepting to get ONE 12 hr shift at our hospital. I absolutely loved her and gave her a really nice gift when I left. I see her precepting other students sometimes and they all rave about her.

In contrast, I had a preceptor as a new grad that I foolishly expected to be like my old preceptor. She did not do any of the above things, in fact did nothing at all. I just followed her around while she chatted with coworkers, patients, doctors. She never introduced me, never taught me anything, never gave me any autonomy or responsibility of my own. When I asked her questions she got defensive. I don't think she is a bad nurse, but I was very disappointed in her as a teacher. Not all nurses are good teachers, some were but have gotten burned out. As for me I can't wait to be a preceptor, I LOVE teaching, that is one of the best parts of being on a postpartum floor. I can't wait to teach students, externs and new grads.

I do not think people should be forced or required to precept for any reason other than an emergency when the regular preceptors are all sick and no one else is available. It is totally YOUR choice.

sjrn85 · Nov 11, 2005

What disappoints me in some of these posts is the lack of recognition that Agnus did precept for quite a while. She "gave at the office," so to speak. Instead of recognizing what she gave, some have taken her to task for simply stating she can no longer it.

I see a lot of entitlement, and little true appreciation for how difficult precepting can be. I would love for students/new grads to remember that we experienced nurses have been in your shoes, but you have not been in ours. You do not know what it is like to try to blalnce pt. care plus be there for the student's needs.

And what is truly sad is that rather than adapting a preceptor's pt. load to make things more workable for everyone involved, typically management just continues to pile it on.

I'd love for the students/new grads to read what they've written here 20y from now. I would be willing to bet they'd have a different perspective.