What To Expect From Your Preceptor

[Ruby Vee]

We all have had these fantasies of what our preceptor would be like: warm, nurturing, a mother who protects you from doctors, managers and raging Physical Therapists and a friend who welcomes you to the city and buys you drinks at your new favorite bar. We all expect and are certain we deserve an educated, experienced and competent preceptor who loves to teach (and does it well) and never says a discouraging word. Unfortunately, there are precious few of these paragons of precepting and too few of them for everyone to get one. So some new orientees are going to have to make do with an imperfect human preceptor who may or may not like to teach and may or may not be good at it. Some will get a preceptor who hates to precept or is burned out on it or has so many personal issues going on that an orientee is enough to push them over the edge. Sad, but true.

My first preceptor was experienced but not quite competent, hated to teach and was what we called, in those days, "Manic/depressive". She'd be uppity up up or she'd be downedy down down -- and sometimes more than once in the same shift. Some mornings she'd be practically catatonic until she disappeared into the bathroom and would come back bouncing off the walls . . . later, when she accidentally overdosed, I learned why.

Your preceptor is not your friend. Hopefully she's friendly and approachable, and maybe one day she'll BE a friend. After four decades in nursing, I have several friends who were once my preceptors and several who were once my orientees. But she doesn't have to be your friend to teach you. She doesn't even have to LIKE you -- or you her -- in order for you to learn from her. Some orientees get lucky; others get someone like Diana, my first preceptor. You take what you get and learn the most you can from them -- even if, in some cases, that is what NOT to do. (Drinking before work and getting high AT work -- definitely a "don't.)

A good preceptor can teach in the manner that most fits your style of learning. An adequate preceptor can teach in more than one style. A new preceptor or a poor preceptor may have only one way of teaching and that may or may not be the way you learn best. So you may have to struggle to learn, find other folks who can maybe explain those pesky pacer checks better than your preceptor or look things up a LOT. Looking things up is never a bad thing. Even a good preceptor has one or two things they cannot for the life of them explain to you right at this moment. After 4:00, I get stupid and while I can check pacing thresholds in my sleep (and probably have), I absolutely cannot explain them in a coherent fashion. Fortunately, I recognize this and sent my orientee to a colleague if they absolutely have to have pacer checks done right now. On the other hand, my colleagues are always sending their orientees to me to explain how LVADs work. If you have more than one preceptor, that's a blessing. You'll learn different things from each of them.

A good preceptor will stress critical thinking -- and the WAY they stress is may or may not make you uncomfortable. Mortimer fires questions at his orientees until they can snap back the answers faster than he can come up with questions. Renae explains things until her orientees' eyes glaze over and I swear I saw one of them go to sleep while Renae was explaining and wake up just in time to summarize . . . . Edith comes up with ever-outlandish scenerios and asks her orientee to walk through them, verbalizing what they'd do in each instance. (If the power ever goes out in the whole hospital while your patient is on dialysis with a balloon pump and an LVAD, each with a battery that lasts less than an our and is on 4 pressors and no way to contact the pharmacy for refills and then a tornado comes through town and the building catches fire, Edith's orientees will have already considered that possibility and come up with a plan. One of those styles will seem like a horror show to you and another might seem like fun. Hopefully you'll get the preceptor whose style you like. Maybe you won't.

Some of you will get really great preceptors and some of you will get really awful ones. Some of you will get bad preceptors who will learn and one day become great ones. Some of you will get the great preceptor whose husband is in the CCU down the hall in cardiogenic shock . . . again . . . and whose mother is living with her and is showing signs of dementia and whose son just totaled the car (again) and who really ought not to be precepting this Summer, except we have more new orientees than we have experienced preceptors so she's going to have to suck it up and take an orientee (again.) You can learn from any preceptor -- although some will be a better fit than others.

A preceptor is there to help you grow from a brand new novice nurse to a competent, skilled nurse. But we're not here to spoon feed you the answers and we WILL tell you to look stuff up. Believe me, that's easier now than it was when I had to lug a 10 pound text book everywhere I went. You might think it would be so much easier if I'd just TELL you the dose range for Lasix or the procedure for hanging blood instead of making you look it up. And it would be. It would be easier for both of us. But you'll remember better if you look it up. You'll also learn your resources and how to utilize them. And every single orientee I've ever had (including "guest orientees" I've only worked with for a day) has looked something up and then taught ME something I didn't know. As a preceptor, I believe that if you don't learn something from every single orientee, you're not doing it right. Clearly I'm doing it right, because some of my most respected colleagues were once my orientees.

I hope you all get the preceptor of your dreams. But if you don't, it's not the end of the world or even your career. Ask the right questions. (That would be thoughtful questions. Not "How do I put in a Foley?" but "I've looked up the procedure and I think I have everything I need, but I've never done this before so can we talk it through together before we go into the room?") Write down the answers so you'll remember for the next time, and go home every evening and study over your notes. Why were we concerned about Mrs. VT's K+ of 3.1 but not Mrs. ST's? Could you have set up your sterile field a little differently so you wouldn't have had to reach all the way across it?

You'll finish orientation, but hopefully you'll never be finished with learning.

[Susie2310]

What you wrote about the hit or miss from the preceptor pool is reality.

And it shouldn't be, but it won't change.

I had had a long conversation with a friend that was enlightening. He said that healthcare systems are set up to fail on the front lines. Errors happen in such large numbers because the front lines are unsupported, while the offices are filled with people (and salaries) to audit the check boxes that the front lines have to check to ensure compliance with federal and state guidelines for accreditation and reimbursement.

Yep, that pretty much sums it up.

So, your burnt out preceptor who can't teach is what you're left with because all the money for precepting training programs and a reduction in work load for that trained preceptor is not possible. The money has to go to yet another QI nurse who audits the checkboxes per federal and accrediting body regulations, and he has to call the already stressed floor nurse (and have an unnecessary 15 minute conversation with her) about making sure the stroke education is documented in this box, and the meaningful use checkbox is also ticked off, and how the checkboxes need to be checked every 24 hours or the cycle starts all over again.

In my area the large health systems have announced very good profits, and have recently built new large buildings and re-modeled others, so I do not believe the lack of support of front line nursing is due to lack of money, but rather due to priorities. Quite simply, the choice is made to allocate money to other (areas).

[sonia211, BSN]

Learning is a journey NOT a destination!

[Msalex312]

All of my preceptors except one fit the ideal description. The "one" told me to quit, criticized everything, didn't allow me lunch or bathroom breaks, didn't allow me to take my prescription medicine even though it was approved by the school and the dean. I caught her confusing my patient with another patient on the floor. She insisted the patient was on a med with a condition they did not have. I agreed, said I would double check and I was right. Whenever she was ignorant on a subject she would say " what do you think?". DUH obviously you don't know either. It was awful. I smiled, I complimented her awful hair, I brought her donuts. A mouth full of donuts makes it hard to talk trash. I asked her about herself. I pretended I cared about her response. I passed because I was a good student despite the fact she thought I was...whatever was going on in the bird brain. I took notes of words and actions and super indecent photo used to communicate via text....As a preceptor you should not be licking someone as your text response photo.

[Ruby Vee, BSN]

I'm bumping this up because there has been interest expressed in an article about what to expect from a preceptor. It's old, but still relevant.

[SmilingBluEyes]

Loved it!

[iamalagirl]

One of my preceptor was from the Hell... She was taking classes to be an educator. I feel so sorry for her future students. It seemed like she wanted to be an educator so that she could belittle new nurses in front of patients and doctors. She yelled at me "You don't know it!?" in front of patients whenever I asked her questions. She quizzed me about meds in front of patients and when I answered right, she was visibly disappointed. She continued quizzing me until I make one mistake and that was it...for the next 10 min, she just kept scolding me in front of patients.

I had more than one preceptor during my orientation, and she got so mad at me for doing things in the ways I learned from other nurses. For her, her way is right and nothing else.

She did nothing but confusing me and making me hate this nursing industry that nurses treat other nurses bad.

There are nurses who should not be a preceptor at all.