Dear Nursing Students/Orientees: A Love Note from the Preceptor from Hell
So often what we do pushes us to our edge where we struggle to not only live the moment we are in, but to redefine ourselves and our goals. Written in an exhausted, frazzled moment after an insane day and a night of trauma call. Posted because I know there are more orientees like mine and more preceptors like me.
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.
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. ::gasp:: 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 arsenal 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,
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.Last edit by Joe V on Jun 15, '18
CheesePotato: Noun. Constantly teaching. Forever learning. Overtired, dark humored, over caffeinated, occasionally sulking, chronically petulant. Always got your back.
Joined: Jan '12; Posts: 241; Likes: 2,373
OR circulating/scrub nurse; from US
Specialty: Sleep medicine,Floor nursing, OR, TraumaDec 3, '12Occupation: CNA, PCT,now RN CMSRN Specialty: 6 year(s) of experience in LTC, Acute care ; Joined: Mar '10; Posts: 387; Likes: 595If I didn't have my baby in arms, I would have stood up and given a standing ovation. Yes, I like this article that much. I'm so inspired that I want to put on myand drive to work though I don't work night shift. Thank you for putting things so clearly, I will bookmark this and reread it often especially now that I'm a brand new preceptor. This is the preceptor I want to be, professional through and through but definitely not from hell...
Thumbs up!Dec 3, '12Joined: Jan '05; Posts: 306; Likes: 486Wow... just, Wow.. Very well written.. and very true, and very needed..Dec 3, '12Joined: Jun '10; Posts: 182; Likes: 411Dude...what's your problem? If you don't want the burden of precepting, or working with students then don't! All of this is so unnecessary. Why make yourself this upset and angry? This letter is dripping with anger and hostility. Glad I don't work with people like this...And super glad I didn't have a preceptor like you either. It doesn't take all this nonsense to help someone become a great nurse.Dec 4, '12Occupation: RN & Critter Mama From: US ; Joined: Feb '04; Posts: 4,977; Likes: 20,733Described how I try to be. And I base that on the nurses that I worked with in nursing school who kicked my butt and the nurse that mentored me (didn't precept, she hated doing that) as a new nurse. They weren't warm and fuzzy, which meant when they approved of what I did, then I absolutely KNEW that I was doing a good job.Dec 4, '12From: US ; Joined: Jan '11; Posts: 213; Likes: 174Will you be my preceptor?! This is what I like in someone who is instructing me.
I don't like to be coddled/petted like a child and I need to know what I am doing wrong. There are some instructors out there who are too nice which really doesn't help me learn and some who are too harsh and shut the door in my face (literally). It takes a balance of gentle and rare praise and constructive criticism to help me learn and to show me that someone is looking out for what is best for my nursing practice. I also liked to be pushed with my critical thinking so I can see the big picture and get a better understanding of the situation.Dec 4, '12From: US ; Joined: Nov '12; Posts: 47; Likes: 111I am a very sensitive and emotional person, and yes, a crier. I used to be embarrassed about it growing up, but now I accept it as who I am. I honestly think it will make me a better nurse. I mean, I don't plan on bursting into tears throughout my shift over every little thing, but I'm not the "stiff upper lip" type, either.
That being said, I hope when my time comes, and I'm starting at a hospital, totally wet behind the ears and scared to death, I have someone like you as my preceptor. I want someone on my side, helping me succeed to the best of my ability, pushing me to do and be better, because I don't want to be a good nurse. I want to be a great nurse. I want to know what I'm doing wrong and how I can improve. Your article was excellently written and I enjoyed reading it very much.Dec 4, '12Joined: Jan '11; Posts: 1,825; Likes: 2,419Good post, op. I have been precepting for a while ( nurse for 2 years lol). Sometimes I really get sick of it. We don 't get a choice in whether we want to precept or not. There is such a revolving door of people , a typical med surg disaster. Some orientees are good others are AWFUL. Some get angry if you insist on watching them do a procedure. GET OVER YOURSELF. I don't know you from anyone else on the street, and in the end IT IS MY PATIENT also. If I ask questions , they get incredibly defensive. How else can someone gauge what an ok assignment would be ? God forbid a few be told that they are doing something wrong. They get so defensive and angry/upset. When I was orientation, and even now, if I am not doing something correctly or someone has something to teach me, I WELCOME IT. IT does not have to be said with hugs, rainbows, and smiles either. If you are straight cathing a pt and not following sterile technique, WHY SHOULDN'T I SAY SOMETHING? The other day, a patient was SOB and wanted a respiratory treatment. The orientee I was stuck with ( yes I said that) sat down and charted for about 10 minutes. I mentioned to page respiratory and how to do that. Another few minutes went by. I did it myself, while she gave me an annoyed look. I don't even understand this logic. Page for resp. tx. for SOB FIRST, ALWAYS, then chart your routine assessment( which as she is new , takes a long time..... ). Same thing happened a few times, when I thought a MD should be paged ASAP about a change in pt condition and told her, she went and did something else that took up time. In the end, if it could harm the pt, I go ahead and do it.
I think some people just get incredibly defensive about their lack of knowledge.Dec 4, '12Occupation: Director of Nursing Services Specialty: 26 year(s) of experience in RN, BSN, CHDN ; From: US ; Joined: Jan '05; Posts: 10,271; Likes: 6,112Wonderfully written, being a preceptor is not a game it is a serious responsibility where you help develop a RN who is one you want to look after you or a member of your family
You are not there to be a best friend, but you are there to support, mentor and teach
I imagine you have some successful New Grads who were under your wingDec 4, '12Specialty: 14 year(s) of experience ; From: US ; Joined: Dec '06; Posts: 4,090; Likes: 8,711You remind me a lot of one of my old preceptors. She cut me no slack, and I am thankful to this day. If I have any temptation to take the easy way out of a situation, I think to myself, "what would my old preceptor do?", the answer is "she is long gone, but if she finds out you are slacking off, she will find out about it and come kick your backside, so do the right thing."Dec 4, '12Specialty: 2 year(s) of experience in CVICU ; Joined: Jul '12; Posts: 222; Likes: 383That's a good person...nursing aside. Wish more people could see things through your eyes.Dec 4, '12Occupation: Nursing Student Specialty: 1 year(s) of experience in ED/Trauma/Field Case Manager ; From: US ; Joined: Oct '11; Posts: 57; Likes: 30Amazing and eye opening! Just starting out in nursing school, but will save this for future reference! Thank you so much for giving this honest account, from the other side. I appreciate you for it! Wish you could be my preceptor, or at least someone as thoughtful as you!
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