Nursing Student Terrified about Preceptorship

Amanda.RN · Jan 21, 2012

Congratulations on making it to your last semester! You're on the 'home stretch'!! :)

Take a deep breath! You are there to learn, so your preceptor would never just have you go off on your own and attempt to care for these critically ill patients. As a preceptor, I can assure you that would never happen.

How exciting that you get to have ICU experience while still in school! You will learn so much!! Try not to be upset about having been placed with adult patients, and remember that being able to list "Cardiac ICU preceptorship" on your resume will look appealing to future employers! During future interviews, you can even explain it in a way that your instructors felt like you excelled enough to be placed in such a setting (which I'm sure you have). The ICU can be a high intensity area where you are expected to be professional, knowledgeable, safe, and compassionate - your instructor(s) obviously think a lot of you to have given you this opportunity.

I am a bit concerned about your comment "haven't learned much" throughout your schooling. Do you really feel that this is the case, or are you being insecure / anxious about this upcoming venture? It sounds like you did have experence doing cares and ADL's, administering medications, and starting an IV. Your preceptorship is the clinical that really gives you the most "real life" experience. You will learn how to better organize yourself and the duties / tasks you must perform. The preceptor will have you shadow them for quite some time initially. After you have seen their practice style and observed procedures (IV start, administering medications, trach care, etc), they may have you start doing some of these things, of course with them right next to you (so no need to worry about being left on your own!). After that, they may have you take over most or all of the care for one patient (again, with them right next to you providing guidance). If ever you feel uncertain about something or you feel as though your preceptor is 'letting the reigns go' too much, just tell him/her. The preceptor is there to foster your growth and provide you with a real life experience that will assist in your transition from nursing student to nurse. Your instructor usually checks in with the preceptor throughout the preceptorship too.

I recall being SUPER nervous going into my preceptorship as well. That's a normal feeling. And I've always told all of my students and new nurses that fear (anxiety / nervousness) is what prevent errors ... and it's true! The second you lose this fear of making a mistake, a mistake will occur. Check, double check, and triple check... this'll always be worth the extra time it takes! :)

I'm sure that you will do great in this clinical. I hope this information has helped put you at ease and answered your questions. If you have more questions, please feel free to ask! :)

Again, congratulations on getting to this point! Good luck to you!!

Amanda

aismail3 · Jan 22, 2012

Amanda,

Thank you so much for your lovely response. I can only hope that my preceptor is patient and caring or else I'm doomed. As for me feeling that I haven't learned much, I'm not very good with medications. I'm in my final semester and I can't remember any medications.

(1) Can you list some medications and/or pathologies I should look up before clinical?

(2) Also, I'm in the Cardiology ICU, but my friend is in the Cardiothoracic surgery ICU. What is the difference? What will I find in my ICU and not in hers?

(3) I'm also in the process of watching some skills videos, like how to insert a catheter (which I've never done!) and start an IV. What else should I look up that is pertinent to the cardiology ICU?

I would really appreciate it if you can help me again! Thank you and God bless!

nurseprnRN, BSN, RN · Jan 22, 2012

stop with the doomed stuff . amanda's right. i precepted students in critical care settings a lot. i can promise you i expected them to be scared and overwhelmed and feel like they didn't know anything. but i also knew that the instructors didn't send anyone to icu whose mama had raised a dang fool.

cardiology is a medical specialty area; you will see people with heart disease or suspected heart disease. they will be having a lot of really cool testing that you will be able to go and observe; you'll learn a lot there, and you can get a little idea about it by reading up on cardiac catheterization, muga scans, and other cardiac diagnostic testing. learn a bit, if you can, on what coronary arteries feed what part of the heart and why we care, be solid on the normal blood flow from veins->heart->lungs->heart-> arteries and the valves that are in there . read up on congestive heart failure, that's big. learn a bit about very basic ekgs-- what's a normal p-qrs-t and what's normal sinus rhythm, atrial fib, and a pvc. oh, and get somebody to give you a really good stethoscope-- you'll hear more with it and you'll use it for years.

cardiothoracic is a surgical area; your friend will see people who have had or are about to have open chest surgery of some kind. she might even see some of your patients postop and you can give a joint presentation to your clinical conference.

you are going to have a great experience and you will learn a lot of cool things you can use anywhere. ask a lot of questions, be very assured that your preceptor won't expect you to do anything without her watching, so all will be safe. i used to tell my students that icu is the same as med/surg in that we did the same things they did, only a little faster and with fewer trips up and down the hall. breathing, circulation, making urine, mentating... it's all good.

aismail3 · Jan 22, 2012

Thank you very much for your response. I guess what's really affecting my nerves is that I still haven't met my preceptor. Once I actually meet her, I will either be relieved by her friendliness or terrified if she turns out to be a wtich! :) But, honestly, I have heard horror stories about crazy preceptors who expected the students to know everything.

I'm going to make sure that I review as much as I can about the cardiac system before my first day. I'm currently in the process of looking up commonly used medications, can someone PLEASE provide me with a list of medications that I am very likely going to see and use in this ICU.

Thanks again. And, I'm looking forward to more responses!

PacoUSA, BSN, RN · Jan 22, 2012

i guess what's really affecting my nerves is that i still haven't met my preceptor. once i actually meet her, i will either be relieved by her friendliness or terrified if she turns out to be a wtich! :)

what makes you think you won't get a male for a preceptor? just sayin' ... :uhoh3:

aismail3 · Jan 22, 2012

What makes you think you won't get a MALE for a preceptor? Just sayin' ...

Um, because I was given HER name and phone number. I'm suppose to call her on Monday after lecture. The majority of us have female preceptors, only a handful have male preceptors.

allnurses Guide · Jan 22, 2012

I was scared about my preceptorship too and very disappointed by my assigned area as well. I actually got a long term acute care unit.

There is a decent chance by the time you are done you will feel a lot more competent and have had a chance to do some of those skills you have not yet had opportunity to try. Your preceptor hopefully volunteered for this position and is going to be a good mentor. Try not to let your nerves get the best of you.

By the end of my rotation I had done pretty much every skill we learned in school several times and many we had not. I was managing 4 patients nearly independently and had a great grasp of time management (something ICU should be of great help to you for!). I never expected to miss it, but I do. I can't wait for my internship to start at the beginning of Feb!

This is meant to transition you from student to nurse, so you will have days when you are frustrated and struggle, but you will have Aha!! moments as well when you get elated you are finally becoming a "real" nurse. The time will go very quickly.

ICU may not be your first choice, but having that experience is going to open up opportunities for you when it comes to interviewing. We all know Pediatrics is very competitive (as you saw just within your own class alone) and difficult to get into. Not very many who wish that for their specialty actually get to go right into it these days, so having the adult ICU experience will prepare you for your job search when you get out of school and open up doors for finding employment. I wish you the best of luck and a great semester!

careo180 · Jan 25, 2012

I worked as a tech for over a year at a pediatric hospital and had my preceptorship and they still didn't hire me. there was only one new grad position and my friend who had worked there a year longer than me got the position. now i'm on medsurg and i'm hoping after a year I can get back to the children's hospital.

GinRN77 · Jan 26, 2012

Thank you very much for your response. I guess what's really affecting my nerves is that I still haven't met my preceptor. Once I actually meet her, I will either be relieved by her friendliness or terrified if she turns out to be a wtich! :) But, honestly, I have heard horror stories about crazy preceptors who expected the students to know everything.
I'm going to make sure that I review as much as I can about the cardiac system before my first day. I'm currently in the process of looking up commonly used medications, can someone PLEASE provide me with a list of medications that I am very likely going to see and use in this ICU.
Thanks again. And, I'm looking forward to more responses!

As far as medications for the ICU- it's more of class systems of meds that you want to learn and how they will be functioning. Beta-blockers, Ace Inhibitors, diuretics, calcium channel blockers, know how morphine is beneficial, what meds are used for rates, others for pressures. Go over your rhythms, pathophysiology (CHF, Afib RVR, etc.). That is a good starting place.

Good luck! It will be a great learning experience!

foreverLaur · Jan 26, 2012

i would read up on dysrhythmias and pacemakers including aicds and cardioversion and defibrillation. also cardiac injury markers - ck and troponins. meds would include antiplatelest, antithrombotics, lytics, statins, acei, arbs, betablockers, ca channel blockers... also cardiac echo and ejection fraction, stress testing including nuclear testing, ablation procedures. familiarize yourself with cardiac anatomy and the coronary circulation (left anterior descending, left circumflex, right coronary and what area of the heart muscle they supply).

i would say dysrhythmia interpretation is the best place to start: measuring cardiac intervals like pr, qrs, qt, recognizing sinus, atrial, junctional, and ventricular dysrhythmias (abnomal rhythms like atrial fib, pvcs, v tach...)

i would also read up on iabp, ecmo, cvvh, cvvhd, cvvhdf, vents (although respiratory therapy mostly manages those), swans, a-lines...

brush up on trach care and suctioning, tube feeds, cvc/picc dressing changes, drawing blood off picc/cvc....

aismail3 · Jan 27, 2012

Well, I start tomorrow. I am so nervous and scared to the point of crying. I'm going to review as much as I can. I'm also going to watch a couple of videos on youtube. But even then, I am sure that after studying I won't remember 85% of what I studied, so what's the point? I can only hope my preceptor is nice and understanding. I'm going to let her know about my lack of experience. I am truly hoping that the first day I'll get to do more shadowing just so I can get more comfortable. But, who knows, she might expect me to care for a patient. And if that's the case, we'll that patient's life is going to be even more at risk!