Preceptorship: My Nursing Student Didn't Take Me Seriously Because of My Age
I wasn't planning on posting my encounter with this student I had a semester ago. Until the student's clinical instructor returned to my unit the following semester. I was pulled aside and was given a formal apology for the behavior of said student.
I graduated and became a licensed RN at the age of 21. I started working a med/surg floor just a few months later. I'll post detail of my student pathway in the comments.
After I just reached my one year mark working in my unit, I was given a student to assist caring for a patient with a small bowel obstruction.
The issues with my student follows (no particular order)...
1) Pt had a mediport and MD allowed to access because of multiple electrolyte infusions. I informed student what I was going to do. He thought a mediport was a brand name needle for a peripheral IV and wanted to insert himself for more practice. I explained the difference between a central and peripheral IV, but he insisted to insert. I asked the instructor if it was in his scope of practice and, of course, it wasn't
2) I inserted an NGT for my patient. I called for xray to verify placement prior to leaving for lunch. I returned, did rounds for my other 4 patients and came back to my students and patient. During this time, my break relief informed that the student walked the patient around the hallway. When they returned, the NGT was out and I ask why I wasn't informed immediately. His response was, "She sneezed it out. You weren't here. I told my instructor. I figured she would have told you."
3) My patient was pain management around the clock and my student attempted to advocate for pain medications. I praised for his assessment. I asked him to take vital signs and report the respiratory rate and O2 sat. IT WAS 9 and 87% I rechecked and it was still 9. I questioned the student what was a common clinical side effect of opioids. He confidentially said "Addiction." I corrected that it was not pertinent to the current situation and I explained respiratory depression. He was adamant that addiction was correct and went to his instructor to validate. I was right.
4) I tried to explain that an IVF Normal Saline bolus and IVPB of anything does not infuse simultaneously and we would require a second IV pump. He still didn't understand and asked for clarification with his instructor. The instructor said verbatim of what I said including the use of a y-port.
5) Student saw my patient's K+ 3.3 and immediately gave orange juice. I explained it wouldn't bring up the K level compared to IVF and I asked if he was mixing it up with blood glucose levels. He didn't understand went straight to his instructor before I could explain.
6) The clinical instructor wanted the student to practice hanging IVPBs. I informed the student that we will be hanging K+ replacements. We met in the patient's room and I sat the supplies down on the clean bedside table. Before I could verify/scan patient identity, my student started opening IV tubes from the packages and was about to pike the potassium back and I firmly told him to stop. He dropped everything and said "fine." I explained, that I need to perform the 5 rights (there are probably more) of medication administration. We completed the task and he stormed off.
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The instructor found out that the student (while walking to his car) openly admitted to his classmates he couldn't take someone who was younger than him seriously. He got wind of my age from his classmates. Per the instructor, this student had a health care work history (non-nursing) and the program was just a filler until he can apply to medical school.
In the end, no patient harm was done. I understand what it was like to be a nursing student and I stayed patient. I always educate and make sure my students are always safe in any patient interaction. I took theses small circumstances as teaching points for any nursing student having a rotation for my unit.
Specializes in Mental Health, Gerontology, Palliative.
brillohead said:
I'm gonna guess, from his superiority complex, that he's interested in being a surgeon!
I graduated nursing school at 44yo -- virtually everyone who precepted me was younger than I was. Age is just a number....
True story
In the city that I trained the head of the hospital was a rather tiny lady but mega cahones. The hospital had just been made smoke free and the hospital head was walking into the building when she spotted two orthopaedic registrars (trainee orthapedic surgeons) smoking outside of the hospital main doors.
When she politely requested these men move on, they apparently drew themselves up to a great height and stormed "who the hell do you think you are?"
I wasn't there but was told that both surgeons went a very nasty shade of green when she handed them her business card.
Moral of the story people. Always treat people with respect
Sounds like he will not be a nurse long, or he will go straight through and get is PhD and then say everyone is wrong because he has piece of paper and the book says it will work the way he says it will.
If I was the preceptor after the second event of the day I would have informed the instructor and told them what was happening. I also would have not allowed the student to preform anymore care for the patient and failed him on his daily evaluation.
I'm a bit scared for this person's patients if and when he actually does become a doctor and one of the nurses comes to him with a K+ level of 3 and he just says "Give them orange juice". I am hoping he improves in critical thinking and humility by then!
Absolutely! That bit of info would be irrelevant except that he managed to impress a few people with it. He sounds like an incompetent big talker but he's only fooling himself.
Wow! That student needed a swift kick in the ass. No matter what the age of your trainer or instructor, they have more knowledge than you. You're a student. Shut up, listen, ask questions. Then if the instructor is not helpful, get your professor involved
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Apple-Core said:
I hope I get a preceptor like you!
I've heard some horror stories about preceptors leaving the students standing around for hours on end, or berating them in front of patients, or being so intimidating and condescending that the students leave in tears.
From what you have described I would have been in hog-heaven having all that patient instruction, guidance, and education! Keep up the good work, and don't let this arrogant pleb put you off being a great preceptor to future students!
Despite the horror stories you may have heard, most preceptors genuinely want their students to learn, succeed and thrive. The thing is, we're nurses. We're not teachers. Some of us are interested enough in teaching to have sought training in how to precept, taken a class in the adult learner or taken the initiative to form or join a preceptor support team (or whatever is available in our institution). Some nurses don't like to teach but will do their best when drafted into it. Some nurses HATE teaching, have discussed with their manager and charge nurses their desire to NEVER precept and have been drafted into it anyway without their knowledge or consent. They may still want to do their best by their students but are overwhelmed by the difficulty of their assignment (patients PLUS students is about 4 times the work of patients alone -- if you're trying to actually teach the student, anyway) or by a student who is a poor fit for that preceptor's style.
On many units, you will find that the preceptors who are enthusiastic about precepting and/or are good at it will have already been assigned to new employees orienting to the unit. That means the students may be assigned to the brand new preceptor who has no idea what to do with a student and hasn't been to the precepting workshop, the nurse who is suffering through a family or personal crisis who has just enough energy to do her own assignment and nothing leftover for a student or even a float nurse or a traveler. (Not ideal, but done in a pinch.) Usually even the poor or new preceptors want to do their best by the student but may not know what that is. A confident, extroverted student may overwhelm or run right over an introverted nurse with poor self esteem.
Students are half of the preceptor/student dynamic, but it is rare to see a student on AN who is aware of that and takes responsibility for their side of the interaction. If more students understood that they really DON'T (despite what they may have heard from tactful nurses) decrease the nurse's workload, or do the work of a tech, they might be more appreciative of the time and energy the nursing staff gives them.
If the preceptor is doing it right, it takes quadruple the time to do a task with the student than without it. The preceptor is explaining what they're doing, sharing what to look for while they do it or tips for doing it better, pointing out the policy or procedure for doing what they're doing, or coaching the student through the task. Plus they have to take time out ahead of time to explain the student's presence to the patient and seek their permission to involve the student. There are preceptors with bad attitudes, but not every student with a bad interaction has met one of those. Sometimes, as in the original post, it is the student with the bad attitude.
Fail him. Hes not performing to the standards of competency. Period. Just because it feels like youre being vindictive it doesnt change the fact that he clearly isnt performing to even the minimum standards and probably wont by the end of the semester
The instructor should have failed him in clinicals and that would have humbled him (hopefully). He sounds like a pompous jerk.
Don't let him make you feel any different because you did the right thing. I've had nurses resign because they didn't want "the young girl" being their supervisor. Some people are petty that way. Keep being great!
I wonder what semester he is on. Either way, it doesn't matter how old anyone is. To me, the nurse has the license I achieve to get and should learn as much as I can. As students (even in my last semester), I don't think we help a lot. Nurses still need to perform their own assessments and be there to give meds. My preceptor will question me about meds and if we should do a specific thing. I also try to tell her what my goal is for the day. I have had 1 preceptor who wasn't so great, but later learned of personal issues that were going on.
All in all, you sound like a great nurse and one I'd like to follow. Can always learn something new with every nurse, be it knowledge or their style of management and assessments.
I feel like your age here was just an excuse, and that he would have found another reason to dismiss you like that if you hadn't been younger. Sounds like you handled him like a pro :)
I like a lot of people am an older student with 90% of my class being younger than 24. I am currently on a surgical floor with quite a few of the nurses being a lot younger then me. That doesn't bother me in the least. If they know their stuff and can teach me I'm all ears. I'm there to learn not to judge. He obviously had no respect for anyone and I don't think it would have mattered if you were younger or much older I think he still would have had an issue. Good for you for being so strong through this event. I am a true believer that life likes to put people like that in our path to teach us and make us stronger 😊 it certainly has made you!
Tenebrae, BSN, RN
2,021 Posts
True story
In the city that I trained the head of the hospital was a rather tiny lady but mega cahones. The hospital had just been made smoke free and the hospital head was walking into the building when she spotted two orthopaedic registrars (trainee orthapedic surgeons) smoking outside of the hospital main doors.
When she politely requested these men move on, they apparently drew themselves up to a great height and stormed "who the hell do you think you are?"
I wasn't there but was told that both surgeons went a very nasty shade of green when she handed them her business card.
Moral of the story people. Always treat people with respect