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Question for those of you who precept NP students

Posted

Specializes in dealing w/code browns and blues.

It seems as though the trend these days is for schools to churn out NPs as fast as they can with little regard to how much (if any) experience the student has as a nurse. I know I can't change that. I've precepted students in the past without any issues. However, right now I have a student that has less than a year experience as a nurse and quite frankly, it shows. How do you handle having to teach your NP student basic nursing skills as well as the clinical aspect of becoming a well rounded NP? Is it inappropriate if I suggest working as a nurse for a bit longer? Thanks in advance guys.

ChellyFutureNP

Specializes in Primary Care, Progressive Care. Has 8 years experience.

I understand where you are coming from and I used to think that an NP student must have at least 2 years of RN experience before going to NP school. However, I am following an NP at an Internal Medicine clinic who never had RN experience in her life and she is really GOOD. Her assessment skills is phenomenal. She is good at listening, very patient, and she has the skills of a nurse like I do. I have been an RN for 8 years and I am graduating in May of this year. Anyway, I think it all depends on the person. A few years of experience as a nurse is definitely an advantage. =) But is she feels like she is struggling, she definitely needs to practice or work as an RN for a little bit.

PS: Sorry for my reply... I know you wanted to hear from preceptors. Good luck!

doctorwhofan

Specializes in dealing w/code browns and blues.

Chelly,

Thanks for your reply. I work with an NP that bridged over and had never been a nurse prior to becoming an NP. She is very smart and a great colleague. It's not something that I personally could've done as I learn by "hands on". I have great respect for her in her practice.

Having said that, I feel that everyone is different and some people learn at different speeds. I just find it frustrating to have to weed through what this particular student does and doesn't know already. I was just wondering how others have dealt with this issue as I know it has become more common recently for nurses (or random bachelor prepared students-lol) to jump on the NP bandwagon. Should I have to assign the student to look up the differences in a PICC line and a TLC? Is this something he should already know since he's been a nurse? Should I be the one to have to explain what it means when a phone number shows up on the pager? Didn't he call a doctor when he was a nurse? These are the little things that are getting in the way of the daily NP stuff.

ChellyFutureNP

Specializes in Primary Care, Progressive Care. Has 8 years experience.

Chelly,

Thanks for your reply. I work with an NP that bridged over and had never been a nurse prior to becoming an NP. She is very smart and a great colleague. It's not something that I personally could've done as I learn by "hands on". I have great respect for her in her practice.

Having said that, I feel that everyone is different and some people learn at different speeds. I just find it frustrating to have to weed through what this particular student does and doesn't know already. I was just wondering how others have dealt with this issue as I know it has become more common recently for nurses (or random bachelor prepared students-lol) to jump on the NP bandwagon. Should I have to assign the student to look up the differences in a PICC line and a TLC? Is this something he should already know since he's been a nurse? Should I be the one to have to explain what it means when a phone number shows up on the pager? Didn't he call a doctor when he was a nurse? These are the little things that are getting in the way of the daily NP stuff.

YES, that sounds very frustrating. Reading your specific examples got me all stressed out. =) Well, I'm interested to hear what precepting NPs have done in these types of situation. My other preceptor is precepting someone who also never had experience as an RN and she is also frustrated about it. I honestly told her that I wouldn't know what to do except tell her to review these things at home. But not everything could be learned just by reading or watching.... Hmm. Tough life.

greygooseuria

Specializes in Family Practice, Primary Care. Has 6 years experience.

Even a nursing student straight out of school should know those things so that all seems a bit odd.

llg, PhD, RN

Specializes in Nursing Professional Development. Has 43 years experience.

I am not an NP, but I have precepted other types of grad students.

My advice: Be sure to give that feedback to the instructor -- and incorporate that information into your evaluation of the student and grade. The school needs to know that is sent you a student who was unprepared for the realities of NP practice. And the student needs to hear that his performance is not up to par. Within your role as a teacher, it is your responsibility to all involved to provide them with that negative feedback so that they can address it -- both within this student and for future students of that school.

Sometimes, we have to give bad news to patients... and sometimes, we have to give bad educational feedback to students and/or the schools that sent those students to us.

I don't mean this to be as callous as it may sound, but sometimes I think to myself, "This is what bad grades are for."

anh06005, MSN, APRN, NP

Specializes in Cardiac, Home Health, Primary Care. Has 6 years experience.

Definitely discuss issues with the actual clinical instructor. As a home health RN we sometimes took pharmacy students (3rd-4th year) so they could do patient education and see what the patients can be up against. There was one student who did online shopping on her phone in the home, didn't seem to listen, and told the patient he can try to take something the caregiver said (not 5 minutes before) he can't take due to adverse reaction.

This student went out with several of us and all of us noticed something was off and it worried us. We discussed it with the professor and we aren't really sure what happened to the student but we don't think she graduated. We didn't want the schooling to go to waste but from what we saw she was unsafe.

Again not sure where the student is now but hopefully not in a position to truly impact lives and physical health unless she did a 360 and got her head on straight. Unfortunately wanting to do something isn't quite enough in healthcare. You must be safe too.

doctorwhofan

Specializes in dealing w/code browns and blues.

I am not an NP, but I have precepted other types of grad students.

My advice: Be sure to give that feedback to the instructor -- and incorporate that information into your evaluation of the student and grade. The school needs to know that is sent you a student who was unprepared for the realities of NP practice. And the student needs to hear that his performance is not up to par. Within your role as a teacher, it is your responsibility to all involved to provide them with that negative feedback so that they can address it -- both within this student and for future students of that school.

Sometimes, we have to give bad news to patients... and sometimes, we have to give bad educational feedback to students and/or the schools that sent those students to us.

I don't mean this to be as callous as it may sound, but sometimes I think to myself, "This is what bad grades are for."

Thanks for the advice. I am also of the belief that sometimes people get bad grades. It's weird-I feel he has the book part down ok but the practice part is not there. I don't really feel this is entirely his fault. I feel the school should take some responsibility in assessing students prior to admitting them to a graduate level course that requires critical thinking skills that are to be put into daily use.

I spoke with him a few weeks ago. I told him that I didn't feel he was as far along as he should be considering we were 2 months in. I asked if he had any thoughts as to what would help him out. He also thinks he needs more experience. I can't fix that at this point in the game.

penniv

Has 13 years experience.

I think as preceptors we have a responsibility to our patients, peers and the public to produce the best students we can. That being said, we are dealt the hands we are dealt.

I'm an Ortho NP and so it is a rare day that I get a student with Ortho experience. I do expect them to have a basic working knowledge of nursing though. I had a student a few years ago that took the fast track RN-MSN and I told her that I didn't think she was ready to practice as an advanced practitioner until she had better critical thinking skills. She understood and discussed it with her advisor. She cut back to part-time and started working part-time at a local hospital to help gain some experience.

Hope this helps!

Penni

rnsrgr8t

Specializes in Peds Urology,primary care, hem/onc.

I precept Grad students all the time and totally agree with the other advice you have been given. I would definitely call the instructor for the program and have a discussion. I have not had students that did not have prior RN experience but you can be concrete in your examples of where he is lacking. I would also give these to your student (so he has clear documentation of where he is lacking). You are there to teach them how to be an NP. The understanding is they have the basics down prior to coming to you. Example would be you would not expect a Graduate level Pathophysiology professor to teach remedial A&P b/c their students have not taken the class/do not have the basics etc. I do not think this is necessarily a reflection of the no RN experience (as PP have said, they have had those students without an issue) but a reflection on this student. Bottom line is you are not doing him or his future patients any favors by not addressing what you are seeing.

I typically have always had students I have LOVED. Last year I had one that I thought was going to give me grey hair. Was not a lack of nursing experience, just no people skills or critical thinking skills (one of THOSE scary nurses you always worry about when you work with them). I worked with this student and her instructor VERY closely throughout the semester and thought we had made enough progress I was ok to pass her. Ran into a friend of mine that works in a different department and she ended up failing her b/c she went on to work with her and she completely regressed and was back to the way she was before she did her rotation with me. We feel bad and want them to succeed, but just like in nursing school, sometimes we cannot let them b/c they are just not working at the appropriate level. Good Luck!

BostonFNP, APRN

Specializes in Adult Internal Medicine. Has 9 years experience.

Having precepted for a number of years both medical students and NP students in both the hospital and clinic settings, this is my personal/professional experience:

1. Prior experience can either be a great help or a great hindrance. One of my most challenging students, who in the end I was unable to pass, was a NP student who had almost 30 years of trauma ICU experience at a level I center as an RN. She did wonderful in the hospital setting. She really struggled in the clinic setting where she was not able to balance her prior acute experience with her primary care APN education.

2. Some NP students absolutely need prior RN experience; this is often evident right away.

3. Some NP students don't require any prior RN experience. One of my best students (and now providers) had no experience in healthcare.

4. Education can be a double edged sword. I often find medical students are much more adept at firing off a differential by often that differential is beyond what would initially be considered and results in wanting to order more tests or medication than is required.

5. Education is not all the same. We stopped accepting students that are not in one of two local programs because we found them to be unprepared.

In short, if you think they need more RN experience than that is within your role to discuss with them and their faculty.

Sent from my iPhone.

doctorwhofan

Specializes in dealing w/code browns and blues.

Thanks everyone. I appreciate all the insight.

Jules A, MSN

Specializes in Family Nurse Practitioner.

I only precept NP students I know as psych RNs from one of my jobs or those who come highly recommended from a colleague or friend. I'm happy to have anyone spend a day with me who has an interest in getting a feel for psych or my role as a psych NP but I am not willing to precept a NP student with no psych experience who will likely be a sub par provider.

I'm happy to have anyone spend a day with me who has an interest in getting a feel for psych or my role as a psych NP >>

Hi Jules,

I'm a little confused; I just read another post where you said you attended a community college, and that your undergraduate degree has served you fine. Is there a non-postgrad NP program somewhere out there? If so, I'd love information about it.

BCgradnurse, MSN, RN, NP

Specializes in allergy and asthma, urgent care. Has 11 years experience.

I've precepted FNP students for a few years. It seems to me that their ability to succeed is independent of their nursing background. I've had really sharp students with no nursing experience, and one horrible experience with a very seasoned RN. This particular student just couldn't get out of the "following someone else's orders" mindset. She had so little confidence in herself, and it hampered her ability to think critically and go through assessment, differential diagnosis, and treatment processes. I did have to speak with her advisor and she ultimately dropped out of the program. Give me a student who is smart, willing to work hard, and is able to think critically any day, regardless of how much nursing experience he or she may have. I will only accept students from a few reputable programs in my area-I will not take them from online for-profit schools.

greygooseuria

Specializes in Family Practice, Primary Care. Has 6 years experience.

I forgot to add, I precepted a student from a local school for a clinical rotation this semester and it was a blast. I had a great time teaching and I basically took her from someone who was scared to see a patient alone to being completely independent and basically doing my job (obviously I followed her and made sure her orders were good and did differentials with her, etc.) but my goal was to make her as high functioning as possible. She even ran a code by herself (but she's also an ICU nurse)! It was a very positive experience.

Jules A, MSN

Specializes in Family Nurse Practitioner.

I'm happy to have anyone spend a day with me who has an interest in getting a feel for psych or my role as a psych NP >>

Hi Jules,

I'm a little confused; I just read another post where you said you attended a community college, and that your undergraduate degree has served you fine. Is there a non-postgrad NP program somewhere out there? If so, I'd love information about it.

Perhaps I should have said my undergrad degree served me well? I'm a NP now with a MS and post master's certificate. :)

Edited by Jules A
typo ;)

doctorwhofan

Specializes in dealing w/code browns and blues.

Update-I spoke with him about working as a nurse for a bit longer after finishing his Masters. He thought that was unacceptable to "take a step back". I pointed out some of the things he had been lacking in for basic nursing knowledge and I was told that he "had been working on this and as a student it can't be held against him for continuing to learn". Sigh. We even had a great opportunity come up when he asked what a very common abbreviation was on the chart. I explained. He said he'd not heard of it so I reminded him that perhaps this was a reason I had suggested practicing as a nurse for a little longer. He still doesn't feel it will be necessary. I will be speaking with his clinical instructor next week. At this point he is quite defensive when I try to teach him things or correct him on things that he is wrong on. Thanks again for all the advice with this one! I think I will start screening before I agree to more students.