Question for those of you who precept NP students

Specialties NP

Published

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.

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.

Specializes in allergy and asthma, urgent care.

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.

Specializes in Family Practice, Primary Care.

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.

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. :)

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.

Specializes in Adult Internal Medicine.
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.

I would point out that it is not a "step back" as he hasn't progressed past that point yet. In fact it may be a step forward for him.

Honestly the student sounds dangerous. In my opinion the most dangerous student is the ardent that doesn't know what he doesn't know.

Sent from my iPhone.

I precept as well. I think it is important that we let the school's instructors know about our concerns and give some concrete suggestions for improvement. My current student is very smart and works well with patients (she does have some RN experience). But her notes are pretty terrible. She is working diligently on this and has improved, but in my recent evaluation, I suggested she continue to turn in notes for grading and constructive criticism by her faculty.

Having said that, if a student were bad enough, or dangerous, or stubbornly insisting everything was OK when it wasn't, I would have no problem contacting the school and telling them to remove the student from my site. I don't get paid for precepting, and there is no reason I should have to spend so much time working with a student that I don't think is cut out to be an NP. And it is still *my* practice, for which I am ultimately responsible. (P.S. I saw this happen at my program when I was a student. It caused an uproar, but I totally get why the preceptors did what they did.)

Jules A raises a good point. Many NPs prefer to precept only students with experience in their specialty or their environment or with their population because they do not enjoy teaching remedial are basic concepts. Other preceptors do not mind and think that this is part of the job. I certainly think that a precepting NP should have this discussion with the nursing program prior to accepting a student.

Some nurses at the hospital I work are been nurses longer than I've been alive. They are going back to be an np. They are still clueless. Others barely worked as nurse and they do great. Time related experience don't mean crap if you just coast through without trying to learn. We have an np that works at our clinic end of the job, by that was an Rn instructor for 20 years. She couldn't pull it as an NP in the hospital. Nursing and nurse practitioner-ing are two totally different things.

What would be some advice from seasoned NPs to brand new students in NP school? I am constantly pushing myself and wanting to put my best foot forward so it'd be nice to hear what you guys think

Specializes in ICU, Telemetry, Cardiac/Renal, Ortho,FNP.

These are interesting insights but as a current NP student who has already practiced as a doctor for a decade and a couple of years with ICU stepdown as a nurse, I'd say lighten up a little! Not a lot, just a little. I agree prior experience doesn't guarantee anything in being an NP. I can say that first hand b/c some of the NP's I've precepted with were brutally honest about being horrible RN's on the floor! I know several NP's, doing very well, that never practiced a single day as an RN instead years, like me, as a D.C. It's hard to tell sometimes who will/won't do well. They are there to learn from you and it's hard if you're juggling a lot of things and the stress that you are now accustomed to is overwhelming to a student. I'm sure everyone has good intentions but honestly, I could have done without my Ob/Gyn preceptor doing grand rounds with every patient and medical Jeopardy questions all day long. It wasn't pretty and it didn't help. I think most programs require some time as an RN but that's the problem...too vague I guess.

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