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Questionable Preceptor

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by MagicalBunny MagicalBunny (New) New Student

I am currently a student doing my capstone/transition to practice on a medsurg floor and will graduate in about 3 weeks. This is my first time being back in the hospital since COVID hit. I have not been in the hospital or seen a real patient in about 4 months. I have told my preceptor this and have asked her to be patient with me. I am assigned to the same preceptor for 11 12 hour shifts. This is my first time seeing certain skills, equipment, etc. For example, my first day on the unit was the first time that I have seen drains (penrose, JP) and I asked her if she could explain what it is and how to drain it because my school did not teach us about them. My preceptor responded with "How have you not seen this before?" She asked me to do a central line blood draw as well which my school also did not cover how to do so I told my preceptor if she could could explain to me how to do it as I go because I have never done one before and she rolled her eyes and said "Just watch me do it" but did not explain what she was doing when performing the skill. She also told me to push meds no matter what it is over about a minute, which seems unsafe to me. She was annoyed with me when I was pushing the meds too slow and I explained to her that the drug book said to push it over a certain number of minutes which is why I was going slow. When I have questions she gives me very short vague responses and seems irritated that I do not know certain things. My preceptor has not really taught me anything and makes me feel like I cannot ask questions due to her vague replies. It is just frustrating because I was looking forward to be with a preceptor and potentially getting a job on the unit after graduation. Is there something I can do to make my experience better?

Been there,done that, ASN, RN

Has 33 years experience.

Preceptor does not want to teach. I applaud you for using your own judgement. Make sure your instructor is aware of the main issues ( so far) of having you draw from a central line and pushing IV meds too fast.

Good luck.

I agree, she does not want to teach and also may be one of those people who need to continually bolster their own self-esteem by finding some kind of fault with others.

Preceptors should understand that there are numerous things to which students will have had no first-hand real life exposure.

I'm sorry your experience is going this way.

While this isn't your fault and it isn't even really about you, you may be able to make some gains by taking a more proactive approach and show her that you are being responsible for some of your own learning. I'm not saying you are doing this, but I do think it's inappropriate for students whose schools have provided poor learning experiences to show up on a nursing floor and expect a preceptor who has a full patient assignment to fill in all the gaps including teaching lessons that could have at least been mentioned in basic M/S nursing classes or in the lab or in the prior clinical experiences.

I would not expect a student (even in the last rotation) to know their way around the different drains. On the other hand, drains are a pretty basic part of M/S nursing and I guess I would not feel truly great about a student just asking me for a mini lecture about them. I would like for the student to briefly review on their own so that they can ask specific questions or double-check their understanding.

Does that make sense? I would stop mentioning that your school didn't teach you x, y, z and just do your best to 1) observe when you have the opportunity 2) quickly review when you are completely unfamiliar with something so that you can ask specific questions rather than asking for a complete lesson.

Have you reviewed your texts to understand the CL blood draw procedure now? Reviewed the facility's policy and procedure? This is how you learn. She easily could have talked you through it, and that's what I would've done as a preceptor. OTOH, you aren't completely helpless so I hope you have reviewed these items on your own now that you have seen a central line and observed how she drew blood from it--rather than throwing up your hands and not supplementing your own learning because she doesn't like teaching. Take every opportunity to supplement your experiences by reading and reviewing what you have seen that day.

Follow the medication administration procedures you were taught. I'm sorry you are faced with the pressures of someone who wants you to do wrong.

Hang in there! Do everything you can to stay in the game and learn as much as you possibly can. Best of luck ~

TriciaJ, RN

Specializes in Psych, Corrections, Med-Surg, Ambulatory. Has 40 years experience.

I can't add to the great advice you've already been given.  You have the double whammy of a school that skipped a lot of things, and a preceptor that doesn't relish filling in the gaps.  So you're going to have to be doubly self-directed.

You are going to spend a lot of your own time boning up on things.  As much of a pain it is now, it will make you a stronger and more resilient nurse.

Hang in there.

Chickenlady, ADN

Specializes in ER, GI, Occ Health. Has 7 years experience.

She shouldn't be precepting.  Even if she thinks you "should" know how to do it, it is her job to teach you the correct procedure as per hospital policy.  I think we all know that how things are taught is school and how the hospital wants it done can be quite different. 

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 10 years experience.

On 7/20/2020 at 7:47 PM, JKL33 said:

I agree, she does not want to teach and also may be one of those people who need to continually bolster their own self-esteem by finding some kind of fault with others.

Preceptors should understand that there are numerous things to which students will have had no first-hand real life exposure.

I'm sorry your experience is going this way.

While this isn't your fault and it isn't even really about you, you may be able to make some gains by taking a more proactive approach and show her that you are being responsible for some of your own learning. I'm not saying you are doing this, but I do think it's inappropriate for students whose schools have provided poor learning experiences to show up on a nursing floor and expect a preceptor who has a full patient assignment to fill in all the gaps including teaching lessons that could have at least been mentioned in basic M/S nursing classes or in the lab or in the prior clinical experiences.

I would not expect a student (even in the last rotation) to know their way around the different drains. On the other hand, drains are a pretty basic part of M/S nursing and I guess I would not feel truly great about a student just asking me for a mini lecture about them. I would like for the student to briefly review on their own so that they can ask specific questions or double-check their understanding.

Does that make sense? I would stop mentioning that your school didn't teach you x, y, z and just do your best to 1) observe when you have the opportunity 2) quickly review when you are completely unfamiliar with something so that you can ask specific questions rather than asking for a complete lesson.

Have you reviewed your texts to understand the CL blood draw procedure now? Reviewed the facility's policy and procedure? This is how you learn. She easily could have talked you through it, and that's what I would've done as a preceptor. OTOH, you aren't completely helpless so I hope you have reviewed these items on your own now that you have seen a central line and observed how she drew blood from it--rather than throwing up your hands and not supplementing your own learning because she doesn't like teaching. Take every opportunity to supplement your experiences by reading and reviewing what you have seen that day.

Follow the medication administration procedures you were taught. I'm sorry you are faced with the pressures of someone who wants you to do wrong.

Hang in there! Do everything you can to stay in the game and learn as much as you possibly can. Best of luck ~

Definitely all of this. A preceptor for a nursing student is not there to provide information your school failed to teach you. They are there to reinforce teaching through hands on, real time experience. Big difference. As a preceptor who loved to precept, a student coming in and demanding I "go slow with them" would irk me quite a bit. In fact, long before Covid challenges, I told every student that I precepte, that that my job was to care for the patients and give the student experience opportunities. Then I told the student that their job was to keep up with me and do their own research. I wouldn't be slowing down for them so if they wanted to learn, keep up. They always did too.

Your preceptor isn't enjoying precepting you. I would discuss with your instructor and see if you can be reassigned. It may be you, but honestly nurses are just plain burned out through Covid. Having a student around can sometimes just be the straw that breaks the camel's back on an otherwise really good camel.

On 9/10/2020 at 1:53 PM, Chickenlady said:

She shouldn't be precepting.  Even if she thinks you "should" know how to do it, it is her job to teach you the correct procedure as per hospital policy.  I think we all know that how things are taught is school and how the hospital wants it done can be quite different. 

She is a student, NOT an employee. There are no policies on what a bedside nurse is required to "teach" a student and tons around how the nurse is responsible for patient care and safety. The onus is 100% on the school to teach, until the student is hired on as a floor nurse. Then the hospital must teach.

juan de la cruz, MSN, RN, NP

Specializes in APRN, Adult Critical Care, General Cardiology. Has 27 years experience.

At first, I was like "what a ...!" but then I read the responses and agree, this staff nurse does not need to take on the school's faculty role 100%.  That preceptor is not getting any extra perk for the extra responsibility.  And the preceptor may just be projecting their own experience as a senior nursing student who already knew about the things the OP still lacked knowledge on that much farther in the program.  Unfortunately, the OP have the COVID pandemic putting a damper on the entire situation.

Agree that it is up to the senior nursing student to really start "putting things together" and not rely on being "spoon fed" if you will.  That's one of the purposes of the senior preceptorship.  Ask yourself, why does my patient have those drains and what surgery did they have?  Look up information on a Penrose and a JP which is not that hard to find.  What are central lines and why are they used?  I'm sure you'll find a Youtube video about it.  This is not teaching yourself nursing...this is making an initiative to learn ahead so that the rest of the process becomes easier.

I find that even for practicing nurses, we still have to constantly look up information for ourselves whether it's because we have a new patient diagnosis we haven't seen before, a new medication, or a new policy or procedure.  We never say "I was never taught that in nursing school". Bottomline is, don't be all "cocky" and "know it all", but at times, you can impress a staff nurse on the unit if you start doing your own homework and having an idea of what they are showing you on the unit.

PS...I think complaining about her to your faculty could potentially hurt you so I would think twice about that.

amoLucia

Specializes in LTC.

On ‎9‎/‎10‎/‎2020 at 2:53 PM, Chickenlady said:

She shouldn't be precepting.  Even if she thinks you "should" know how to do it, it is her job to teach you the correct procedure as per hospital policy.  I think we all know that how things are taught is school and how the hospital wants it done can be quite different. 

I'll speak on behalf of the preceptor. She prob had NO choice in being selected as a preceptor. It most likely was just thrust upon her. Some folk don't have the skill or DESIRE to teach/precept. Even if s/he could be an excellent skilled practitioner.

The hospital that I was precepting in has a program where preceptors get paid extra for precepting students. They have a list of preceptors on each floor that are willing to take students. My preceptor actually choose to precept me so she did have a choice. 

I did end up taking the initiative to learn on my own what the types of drains are for and how to care for them after my first day. I understand that she could not teach me everything there is to know; however, it was my first day on the unit and did not have time to look things up at the time which is why I was asking questions. 

londonflo

Specializes in oncology. Has 44 years experience.

On 7/20/2020 at 3:06 AM, MagicalBunny said:

She also told me to push meds no matter what it is over about a minute, which seems unsafe to me.

I have heard that philosophy from quite a few nurses. Instead of knowing the safe administration time they just do everything slow. I had one nurse tell me she does everything over 5 minutes! What a way to waste time if there is no minimum amount of time needed. Also, what is the patient going to think if someone else gives it fast? Scary to have each nurse do something different. 

On 7/20/2020 at 3:06 AM, MagicalBunny said:

doing my capstone/transition to practice on a medsurg floor

There are things you absolutely need to know when caring for post-op patients. Read or re-read those chapters in your textbook. If the book does not show pictures of a penrose or Jackson-Pratt look them up on the internet. Spend time looking at the 4 areas every post-op patient needs to be assessed in: Wind (lungs, gut) Water (IV, UOP, I & O etc) Walk (are they ambulating? any signs of DVT? Any DVT prophylaxis?) and Wound (drains, dressing, pain, swelling etc). If the patient has or develops a temp, check the 4 W's all over again.

 

On 7/20/2020 at 7:47 PM, JKL33 said:

I would not expect a student (even in the last rotation) to know their way around the different drains. On the other hand, drains are a pretty basic part of M/S nursing and I guess I would not feel truly great about a student just asking me for a mini lecture about them. I would like for the student to briefly review on their own so that they can ask specific questions or double-check their understanding.

Does that make sense? I would stop mentioning that your school didn't teach you x, y, z and just do your best to 1) observe when you have the opportunity 2) quickly review when you are completely unfamiliar with something so that you can ask specific questions rather than asking for a complete lesson.

Have you reviewed your texts to understand the CL blood draw procedure now? Reviewed the facility's policy and procedure? This is how you learn. She easily could have talked you through it, and that's what I would've done as a preceptor. OTOH, you aren't completely helpless so I hope you have reviewed these items on your own now that you have seen a central line and observed how she drew blood from it--rather than throwing up your hands and not supplementing your own learning because she doesn't like teaching. Take every opportunity to supplement your experiences by reading and reviewing what you have seen that day.

Follow the medication administration procedures you were taught. 

~

Above (JKL33) gives the best advice in the world.

hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, SOL (Student of Life). Has 19 years experience.

On 9/29/2020 at 5:55 PM, MagicalBunny said:

The hospital that I was precepting in has a program where preceptors get paid extra for precepting students. 

My facility has a program like this and  do you know how much extra I get to precept a student or new hire? $1.00/hour. That won't even buy my lunch. Still I love to teach and precept especially when  my preceptee is eager to gain skills and knowledge to aument what they already know. I run a very busy adolescent psych unit and I will usually say something to students like I have a lot to show you and only a couple of hours a day to do it. I am not here to teach you how to be psych nurse I'm here to show you what being a psych nurse is like. 

Our new hires get an 8 week training which is pretty good in the world of in-patient psych. Many days I walk into multiple discharges and admissions and having to do focused assessments on 14 to 18 patients that's right me with 14 to 18 patients to care for and keep safe. I tell my new hires that hey will be with me for 4 days and I have a lot to teach them before I pass them up the line do the next RN whose first question will be "What did Hppy teach you?"

I had the rare experience of having some astoundingly great preceptors and I try to always pay it forward.

Hppy

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 10 years experience.

I have never seen a hospital give extra pay for precepting nursing students - only newly hired staff. Interesting.

londonflo

Specializes in oncology. Has 44 years experience.

1 hour ago, Nurse SMS said:

I have never seen a hospital give extra pay for precepting nursing students - only newly hired staff. Interesting.

The State Nurse Practice Act for teaching in this state must allow for this. I wonder if the credentials of the preceptor are sent in? In my state I have seen the BSN programs 'drop' a student off for a preceptor to supervise. The is a faculty member who stops by but the staff nurse, for the most part, supervises. I wonder about the International College of Health Sciences who has the PN to Associate RN  program students find their own preceptors in their local area. Who is really held accountable for a student's learning and evaluation? 

This is off the topic but I had a horrible experience with a Master's student from one of the big for-profits who in the 8 weeks I had her on her clinical practicum come once on time for clinical - otherwise not a few minutes late but hours. It was really disruptive because I had to stop to brief her and we were in the full swing of things. When I called her professor I was told:  she has children, is working a travel position several hours from her home (drives there and back daily) and is going to school fulltime. I was essentially told 'give her some slack'. When I asked for the course objectives so I could find out what I was going to evaluate her on and have any kind of documentation, I was told those would be sent by another department when I was to complete them in several weeks.

When I took a planned clinical day off,  adjunct  X covered who was a graduate of the same for profit school. The MS student promptly changed to that person's clinical and I received a snippy note from the professor that X was a 'better fit for the practicum.' Thank God!  (BTW) on the first day with her 'new' preceptor I was told by another faculty that the MS student showed up hours late and was seaching for her new clinical area. From what I can see she has never been hired in a faculty position. And adjunct X (who also wouldn't follow our guidelines)  has interviewed but not gotten any full time  faculty work in the area. -