Stop the preceptor madness!

[Rocknurse]

I just counted 21 posts on the main page alone that were all NP students looking for preceptors. How long is this madness going to continue? Why are schools not providing preceptors for their students? My school finds all our preceptors for us, as it should be, and it was one of the requirements I had when choosing a program. If we stop applying to schools that won't find you your preceptor then they'll be forced to adapt! No professional should have to beg.

[applesxoranges, BSN, RN]

Traditional programs in my area require people to find their own preceptors if they cannot place them. Some also "fudge" hours too. One girl's peds' hours was in an urgent care and she openly admitted that she didn't just see peds patients...

[myoglobin, ASN, BSN, MSN]

I believe finding a preceptor to be a significant challenge, but at the same time I'm not sure that there are any easy solutions. Consider my case where my school is online in Indiana (University of Southern Indiana) and I live in Florida (we moved from Indiana about eight years ago and my significant other graduated at the same University). Also my experience is ICU and I'm pursuing a Psych NP degree so my contacts are minimal (and in case I have essentially no relationships with MD's or NP's). It will be a challenge, but in the end I will probably have to "brute force" my way into getting a preceptor by contacting dozens if not hundreds of providers and be willing to drive up to 100 miles or more much as my significant other had to do. It would be nice if compensation could be offered much as it is to clinical instructors. I would certainly be wiling to pay a fee for this.

[Jules A, MSN]

Traditional programs in my area require people to find their own preceptors if they cannot place them. Some also "fudge" hours too. One girl's peds' hours was in an urgent care and she openly admitted that she didn't just see peds patients...

I have also heard a program in this area doesn't require the full peds rotation if having difficulty finding preceptors as well as counting AA and NA meetings toward clinical hours, yeah in the psych NP program not an undergraduate program. It disgusts me.

[Jules A, MSN]

Also my experience is ICU and I'm pursuing a Psych NP degree so my contacts are minimal (and in case I have essentially no relationships with MD's or NP's).

This is directed more toward schools than naive students but I am so opposed to those with no psych experience believing after two pharmacology and one diagnosing course they will be competent to treat the vulnerable mental health patients, and no your ICU patients who have mental illness do not count as significant experience in actually seeing the dosing, reactions of psychiatric medications and behaviors. In particular with children and addictions these inexperienced providers who's work I have seen are horrendous. Please consider getting inpatient acute psych RN experience and then you could easily find your own contacts.

[elkpark]

I believe finding a preceptor to be a significant challenge, but at the same time I'm not sure that there are any easy solutions.

Sure there are. Clamp down on the number of on-line nursing graduate programs. Require schools to provide vetted preceptors who are compensated by the school. In the B&M graduate program I attended, all of the clinical instruction was provided by clinical instructors who were at least part-time faculty of the school (joint appointments between the school and the clinical site).

But that's not going to happen, because nearly everyone in nursing apparently wants to be able to get a graduate degree in the privacy of their own home, in their jammies, without any significant inconvenience. It's no wonder other academic and clinical disciplines don't take nursing v. seriously.

[Rocknurse, MSN, APRN, NP]

I also find it very suspect that so many students have zero professional NP or MD contacts. Both my NP programs provided preceptors but I elected to get my own so I knew they were excellent diagnosticians and prescribers. Lets face it there are a lot of lame providers and we emulate our teachers in many ways so I wanted to learn from someone I knew was good not a brand new NP from the last cohort as were many of the school arranged preceptors. Even outside of my specialty when I got my FNP all I did was ask a few colleagues, they made phone calls and very quickly I had amazing, vetted preceptors.

This is not always possible. I was in the CICU for 4 years and both the ICUs in my hospital are non-NP friendly. They exclusively use PAs. Secondly having been in clinical informatics for the past 3 years I have not been in a clinical environment and so I literally know no one that I could ask to precept me. Luckily I don't have to as my school has contracts with all the major hospitals in my state and organizes all of our clinicals geared towards our career goals and aspirations. I've been a nurse for 25 years but I'd be hard pressed to remember any doctors or NPs I could call upon to ask to be my preceptor. Not even in dialysis did they utilize NPs. Each state is different.

[Jules A, MSN]

This is not always possible. I was in the CICU for 4 years and both the ICUs in my hospital are non-NP friendly. They exclusively use PAs. Secondly having been in clinical informatics for the past 3 years I have not been in a clinical environment and so I literally know no one that I could ask to precept me. Luckily I don't have to as my school has contracts with all the major hospitals in my state and organizes all of our clinicals geared towards our career goals and aspirations. I've been a nurse for 25 years but I'd be hard pressed to remember any doctors or NPs I could call upon to ask to be my preceptor. Not even in dialysis did they utilize NPs. Each state is different.

I had almost exclusively MD preceptors and find it odd that someone who worked in nursing for 25 years doesn't know any docs they can call for a favor. Maybe psych is different and we work more closely with the physicians? OR and ED also. My mother has a ton of MD and CRNA friends. As a RN I had 4 or 5 I was comfortable calling on their cell out of the blue for a favor like this.

[Rocknurse, MSN, APRN, NP]

I had almost exclusively MD preceptors and find it odd that someone who worked in nursing for 25 years doesn't know any docs they can call for a favor. Maybe psych is different and we work more closely with the physicians? OR and ED also. My mother has a ton of MD and CRNA friends. As a RN I had 4 or 5 I was comfortable calling on their cell out of the blue for a favor like this.

It's not odd when you consider I'm from another country :) Also, my school requires us to precept with NPs and not MDs although they will allow that if an NP is not available. The dialysis team I worked with for 5 years do not use NPs and the ICU I worked in for 4 years not only do not use NPs but the surgeons are extremely and notoriously non-collegial (if that's a word) towards us and I would not choose to work with them. Prior to that I was in the UK so that's not an option.

[Jules A, MSN]

Also, my school requires us to precept with NPs and not MDs although they will allow that if an NP is not available. .

Trust me when I say whenever possible a good physician has a far more extensive knowledge base and ability to bring you into the fold than even an excellent NP so imo would be a no brainer. I'd be sure to tell the schools there were no NPs available. Unbelieveable they aren't grateful for physicians willing to assist which except in the cases of horrible NP students would increase collegiality.

[myoglobin, ASN, BSN, MSN]

There is no way that I could afford to go to traditional graduate school. I earn 80K per year right now and cannot even afford medical benefits (I work without benefits paying the Affordable Healthcare Act penalty each year) due to previous student loans and other debts. I owe 100k in student loans, have no 401K and don't even own a home at 48 and my 16 year old son is getting ready to start college.I will also assert that my online courses that I take at the University of Southern Indiana are every bit as challenging as the undergraduate on site courses that I had for my ASN at Ivy Tech in Indianapolis or at Ball State, also in Indiana. Indeed, my significant other told me that the clinical instructors (MD's) that she found for her rotations were in most cases far superior to the clinical instructors that she had at IUPUI back in Indiana for her RN who in many cases hadn't practiced as staff RN's (or if they had only minimally) for years. My significant other who's only background was ICU graduated from the same program and was offered 120K right out of school in Florida no less and probably provides closer to state of the art medicine management than 75% of the MD psych providers that I've worked with before (albeit limited, but still 100's of patients over the years and half a dozen or more psychiatrists in the context of ICU's where I've been). At least she insists on CBT/therapy where appropriate, and monthly labs/EKG's for people on stimulants drugs for ADHD, and unlike many other providers I've seen especially in Florida almost never prescribes for benzos except in short term situations and even that is rare. What's more due to my semi "autistic", personality I could probably work in the same place for 30 years and not develop a single contact (and I pretty much decline to use even those contacts I develop based upon an aversion to the concept of socializing with fellow workers. I won't even use Facebook. I tend to be a bit of "strange" personality by any measure but usually get positive feedback from coworkers and patients). Indeed, when asked at school why I most want to be a psych provider it's' because I do in fact desire to provide tele-medicine in my pajamas ( at least pajama pants maybe with a polo shirt on since only my top half will likely be visible and preferably from a small abode in Kauai) and only leave my house to hike, snorkel, garden and maybe go to the grocery once in a while (indeed the primary reason I became a nurse about nine years ago was to live in Hawaii, but thus far my significant other is not interested in moving to an island).

I also think it worth noting that general medical or ICU experience provides a significant background in general pathophysiology that may often have direct implications for mental illness. Indeed, my significant other recently questioned the order of several resident psych MD's who were calling for a higher dose of Clonazepam for a patient with a primary diagnosis of catatonic schizophrenia who was on the verge of needing intubation. A finger-stick revealed a blood glucose in the 40's and it wasn't even considered as a differential by the residents. My point being that this is the sort of thing a nurse with a medical/ICU background would tend to think of first (along with an ABG and perhaps a stroke). Of course that doesn't denigrate the value of a psych background which has it's own value which is also invaluable.

If you think the requirements are insufficient lobby your legislative body for higher ones. However, at the present time they are what they are and I'm grateful that although challenging there are online options at least obtainable for many with work, effort, and a bit of luck that can facilitate a better career. I will do what it takes to find a preceptor hopefully in the Orlando/Tampa area. However, if it takes moving to a different state be it Oregon, Arizona or Texas that is what I will do. When we first moved to Florida I had to write about 2000 people on VRBO.com to find someone who would rent a fully furnished house with a pool/including utilities for the $1600.00 per month we could afford. I had about 1990 rejections and about five serious offers, and eight years later we are still in the same house. I would frankly prefer to "cold call"/write/lobby and beg a 1000 MD's/NP's that I don't know than ask even one I know personally. My threshold for rejection from "strangers' is very high, but my potential tolerance for such from friends and family is quite limited.

[db2xs]

I call BS too. Luckily, I am not ashamed to crawl on my hands and knees, begging anyone and everyone to see if they know someone who could possibly precept. It is ridiculous, however, that we have to at all.

I admit that the longer I'm in this NP program, the more cynical I feel, which is truly unfortunate.

[myoglobin, ASN, BSN, MSN]

I would also add that the greatest preceptor challenge for my significant other (and I anticipate for myself in the future) wasn't finding psych preceptors (NP's or MD) but family practice ones for the assessment class. That is because we need to find a clinic that sees adults, teens, children and pregnant females and infants. It also has to be one willing to let us do assessments. Thus, I would argue that if "working in the field" as I have in acute care/ICU for the last nine years was a great boon for finding a preceptor (as it is asserted that working in psych would be for finding those preceptors) then I should have no problem finding someone. However, that is not the case.