Unsolicited Advice From A Preceptor

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    We all understand the difficulty in finding preceptors. Now that I have started precepting students, I understand why. Here is some unsolicited advice to NP on appropriate behavior during clinicals.

    Unsolicited Advice From A Preceptor

    I'm an FNP and I want to share some advice that I assumed was obvious, but apparently is not. I started precepting students this fall and i had four over the semester. Two were rock stars - one is just graduating and I recommended her for a job with my practice and she was hired, the other is graduating in May and I told her that I would love to recommend her for a job as well.

    Student 3 was very good, and I would have been happy to recommend him as well, until his last day. I see patients in nursing homes and assisted livings and go to several facilities each day. On his last day, we made the morning rounds, and then I told him to meet me at the last place after lunch. About a half hour later, he texted me and asked if he could skip the afternoon since it was going to be a light load, and he had a lot of studying he wanted to get done.

    You do not ask a preceptor if you can leave early or skip a day etc. unless it is for something urgent (a sick child or such). Right there my opinion of him changed and I wouldn't recommend him for a job now.

    Then there was student 4. She's been a psych NP for five years and is getting her FNP certificate, so you'd think she'd understand the basics of professionalism. First, she was late every day except one, often over 30 minutes. She had a long commute, so I even told her to meet me at my second stop instead of my first (about 45 minutes later) to make it easier for her. She was still always late, and usually never notified me at all.

    Then on her last day, she went to the skilled unit at the facility, even though we always started on the assisted living side, and saw a patient without me even knowing she was on-site. It was a new admission who I had never seen, which makes it even worse. She finally came over to find me an hour and 15 minutes after her scheduled start time. She did not contact me at all to tell me she would be late or that she was at the skilled unit. This was so far out of line. I was tempted to fail her for the rotation, but I'm probably too nice and passed her with a poor evaluation.

    My points are:

    1. Your preceptors are doing you a favor. They usually do not get paid for this. You need to respect their time.

    2. Show up on time. And that means early. Allow time for traffic. Think about how you feel sitting in the waiting room when your provider is running late. It sucks. So be on time.

    3. Do not go off on your own unless your preceptor tells you to. It is completely unprofessional to see patients without permission from your preceptor.

    4. Treat every rotation as an extended job interview. At a minimum, you want your preceptors to be willing to provide references for you, and you might find it's a place that you would like to work. If you leave a bad impression, you will definitely lose your chance of working there, and will likely lose your reference as well.

    5. When a preceptor has a bad experience with a student, they are less likely to take students in the future. I know how hard it is to find preceptors, and if providers stop offering because they have bad experiences, it makes it harder for everyone.

    I'm not going to stop precepting (although now I definitely understand why providers do stop), because I had some great preceptors who really went out of their way to help me, so I'm going to keep paying it forward. But I'm really frustrated right now.

    Please, I ask everyone to be professional on their rotations - show up on time, follow professional standards and norms, work hard, and generally act like you want to be there.
    Last edit by Joe V on Jun 16, '18
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  3. by   CrunchRN
    I would give dude #3 another chance. He was just stressed.#4 may be a lost cause.
  4. by   caliotter3
    Professionalism never hurts. At the provider level, these tips should not even be necessary. Sad state of affairs.
  5. by   Izzy11
    Quote from CrunchRN
    I would give dude #3 another chance. He was just stressed.#4 may be a lost cause.
    I went out of my way on some other things to help him out that I didn't get into on this post, so it really rubbed me the wrong way that he wanted to skip out on what would've been about an hour of clinical time. But I get what you're saying.

    Quote from caliotter3
    Professionalism never hurts. At the provider level, these tips should not even be necessary. Sad state of affairs.
    Right. I thought this went without saying.
    Last edit by Izzy11 on Dec 9, '16
  6. by   Kate_Peds
    Very insightful and much appreciated advice!
  7. by   applesxoranges
    In all honesty, I think people are too nice sometimes. In my paramedic program, they offered to sign all my patient logs because I had so many hours with them. I didn't let them but some people offer to let their students go home early and still sign them off.

    Whenever I had EMT students, I always made sure that there was something we could do such as mess around with IV catheters so they could work on their skills or practice EKG recognition with them if it was a slow night.
  8. by   Buyer beware
    Let's cut to the chase so there should be no regrets.
    Screw the respect. In the post modern world people get paid.
    You want respect get paid and the respect will follow.
    This isn't about some religious calling.
    I've actually heard from some of the most notorious quisling instructors at for-profit schools, of all places, that preceptors (teachers) should want to "pay it forward." This is pretty near the biggest joke I've ever heard.
    Don't be foolish. Most schools would rather take poison then cut the preceptors in on the NP cash cow.
  9. by   cjcsoon2bnp
    As the OP and some commenters have said, it is a sad state of our current professional environment that we actually need to say these things and they are not simply understood. I completely agree with these tips and are things that I pass to my undergraduate students in my clinical and as I progress through NP school I will keep them in mind for myself as well.

  10. by   marcos9999
    I had the opportunity to see good preceptors and horrible ones. I think is interesting how nursing preceptors can vary wildly. There is a quality either being really good or really bad...just a thought
  11. by   imenid37
    When I was getting an MSN in nursing education, I had to take physical assessment and two advanced perinatal nursing courses. I spent time with an adult health NP in the Women's Clinic, another adult NP and PA in an internal med clinic, and an NNP for PX assessment and time with a CNM for the perinatal nursing courses. These people knew I wasn't going to be a colleague, but they went out of their way to show me things and facilitate my getting my requirements completed. Hang in their OP. There are people who really appreciate YOU and YOUR TIME. I will be forever grateful to those who helped me. I know my course coordinator checked in with the preceptors. You may want to remind those slacking students that you have to give honest feedback about their work and professionalism. You shouldn't have to, but there are many immature students out there,independent of their chronological age.
  12. by   NurseLauraM
    On Student #3:
    Whether or not leaving clinical early is considered acceptable depends very strongly on the preceptor and the culture of the unit. I recently finished my NP program, and I had some preceptors who approached clinical with a "these are your hours, I don't care how and when you schedule them, just let me know when you are coming and going". These preceptors would have been OK with me texting to say I was going to study instead, although I never did. I did have one preceptor who often sent me home because her schedule was so light (specialty setting). I never asked to leave, but I did appreciate the extra study time when she gave it.

    Anyway, I digress... while I was occasionally sent home early, I never asked to leave early. Furthermore, if I had, I would have gotten permission way in advance. Exam schedules come out at the beginning of the semester so there isn't really any excuse for texting day of. The only way I could see that as acceptable behavior would if there were already some kind of agreement beforehand allowing it, which I suspect you didn't have. That being said, it sounds like this was strike 1 for this student and hopefully it was just a fluke thing.
  13. by   SopranoKris
    Wow, OP, I am always saddened when I hear of NP students who lack professionalism. I view my upcoming clinicals just as you said, as a potential job interview. I am of the "old school" where being early is on time and on time is late. I couldn't imagine acting how you described student #4. Did she think because she was already a Psych NP that it made her somehow exempt from common courtesy? Going through nursing school, there was a zero-tolerance policy for tardiness. One tardy was a written warning and extra assignment. A second tardy was dismissal from the program. I would think we would hold ourselves to the same or higher standards as we go through our NP training.

    Please know that there are many students out there who really do care about being a professional and will put the time and effort in to it.
  14. by   Daisy4RN
    I think it is sad that you would have to tell people they need to behave as professionals in that situation. We used to learn this in even our first jobs (fast food etc). Maybe its society in general or maybe these people have never learned this, sad either way because it should also be, to a certain extent, common sense. If necessary the Preceptor can and should set the boundaries from the very beginning for those who lack the "professional" skills.