Why preceptors don't precept

[sauce]

I found this article in my E-mail recently, it was a pretty good read, and if one goes around the site they will see several other complaints by preceptors pushing the same issue.

Students are not prepared for clinical.

Has the Bar Been Lowered for RN/NP Programs? : Clinician Reviews

I have seen this in a few students I precept also (which I only do now from certain schools). I had a few kids from online universities (the for profit crap-wagons) as students a few times. It was awful. None of them had any clue how to diagnose, prescribe, or even really do a true physical exam. Basic stuff they should have learned in nursing school, much less an MSN program.

Get with the program people, you go to these for profit schools with no requirements besides a BSN degree, don't learn squat, and expect us to precept you?

Sorry this is real life.

This message is brief, and to all those people who attend these junky schools. Stop making our profession look terrible. If you cant get into a real school, then many you should just stay a nurse, you probably aren't cut out for the real deal MSN level thinking.

Yeah, yeah, I know I sound harsh, but your type are the reason that our profession is looked down upon by so many. Personally, I am pretty well respected, but every time I start a new job or meet a new doc or whatever, I have to prove myself, and it is because of sloths that attend these programs and lower our standards.

So the take-home is. Don't go to a crappy school and expect to find a preceptor, we know better than to waste our time with you. Go to a well respected school and we will be glad to help you out the best we can and accommodate you.

I already wrote a nice long, nasty letter to our credentialing agencies telling them this, of course they turn a deaf ear. The credentialing groups for nurse practitioners is weaksauce, and ran by a bunch of DNP- think they know it alls that are trying to I don't know what, by pumping as many nurse practitioners into the market, ignoring quality.

I cant wait for the flames from this one, people on this forum seem to resent the truth, and sit in their little happy-bubble world full of white coats, stethoscopes, and hopes for a big easy paycheck.

And to those who come here, from those, for profit schools and try to tell us that they were one of the students who "went above and beyond, because learning is about what you put into it" I have one thing to say. you already told us what you put into it by going to one of these programs. A lot of money and no thought. School is supposed to filter out those who aren't fit. PA and MD/DO schools do this. Yeah, every once in a while a junky one slipps by, but you know its a lot less frequent than NP schools.

Just fess up and admit that this is all true.. Preceptors are seeing it everywhere.

NP education is a lax joke with fluffy requirements.

I also gave psychguy and Jules A a personal spot to like this post. Why? Because they have great wisdom and common sense, and you all don't like what they say, because its the truth.

sauce out.

[SkiBumNP]

And don't get me started on how NP schools are too effing cheap to compensate high-quality preceptors.

[IsabelK]

I precept. I don't like to precept first semester clinical students because they don't have enough internal medicine knowledge to make the leap to geriatrics. What I find is that I get NP students coming through who have the book knowledge the school gives them about prescribing, labs, etc, but that previous preceptors many times don't let them practice working with any of it. Physical exam skills tend to be good, but the actual "exam, then do" is lacking. When my students are there I make them sit with labs and med lists and diagnoses and tell them to "figure it out". Generally that starts with them talking through it with me and as the rotation goes on it's them coming to me with assessments and plans, including meds, future labs, and reasons why. I won't take "it's the guideline". Ok, nice, but why??? I also let them practice writing prescriptions for everything from PT/OT (I work in LTC) to actually writing the controlled substance scripts. Since the facility still uses paper, they have to think and can't rely on an EMR to populate meds. This means they have to know how to look up dosing guidelines. This is from a school that does weed out people (I've had students set up to come to clinical and then be told they're not coming because they failed a mock physical exam with SOAP note, failed a written exam, etc).

I agree that there are too many schools that are fluffy NP programs. I also think that it's a mistake to let students go straight through from RN to MSN without having worked for at least 6 - 12 months before starting an NP program. They haven't gotten the basic RN experience they need. And don't get me started on RNs who think they don't have to wipe a butt or pass meds in LTC because "that's the LPNs and CNAs jobs".

It's not just the schools that can be problems. I don't mind not getting paid to precept. I do it because I love it and because I had some amazing preceptors and I want other students to feel like they have had a good grounding in geriatrics. I do think, though, that schools need to screen their preceptors better rather than just saying, "Well, it's a warm body." There are preceptors that do it strictly for the recertification. Others do it because they love to teach one on one. Some, well, no clue why they precept. I've had student tell me that they've had entire rotations where they don't get any hands on, just watch. I've had other tell me they've never seen a preceptor write orders. Others have never worked with labs in clinical. And so on. So yes, the schools are a problem, but so are the preceptors.

And no, I don't hesitate to fail someone if they need to be failed. I don't do it often. Usually by the time a student leaves they're dealing well with how to handle basic geriatric issues and they know where to go to get help (including me--all of my students get my personal line and they can text or call or email when they start practicing if they get stuck). If they're not, they fail. And I tell them why. I also touch base with them at the end of every clinical day to discuss questions they have, how they did, and any concerns either of us have. But I know a lot of preceptors don't do that. It's a mistake. Oh, and there are some schools I refuse to take students from...Just saying those are the programs I rejected when I applied to NP programs.

[bebbercorn]

I precept. I don't like to precept first semester clinical students because they don't have enough internal medicine knowledge to make the leap to geriatrics. What I find is that I get NP students coming through who have the book knowledge the school gives them about prescribing, labs, etc, but that previous preceptors many times don't let them practice working with any of it. Physical exam skills tend to be good, but the actual "exam, then do" is lacking. When my students are there I make them sit with labs and med lists and diagnoses and tell them to "figure it out". Generally that starts with them talking through it with me and as the rotation goes on it's them coming to me with assessments and plans, including meds, future labs, and reasons why. I won't take "it's the guideline". Ok, nice, but why??? I also let them practice writing prescriptions for everything from PT/OT (I work in LTC) to actually writing the controlled substance scripts. Since the facility still uses paper, they have to think and can't rely on an EMR to populate meds. This means they have to know how to look up dosing guidelines. This is from a school that does weed out people (I've had students set up to come to clinical and then be told they're not coming because they failed a mock physical exam with SOAP note, failed a written exam, etc).

You sound like an amazing preceptor!

[traumaRUs, MSN, APRN]

For those that do precept what would make a good precepting experience?

[PG2018]

Too many preceptors allow for mere observation which is awkward, low yield, and boring.

I have been asked to be a preceptor for the university I attended. I'll be taking preceptees this fall and plan to do what my VA preceptor did with me - assign them a panel of patients to manage. Observe for a while then grab a patient to work up, formulate a treatment plan, if safe let them run with it, and then allow them to see the follow up.

The challenge as others have said is too avoid loss of productivity, and with my pay incentivized after salary I'm bound and determined to not lose income in this deal. It's also great to get the credit for ANCC.

[Aromatic]

I've had some people say the reason they don't precept is because "they'll take er jerbz" (south park quote).

More students= more future np = job competition.

At least thats the going word in some places, probably not super popular.

[rnsrgr8t]

I precept NP students and have for years. I work in a Specialty, pediatric Urology and more specifically manage kids with overactive bladder. The hospital I work in has a strong nursing presence so the schools go through our nurse educator and she assigns the students to the preceptors. In general, I have always had strong students but them come from strong programs.

Since most of my students no nothing about my specialty, they do observe me for a few days. Then I send them in alone to get the history and come up with a plan. We do the genital exam together (so we do not have to make the kids do it twice). I have them write the visit notes, order labs/imaging etc. I get a pretty favorable response from my students so I think they enjoy their experience with me.

The best students tend to be the ones who have been a nurse for awhile. I KNOW there a lot of direct entry students who do well, but the more prepared students tend to be ones who have been a nurse for a decent amount of time. My best students come prepared, they listen, eager to learn, ask questions etc. I have failed one student. Honestly, she should never have gotten to me but her previous preceptors did not want to invest the time with her. I felt I owed it to her to try and get her up to speed but in the end she could not do it. I do not mind not being compensated (my MD colleagues have med students and they do not get compensated either).

Just like we did when we were in nursing school, APN students need to realize they are visitors and they take up a lot of our time. They need to come prepared and with their eyes/ears open. Questions come outside of the exam room, not in the middle of the visit while you have a precious few minutes with your patient and their family.

I love to precept. I am lucky I am afforded enough time with my patients so having a student does not slow me down too much. At the end of their rotation, they are saving ME time because of the great H&P they do.

[BostonFNP, APRN]

None of them had any clue how to diagnose, prescribe, or even really do a true physical exam. Basic stuff they should have learned in nursing school, much less an MSN program.

This is what your job is as a preceptor when you agree to take first semester students. First semester NP students need to learn proper physical exams, basic differentials, diagnostics, and prescriptive practices. RNs don't learn how to diagnose or prescribe. They might not even learn a proper physical exam.

The NP program I precept for has a structured standardized patient experience semester prior to clinical rotations so this isn't an issue or me in clinic.

[Misskala]

IsabelK, you're amazing! I would love to work with you! *subacute rehab unit RN, applying to AGPCM-NP schools. Mad love to you!

*I have to say, the NP I work with is the MAIN reason I am still at my job bc she allows me to think through labs before I report to her, and will ask me my opinion on treatment plans bc she wants me to critically think though situations.

Thanks for posting your thoughts on preceptorships. Something a NP student should know so to get the most out of the educational experience. And thank you all for precepting RNs, we need training.

[Maevish, ASN, RN]

Wow. "If you cant get into a real school..."?? Sounded like a dig on community colleges (or other "less than" institutions) which I take offense to because I went to an excellent one for a time and know many others who got their start at JCs as well. There are damn fine teachers everywhere and as a student, school is what you make it.

I agree with the article though and think that things will not improve majorly, if at all. With how kids are being raised, etc are we surprised? Everybody gets a trophy, grown CHILDREN (who are in their early 20s) have their parents go with them to job interviews, and working hard to be the best is frowned on more and more. God forbid someone else get their feelings hurt because someone another person worked their ass of and is better at whatever it is.

That may seem like it doesn't tie in to the topic, but I believe it does. If there's a culture of slacking off and "someone will always give me what I want", then the teachers don't have a chance. As a teacher can only ask a grown adult if they need help in a class so often before they tune you out or stop caring. If students don't ask for help that's not the fault of the teachers.

In college (even in my "real school"), they still spent the whole first day of most (if not all ) GE classes going over the freaking syllabus because they couldn't assume their students would read it themselves. You know, like adults. Nursing classes were a little different, but still, half the first class was wasted on something I could've easily read on my own.

You'd be surprised at how little you can actually know while getting above passing grades. I did that for a my first year classes and I suffered majorly because I had to bust my butt and study (even more than I would have anyway) twice as hard as everyone else on some topics, which was very stressful. I did it to myself, though and admit that I was young and stupid once. I would NEVER advise falling back on being a good test taker because it does no good in the real world.

If the students get good grades, though, how are teachers to know (considering the size of most classes) that someone doesn't really understand something unless they step forward? Personal responsibility is lacking and it's bleeding over into all areas. The students fail themselves and then makes people like the article writer want to give up full stop when the next student may not be that way at all.

There are still some people who take pride in their education and it's sad that the people who don't and who have also worked their tails off are making a bad name for everybody.

Preceptors also must understand that they have students still. They're still in school and are learning themselves. There are situations that are much clearer when studying on your couch than they are when you see an actual patient in front of you with the same issue.

xo

[sauce]

I never said anything about community colleges. I was pointed toward the for profits. Not quite sure how you made that non-existent connection.

Community colleges are the wisest choice anybody could make for their first two years, I was pointing out you have to have like, no brain basically, in order to enroll in a for profit.

The worst part is, people try to defend going to a for-profit.

I mean hey, you don't have to listen, but when your sitting there eating your ramen noodles paying your big tuition bill, when I drive by you in my new F150 platty, youll know I was right.