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.

[BostonFNP, APRN]

I had the same thoughts as you that the on campus programs would be better.

Some brick and mortar program are bad, some online programs are bad. Just because a program in on-campus doesn't make it better automatically.

That being said, most quality online/hybrid program understand that there are some things that need to be done face to face and have skills workshops for this.

I found out that the on campus program is mainly on line too. It was no different then the online program.

Just because some classes are online at an on-campus program, it doesn't mean that it is "no different".

I do agree that the requirements for np programs is lacking. The np programs are expecting students to teach themselves and the preceptors to fill in the gaps. It was very disappointing. I felt like if you can pass a test and complete hours you passed.

How do you feel the requirements are lacking? I only ask because you admit that you didn't get accepted to a local program so went online instead, which seems to suggest that you took the path of less requirement/competition? Are you basic this on your experience in your program or out in advanced practice?

Graduate education is self-driven for the vast majority of studies. I agree that subpar programs seem to dump a lot of responsibility on preceptors that they don't find/secure or pay.

If you can pass tests and pass clinical then you pass. What surprises you about this?

[mar1ama, BSN]

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

I want to be as proactive as possible with my learning experience, which reference books would you recommend for advance pathophysiology, advance pharmacology and health assessments? I am aware that some medical books maybe my option. I want to be as prepared as possible for clinicals and during my future practice. Any pearls of wisdom will be greatly appreciated. Thanks in advance.

[BostonFNP, APRN]

I want to be as proactive as possible with my learning experience, which reference books would you recommend for advance pathophysiology, advance pharmacology and health assessments? I am aware that some medical books maybe my option. I want to be as prepared as possible for clinicals and during my future practice. Any pearls of wisdom will be greatly appreciated. Thanks in advance.

Contanzo's Physiology is excellent.

Goodman and Gillman's The Pharmalogical Basis of Therapeutics is excellent.

Bates Guide to Physical Exam and History Taking is sufficient.

Harrison's Principals of Internal Medicine is a great reference as well.

[Owlgal]

This whole discussion kind of cracks me up. The truth is that there are going to be good and bad RNs, NPs, PAs, MDs, and DOs. It's a crap shoot, really. I've been treated by doctors as a patient that simply were not good physicians. How'd they get through medical school? -- IDK. But they did. Same thing goes for the rest of the health care world.

I believe my NP program is for profit. I didn't ask. Primarily because I really don't care. I really don't care about what my tuition costs. I think I'm in for around $60k for my NP program. It's about 10k more than the state school, but I really don't care. What I did care about was the ability to further my career goals while supporting my family and having a good quality of life. Seriously. Let's look at things here. If normal, run of the mill nurses are making 60-$80k all across the country, what's to incentivize them to become NPs? An extra $20k, maybe? They could pick up a few extra shifts and make that much. And if one is expecting them to quit their jobs to go to a B&M school full-time, and let's say we want them to also take classes on par with medical schools (as some are recommending), so that they can graduate and make $100k ... yeah, that's not happening. If you want an NP to "go to medical school" -- they are going to expect to make bank. $100k is not "bank".

The reason that PAs are content with this type of thing (and their curriculum is not on par with medical school) is that they were making $14/hr working as an aide/phlebotomist somewhere before they got accepted into PA school. They weren't making $80k in healthcare as a professional nurse.

Seriously. You think these online students are stupid? -- I think we're brilliant. I'm making mid 80k while going to school. I'll walk out with the same credentials behind my name as the B&M NPs, having passed the same boards. Sure, I'll have more debt; there is a trade-off there. And, I'll have an additional 2-3 years of real world health care experience that "traditional" students won't have. That's 3 years of seeing patients, networking with physicians, and learning about the newest medications and treatments first hand. I'll have to work harder for my degree. Much of my studying will be alone. I won't be coddled by professors who know and like me (because I'm charming like that) rather than earning my grade through hard work and retention of knowledge. I'll choose my own preceptors -- one's that fit my needs and career aspirations, rather than progressing through the student mill of pre-arranged "career" preceptors. Yeah. I'm super satisfied with my terrible-on-line-for-profit-education.

[BostonFNP, APRN]

Seriously. You think these online students are stupid? -- I think we're brilliant. I'm making mid 80k while going to school. I'll walk out with the same credentials behind my name as the B&M NPs, having passed the same boards. Sure, I'll have more debt; there is a trade-off there. And, I'll have an additional 2-3 years of real world health care experience that "traditional" students won't have. That's 3 years of seeing patients, networking with physicians, and learning about the newest medications and treatments first hand. I'll have to work harder for my degree. Much of my studying will be alone. I won't be coddled by professors who know and like me (because I'm charming like that) rather than earning my grade through hard work and retention of knowledge. I'll choose my own preceptors -- one's that fit my needs and career aspirations, rather than progressing through the student mill of pre-arranged "career" preceptors. Yeah. I'm super satisfied with my terrible-on-line-for-profit-education.

I don't think anyone called online students stupid but I am not sure I agree on your rationale for why they are brilliant either. I can see the simple argument you are trying to make, and very superficially it makes sense, but with a little perspective it breaks down pretty quickly. It will be interesting to see if or how your feelings on the topic change as you get some experience in the role.

[claptrap]

This whole discussion kind of cracks me up. The truth is that there are going to be good and bad RNs, NPs, PAs, MDs, and DOs. It's a crap shoot, really. I've been treated by doctors as a patient that simply were not good physicians. How'd they get through medical school? -- IDK. But they did. Same thing goes for the rest of the health care world.

I believe my NP program is for profit. I didn't ask. Primarily because I really don't care. I really don't care about what my tuition costs. I think I'm in for around $60k for my NP program. It's about 10k more than the state school, but I really don't care. What I did care about was the ability to further my career goals while supporting my family and having a good quality of life. Seriously. Let's look at things here. If normal, run of the mill nurses are making 60-$80k all across the country, what's to incentivize them to become NPs? An extra $20k, maybe? They could pick up a few extra shifts and make that much. And if one is expecting them to quit their jobs to go to a B&M school full-time, and let's say we want them to also take classes on par with medical schools (as some are recommending), so that they can graduate and make $100k ... yeah, that's not happening. If you want an NP to "go to medical school" -- they are going to expect to make bank. $100k is not "bank".

The reason that PAs are content with this type of thing (and their curriculum is not on par with medical school) is that they were making $14/hr working as an aide/phlebotomist somewhere before they got accepted into PA school. They weren't making $80k in healthcare as a professional nurse.

Seriously. You think these online students are stupid? -- I think we're brilliant. I'm making mid 80k while going to school. I'll walk out with the same credentials behind my name as the B&M NPs, having passed the same boards. Sure, I'll have more debt; there is a trade-off there. And, I'll have an additional 2-3 years of real world health care experience that "traditional" students won't have. That's 3 years of seeing patients, networking with physicians, and learning about the newest medications and treatments first hand. I'll have to work harder for my degree. Much of my studying will be alone. I won't be coddled by professors who know and like me (because I'm charming like that) rather than earning my grade through hard work and retention of knowledge. I'll choose my own preceptors -- one's that fit my needs and career aspirations, rather than progressing through the student mill of pre-arranged "career" preceptors. Yeah. I'm super satisfied with my terrible-on-line-for-profit-education.

I think most people who are in NP school, especially the lower tier for profits think they are brilliant since the course work is so easy... until they get out and practice.

People will convince themselves of anything these days lol!

It is hard to take somebody seriously who says "i don't care what my tuition costs"

[Owlgal]

Really? Because I really don't care. It's a known quantity that it's going to cost me a ton of cash. I don't really care how much. Money isn't something that I focus on. I make plenty and save plenty and the things that I truly want and put effort into -- yeah, I don't care how much they cost. I know how much they cost, obviously, but it's not something that is factored into my decision making at this point. I would hate to have my world revolve around money. Obviously, yours does to a far greater extent.

Seriously, I'm on track to make less as an NP than I am in my current career path. Money doesn't motivate me. Doing something that I enjoy, that I can do part-time when the time comes, that doesn't involve the stressors that I currently have. Yeah. That motivates me.

I'm not a twenty-something newbie. Making good money isn't my life's goal. I've done that. Now, I've got a different focus. You seem to have a very narrow focus -- and that's okay. But people are individuals and to paint with so broad a brush as you seem to typically on these boards, is probably going to lead you to miss a whole lot of the nuances that make life worth living.

[claptrap]

Those are a lot of assumptions against someone who only posted a three line comment. Being financially savvy and chasing life goals aren't really mutually exclusive. But anyway, to get back on topic, considering that I do the hiring for my own practice, that I own, I was referred here (by my hiring consultant, which actually made me chuckle a little bit until I viewed these boards) since I am looking to hire 5 NPs. Did not come here to hire directly but she told me there would be a plethora of information in regards to which schools to avoid and the like. For some reason (actually it is because we stopped allowing students from for profits to precept slightly earlier in 2017 due to multiple reasons) this topic caught my eye. It mostly just reinforces the notion to not hire and/or precept those who come from for profit schools, since back when my nurse practitioners would precept many of them they came off as rather snooty and know it all'y until the downslope of the Drunning Kruger graph slapped them in the face and they fell apart in the real world. At least according to the nps, I never really had much input into what went on, just had the assumption it would increase the applicant pool and help out the students a little bit.

For anybody wondering, this is a good example of why we do not let these students into our clinic either prior to or after graduation. Without trying to cast broad generalizations, those who attend low their programs with low standards often, 1. do not have what it takes to get into a real program, 2. do not want to do the work in a real program, 3. believe that their base of knowledge is already great enough and that they can skimp through the essentials straight into practice.

Before stones at cast, the people we do hire we pay well (start at 120K here in northern TX), and we treat them well and give plenty of bonuses. It is just disappointing that I literally had to hire a consultant to help me filter through the plethora of applicants and not make a costly mistake of hiring a no-go.

As a family practice physician, I was rather ignorant of why this was happening until I hired her since I assumed the education was a definite filter and those who graduated automatically had a base knowledge we could build upon during training and all hirees would be open to learning but was I ever wrong.

[Jules A, MSN]

As a family practice physician, I was rather ignorant of why this was happening until I hired her since I assumed the education was a definite filter and those who graduated automatically had a base knowledge we could build upon during training and all hirees would be open to learning but was I ever wrong.

Unfortunately being eligible for licensure holds little bearing with regard to skill set and preparation for practice. Many expect and need a prolonged orientation and I'm not talking an unusual specialty that no one could be expected to have had exposure to but good old primary care for FNPs or basic psychiatric care for psychNPs. Its embarrassing.

The good news is if you are particular, which in my opinion also includes considering their RN experience, or lack thereof, requiring physician references and being willing to spend time during the interview to find a compatible personality you could be very happy. Referrals are a great option from other MDs, NPs or PAs sort of a vetting process. Again those who don't know any physicians or midlevel colleagues would make me wonder what they were doing over the past few years when they should have been fostering relationships and building professional contacts.

Although I wasn't interested in spending my time at one of the many AsSeenOnTV Universities my well respected brick and mortar school was fairly light on anything worthwhile for actual practice also so I guess what I'm saying is that if all the other check boxes are met I wouldn't simply exclude someone from a lousy school, the same as I wouldn't automatically think someone from a big impressive name was worth a hoot just based on their resume. I had extensive RN experience in my specialty and plenty of physician contacts who were willing to precept me, hire me as a NP and mentor me which made a tremendous difference in my skill set and ability to practice safely and competently. In my opinion an experienced nurse, which probably means ED in primary care, who realizes our education is superficial and doesn't think they have knowledge equal to a physician would hopefully make a decent team member. My docs are happy, they bill incident to and collect full reimbursement for my services and although I'm very well paid its considerably less than bringing in another physician.

[shibaowner, MSN, RN, NP]

Those are a lot of assumptions against someone who only posted a three line comment. Being financially savvy and chasing life goals aren't really mutually exclusive. But anyway, to get back on topic, considering that I do the hiring for my own practice, that I own, I was referred here (by my hiring consultant, which actually made me chuckle a little bit until I viewed these boards) since I am looking to hire 5 NPs. Did not come here to hire directly but she told me there would be a plethora of information in regards to which schools to avoid and the like. For some reason (actually it is because we stopped allowing students from for profits to precept slightly earlier in 2017 due to multiple reasons) this topic caught my eye. It mostly just reinforces the notion to not hire and/or precept those who come from for profit schools, since back when my nurse practitioners would precept many of them they came off as rather snooty and know it all'y until the downslope of the Drunning Kruger graph slapped them in the face and they fell apart in the real world. At least according to the nps, I never really had much input into what went on, just had the assumption it would increase the applicant pool and help out the students a little bit.

For anybody wondering, this is a good example of why we do not let these students into our clinic either prior to or after graduation. Without trying to cast broad generalizations, those who attend low their programs with low standards often, 1. do not have what it takes to get into a real program, 2. do not want to do the work in a real program, 3. believe that their base of knowledge is already great enough and that they can skimp through the essentials straight into practice.

Before stones at cast, the people we do hire we pay well (start at 120K here in northern TX), and we treat them well and give plenty of bonuses. It is just disappointing that I literally had to hire a consultant to help me filter through the plethora of applicants and not make a costly mistake of hiring a no-go.

As a family practice physician, I was rather ignorant of why this was happening until I hired her since I assumed the education was a definite filter and those who graduated automatically had a base knowledge we could build upon during training and all hirees would be open to learning but was I ever wrong.

I agree with most of your post but I am a bit confused by your last paragraph. You start out saying you don't want to precept students for for-profit schools but end by stating that education is not a definite filter. NPs do not in any way receive the equivalent of MD schooling and training. Since it appears you have NPs working for you, you know that. While I agree a new grad NP should have a certain basic knowledge and skill set, they will also need OJT. Personally, I would like to see NP residencies and/or more extensive training for new grads, but we need to figure out a way to get the funding. Also, it is hard to take someone seriously with a screen name like "claptrap."

[shibaowner, MSN, RN, NP]

It would be great to see more states and even the federal government provide some reward to preceptors. Maryland and some other states do offer a substantial state tax break to preceptors (MDs, NPs, PAs).

Preceptors should be selective and by only accepting students from reputable schools and/or schools that have furnished good students, they help the nursing profession by weeding out the bad schools. The good schools also give their students coaching on how to be a good "preceptee." As a student, the highest praise I got was when the RNs, NPs, MDs asked "How can we get more students? You were very helpful and we want more!"

[Jules A, MSN]

It would be great to see more states and even the federal government provide some reward to preceptors. Maryland and some other states do offer a substantial state tax break to preceptors (MDs, NPs, PAs)."

While it is definitely a step in the right direction if you look closely the tax credit is not substantial at all: $1,000 per student. The NP hourly requirement also went to emergency session for an amendment due to the unrealistic number of hours a NP would have had to precept to be eligible.

Maryland SB 436/HB 683