Updated: Dec 16, 2019
Being a nursing student is hard…
Walking into a new clinical site as a nursing student is daunting, whether you’re 21 or 51. You don’t know anybody. You might not know anything. You’re in your school-sanctioned scrubs in some unfortunate color like purple or maroon. The word ‘Student’ is emblazoned on your work badge. You planned to show up an hour early, but you got lost in the parking garage, and now you’re cutting it close. You’ve made it onto the unit with help from kind strangers, and now you’re looking for a nurse named ‘Kelly’. You look upon a sea of scrubs and ponytails. Good luck finding her.
Nursing students, I get it. I’ve been there - not too long ago. Nobody who is a registered nurse today got to skip out on the awkward student nurse phase. Take a breath. You’ll be okay.
And so is being a Preceptor.
I work with nursing students quite a bit in my role as an Emergency Department RN. This has given me an opportunity to reflect on my past experience as a nursing student with a new perspective.
Over the last few months, nursing students have asked me for advice: How can I be a better student for my preceptor? I hear the same concerns over and over: I’m worried I’ll get in their way. What if they think I'm stupid? I've realized how little instruction nursing students get about how to approach their clinical experiences - and most importantly, their relationship with their preceptor.
And just like there’s no one way to be a nurse, there’s no cookie cutter way to be a nursing student. Every student arrives on the unit with a unique background, which includes their level of experience, their nursing program, their age, their maturity level, their past career history, and more! That’s part of the fun - and challenge - of being a preceptor - especially if it’s just for one shift rather than a longer term relationship.
The nursing student - nurse preceptor relationship is critical to the success of future nurses. A great preceptor can inspire you to go into their specialty - or even work on their unit. A bad preceptor can put you off from nursing altogether. I have some advice for you to make the absolute best out of every nursing clinical experience - and how to make your preceptor’s life a little easier.
Tip #1 - Be Realistic
Before you even get on the unit, prepare yourself for a shock to the system. Real-life nursing practice is not what the textbooks have you believe. There are realities of working within a hospital environment that the classroom cannot effectively prepare you for. This is why getting actual clinical experience is so important. Go in with an open mind.
I chuckle when I look back on my early days of nursing school clinicals. My classmates and I were scandalized that the nurses we shadowed didn’t wear their isolation gowns - when indicated - at all times. “It’s just irresponsible,” we would haughtily say to each other during our lunch break.
Student nurses, let's get real. That Iso patient had MRSA four years ago and me leaning into the room to shut the lights off without a gown on isn’t going to give anyone MRSA. Your preceptor probably won’t “scrub the hub” for a full 15 seconds. He may push IV medications over two minutes instead of the recommended two. If you’re the perfect nurse who actually does these things, good for you. And I’m ready for your emails. But the reality is that nurses’ To Do lists are miles long. We’ve learned from experience how to be more efficient. And now you get to learn from us.
Obviously, if you see something truly unsafe or unethical going on, speak up. But don’t try to tell your preceptor how to do her job. It’s not a good look, and we probably have a good reason why we’re doing things the way we are. If you want clarification about a skill that we’ve performed differently from your instructor, ask! In Nursing, there are 100 acceptable ways to do a given task. Now’s your chance to observe a variety of techniques, and take your favorites into your own practice.
Tip #2 - Guard your Empathy
My first week as a nurse intern in an ED, an unstable Triple A (Abdominal Aortic Aneurysm) was airlifted to our hospital and rolled into our stabilization bay. I silently watched the team do their thing from the deepest corner of the room, wedged between the airway cart and the cardiac monitor. The skill and cooperation I witnessed that day was incredible. And then, once the patient had gone to the OR, I went in the bathroom and cried.
Thirty minutes earlier, as we had been waiting for the chopper to arrive, one nurse turned to the rest of us and said, “Better hope he doesn’t have allergies. With Triple As, one sneeze, and it’s over.” The nurse’s station cracked up, and my jaw hit the floor. They were sitting around laughing about a man bleeding out from the largest artery in his body in less than 3 minutes. I was horrified.
I don’t know what happened to that guy. That’s the way of the hospital. Patients roll away, and you don't get to know the ending to their story. But as I cried in the bathroom, I was so scared for him. And I was scared for myself. When that nurse made his comment, I saw a future for myself that I didn’t like. I didn’t want to be the grizzled, veteran nurse cracking jokes to cope. And I don’t want you to become him either.
I’ve had students charge into critical situations with a look of glee. That is disturbing. It’s okay to be interested in an exciting case. It will be your job, after all. However, you are brand new to this world of healthcare. Start from a place of deep empathy, and then guard it. Time and experience will harden you to the emotional realities of the work that you do. And it should NEVER lead you to feel glee over another person’s trauma, pain, or grief. So don’t start that way. If that’s you, do some soul searching. And maybe pick a different profession.
Tip #3 - Read the Room
Being a good nurse requires emotional intelligence. It doesn’t take a nursing degree to recognize a serious or stressful situation. Know when to be helpful and when to get out of the way. And if in doubt, ask. I respect so much when students ask, “Is this a good time for me to try that new skill?” And I respect them even more if they respect my “No.”
When you hear a critical or behavioral code called, it’s okay to watch. In fact, you should. But make sure you look to your preceptor for guidance and stay out of the way.
Tip #4 - Take Initiative
If you know how to spike a bag of saline, spike the bag of saline! I’m impressed with nursing students who have confidence in themselves and want to practice their skills. It also takes the onus off of me, the preceptor, to manage every minute of their shift. That gets exhausting real quick. As a preceptor, I’m managing myself, my patients, my team, and now a nursing student. If you can reduce my mental load by emptying the trash can when you see it’s full, collecting urine samples, and offering blankets before I have to ask, you will make my life SO much easier - and make a great impression.
Tip #5 - Tell Us What You Want
You get out of a clinical experience what you put into it. Every time you have a shift with a new preceptor, have a chat before you start. Let us know where you are in your studies, any experience you have, and what skills you’re comfortable performing. Then most importantly, tell us what you’d like to do or see that shift.
If this seems uncomfortable to you, here’s a script:
Kelly, before we start, let me give you a quick rundown on where I’m at with my clinical skills. I’m a senior at the U and feel comfortable with a lot of skills since I just finished an internship on a Med-Surg unit. This is my first time working with oncology patients, and I'm excited to learn about port care and chemo drug administration. I learn best if I watch you do a skill one or two times first before I try it for myself. Thanks so much for precepting me!
Kelly, this is my first nursing clinical ever. I used to be a lawyer. I’ve never been in a hospital before, and frankly, I don’t even know what a nurse does. Today, I’m excited to shadow you and learn how the unit works. Thanks so much for precepting me!
Nurse preceptors will welcome this communication. It’s truly a gift to know your student’s needs and expectations upfront. It lets us leave the guesswork out of it!
Most importantly, if there’s anything we’re about to do that you’d like to take a whack at, tell us! You’re joining us nurses on a typical day of work. Our first instinct will always be to do a task ourselves - because that’s our job! Don’t be offended if that happens… It’s just muscle memory! We’re in the Nursing Flow. When you’re a preceptor, you’ll understand.
Tip #6 - Be Open to Feedback
If your preceptor corrects you on a skill you perform, or suggests a change to the way you assess patients, take it in stride. After all, you’re there to learn! If we didn’t offer advice, you wouldn’t be getting your money’s worth.
Unfortunately, I’ve had a few students who seemed completely uninterested in what I had to say. Their attitude made me not want to share my wisdom with them - or put in a good word for them with my manager. Interestingly, a lot of pushback I receive is from nursing students who have previous CNA or Tech experience and think they already know most of what I have to share. These roles are all part of the same team, but we do very different jobs. Experience is great! Don’t let it get in your way.
My favorite nursing student is the one who shows up confident but willing to learn. You’re a student for a reason. You won’t know everything!
Nursing students, don’t be afraid to embrace the role of Student.
You will continue to learn from others for the rest of your life. You will learn from peers. You will learn from supervisors. You will even learn from the nursing students you will precept. Be open to learning always, no matter who is your teacher. Nurses must be life-long learners, or the system will never change.