Frustrated With Clinical Preceptorships

I am currently finishing up my GNP and ANP Post-Master's through UMASS Boston Online (I live in Portland, OR). I must say I am rather discouraged and not happy with how my program went. I struggled to find preceptors willing to take on an NP student, and once I would find them, some just didn't work out, didn't have time to teach, didn't want to teach, etc. I consider myself well-respected at work, I even precept new ICU RNs, and have no problems relating to coworkers, etc. I also struggled with UMASS's program director, and I am not sure why that is. I have never had issues or problems like this before in any other job or school situation. I am a member of Sigma Theta Tau, my grades have been stellar. 

I feel I did not get a good enough experience in my Adv. Health Assessment to feel confident in my assessment skills. The preceptor would hardly let me practice much on patients. Since I am doing a distance course---no skills lab to really practice my skills. Now, I am currently working with two preceptors to complete my other two clinical courses-which were delayed and I was forced to take an incomplete d/t the inability to find preceptors by the time classes started (I had been trying for months). As a result, I am doing all of the clinical hours for both of those classes right now (3-4 days per week). It's overwhelming to me. The Program director is pressuring me to get my hours done asap-by October (it's going to be longer than that!). I am at the whim of preceptor schedules, I work 20 hours per week, and have projects that coincide with each of these courses. I am doing the best I can to complete my hours. 

I have an MD and an FNP for my preceptors now. The MD makes me feel nervous, inept , and I just clam up and become a bundle of nerves with her. We don't connect well, and she doesn't really do much in the way of teaching. All of my experience and knowledge seems to go out the window when I am with her. My other preceptor, an FNP-is similar to me in backgrounds: we have both worked in critical care for 16+ years, and she is just more down to earth and open to teaching, to involving me with each patient. However, the lack of confidence I have in my skills has me wondering if I am cut out for this....if I will ever get it (I struggle with charting even-changing over from nursing lingo/assessments to an actual medical history and physical/progress note/procedure notes, etc). Does this EVER get easier? Or am I just....not cut out for this? 

I am even doing an NP skills "boot camp" in October that teaches you assessment skills, suturing, simple office procedures...reading xrays....because I have not had any of that in my program. I am so discouraged that I will have to repeat courses just to feel more comfortable with my skills. And I dread boards. I simply feel so unprepared that I haven't even thought that far ahead. 

What has everyone else experienced? What advice would you recommend for salvaging all the time/energy/MONEY I have put into this? I regret not attending an actual, physical ANP/GNP program. But it's too late now to go back, and UMASS had the GNP track that was just what I was looking for at the time. It seemed promising.

I would love feedback, suggestions.....I am all ears.  

lawRN23 lawRN23
14 Responses Aug 15, 2011

I feel that everything you described in your post has been my experience. I attend a SUNY school in NY and although I do very well in my exams, I feel super stressed about clinicals. Our school gives us a list of potential preceptors, but it is up to us to secure clinical placement, which is a very daunting and humiliating task. I have had to basically cold call places, send resumes, visit offices, like I am a door to door salesperson. This last clinical place I am at has really discouraged me. The two MDs who are there make it very clearly obvious that they a) are annoyed at having a student there b) are very standoffish and refuse to interact and involve me in any patient care. I understand that sometimes the institution they work for are the ones who agree to precept students, well then their staff should be made aware, hey, we will have students. I mean, I am not asking to take over your patients, ask a million questions, or be in your way. But at least acknowledge me. I try my best to be as polite as possible but to be honest with you, I have developed a horrible case of anxiety because I feel such hostility toward my person as if I am bothering them. I agree with what other posts stated about us NP students having a lot more courses or material that will actually help us in the real world, suturing, x-rays, casting, etc. We have wasted time on really unnecessary classes that in my opinion should just be limited to undergrad, such as nursing theory, nursing informatics, I mean, it's not even like they're teaching us how to code, it's basically just fluff after fluff after fluff. I know I absolutely do not feel prepared- at all.

Please reply with authenticity, support, and respect

Thank you for your posting..!! Where did you complete an NP skills "boot camp" which this is something I'm HIGHLY interested in. I would love to advance my skills and believe this would be a fantastic opportunity.

Based on your statements, you are not feeling very confident right now. You seemed to be rushing the program Take your time. You know the stuff. You have 16 years of experience. Don't let yourself be intimidated by MDs or NPs. Approach them with confidence, a pleasant attitude and thanking them for taking you under their wings. It's a MAD, MAD, world. YES, YOU CAN. GOOD LUCK.

I am at the University of Phoenix in Southern California for my NP program and while I have found preceptors here in California my family is moving to Portland Oregon in the Summer of 2015... and I will still need another 3 months of clinical hours- any suggestions for finding preceptors since I literally know no one in the area! I am also currently an RN in the emergency department and would love any feedback on recommended hospitals to work at in the area!

I was just accepted at UMASS and no I am not sure. In the state of VA the program is requiring Federal/Military clinicals. Did they require that of you?

I completely sympathize with your situation! I was in a FNP program at a "high-end" university in CT, and I feel much the same as you with regard to the program. We all struggled to find clinical preceptors for clinic rotations. Many of us in the program had to accept less than desirable rotations because there simply were not enough sites available. In part, I blamed the school for this problem. The school should have had more appropriate sites available for students!! However, I believe the school was more concerned about tuition (and it was $$$$ at this university) and getting bodies to register for classed versus providing students with quality clinic rotations. Also, many of the didactic courses left much to be desired!! We also didn't learn anything about practical office procedure skills (e.g., suturing, casting/splinting, 12-lead EKG interpretation, x-ray interpretation, etc.). We spent more time going over useless exercises such as writing up clinical logs (which reminded me of "care plans" in nursing school) and other stupid exercises (e.g., journal club) instead of learning practical material. There should have been more emphasis on practical skills!!! In fact, after graduating, I (and several of my classmates) took a 3-day Fitzgerald Board Review exam, and we all learned more in that 3-days review course than we did in 3 years of grad school!!!!! Sad, isn't it?? In general, I think this is a problem in many NP programs. I think there are some schools that have better programs and are better equipped to find students good clinic rotations, but I think most programs lack good organization, qualified teachers, and good curriculum!! I definitely think organizations such as the ANCC and AANP need to call for a revision of NP program curriculum. In general, NP students need more comprehensive instruction in pathophysiology, physical assessment, pharmacology, and certainly in the didactic and clinical phases of instruction. After graduation (with a 3.8 GPA) and passing ANCC board certification, I still ended up going to a couple of different NP skills workshops (to learn what I wasn't taught in my FNP program). I also ended up (on my own time and dime) doing additional clinic rotations. Sadly, I think most NP programs at colleges and universities just want to fill seats and take your money. I think most program lack good substance!!

Hi, I command you for using your "own time and dime" to enhance your skills. That will only benefit you and your patients. #GreatNP

I believe NP schools should be responsible for providing preceptors as part of the costs.

I am so glad I found this website before being actually accepted into the FNP program. An accredited online FNP program, for which I am applying, will not consider your application UNTIL you have a list of respective preceptors. Submitting my resume, letter of intent, and recomendations, was the easy part. Locating a preceptor has been like pulling teeth. No wonder there is a national shortage of access to primary care. I have worked in acute /critical care for 16 years now. No shoratage of preceptors here. It 's unfortunate that NP programs lack professional network to facilitate, and ensure, a solid clinical experience. That should be taken into consideration prior to the school becoming accredited. They should have to submit and dedicated, contracted, preceptors. The incentive of an established financial compensation has never failed to secure volunteers. It's clear that the demand far outreaches the supply. I could not imagine a graduate school accepting payment for tuition and then you're stuck, and cant complete your studies. This is a mess and I am seriously considering aborting this career plan.

This field is very competitive. I sense that the NPs & MDs are not looking to precept future NPs who will be competiting against them for patients.

You are stating my life story right now. I am currently struggling to secure a preceptor for my pediatric rotation. Our oprogram does not have a clinical coordinator as well and we are forced to "cold call" physician offices and clinics in hopes that someone will accept us as preceptees. This is the most difficulkt task I have ever had to experience in my post graduate study thus far. Its very discouraging as well. I lack the confidence as well to complete a comprhensive assessment on a patient because we didnt have open lab or health assessment lab. It is comforting to know I am not in this alone.

Wow! It's amazing your story sounds just like mine. For a moment, it seemed as if someone had copied all my thoughts and feelings and posted them. In the beginning, I was an advocate for the online NP programs but, now I highly oppose the idea. On many occasions I feel alone, teaching myself and hoping I am connecting the dotes. However, it never seems that these efforts match up. I have had those same experiences in clinicals with the MD I had, I felt so confident up until I was with her. My mind, body and soul would all clam up and at times I was not sure if I was competent to be an BSN prepared RN. Like you, I precepted nurses, students and PCAs. The doctors, residents and my coworkers loved me and I recieved much praise on many occasions but, in clinicals it was not clicking. Since the program is online, there is no lab to practice and honestly, I do not feel confident in my professors or program. When I started things were promising but now I just do not know.

Update: Okay, so I made it. Got my hours in. I was SO FORTUNATE to find a preceptor with Kaiser Perm and she was fortunately a life saver. I am not sure why this is such a struggle and I am ultimately disappointed in how NP programs are not doing a better job of working with students to find meaningful, committed preceptorships. I know I pain a precious dear penny for my NP program, and I think that is something that is truly lacking with regard to the programs. (well, that, and not truly prepping you for the 'real world' of practicing). I barely got my clinical hours finished in time to graduate, and the Oregon State Board of Nursing was a nightmare. They failed to tell me as I was starting my clinicals way back earlier in the program that I needed to have THEIR form signed by my preceptors (the work agreement between the clinical site and school was not enough). That meant tracking down a few of my preceptors-some of which were leery to sign another document. How unprofessional is that? The work agreement is reviewed by school's legal department and dean. OSBN has a long way to go in streamlining this process. Once I finally graduated and passed boards-I had dual board certification-OSBN wanted me to apply for a separate licensure for both my ANP-C and my GNP-BC. (which means paying twice the fees for that). What?!?!! Thankfully my new manager said don't bother-just submit one certification. Can still use both. No need. Thanks heavens I spoke with her first.
While it hasn't been an easy road, it was worth it. I got hired right away in Portland with United Healthcare/Evercare and I am working with my favorite population-the elderly. I have 48 lovely patients that desperately need NPs. NPs should be on the rise. It's tough work, and I am frustrated to learn more on the job than I did in NP school.
Stay the course. Be persistent. And be creative with getting your clinical hours. Look at programs such as Evercare, home visits, Nursing homes, hospitalists. Clinics are more difficult. I also recommend doing rotations with other speciaists that may agree to take you on for perhaps a week rather than a whole term I did rotations with a dermatologist and opthalmologist-the elderly population as you know has common issues with these areas. I even did a rotation with a FNP that was in women's health (got pretty proficient in pelvics! Something I dreaded but overcame) This will enable you to add up your clinical hours and get a more rounded experience, and help you get over your fears with certain procedures and specialty issues. Good luck.....feel free to contact me if you have any questions. Always glad to help other NP students out so they don't go through what I did~!

(LawRN) I'm so glad to hear you finished your clinicals and are working in the field. I came across your post because I am in portland and looking for clinical sites for my fnp program and having similar difficulties. Are you willing to consider helping me with some clinical assistance-- maybe paying it forward? I would love to be in contact/pass on my resume to you, maybe have an interview to consider taking me on as a student? Thanks so much.

I live in the Atlanta area and unfortunately it is the same way here. I have called many pages of physicians and clinics. No one will precept students or they are already precepting residents. I feel like so many health care providers have forgotten that they too started by being precepted. With the shortage of medical professional in the family practice arena I thought it would be alot easier to find a family practice preceptor. I was very wrong. Reluctant and discouraged I will continue trying to find a preceptor.

Similar to all the people above, I am feeling the same kind of frustation in my current FNP program. It seems as if practitioners are not made the same way they use to be, and no longer have the time to teach one how to do things properly. I am an excellent nurse, but feel thus far that I fall short from what expectations should be for a nurse practitioner. I believe that even though nurses have been taught well in school, we have been ingrained with this idea that when something wrong occurs we should tell someone and allow them to handle the problem. Now it becomes more difficult when you are the person who has to make all the decisions but have learned how to do things a particular way for so many years. I am so frustated with how things are going thus far that I am questioning whether I want to be a nurse practitioner. Hopefully, things will get better. I do not mind doing plenty of work in my current program as long as I learn something. I will tune back in with you all to let you know how it goes.....

I hope that by the time you read this message, everything has been settled in your life. You are not alone, I am in the same situation that you were last year; am the same type of academic student in addition to being well respected at work. I am a first year FNP student and arrived to your posting by researching NP boot camps that could help me become more competent in my skills. The university I attend will not have a specific course for suturing, minor office procedures, xray interpretation, so I am trying to take before I am midway or the end of the program (of course given that I pass all my exams). I will need preceptors until next year, so I would not be able to share my experience, all I can say is that the university I am at has a list of affiliated sites where we would be assigned to go. Knowing that a high number of patients exist in the area I live in, I probably anticipate that the preceptor will not have much time to teach me. I will just try to take advantage of every opportunity and be proactive. Hopefully, my optimisim will not be depleted. Any feedback from you will be greatly appreciated.

Wow. Wow. I know you posted last year but I am curious to know how it all worked out. I am currently in the same boat you were last year. I live in the portland area as well. Any feedback from you will help

Portlandgirlly-things are going quite well. I just re-read my first post. I have come a loooong way, and so glad I hung in there. While I hear that the preceptorship problem is still pretty significant out there, I am hoping that students are remaining persistent and creative in obtaining their clinical hours.
I am doing quite well, though very busy with my new job-it's nearly been a year! I still work for United Healthcare/Evercare, with the elderly and disabled, which I still love. It's a lot of work, and it never seems done, but I love the NP role in this format-it's desperately needed for this population. I hope that schools are getting the picture that this is an area that truly needs work. They need to be more involved in assisting students in lining up preceptorships. It is going to be even more important as we need more NPs/primary care providers in the pipeline.
Good luck to all of you; if you ever have any questions or anything I can do to help, let me know. ;)

Hi LawRN23

I am in an online NP program, currently in the early stages of the program, altough clinicals do not start for about a year and a half I am beggining to try to locate preceptors now. Is there any advice you can give me to find preceptors? I am currently living in Olympia, Wa and I am open to traveling to clinical sites.