Vital Views

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Welcome to Vital Views podcast for UNLV School of Nursing. I'm Joe Gaccioni, communications director for the School of Nursing. We are continuing our coverage of Nurses Week from May 6th to May 12th. This is an annual national recognition of our nurses. For this year, we wanted to focus on nursing positions that aren't as publicized as, say, registered nurses or ER nurses. Our previous episode, if you missed it and you should go back and listen to it, we talked all about part-time instructors. For this episode, we're chatting about preceptors. Talking to us today is Brittany Lynn Perez, registered nurse who has precepting experience. She works at UMC of Southern Nevada in the Pediatric Emergency Department and is an Emergency Nursing Pediatric Course Instructor. She's also studying in UNLV's Psychiatric Nurse Practitioner Program. Brittany, thanks for coming on.

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Thank you so much for having me here. I'm really excited.

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Now, are you currently precepting or taking a break from that?

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I had to stop because this is the year where everything gets real with the program. So I have like 145 clinical hours this semester, like 225 next semester. So I'm actually only working per diem at UNC right now.

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Okay, so then talk about precepting. What is precepting

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compared to other educator roles? So I'm glad that you asked that because I really think clinic like teaching clinicals and precepting on the job training essentially is that's where the students can apply what they're learning these like abstract concepts that they're learning in lecture to real patients, real-life situations, and that's where they really start to become nurses

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like before they graduate. I've heard of preceptors when it comes to final semester students, but can you precept for earlier semesters? Yeah, so generally

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I'll only have those students maybe for like half the day or the whole day, and I don't get to work with them more than like maybe once a shift as they go throughout the course, but when I really get to work with the students is in their final preceptorship. So it's like 140 hours maybe or 120, I can't remember anymore, but it's like 10 shifts. They spend and they basically work alongside me for those 10 shifts, they follow my schedule. So if I'm night shift, they're there with me on night shift and from beginning to end. And that's basically when they're applying all of these abstract concepts that they've learned throughout the program to realize situations to prepare them for becoming a nurse and right after

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graduation. How big are the groups normally? I will only be paired with one

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maybe two students and it's really I would say it's honestly probably the most important part of the nursing program because that's when they get a feel for what nursing is and having to really apply their critical thinking.

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Well, especially that one-on-one time when we spoke to the part-time instructors, they said typically they're in groups of maybe they have eight students. Sometimes I think one said 16, but I think it was just two groups of eight. Yeah. So, I mean, even eight's not a bad number, but just to have that individual directed time.

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Yeah, and so when you have a clinical instructor and they have their eight students, each of those eight students will be paired with a nurse for the day.

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Why precept? What is the impact it has not just on the student but on you?

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It's really easy to get jaded as an ER nurse after a decade. So I find that when I'm working with the students, I see these situations through their eyes, and it kind of like, I don't know, I get like more energized and stuff. I'm like, oh yeah, like this situation is really sad or this situation is, you know, these patients come in every day for like these silly things, but the students, they still care, they still are excited, they still want to learn and I just feel very like energized after I have them for a shift and I'm like, yeah, things aren't so bad.

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Was there a precepting moment that left an impression on you, something memorable?

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I can't think of any specific incidences, but I can think of like my favorite moments are when I'm like talking with the students and I'm trying to get them to connect these different concepts and you almost see them like a light bulb goes off, and they're like, oh, that's why we do this. Like, oh, vomiting in a child with a VP shunt is an emergency because these symptoms could be indicative of like hydrocephalus or maybe the shunt stopped working, and that's why it's an emergency versus any other kid who's vomiting. Like, I don't know.

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Do you find that you have to deploy different tactics to reach a student? Like, I'd imagine not all of them are the same so you have to try

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different ways to teach them. Some are more timid than others. I had a lot of anxiety as a student and I still do so I have a lot of empathy for like the students who are like so nervous of like making a mistake I'm like listen this is a safe place I'm not gonna let you mess up I'm not gonna let you hurt a patient like I'm here with you every step of the way but I'm gonna push you out of your comfort zone.

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But I think you hit the nail on the head when it comes to having empathy as an educator because you've been in their shoes and you're still a student right now so you understand what they're going through, maybe not the exact same level, but you can feel what they're feeling and it's probably easier to connect. There's no gap necessarily between you two. Yeah, I almost want to like talk about Patricia

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Benner's stages of learning and she's actually a nurse theorist. She lectured here like last year, she was pretty cool. Anyway, these students are in the novice stage and they're like still learning and then like after years you get to like master stage so I'm kind of in that in the pediatric ER. I feel like I have a pretty good mastery of what I'm learning and then you switch to a different role of being a nurse practitioner student and you're like wow I am back at being a novice and it's not that fun so I have even more empathy for my students because I'm like yeah being a new learner in a new situation is like it can be really scary

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from novice to expert. Yes. Well now you're a student right now you're in the Psych NP program, just generally how's that going?

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It's a little bit terrifying. Like I said, going back to being a novice is different. I like it when I know all the answers. But it's good. I really like it. I think this is what I need to do in my life. I want to help the, I want to specialize in like children and adolescent psychiatry. And you know, from being in the ER and the front lines and you see all these kids that need these mental health clinicians, and there just are none in the Valley, and it's like, you know what, I can do that. I can fulfill that role, I can help.

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Do you feel like maybe your preceptor role kind of helps you in this case, because you're used to guiding and counseling and even mentoring?

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Yeah, actually, I didn't even think about it that way, but I think you're right, because there's a lot of motivational interviewing with patients, especially with adolescents who maybe don't want to be told what to do, but you kind of have to guide them to the right answer. So it's like, oh, well, why are you, why do you want to do this this way? What is your goal? What would you like to achieve? What kind of steps can you take to get to that goal? And I definitely apply that to my nursing students. It's like, okay, so you want to help this patient stay calm while you start this IV, you know, what kind of steps are you going to do beforehand to get to that point?

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That intervention is so critical in the child development stage, in adolescence. In talking with other guests on this show, we've talked about how in some cases is a developmental issue, is it really an issue or is it just part of their growth? You know, it's like how do you find, how do you pinpoint those potential problems ahead of time. And I would imagine being a psych NP, you'd be able to help with that. You'd be an additional resource to help families say, let's focus on this because we don't want this to potentially get worse as they get older.

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So you're talking about basically early intervention. And early intervention is something I'm really passionate about. We have early intervention services in the state, by the way. And if anyone thinks their child has a delay, they should definitely contact their pediatrician and get a referral because it's free. But also, yes, with kids, you can catch things early and help them sooner before it becomes a bigger problem. Like, unfortunately, a patient that maybe has been struggling with homelessness for years and is in their 40s or 50s and has a lot of like maybe schizophrenia or problems, you're never going to be able to really help them meet their full potential at that point. But maybe if somebody had helped them when they were a teenager, you could have affected their whole life and improved it.

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Because it could be easy to say that, oh, this is just teen angst, or this is just part of growing up, and it's a phase, and they'll get out of it. But sometimes it's not a phase. Sometimes there are deep-rooted issues that will fester. I mean teenage angst like like those

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feelings are still real. True. Like it is still it would suck being a teenager especially now when your whole life is just like plastered on the internet and anything that's embarrassing that you say or it's just there for everyone to see. So I definitely feel bad. Especially coming out

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of a pandemic too those these last couple of years there have been feelings of isolation and another weird one has been, not to deviate too much, but the idea that, oh, because newer generations are more quote unquote tech-based, tech-savvy, that they should be experts on all these things, but that's not necessarily the case too. So there's like an added social pressure.

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There is. There's a lot of pressure on teenagers nowadays to be, it's like we need you to act like a mature adult at all times, but we also are going to in turn treat you like you're still a child. Kind of navigating that can be really hard.

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And to kind of bring it back to precepting, when we talk about intervening, you're at that moment where you can intervene on the student's behalf and say, you can make a mistake now more or less. There are always going to be mistakes that you'll make. Absolutely. But if you can correct them now and intervene and say, you can do it better this way, that's going to save not just time but lives, potentially, when they go out into the real world.

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That's actually a really good point because now is the safe place to make a mistake and now is when you learn how to recover from a mistake. You don't hide it. You're not punished for a mistake. You own your mistake and you learn from it and you don't repeat it again.

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And having a good instructor, whether it's a PTI, preceptor, that makes all the difference because you don't want someone to grind you down and punish you for mistakes. Because there needs to be some level, I think, of leadership, but leadership can manifest itself in so many different ways and positive reinforcement goes a long way versus just critiquing all the time what someone's doing wrong as opposed to growing someone.

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Yeah, no, nurses should not eat their young anymore or ever really. That's not a good way to learn. That's a good way to like, like you said, be beaten down almost and like, and that's how you get burned out and you leave the nursing field within the first two years.

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What made you want to be a nurse?

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So my mom was a nurse, and she went on to be an MP, and then she actually did go to medical school as well. So I grew up never wanting to be a nurse and never wanting to follow in her footsteps. I'm like, I don't want to do that. And here I am. My first major was actually environmental science. I actually, I went to CSN and I applied to the nursing program and I got in and I think it was only until, it wasn't until halfway through the program that I finally was like, you know what, I did

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make the right choice. What made you want to switch because you mentioned before that you initially didn't want to go down that path. What was the, what was the

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moment for you or was it more gradual? It was definitely gradual because I was doing all the same prerequisites and stuff and I don't want to say it was a whim but it was a let me apply and it ended up being the right choice for me.

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Do you and your mom get to bond about nursing stories and share tales or maybe pieces of advice from her like when she was in nursing school?

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Yeah, she actually specialized more in women's health and in like cardiology and she's done like a million things. Whereas I am definitely on the opposite spectrum, like pediatric and adolescence only, psychiatry. So we have like totally different interests in the field. But yeah, we bond.

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Where do you want your nursing career to eventually take you? Like five, ten years down the road?

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On a beach somewhere?

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No.

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I want to become better at helping children and adolescents in the community. I know that sounds so corny, but it's like I want to make a difference in this role that I can do.

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Like have you on practice maybe?

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Yeah. I have a crazy idea of like being able to do home visits for some patients because like maybe their parents are bed bound or their situations are just really up in the air and a lot of kids can't get to the office regularly for sessions.

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That's not a crazy idea. That's actually a really good idea. That's usually half the battle is transportation, just the convenience of getting to one place. So that's, you know, bring the care to the person. I mean, at the end of the day, they're still getting what they need.

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Yeah, and just kind of trying to remove some barriers. What do you think makes a strong nurse educator? Sometimes I think the people that struggled as students end up being a better teacher because they they understand how hard it is. That's interesting. Sometimes. Because

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sometimes being the best student doesn't translate necessarily into being the best nurse or the best you know whatever your your career might be it's not always just about the grades or studying tests. I mean you need that knowledge. You need to have strong foundations. But that's interesting because then you think about if I could do it differently, what would I do differently? And that we've heard that from other other instructors. Like they said I just wanted to try it my way. Mm-hmm. Yeah, I wanted to like I want to

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challenge my students but from a place of love, not just beating them down because this is how I did it when I was a nurse, you know.

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Well, Brittany, that's all the time we have. Thank you so much for coming in.

0:14:54
Thank you so much for having me.

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I'm a huge fan. I love your show.

0:14:57
Thank you out there, everyone. Thank you out there, everyone. Hope you have a great day.

Transcribed with Cockatoo