Are you thinking it’s time to dive into precepting a student?
Let’s talk about it! I could talk about precepting, students and midwifery all day long. I’m not an expert by any means and learn new things every day. Let’s get that disclaimer out of the way.
But I do think there’s not a lot of mentorship when it comes to taking midwifery students.
This makes sense. Most people just want to get to the catching babies part and in midwifery training there is way too much to teach to spend time on precepting. Also, most students wouldn’t take it to heart because the firehose of information is incessant.
But if you’ve asked…When do you take a student after graduation? How long do you take a student? How do you know what students to take? How do you know if your site is right for students, or your team?
These are just my opinions; I didn’t get any of this advice along the way except tip #1. I’m also not an expert on taking students in the community birth settings (if you are and you’d like to guest post about it…email me ASAP!)
Read on and see if you’re ready to take a student…
Tip #1: You’ve been practicing about 2 years as a *provider.*
Provider is the key word here. Sometimes I find students that have been labor and delivery nurses for a long time and they are very eager to jump into the precepting pool on the backside of graduation. I’m going to caution you on doing that. There is a HUGE role transition that happens from nurse to provider. Sometimes you don’t see it happen and sometimes you feel every moment of that transition (i.e. the pager goes off 30 times in one 24 hour shift or everyone looks to you for the interventions for the postpartum hemorrhage).
Whether you work in the hospital, birth center, clinic or home, you have to learn the new ebb and flow of provider world. This includes how to call your patients about lab results, how to finish your clinic notes on time, how to send your schedule requests to the scheduler. You’re learning all of that AND you’re doing the midwife work too.
To me, the most stressful thing you could do is add on a student as your shadow when you yourself are still learning. At 2 years, I see most midwives hit their stride with work life and home life. That’s the time I would recommend thinking about taking a student.
Tip #2: You’re confident in a brief and debrief situation.
The best situation here is an obstetric emergency. You were the midwife running the emergency; now, on the back side, the patient/baby are safe and you have to lead everyone through what happened, why the interventions were done and what could have been done better.
If you’re heart rate just increased – you’re not alone. Leading brief and debrief situations is hard.
The other side is a brief; I liken this to the report you run with your obstetric back up. It might go like this:
Midwife: “Mrs. Smith in room 3 is an induction for pre-eclampsia. Her foley balloon came out last night and she’d like to proceed with cytotec this morning instead of pitocin.”
OB/GYN: “Why cytotec? Why not pit?”
Midwife: “We reviewed both options and she’d like to hold on pitocin because she had a bad experience with the medication during her last induction.”
OB/GYN: “Okay.”
Midwife: “Her first dose is due in the next hour. I’ll be sure to keep you udpated!”
If you can’t justify your plan of care and running the board with your providers is overwhelming, taking a student is going to overwhelm you more. Work towards confidence in these situations. When you get there, you’ll know.
Another example is a debrief about birth maneuvers or hand positions. Usually there is some coaching and fine tuning needed – if giving feedback makes you uncomfortable, you might need a little more time before precepting.
Tip #3: You’re confident in calling and coordinating with a backup provider and team (with someone watching you’re every move).
It’s not uncommon to be in the hospital overnight running the unit with a back up provider at home. Do you know your unit protocols well enough to call or not call your back up without having to look them up? (It’s always okay to recheck the policy, but that’s not the point here). Are you comfortable enough to know when your phone call is a “this is a courtesy heads up”, “I’m going to need you in house in the next 1-2 hours”, “or a “I need you ASAP!”
There’s an easy way to know if you’re confident in these situations and it’s simple: TIME. Give it some time and you’ll find out really quick if you’re calling your colleagues or back up providers for consultations, co-management or referrals.
The flip side to this tip is this is exactly how you’ll teach it to students: Are we collaborating, co-managing or outright referring this patient with an OB/GYN?
Tip #4: You’re confident in emergencies.
You just handled a shoulder dystocia in room 4 and postpartum called to say they need you ASAP for a hemorrhage on their unit. What do you do?
If you’re not sure, hesitant and your heart is racing again, it’s a red flag that a student isn’t going to make the situation any easier to manage.
But, if you can say “We’re going to debrief that dystocia in a little bit. Right now let’s boogey over to postpartum and see what’s going on. What do you remember about the patient on postpartum? Any risk factors or history that are important?”…you might be ready to take a student.
Here’s the other thing with students. They are there to learn. You have to be comfortable enough to let them do some management of the emergency while you’re guiding and teaching them.
Yes, it’s hard because it’s hard.
Tip #5: You’re confident in talking with nursing team and charge nurses.
This is a different but similar communication goal to speaking with your back up provider. The charge nurse runs the floor and has the best idea of where the staff are and where they are needed. The provider and the charge nurse are responsible for everyone on the floor. I think of it as co-captains on the ship.
Sometimes I find that new midwives struggle to work with the charge nurse because they don’t have enough experience at this type of floor management. Think about these decisions:
- You’re unit is full and you have to push inductions backwards. Do you know how to quickly rack and stack the inductions based on medical need? Are you comfortable calling and telling the patients why inductions are being moved?
- Your triage nurse tells you that three of your patients arrived in triage at the same time. She gives you a brief report on all three patients and then asks you what your plan is.
- You’re repairing a laceration in room 2; the charge nurse tells you that room 6 feels the urge to push and the triage nurse admitted a multip at 8 centimeters. She’s just letting you know and you respond….
Throwing a student in the mix makes everything a little harder. If you’re able to answer all of those examples and can turn to your student on your shoulder and explain the management and critical thinking while you communicate your plans to the team…you’re probably ready to precept.
Tip #6: Know how to use your resources or find your resources (but, you also know you don’t have the answers to everything).
Here’s a truth I abide by: Don’t give your students all the answers; make them look them up.
But…if you’re a provider, you know that we look stuff up ALL THE TIME. If you’re not efficient in finding answers among your resources, it might be worth while to wait until you are more efficient before taking a student.
Once you feel efficient, you’ll be able to guide students more effectively to look up their own answers while they are in clinic with you.
Tip #7: You have established mentors.
You’re going to need some sound boards. This was true for me every year I’ve taken a student. And your mentors can be anyone that’s a provider – OB/GYN, midwife, advanced practice nurse – pick your people.
If it’s your first time precepting, touch base with this mentor before you start precepting. Ask about things that have made precepting successful for them, or just let them know you might reach out a few times over the next few months to use them as a debrief or sound board.
I find mentors can provide you an alternative method or way to teach something.
Tip #8: Your home life isn’t insane.
Precepting is an incredible amount of work in addition to the hard work you are already doing as a midwife. Even for seasoned providers, your day will move 20-30% SLOWER than a day without a student. Only at the very, very end of teaching a student do you get a couple of days where you are following and fine tuning while they are doing the majority of care.
If you’re not ready to take that burden on and work is a break from your home life…you might want to wait on taking a student.
Tip #9: You’re not burned out.
Plain and simple. If you are in the midwifery/provider game for the long run, you have to protect yourself.
Students can tell when you are burned out.
It makes you less of a good teacher.
No judgement here, that’s just the fact.
Read up on how to prevent burnout here.
Tip #10: You’re comfortable talking to faculty and presenting facts – but hopefully you never have too.
Ideally, your contact with faculty is minimal in most situations you have a student. You’re signing a form citing accomplishments in clinicals while highlighting continued opportunities to improve. But sometimes you see a student that isn’t progressing and meeting milestones. Or isn’t going to meet their semester goals or numbers. Or maybe the student isn’t a good fit for your site. Or your site isn’t a good fit for the student.
Regardless the reason, if you are uncomfortable calling up a faculty member to discuss a student, it might not be time to precept.
That’s a wrap! Was this helpful to you? Let me know!
If you’re thinking it’s time to be a preceptor, check these resources out:
- https://www.midwife.org/Developing-preceptor-skills
- http://narm.org/preceptors/preceptor-resources/
- https://portal.frontier.edu/web/fnu/preceptor
And if there’s something else you want to know as a student, tell me all about it: amidwifenation@gmail.com
Also, if you just need a mentor in your midwifery career, I’m happy to correspond via email with anyone in need. Midwifery needs more midwives. You need mentors. Mentors need mentors.
It’s a new year, find your people! And if you need people, I’ll be your people 🙂
See you next week,
Jamie
1 year ago on the blog…What Happens At My 28 Week Visit?
2 years ago on the blog…Chelsea’s Birth Story (Part 1)
3 years ago on the blog…11 Tips On How To Prepare For Midwifery Clinicals
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- The Job interview: How to Prepare
- How to Recover from a 24 Hour Shift
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