/'priˌsɛptər/ - An experienced clinician who supervises nursing students in a clinical setting to give them practical experience with patients.
Craig Thomas, an advanced practice nurse practitioner, treats cardiology patients at UVA Health System’s Advanced Heart Failure Center. Since earning a BSN in 2001, an MSN in 2009, and a post-master’s in acute care in 2011—all from UVA School of Nursing—Thomas has been a nurse for 17 years, a nurse practitioner for seven, and a preceptor for more than a dozen. While Thomas has precepted a number of RN to BSN and DNP students, he most often is a mentor to advanced practice nursing students.
You’re a busy nurse in a unit where critically ill patients are the rule. Why precept?
Personally, I like to teach. I like taking what I’ve learned over my years and sharing that with people who are sponges for knowledge. It also allows me to stay current. Students today are learning differently than I did, so it keeps me in the know, and challenges me to make sure that I’m as cutting-edge as possible, because I know I’ll be asked hard questions.
Did preceptors play a role in your own development as a nurse?
Definitely. [Former professor] Kathy Haugh was one of my first memorable clinical instructors, and she had a passion for cardiology and for teaching, and we really bonded over that. I knew where I wanted to be after having her as my first Medical-Surgical clinical instructor on 4 East—where I also sought employment after graduating. I had truly great preceptors there, and always felt like I had support, that I was allowed to make mistakes without hurting patients, and my learning and my development as a nurse really grew because of them.
Based on the way we ask questions, it helps get truthful and perhaps more insightful answers. Honesty and openness is really the only way to help people in our field … so I dig in to find answers until I feel like I understand where they’re coming from.Craig Thomas, ACNP, Advanced Heart Failure Center & UVA Nursing preceptor
Are there lessons you always try to impart—tricks of the trade, or key pieces of information—to the students you precept?
My key takeaways tend to be about helping clinicians uncover things. If you ask the right questions, you’ll get the right answers.
I like to help students find their own methods for physical exams, and encourage them to do things the same way each time, so you never miss anything. For me, a patient’s usually sitting, and I have them lean forward so I can listen to lung sounds first. The rest of the exam is with them reclined, and I always assess them from their right side—that’s standard of care, and helps when you go back and chart.
Also, I go head to toe, covering all the different systems, leaving feet for last. One little pearl is, if somebody has stinky feet, you don’t want to play with those and then, say, check the pulse in their neck.
Pay close attention to the way people speak when you’re talking with them. Heart failure patients commonly experience shortness of breath, so speech patterns can show that—they might have to take a breath in between every other word. Alternately, they might complain about shortness of breath but then talk in extensive, and long run-on sentences.
One thing I come across frequently with heart failure patients is related to medication management. We print out a list of medications that we think they’re taking, and ask them to check it, checking off how often and what they take. Probably half of patients, though, don’t check anything at all that’s on the list. A more novice clinician might glaze over this, but I ask, “Are you taking your meds? Do you know them?” and they say, “Yes,” but then refer me to the list.
In my mind, that tells me someone doesn’t know their medications well. Patients want to have the right answers, and if we give them this list, they’ll just say it’s right. So if they don’t seem to know much about their medication, I’ll dig deeper: “How do you take them at home? What’s your process? Do you use a pill sorter? A list on the refrigerator? Do you have a family member help you? Describe it to me so I get an idea.”
Even with the ones who check off each medication, I still ask. I don’t necessarily dig deep through every pill, but do check the ones important to their cardiac care. “You checked here you’re taking Lasik, 40 mg a day. Is that still working? Can you tell a difference when you take it?”
So based on the way we ask questions, it helps get truthful and perhaps more insightful answers. Honesty and openness is really the only way to help people in our field … so I dig in to find answers until I feel like I understand where they’re coming from.
Are there ways that YOUR nursing has changed as a result of your teaching?
Certainly. Every time I precept, I learn something that I can apply to my own practice to improve it. It might be as simple as a new way to chart, or use EMRs [electronic medical records]. It’s easy to get into a routine, to do the same thing for 40 hours a week, for 17 years. Students challenge you to think about things differently. Even with novice eyes, they come to the clinic environment with different viewpoints.
I know a lot about what I do, and I do take good care of our patients, but I never claim to know it all. I can’t think of a time that, because of our student-mentor relationship, I didn’t benefit in some way from their experience and perspective.
What’s neat about the Advanced Heart Failure Center?
I’m tech-y. I like gadgets, and things, and this population—with all the LVADs, defibrillators, pump flow rates, pacemakers—it’s a lot of very scientific machinery, a lot of high-end science, and incredibly intelligent design, and I enjoy that.