Beyond Books

Even after all her previous work as an emergency department nurse, and all her hours of study in the classrooms and labs at Columbia Nursing, Rachel Epstein  ’14, still felt apprehensive the first time she walked into a patient’s room as a trainee in primary care. It was her preceptor, a more experienced nurse who had once been in her shoes, who calmed her nerves and helped her summon the perseverance needed to get the job done.

The patient was an obese woman suffering from debilitating pain caused by enormous uterine fibroids. The growths had been discovered months earlier during a visit to the emergency department. While there are several surgical options for treating fibroids, the patient’s condition worsened over time because without insurance, she couldn’t find a surgeon willing to take her case.

Together with her preceptor, Epstein reached out to multiple physicians, the chief nursing officer, and other senior hospital executives. “My preceptor’s commitment and tenacity were inspiring,” says Epstein, who came to Columbia Nursing to become an adult gerontology nurse practitioner. When they were finally able to find a physician to take the case, “I suddenly realized that the role of the nurse practitioner entailed far more than diagnosis and treatment plans. It is also about advocacy and activism.”

Preceptors guide students from the classroom to the exam room and beyond, demonstrating how to transform the theories taught in books into clinical practice. These experienced nurses fill many roles, from encouraging the mastery of new skills to teaching the ins and outs of the mission and culture of a particular workplace and how to communicate with patients and other health care providers.

Clinical placements make it possible for Columbia Nursing students to work and learn in some of New York City’s most challenging and rewarding health care settings. Preceptors mentor students in dozens of facilities in the metropolitan area, from inpatient hospital wards to community clinics.

During her rotation in cardiothoracic surgery, Simran Gill ’14, a student in the nurse anesthesia program, learned from her preceptor that sometimes the best course of action is to ask for help. Gill administered anesthesia to a patient undergoing a transfemoral aortic valve replacement, a complex procedure that requires accessing the heart via a catheter inserted in the patient’s groin.

Near the end of the procedure, the patient developed a cardiac tamponade, which occurs when blood or fluids fill the space between the sac that encases the heart and the heart muscle. The condition can be life-threatening if not properly managed by the medical team.

Nurse anesthetists are trained to carefully monitor blood pressure for abnormalities during cardiac procedures and adjust medications used to sedate patients. One thing Gill's preceptor taught her to watch for is signs of tamponade, because certain types of anesthesia can either exacerbate or alleviate the symptoms. Gill recognized that the patient was in distress. Gill had studied this scenario – enough to know that the seconds mattered. She immediately alerted her preceptor, who quickly helped stabilize the patient.

A few days later, the physician caring for the patient told Gill that “the reason she survived and she could walk and talk was because of the steps the nurse anesthetist took,” Gill says.  

For other students, many lasting lessons came from experiences that didn’t unfold the way they read about them in their textbooks.

Alysha Koorji `14, also had a preceptor who wouldn’t let her back down from a task that made her apprehensive – her first time inserting a central line. Koorji, who is training to be an acute care nurse practitioner, had done plenty to prepare. She had practiced in the simulation lab, observed and assisted with the procedure several times, and reviewed videos of the process the night before. Still, when the time came, she was anxious. Her preceptor reassured her that she could do it.

“My preceptor said, `Take a deep breath, and whatever you do don’t let go of the wire,’” recalls Koorji, referring to the guide wire used to ease the catheter into position for the central line. “There was this voice then, which stays with me to this day, saying `You can do it,’ and it’s the voice that taught me to trust myself and finish the task at hand.”