I've been a nurse for 4+ years. In this time I've formally precepted two new grads. Informally I teach people all the time, but the new grads are the people I get excited about. Okay so I had very little time to spend with the first one, and I was only a year out of school, and I had my full load as well so it was difficult, plus I had no feedback so no clue how I did.
This time is going better. My orientee is two months into orientation, and has made a lot of progress. She can organize her shift, has a decent brain sheet that she prefers (I made it, but hey we gotta start somewhere, she will make her own eventually), and successfully do a shift with 3 patients. Now this is LTAC setting, so most of them are pretty acute. She has been nice enough to come in on a couple of very short-staffed nights and was not on orientation those nights. One of them she had a 3 patient load and handled it well, asking some questions and mostly just doing her thing, on time and correctly. The second shortstaffed night, they put her in there with four patients: one vent getting blood and on a heparin drip, one trach collar, one easy on TPN pt, and a confused nursing home style patient who likes to rip dressings off and play in his wounds. That night was really hard for her, a days nurse stayed till 11 pm to help her with the blood, and she was kinda shellshocked by the whole experience. (god I remember the first of the really hard nights!)
Anyhow so back to normal staffing, weee! I give my orientee a 4 patient load and instruct her to delegate tasks to me, but manage the load. I'm going to tell y'all how it went and then I want to know, how to do things or say things that have a slightly different outcome.
She gets VS and assessments are completed at the same time, by 2030-ish on all four. VERY good. Meds- 3/4 are done by 2130, again very good. So I pull meds on the 4th one, the complicated one, and meet her in the room, she gives some, I hang some IV antibiotics, we do the complex skin care together and roll the patient, clean him up, etc.
Then it's charting time, PRN med time, and dinner time. After dinner and through the wee hours the delegation goes well, but in the AM's here we draw our own labs if they have PICC or central lines. So 3/4 of the load has labs to do. I did one lab draw, she did two and remembered to turn fluids/tpn off 30 minutes prior with a flush. This is a big deal because it takes until noon to get the correct results back if you have a contaminated sample at 0500. We all don't like being the nurse who did that.
Labs and such, along with all 4 having 0600 meds, of which I did one pt's meds, puts us behind. I start grabbing a pen and adding I/O's on any flowsheets within reach if I know I have the right info. Our relief shows up early, I pretend to read a book during report so I can keep from interrupting her while she gives report. Report is good, we get outta there on time. Woot baby!
Ok. Now for background I am a move it, shake it, don't wait type of nurse who most of the time, would rather do something at roughly the speed of sound, than tell someone else to do it. While you talk about suctioning that snot I have jumped under you and got the loogie out. Seriously.
When I was new, my nightshift preceptor let me delegate only non-nursing or helping tasks to her, so that I could get the nursing things done and learn how to delegate. Like, she would get bedtime snacks, and help me turn and clean folks, and help me weigh them. (my first nursing job we weighed every pt. almost every morning.) Then in the AM she might run down the hall and do everyone's accuchecks while we got 0600 meds done and taped our report. Here I am trying to help my orientee do her meds and draw her labs, both of which are pretty essential nursing functions at this place.
Question: do I make it worse for the orientee by helping with meds? Am I making her look and feel less competent by helping in that area?
Also, how in the bejesus do I go about getting off that transition point to just being a resource for getting people's ice water, food, turns and cleanups done? Along with answering questions, of course. I realize that it is invaluable to follow the orientee around like you are their twin for the first couple weeks or so, to help with identifying strengths and weaknesses, and give good advice, and show how to organize the shift. That part I've got down. The transition from almost got a full load to ok they can handle their full load, that part is where I feel stuck; it feels like I am not transitioning the orientee properly.
I do NOT remember how my preceptor managed this with me. It may be that I took off like a rocket and just tried to do it all until I could, but really I'm not sure.
I'm sorry this is so long, and this orientee will be done with orientation soon, but I could use the advice for next time.
Dec 20, '09
Is your preceptor still around? If so ask them. If not, ask someone else that precepts that you respect and see what they say....I love precepting, I think it's awesome to see someone grow in the RN role!
Dec 22, '09
How many patients is a full load considered?
How much longer does she have left of orientation?
Dec 23, '09
Four is considered full here, five is ouch but sometimes happens. She is right at her 11th week I believe. I have put so much effort into this training that I don't want to screw up the "letting off" and "letting go" part, yano?
Dec 23, '09
Maybe you could ask the orientee what she would prefer? Oftentimes it is a matter of personal preference. Some like the help - some will be offended. If you don't ask, one orientee will be helped and the next offended, by the same treatment.
And/or you you ask those recently out of orientation what did/did not work for them and what they would suggest.
Dec 23, '09
I am a new nurse, but have trained several staff as a CNA. I know when I am training, after the new staff feels they are competent, and I feel the same, I will go and help other staff with things while remaining available as a resource for questions. I have seen several nurses train this way too.
It sounds like you have done a great job getting her prepared for working on her own and just need to let her go on her own. I am sure you can help other staff or stock the unit to keep yourself busy, while allowing her to manage the patient load on her own. This might also help her learn to delegate better. If you are not right behind her to offer to do things she will have no choice but to find the CNA. Even if it takes her a night or two to realize she cant do everything, she will eventually learn she has to delegate to be a successful nurse.
This will give her more confidence when she is on her own. I also notice alot of people, myself included, second guess themselves when their preceptor is around. Sounds like you are doing a great job training. I only wish that all nurses had the desire to share thier knowledge and see other nurses succeed!
Dec 23, '09
Well I did the "very little help" thing last night- I made myself a resource for the entire unit and helped with questions and did occasionally rescue my orientee from drowning. In my world that means I ran my everloving butt off for all the nurses. My feedback was that the job is doable, but just barely, and she didn't enjoy the experience. It left her feeling disappointed and a little abandoned, but she did pull through and do roughly 95% of the load herself. And let me tell you, there were no light loads anywhere on that shift.
Dec 27, '09
I think in the long run she will be grateful that you back off now and let her see that she can handle the full load on her own before she really is on her own.
Dec 28, '09
The fact that you care enough to ask makes me hope I have someone as dedicated as you! She should be very appreciative of the experience that you have offered and the education you have provided as she starts her career. Preceptors can make or break a new nurse I have no doubt!
Jan 6, '10
Indy you're an awesome preceptor! can you please be my preceptor?hehe.. I will be starting in a LTAC facility this month as a new grad, orientation is 6 weeks with 1:8 ratio. Any tips?? My greatest weakness is I lack assertiveness. =/ What can I do to make the most out of my orientation? What are some of the good characteristics that new grad nurses should have while on orientation aside from a willingness to learn?
Jan 9, '10
I work in an LTAC and I can tell you, 8 patients is too many! Holy crap, I can barely handle five with a tech!