Very few institutions expend the resources to teach their preceptors how to precept. Here are some of the things I've learned.
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If you believe everything you read on allnurses, preceptors, by and large, are awful people put on earth to torment new grads. Since I genuinely believe that most preceptors honestly try to do the very best they can (however reluctant they might have been to take on the task) I'm concluding that it is their precepting abilities, not their intentions that are lacking. The awful truth is that very few hospitals put a genuine effort into precepting the preceptor, mentoring the mentor or teaching the teachers to teach. Most of us are just pointed in the direction of the new employee with vague instructions to "orient them." Here is a bit of what I've learned in my many years as a preceptor.
It's not just about teaching the new grad how to put in a Foley, drop an NG or violate a vein. We also have the responsibility to teach them to be good employees and good colleagues. Most new nurses have never held a real job before -- with apologies to those of you for whom nursing is a second career. I was a waitress, cook, bartender, maid, wedding photographer, lab assistant and tutor to work my way through college, but nursing was my first real job. I needed to learn the importance of staff meetings and the proper way to dress for one, teamwork and about taking on additional responsibilities such as Policy and Procedure Committee or Nursing Grand Rounds. That's part of what we as preceptors need to impart. A new nurse who hasn't witnessed good teamwork will have a tough time being a good team player and one who hasn't been shown professionalism may conclude that it isn't important.
Part of being a good preceptor is socializing your orientee to your unit. That doesn't mean you become their instant best friend. After you've been out drinking until dawn with someone, it's pretty hard to tell them that their organizational skills are lacking or their sterile technique is absent. But it's important to introduce your orientee around. One of my former preceptors made the point that part of my orientation was learning to order lunch from the local take-out. At another hospital I learned that failure to mark a holiday or a co-worker's birthday with a potluck was inexcusable. Your unit may never order take-out or have a potluck, but you catch my drift.
Be present. A new graduate shouldn't have to hunt you down when they have a question -- you should be close enough to anticipate most questions and immediately address the others. So no taking two hour lunch breaks because "someone else is doing the work." You're not going to know that Suzy is sticking urine samples in the lunch refrigerator until after someone ELSE finds them if you're not paying attention. Or that Hortense is using clean gloves for sterile procedures because you forgot to show her the sterile gloves. I once witnessed a sentinel event from a distance of about 12 feet. All of the preceptors had gone to lunch together leaving six orientees alone with six fresh from the OR CABG patients. I was one of the orientees, switching jobs after a cross country move. I tried my best but I couldn't orient five new grads at once (nor was it my responsibility) and a patient died. That death still haunts me -- I hope it haunts those six preceptors as well.
Check their meds. Even a new graduate with the best of intentions and the most photographic memory can sometimes confuse digoxin and diltiazem -- and sometimes with fatal results. As a preceptor, you should know exactly what they're giving, when and to which patient. I got involved in something else one time and my orientee marched into a patient room and gave the 60 units of NPH insulin intended for the patient in room 2A to the patient in 2B. (Few mistakes are fatal if you own up to them right away and immediately set about mitigating the damage. But it did screw up the patient's day and the orientee's month.)
Teach to the best of your ability in the manner that your orientee learns best. One of my orientees could only seem to learn by getting her hands on. Showing her how to change a ventricular assist device dressing didn't seem to make an impact, but standing at her shoulder and talking her through it just once made her a pro. Another orientee was scared to death to touch a patient unless we first went over the procedure step by step with the written procedure in hand. Standing at Matilda's shoulder talking her through the procedure wouldn't have helped Matilda to learn unless she'd first read through the procedure, and Greta couldn't conceptualize the procedure by reading it without doing it.
If you find that you cannot teach your orientee in the way they best learn, perhaps it's time to let someone else give it a try. I tried and tried to explain how to do pacemaker checks to Amanda -- she became frustrated and convinced she was stupid, and I became frustrated and convinced I didn't know my stuff. I asked Stella if SHE could explain it so Amanda could understand it -- and she could. She used slightly different vocabulary and analogies and Amanda got it the first time. That said, I've also found that if you find you can't explain something to your orientee clearly enough that they can grasp it, it usually means you don't understand it as thoroughly as you thought you did.
And keep in mind that as you're teaching your orientee how to be a successful nurse, you're also learning something from them -- or at least you should be. I learned to communicate with developmentally delayed adults from a new nurse who had been a home health aide. Ed had been a sound technician before becoming a nurse, and taught me a lot about dopplers. Iza had gone to nursing school in the Philippines and during the months that she was my orientee she perfected my bed-making skills, showed me better ways to arrange linen and proved to me that even confused patients can be left neat and tidy at the end of your shift. (And if she'd been just a little slower to learn, making her orientation last a little longer, she could have taught me how she did that!) If you're not learning something from each person you precept, you're not doing it right.
I'm sure there are things I'm forgetting to mention here, so I'll welcome tips from all of you to help me become a better preceptor.
