Precepting the Preceptor

Very few institutions expend the resources to teach their preceptors how to precept. Here are some of the things I've learned. Nurses Announcements Archive Article

Precepting the Preceptor

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.

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Ruby Vee

About Ruby Vee, BSN

Ruby Vee BSN

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Specializes in Emergency Department.

Very well put. I hope the NPH insulin preceptee is doing okay. That kind of thing can shake a new grad pretty badly.

I'm not precepting anyone yet, but I'm planning to get started in the next year. I'll keep a link to this article before I get my first new grad.

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I start my first job as a brand new RN next week, I hope and pray that I am assigned a preceptor with as much passion and compassion as you!

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Specializes in ER.

My boss has asked me to preceptor new nurses. I'm not sure if I'm responsible or patient enough to guide a baby nurse through an ER orientation, but I'll try. You can be darn sure I'll be bringing my questions to allnurses.

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Specializes in Peds general and ICU/Comm. Disease RN.

You speak so eloquently and expressed exactly what I, as a former preceptor, felt. Thank you. I just don't have anything to add.......very well put!!

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I wish I read this a year ago. I was preceptored a year ago in a large teaching hospital and my experience was horrendous. During a night shift I broke down crying from the pressure of my preceptor and her 'friends' that felt I was incompetent. I am a mature student and they were all very young people. My learning style was quite different from her teaching style. I completed my stint in the department, got a job with the institution and still see my preceptor sometimes. I still clam up when I see my former preceptor and become very nervous. I am still trying to overcome the negative things I was told by my preceptor BUT I AM getting there.

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Specializes in none yet.

I would like to add some advice to the excellent advice given by Ruby Vee. I use "she" in this advice writing, but I think it would be the same for guys. I am female. If some of the advice needs to be adjusted, perhaps someone else can write about that.

Act responsibly like you would for a patient. Monitor her, give her help when needed, give her encouragement. You may not be a teacher, but you are a nurse and you know how to care excellently for patients in need.

Act toward the new nurse like you would a treasure. Smile, give her thumbs up, do anything to show her you are proud of her. Find things to be proud of, even if it is just using the phone to call the doctor from a written script.

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Specializes in Psych, OB-GYN.

I'm a new nurse and begin orienting next week - This thread has me in tears - scared to death to be a nurse. I just hope that the preceptor that was assigned to me has either read this information or already has the right heart for me.

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This was a very insightful article. I have been fortunate enough to be hired by a teaching hospital with a program to precept the preceptors, or coaches as they are now referred to. My coach is a great nurse, good teacher and good role model. She has introduced me around and that has made me feel at home on the unit.

I have felt rather inept when performing some procedures for the first time after watching the "coach" do them. I blundered through them and kept forgetting the steps. After reading your article, I realize that I am a hands on person. I remember more when I do rather than when I watch. I do like to read about the procedure as well as it locks in my hands on learning.

Thanks for sharing your experience.

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I recall the saying, "Nurses eat their young". To the newbies, don't allow it. To the preceptors, don't do it! Remember your communication skills, try to diplomatically resolve situations with your preceptor. If that doesn't work, you can always, after some self-examination, request a new preceptor. Gossiping about the experienced nurses will only make things worse. Constructive conversation with your manager is much more effective. I eventually became friends with the nurse who tried to "eat" me. Great technical nurse, not a "people" person. Excellent article.

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Love this! I am precepting my first GN and we just finished up our first week together and I hope she has learned half as much from me as I have learned from her in this week.

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I wish I read this a year ago. I was preceptored a year ago in a large teaching hospital and my experience was horrendous. During a night shift I broke down crying from the pressure of my preceptor and her 'friends' that felt I was incompetent. I am a mature student and they were all very young people. My learning style was quite different from her teaching style. I completed my stint in the department, got a job with the institution and still see my preceptor sometimes. I still clam up when I see my former preceptor and become very nervous. I am still trying to overcome the negative things I was told by my preceptor BUT I AM getting there.

I had a terrible preceptor also :( Our school held clinical there and she was a nurse on the floor. She was assigned to do my precepting later. She told me right away before I started that my school didn't teach you anything and her nursing school prepared their students to start on the floor right away with no problem. I knew right away she was going to be trouble. She told me every issue each nurse on the floor had and had nothing good to say about them so I knew when my backed was turned....she was talking about me. If I asked her to show me something she grunted. She handed me my patients papers after report and sent me on my way. If I had a question, or needed to clarify she was very rude. Once I said " I have pushed meds with a Picc line before but maybe you could come with me", she floped her papers down and looked at another nurse as if I was stupid. At lunch time she involved other nurses in discussions and you could tell they were being manipulated into saying things they were not comfortable with. If I see her again now that I am an RN I will let her know how unprofessional her actions were and what a terrible nurse she is for putting her patients at risk just to watch a preceptee squirm.

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