Being a Preceptor

[sweetsleep28]

So, I've become a preceptor at my facility. The past week I have had a GPN with me. She's very emotional. It seems that every little thing makes her cry! She thinks that she should know everything already, and becomes terribly upset when an issue arises. I have tried to be nothing but supportive. I have not tried to push her to pick things up quicker. I've allowed her to work at her own pace and have always been right with while assessing,passing meds, etc. She is very green and has absolutely no healthcare experience. LTC is a hard first job to have. Sadly it is almost sink or swim. I don't want to see her sink. She has the foundation but just needs to build on it. She's numerous times a day that school didn't make it out to be this way. I am trying my best to pass the knowledge that I have onto her, but it is becoming more and more difficult to do so. I can handle the emotions of my patients, their families, etc. But I become terribly uncomfortable when she breaks down into a fit of hysterics over a dropped multivitamin and begins to cry uncomtrollably. I am at a loss of words as to what to say to her. Anyone ever been in a situation like this. Any input on how I should handle it? I meet with my DON and her on Monday to go over how her preceptorship is going. I want to be able to say good things about her, but I'm not sure if I am going to be able too.

[Zookeeper3]

I've had a few nurses like that. Mostly if you don't let them get those "bad" feelings out, they stay bottled up all shift. I've said/done:

-"take 5 minutes in the bathroom, finish crying and meet me back out here"

-"you need to assess yourself first, you can't care for someone when you need care yourself"

-"Deep breath and no negative thoughts, lets continue"

- Meet with this type of person after every shift and outline the most important areas to focus on and end with praise.

-Complement little successes, to build esteem

-Provide imediate feedback, sometimes tough love- "you can cry when you make a med error, but you will likely drop 5 more pills on the floor today alone, so you will run out of tears at this rate (said with a smile and soft voice), so lets keep it in perspective.

-my favorite, "you are your own worst enemy here, your unrealistic expectations of yourself are preventing you from relaxing and learning".

**Never wory about having to have positive things to say, I simply describe what I have witnessed, and document it daily and leave it up to the supervisor to determine where to go (assuming there are no safety issues).

[mindlor]

Why oh why could I not have had you for my preceptor zookeeper!!

You seem like you are amazing :)

[Do-over, ASN, RN]

I'd wonder if there was more going on with her... Her reaction, from your description, seems out of proportion to the incident. A "fit of hysterics" over dropping a vitamin is not what I would consider "normal".

If there are problems, sugar-coating won't help her.

Do you have an EAP through the employer that she could call?

[nurse2033, MSN, RN]

You need to make it clear to her that hysterics on the job are unacceptable. Her job #1 must be to control her emotions so she can work. I would tell her flat out that unless she finds a way to control her emotions she won't make it through. You are putting a lot of energy into this situation that would be better spent in other ways and must be taking a toll on you. I spent six years as a preceptor and unfortunately there is the occasional employee that can't cut it. You might help her with some strategies on how to stay focused but crying on the job should be reserved for an occasional highly charged incident. You can't fix all of her underlying issues. It sounds like you are being as supportive as anyone could expect, so even in the best environment she still is having trouble. I would be frank in evaluations and expectations- like "make it through 3 shifts without losing control of her emotions". Good luck!

[llg, PhD, RN]

I think the OP has gotten some great advice in this thread. This orientee has problems that go beyond the normal "nerves" of a new grad. In such a situation, all you can do is to try some of the approaches mentioned above ... and don't take on the responsibility for "fixing her life and/or ongoing emotional problems." At some point, the orientee needs to take responsibility for her emotional stability -- and either sink or swim.

Be kind. Be fair. But don't get sucked into being an enabler. Set standards of behavior and starndards of performance -- and stick to them. If she can't meet those standards, she will have to go.

[PeepnBiscuitsRN]

I got to the verge of what you're describing over many points on my orientation. I had a (bad) complex of thinking I need to be perfect and know everything and have it all down pat by orientation's end. Almost had a panic attack over giving 1mg of Bumex instead of the 0.5mg prescribed. Most of it is personal- a "me" thing I need to straighten out. But a little bit of it, I think comes from nursing school- being primed that if you don't complete that med pass in the 20 minutes they give you- and they did indeed, give us 20 minutes to do it for 2-3 patients which is pretty reasonable except they also made us do all the PCA work too, like vitals, toileting, diaper/gown/bed changes/baths AND the med pass...and we had to get those meds within the 20 minutes they were scheduled. I know it can be done and has been done...but depending on the instructor, your clinical experience can be REALLY anxiety provoking.

Anyways, I've learned to do my sobbing in the car on the way home- or to not do it at all and just suck it up and learn from my mistakes. I think that might be what you have to tell your little orientee, nicely of course so as not to induce another temper tantrum. She's kinda acting like a 3 year old, and it probably looks REALLY weird to the residents, their families, the other staff and anyone else witnessing it. Make it clear to her that you're not scolding her- you're teaching her, and that's what it's all about, kiddo.