Dear Preceptors

[purplegal]

If you are a nurse that is precepting, or are someone that is considering precepting, there are some things you should consider when deciding to mentor a new nurse. Coming from the perspective of a recent graduate who had an unsuccessful orientation, there are many things that I would have liked to have seen out of my previous preceptors. Although I cannot speak for all orientees, these are things that I feel could benefit many new nurses.

1. Make sure you are ready to be a preceptor and that precepting is something you really want to do. Are you ready to let a new grad make some of the decisions on their own, or do you feel better when you are in control of the majority of your patient's care? If you are, that's fine, but realize that may not be helpful to a new nurse who needs to experience patient care themselves. Are you someone that likes to teach others, or do you honestly prefer to handle patient care on your own? Some people are natural teachers, while others are not. Be honest as to whether or not you feel like you can be both nurse and teacher. While a new nurse is not a student, and should have some basic knowledge, you need to be prepared for someone that comes from a different educational background than you, and be ready to provide explanations when their understanding differs from yours.

2. Let your expectations be known. Be very specific as to what you are expecting from the person you are orienteering. ASK about their other preceptors, what their expectations are, and what they have already done. TELL them whether or not you want to be told, step-by-step what your plan for the day is, or whether or not the orientee can go ahead and provide patient care, and report back to you later. MAKE GOALS with the employee each day, so you both know what the plan is in order to make progress. Let your orientee know if you are willing to show them a new skill, or if you would prefer them to look it up themselves. Make sure you let the employee know what actions you feel will be necessary if your expectations are not met.

3. Be honest...with the ORIENTEE. If you honestly feel that the orientee is struggling, address the issue with the employee. While the manager, of course, needs to know the situation, make sure that ALL issues that you are bringing forth to the manager have already been addressed with the person that needs to know them the most, the person who has the most control in fixing any issues that may arise...the orientee. DO NOT delay in addressing any concerns you may have. Your orientee will NOT appreciate any surprises later on. Always make sure to express the gravity of any concerns you have. Do not brush the concerns off when addressing the orientee and make them sound much worse when you talk to the manager. HONESTY IS KEY in order to make sure that everyone is on the same page. Do not keep secrets from your orientee, and try not to have "secret meetings" during shifts. If you must talk to the manager on your own, do so when the orientee has left for the day. Your primary focus during the shift with your orientee is on them, and performing safe patient care. Additionally,it raises trust issues when the orientee knows that you are talking about them without them present. Also, if you honestly don't think you can work with this person, speak up so someone who can will be able to do so.

4. Do not make comparisons. If you are orientating more than one nurse, PLEASE, PLEASE, PLEASE refrain from comparing one person to the other. While it is human and natural to do so, please remember that each person is an individual, with their own personal knowledge base and unique experiences. Even if you do compare the two in your head, please do not make it known to your orientee that you prefer the other person over them. Orientees know when their preceptors prefer someone over them, and that puts pressure on them. As a preceptor, your job is to do your best to ensure the success of ALL your orientees, not just the ones you prefer.

5. Be positive. Although concerns are important to address, make sure that they don't become the only thing you focus on, or even the primary thing you focus on. The new orientee is not perfect, but generally, there is always something positive you can say about them and their progress. Positive reinforcement is needed as much as criticism, as it is hard to continue making an effort when one does not feel they do anything right.

6. Keep promises. If you say that you will help a new nurse with a certain skill, procedure or anything new, do so. Always be at the shifts that you say you will be at, unless of course, it is an emergency.

Thank you,

A New Nurse

What else do you think preceptors should keep in mind when orienting new nurses?

[Farawyn]

I think this is doable.

Nicely done.

What are your plans now?

Do you have a new preceptor?

[evolvingrn, BSN, RN]

Best wishes!

[Hoosier_RN, MSN]

I agree with all but #1. Sometimes experienced nurses (and some newer ones) are not given a choice to precept, but are told to just do it. I love to do it, but not all of my co workers do

[Farawyn]

I agree with all but #1. Sometimes experienced nurses (and some newer ones) are not given a choice to precept, but are told to just do it. I love to do it, but not all of my co workers do

I was always a preceptor. The orientees got to review us as well. I'm still friends with all of my orientees and my preceptors.

It started with 1 great preceptor for me. I took what she gave me and passed it on.

[purplegal]

I agree with all but #1. Sometimes experienced nurses (and some newer ones) are not given a choice to precept, but are told to just do it. I love to do it, but not all of my co workers do

That does not seem like a good policy. Just because someone is a good nurse doesn't mean they will be a good preceptor. Also, it will become evident to the new nurse that their preceptor doesn't really want their job. Some things, people just know.

[Farawyn]

That does not seem like a good policy. Just because someone is a good nurse doesn't mean they will be a good preceptor. Also, it will become evident to the new nurse that their preceptor doesn't really want their job. Some things, people just know.

On some floors, beggars can't be choosers. They take the most experienced nurses and give them the orientees. It's just the way it is.

I was lucky.

[purplegal]

I was always a preceptor. The orientees got to review us as well. I'm still friends with all of my orientees and my preceptors.

It started with 1 great preceptor for me. I took what she gave me and passed it on.

I like the idea of orientees reviewing their preceptors. If one person does not succeed with a certain preceptor, it may be that the particular orientee isn't a good fit for the unit. However, if more than one people have difficulty with a preceptor, it may be that the person simply isn't a good choice for precepting. Good nurses may be removed from the unit if they are with a preceptor who really should not have the task.

[Been there,done that, ASN, RN]

That does not seem like a good policy. Just because someone is a good nurse doesn't mean they will be a good preceptor. Also, it will become evident to the new nurse that their preceptor doesn't really want their job. Some things, people just know.

You had a lousy orientation.. you made it. Rethink what made it lousy.

This is not the fault of the preceptor, this is MANAGEMENT'S fault.

The facility should have a orientation process designed to retain and recruit nurses. This of course, includes trained and willing preceptors.

Your facility wanted a warm body. They went through the motions of an orientation.

Personally, I enjoyed teaching and mentoring. I am disappointed with my colleagues that are not able to welcome the newbies.

[LadyFree28, BSN, LPN, RN]

When I precepted at previous jobs, I enjoyed being a preceptor; my focus was being able to have my orientee focus of understanding critical thinking, cultivate critical thinking and the three C's: competency, consistency, confidence-meaning, If one can become competent on best practices and the policies and procedures consistently, they can cultivate confident nursing practice as a novice; the goal was to be confident in being a novice, know resources, and confidently understand the power of critical thinking in order to build their practice.

Well.

Some that have been oriented by me were regarded as great nurses by management; I watched them grow and can have stimulating conversations on nursing and the specialty that we are in; I stay in contact as I ended up frowning professionally and had to relearn being a novice all over again once I received my degree, and then when learning a new specialty.

Others were ok, one emphasized too much on the C of confidence and almost lost her job, but bounced back from that, and then one orientee just wasn't ready for Primetime...this orientee did not like to take direction, did not like when I set goals for her, even when they were increasing as the weeks went on; she would forget policy and procedure and her confidence of looking up information was lacking; however, she learned enough where she finished orientation, but ended up resigning and working at a Dr's office.

This one sticks out because I really worked with this orientee because I knew how it feels to be a fish out of water; to have to start at square one; what rubbed me the wrong way was when she decided she want to take an easier assignment, and then proceeded to tell me she was doing quite WELL, when she was avoiding a challenging assignment. No Bueno. She was in over her head and it most likely wasn't a good fit, but wanted to muddle through by avoiding a good amount of knowledge in order to work in the specialty, and that want going to work out anyway.

[calivianya, BSN, RN]

That does not seem like a good policy. Just because someone is a good nurse doesn't mean they will be a good preceptor. Also, it will become evident to the new nurse that their preceptor doesn't really want their job. Some things, people just know.

It doesn't matter if someone is a good preceptor or not if there aren't enough experienced nurses to go around.

My first job out of school was on a unit that had trouble retaining nurses, so I had a preceptor who was sick and tired of orientees and didn't hide it. However, she had worked in that specialty for twelve years and pretty much knew everything, and I would pick her again if I could have chosen my preceptor. It's way better to have a preceptor that's an awful preceptor, but knows the job, over nurses who are new to the job themselves. New nurses can't teach an orientee what they don't even know yet.

[LeChien, BSN, RN]

My school and the hospital it was associated with required anyone who wanted to precept to take a precepting class first. I think it was a great idea.