Dear Preceptors

Hoosier_RN, MSN · Feb 22, 2016

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.

I hear you. But sometimes there are a limited number of people available to precept that have experience. They can't work 24/7 on each unit. It's sad but true.

RNator · Feb 22, 2016

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.

Good point!! Sometimes a nurse is cast into the role of preceptor and perhaps shouldn't be. Management needs to own their program 100%.

Ruby Vee, BSN · Feb 22, 2016

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?

This is a thoughtful and well-written piece. I do think some of your points are incompatible with real life on the nursing unit, though. Having a private meeting with the manager after the orientee has left for the day is unrealistic. The manager works 6:30 AM to 4 PM; orientees work 7-7 along with the preceptor. While it is doable if the orientee and preceptor are on night shift, it places an unfair burden on the preceptor to stay hours after her shift in order to connect with a manager who has back-to-back meetings from 0645-1100. If the orientee and preceptor are on day shift, it just isn't possible.

Second, in a busy unit with high turnover and few senior staff, everyone with a license that has been renewed at least once precepts. Even people who prefer not to precept. Even people who are abysmal preceptors. You just don't get a choice about that. It is up to the orientee to make the best of whatever preceptor they are given. I agree that your idea would be NICE -- it just isn't always (or even often) feasible.

FurBabyMom, MSN, RN · Feb 23, 2016

I think in an ideal world, everyone would have a wonderful orientation, be paired with someone as a preceptor/mentor with whom they are a good fit (learning style and personality) and all of these other lovely things. Reality, however, doesn't allow that most of the time. Sometimes it's turnover, sometimes it's any number of other issues that cause the ideal to be wishful thinking.

I *do* agree that performance issues need to be discussed - ideally with the manager, educator, or orientee themselves. Not always is that something that can be done. I was pulled into my supervisors' office last fall - to be told what was going on with someone who was about to be paired with me. I'd been told what they'd been doing, the goals that had been set for this orientee, etc. I was also pulled into a meeting after I'd worked with this orientee several times about my observations - and another coworker who'd precepted them extensively was also included. Our goal was not to talk about this person, but we were asked to share our experience and what we felt the issues might be.

I approach my orientees differently based on their reported experience level. I'm in the OR - and if I have one of our new grads with me, there is a good chance they need a lot more help and prompting than say - someone coming to our OR after working for years in another facility's OR. Our new grads need more help on their first rotation than right before they leave orientation. I tend to have conversations with my orientee to see what they have been doing, what they think they need to focus on. Sometimes they have this big huge thing they want to work on - and I generally remind them that full independence is probably not going to happen in week 6 of a 6 month orientation program, how about we pick 3 tasks for total independence and play the rest by ear?

I am totally fine letting my orientee make decisions and prioritize tasks that need done. I am not fine when their judgement goes against policy or could harm my patient. I have to balance their learning needs with my patient's needs. Say you're my orientee, you want to focus on positioning and counting. No problem. Because nothing is ever simple - say something unexpected happens like our elective case gets bumped by an emergency. I am probably going to give my orientee specific tasks to do to help, or ask them to stand back and watch (wholly depends on the situation and what I know about their skill level). I mean no offense, but it's just how emergencies work - my first true emergency I was told exactly how to help, then to observe and then when I could do more. Yes, it *is* about your learner/orientee, but more importantly, it's about the patient. Sometimes, this gets lost in the shuffle - and orientees see preceptor intervention as shorting them/offensive, but maybe it's just something you haven't been prepared for and we are focused on the patient? I started as the person who was asked to watch, or run for things, or count - and sometimes that's still my job if I'm helping with someone else's emergency.

I *like* orienting new folks. I'm told I'm a good teacher. We had a lot of turnover in our department in the last year or so - so we spent a lot of time precepting. Even when you love to teach, there are situations that are hard to teach during and reasons you may want a break. There are probably also reasons you don't always get that break. It's like others have said - there may be 2-3 people who *can* precept so those people are stuck doing all (or a majority) of it.

I *do* agree there ought to be some kind of review/evaluation for preceptors. But wouldn't it be so wonderful - if the orientee would discuss their concerns with their preceptor? You want us to talk to you directly - why can't that be a two way street? I tell my orientees to tell me when I'm telling them something they know, or if my explanation doesn't work for them - if things are unclear, etc, just to speak up. Sometimes it's not the time to talk about it - situational awareness is key - but I try to treat them the way I want to be treated. I don't correct them in front of a room full of people (unless what they're doing is clearly dangerous to my patient and I approach it from a patient safety perspective never a right/wrong way), I don't belittle them, I try to give compliments (they have to be earned and genuine) in addition to the criticism/improvements. I help them identify positives and negatives about a day, and focus on things to work on the next day.

I try to encourage my orientees - this specialty is a hard one to learn. I like to tell my orientees that there is no right or wrong way, so long as the patient is safe and you follow the policy. Sometimes we omit following the policy too but that's a different story. They'll likely pick up things from everyone they work with before coming up with their own routine. I remind them that the expert in anything was once a beginner - and often tell my orientees (especially our new grads) some story or anecdote that proves that I wasn't always where I am now (I did *not* always know how to handle any situation let alone the craziest of situations - though I have a black cloud I often forget to leave at home, so there is that...). I was the new kid, not that terribly long ago. I'm also willing to say that I don't know when I don't know - and I'm willing to teach the orientees with me how to find the answers when neither of us know).

Hollybobs · Feb 23, 2016

This is helpful, I'm relatively new to precepting but I enjoy it and would like to do it well. It is easy when you are working with certain new staff. I'd like to better be able to help those who struggle or are not as initially easy to precept- this is much more challenging for me.

I worked with one new staff member and it was a pleasure- we worked as a partnership and discussed clinical decisions and skills together.

The next time? I worked with a new nurse and felt like tearing my hair out. She complained constantly (about extraneous matters), contradicted all I said but not in a constructive way, dismissed my advice, tried to override my decisions and all with the patient present. Other staff who worked with her felt the same way and even more strongly but I still felt like a failure as preceptor. I would like the skills to better help someone like that become a better nurse and am working on that but it isn't easy!

SororAKS, ADN, RN · Feb 23, 2016

I loved precepting. It was one of the most rewarding aspects of nursing. But I too started out with a preceptor that wasn't really suited to wear that hat. I agree that it shouldn't be that way, but in some instances they do choose someone with experience because that's the only way the nurse is going to be oriented.

JerseyTomatoMDCrab, BSN · Feb 23, 2016

I was never given a choice. 6 months in and I was orienting. I learned to really like it. I was going to school to be a teacher before I switched to nursing so educating is something I always liked. But I know lots of preceptors who were forced into it and HATED it so I think that policy is garbage. It should be a choice and there should be a class potential preceptors can take if they feel they need some guidance.

tinybbynurse · Feb 23, 2016

I was blessed enough to have amazing preceptors when I started my current first hospital job ....I can only imagine having bad preceptors who made me feel scared or nervous .... (one or two scary clinical instructors from school come to mind)

I agree though that you can tell who wants to orient and who doesn't ....how do you think that makes the already nervous orient feel? They don't want to feel unwanted...it's not their fault they were placed with you.

I think it's a great idea for all hospitals to have voluntary orienters ...mine has a workshop for people who want to become better at it.

However, at my hospital too, people are just placed with nurses regardless of choice . Most people are ok with it ..but I agree that not everyone is a natural teacher. BUT, it's no need to be rude to the Orient, and if you work at a teaching hospital with students/residents, you should be prepared for that kind of thing when you're hired.

if people suck at teaching, it's not a bad idea to have a FEW select orienters so that even if someone isn't a great teacher, the Orient is exposed to different teaching styles, approaches, and no one orienter gets burned out if they don't really care for orienting.

I personally would love to orient after I get more experience!

LDAthleteNurse, BSN, RN · Feb 24, 2016

Does anyone have a good list for orientee's? I'm precepting right now and I always want to be my best self! Any experienced nurse care to shed some light on what makes a GREAT orientee?

LM NY · Feb 24, 2016

Not everyone is meant to orient, but most don't have a choice. How can a stressed and overworked nurse with 10 patients realistically orient a new nurse? I agree 100% with the nursing department being held responsible for making sure they have a strong orientation program. I also think nurses should have a choice to precept. I was mainly precepted by two nurses, but had the opportunity to precept a few days with two other nurses when the other two were on vacation or had a day off. I learned a lot from all of them and took away what I believed would benefit me.

Not to sound mean and rude, but one main thing an orientee can do is be more proactive. Take more initiative and stop complaining about your preceptor. Think about ways you can alleviate the stress off your preceptor. Let them know what your strengths and weaknesses are. If the patient had high blood pressure and received some meds to help lower it, go back and recheck the b/p. Don't wait for your preceptor to ask you to reassess. Just do it.

If you know your patient is getting a foley inserted, go get the supplies ready. Do you see where I am going with this? Nursing school does not prepare you for the real nursing world. Try to be a few steps ahead. Of course, with time comes experience. Regardless, there should be a few things that you carried over from school and clinicals.

I wish you the best of luck :)

Ruby Vee, BSN · Feb 24, 2016

I was blessed enough to have amazing preceptors when I started my current first hospital job ....I can only imagine having bad preceptors who made me feel scared or nervous .... (one or two scary clinical instructors from school come to mind)
I agree though that you can tell who wants to orient and who doesn't ....how do you think that makes the already nervous orient feel? They don't want to feel unwanted...it's not their fault they were placed with you.
I think it's a great idea for all hospitals to have voluntary orienters ...mine has a workshop for people who want to become better at it.
However, at my hospital too, people are just placed with nurses regardless of choice . Most people are ok with it ..but I agree that not everyone is a natural teacher. BUT, it's no need to be rude to the Orient, and if you work at a teaching hospital with students/residents, you should be prepared for that kind of thing when you're hired.
if people suck at teaching, it's not a bad idea to have a FEW select orienters so that even if someone isn't a great teacher, the Orient is exposed to different teaching styles, approaches, and no one orienter gets burned out if they don't really care for orienting.
I personally would love to orient after I get more experience!

And perhaps the orientees should understand that the preceptors don't get a choice about precepting . . . and perhaps have some compassion for the preceptor.

A teaching hospital means that there are medical students, medical residents, surgical residents, etc. It means nothing at all about nursing students or new nurse orientees. We were hired to be NURSES, not to be preceptors. We understand that it comes with the job, but not all of us are suited to be preceptors; not all of us want to be. You should be prepared for that when you're hired. A "FEW select orienters" is a lovely idea, but it doesn't work that way. We experienced nurses have explained over and over on multiple threads. We don't get a choice. Please understand that and have some of that overdeveloped compassion for us.

Libby1987 · Feb 24, 2016

There is such a difference between teaching another nurse how to perform a procedure or how to follow a specific protocol. Doing it on an individual basis can be both fun and inspiring.

It's a whole nother thing to try to teach someone how to be a nurse, while also responsible for the assigned patient load. Completing a nursing program and having substantial nursing experience, neither of those prepare one to teach someone how to function as a nurse nor do they lend to someone wanting to.

Do hospitals ever teach their new grads in a group? I don't mean classroom, but out on the floor, intern style.