Difficulty precepting

[jellybean312]

Hi all! I've been a nurse on a stepdown unit for four years, and have been a preceptor the last two. I've had a few experienced nurses and several GNs.

I don't know if it's that I've been "spoiled" with well performing previous GNs or if it is something else, like a communication issue, confidence problem or lack of education. I am four weeks in with my current GN, and instead of focusing on time management, order entry, preparing a good report, interdisciplinary communication, etc., I feel that I am spending an extraordinary amount of time on Nursing 101 basics.

I understand, fresh out of school you're going to be nervous. I'm sure not everyone is perfectly at ease with tasks the first time they do them, such as managing PEG tubes, or monitoring heparin drips, etc. That is why I am here! But I would expect that a GN could at least be able to explain the reasoning for checking residual or verifying placement of the PEG, or why our patient with multiple DVTs is on said heparin drip? A GN should be able to perform a head to toe assessment and be more concerned that it is complete, and less concerned that it gets charted early in the day. I mean, to the point that when we take time out to chart, it's questions like "what did his breath sounds sound like, did you hear a murmer, did he have pedal edema?" After I've stood at the bedside with her and assessed the patient, side by side. Is she going through the motions? Should I request extra time precepting? Suggest time in the skills lab or with the Nurse Educator? Or is this normal and I've worked with better prepared GNs? I'm afraid to let her loose in a few weeks, what do I do?

[AnthonyD]

Some new nurses are awesome and do great right out of the gate. Others just need extra help/time/guidance/patience; sometimes they simply aren't cut out for the unit; and sometimes you have to wonder how some of them graduated nursing school at all. I hate to say that, but it's true.

I would talk to your nurse educator and make sure you're raising your concerns. Emailing her about it will also leave a written record that you did in fact try - in case it's brought into question later.

Does your unit just have new nurses with one preceptor for their whole orientation? If so, ask if she can be placed with someone else for a few shifts and get their feedback on her performance to see if it correlates with what you're finding.

It sounds like you're doing all the right things, but you can only do so much - ya know?

[TriciaJ, RN]

You seem to be noticing a definite difference in skills level between your current grad and previous ones. I'm sure your observations are valid. Maybe she attended a less-than-stellar school or maybe she managed to fly under the radar.

In any case, it is your job as a preceptor to get her up to speed. But you're only one person; do enlist the help of the nurse educator or whatever other resource you have. You're right to document the specifics of what you've observed.

Maybe you could itemize her skills deficiencies into a checklist and have the nurse educator review these skills and get them checked off before she is cleared to come off orientation.

You seem to be a conscientious preceptor. Good luck to both of you.

[jellybean312]

Usually it is just one preceptor. I'm going out town in a few weeks, so out of necessity, she will be with someone else the last two weeks. No luck trying to reach my educator - she's been out of the office since Wednesday.