Experienced Preceptors - Dump Advice Here!

[NursingAgainstdaOdds]

After much resistance on my part, my boss went ahead and assigned a new GN to me to precept. All that nonsense aside, I really need some advice.

I find myself feeling incredibly inpatient with the whole thing. I frequently feel as though I'm failing this new nurse, because we're not jiving at all. I really could care less if I got a friend out of the process - strictly professionally speaking here, I just want to be good at this and produce a competent and effective nurse from the process.

I really don't want to get into it much, because I don't want to discourage any GNs on this board, or make them paranoid about what is going through their preceptors head, and least of all I don't want to be flamed because I can't possibly explain it all here. In a nutshell - I'm frustrated, and need some encouragement and words of wisdom from you wise nurses.

Thank You.

[rn-jane]

I've been a preceptor for about 8 years and I hope I can offer some advice to you. First of all not every preceptor and oreintee will get along at first. Personalitys may clash and there is always the oreintees that feel they know everything you are trying to teach them. I usually lay down some ground rules and I have them shadow me for at least two days before I give them any part of a assignment. I will then start them off slowly and try to establish a repoire with them, I will go out of my way to finc good daily learning experiences and try to get them excited about new things, such as helping docs with procedures, and giving them enjoyable assignments. We start off the day with going over the plan of care with their patients and end before we clock out about what we learned and where we could have improved ourselves(if needed). I guess I am more like a motherly figure versus a friend. I've very protective of my orientee and even if they feel they can handle more unless I'm sure if it's the right thing we don't move on. Some preceptors on my unit will basically give them an assignment and leave them be, I'm right beside them the whole way and only step back when I know they are ready. I love precepting and really only had one bad experience and it was this past year where we totally clashed and I had bad vibes about her. My vibes were right but that's another story. Trust your instincts, don't expect too much out of them at first and don't try to be their friend. You are their mentor, teacher and they will feel free to come to you in confidence for guidance even off of orientation. Friendship may or maynot come later. Feel free to pm me.

[Ruby Vee, BSN]

i'd love to help, but don't know what the particular problem is. hang in there -- precepting is a difficult process, and not everyone understands how tough it is. if you're thinking "i want to do the best that i can for this person" rather than "*&^%$ manager stuck me with another newbie" you have half the battle won! so you're at least halfway there!

patience is a virtue -- and not everyone has it. furthermore, we all have vastly different amounts of it at different times.

pm me if there's something specific i can help with . . .

[Babs0512]

Not everyone is meant to be a preceptor. I don't mean YOU specifically, but that is the truth of it. I LOVE to teach. I will start my orient out with 2 patients of her "own". I will go in a do a complete assessment on GN's patients without her knowledge, for two reasons, first, they are ultimately my responsibility and two, I want to see if GN can pick up on any specific problems. After GN assesses her patients, (I push for that as one of the first things we do) we talk. On the CHF'er, I asked GN "What did his lungs sound like?" She tells me 'Clear" I said, please go listen again, she comes out and says "yep, they're clear". The patient had rales in all lung fields and I had already called the PMD for a IV lasix order, and CXR.

I brought new nurse in the room and said, please show me your technique for assessing lung sounds. She was listening anteriorily - his bronchial sounds were clear. I said, listen posteriorilty - then she heard the rales. We checked for pedal edema, negative.

I took her in the hall and she said "I listen to lung sounds my way!" I said "clearly you way isn't correct, you must listen anteriorly and posteriorly because as you know now, they can be completely different. I told her I already got a IV lasix order, I asked her what she knew about Lasix, she was able to tell me. I suggested we monitor his I&O, she said "It's not ordered" I said, "Don't worry, monitor his I&O, check his lung sounds in about an hour, and peek in on him often." This nurse now works in ICU, has for the past 10 years - she said to me "thanks for making me check his lung sounds numerous times, I've never forgotten the difference."

I quiz my preceptee's on all medications we give, so it takes longer. If we come across a med either of us don't know, we look it up. In slow times (every once in a while) I'll go over "what would you do if..." scenerios. I always find something to compliment them on, as I remember being new once too. The biggest issue is prioritizing. Nurses often come out of school being very task oriented. Sometimes tasks like bathing or wound care can wait until later in the shift, stat meds, crumping patients have to take precident. Lets face it, we have to constantly prioritize all day long.

I once had a preceptor who would rarely answer a question directly. She would say to me, "so what would you do next"... I would respond, and she would say "...and..." I would respond again, and this would continue until I answered my own question. I thought she was a female dog, but she was an excellent preceptor. She said to me, Babs, you know this stuff, THINK it through before you ask me for an answer. She's still a "female dog", but I have respect for her.

In short, I try to make everything a learning experience. It's hard work, but we've all been there, and it's nice to give back once in a while.

[Babs0512]

If it helps nurseagainstall odds, Our job as preceptors is to show the GN the policies and procedures of our place of employment - how to hone their assessment skills, medication skills, other techniques. We don't have to be their friend, but they do need an advocate. Show them how to prioritize, and the re-prioritize as the day goes on. Encourage them to ask questions and even involve interdisiplanary departments as needed. And encourage them to speek with the docs, a fear they have to get over. I point out that my belief is that a nurse is a patient advocate, first and formost. We want to do the best job for the patient that we can. We need to speak for them with the docs, after all, we often know the patiets better than the docs do. We can make decisions on many things and get orders later. We can thicken liquids with a direct order, we can use restraits if absolutely necessary as long as we have an order in 24 hours. We can put air mattresses on beds and get an order later. Encourge autonomy. Nuff said, I"m sure this is stuff you already know. Just know that it always takes longer to finish your day with an orientee, at least at the beginning.

[Turtle in scrubs]

Some preceptors on my unit will basically give them an assignment and leave them be, I'm right beside them the whole way and only step back when I know they are ready.

I recently began precepting. Overall it is going well, but certainly challenging. I'm finding it difficult to be with my orientee every step of the way as she is caring for her patients and also take care of my own patients.

I know it will be easier in a way as she progresses to a full pt load. Ironically then I really will be able to be with her every step of the way and not keep running off to take care of my pts. As for now I'm just really trying to avoid the "divide and conquer" technique that prevailed during my orientation.

[NursingAgainstdaOdds]

Thank you all for the advice - I've found it really helpful and enlightening. In part because I've been thinking things through after starting this thread - I've been able to re-group and we've been having a great learning day, as well as a great teaching day. That is my goal, so I'm happy we seem to be connecting at least on a learning level.

I think at least part of the problem was I was very reluctant to hand over the information as it was needed, especially if it was something we had already gone over multiple times. I think I've figured-out that being more open to questions, even really repetitive ones, has given me more positivity as a teacher and her more confidence as a learner. As the day has progressed, there has been less of those types of questions. Interesting, I think!

[classicdame, MSN, EdD]

I recommend you contact your Educator. This should be a nurse with experience in adult learning and may have guidance and/or resources for you. Good luck!

[CountryVisitingNurse]

I have just had a student with me who had a problem with absentism, couldnt take a BP recapped a needle, and numerous other scary things -- before going to her teacher at the college I decided to speak to my supervisor first. because our agency is short staffed they are pushing us to "help the students" pass so they can hire them... my supervisor agreed with me that this particular student had issues... and that she should probably fail... but then just assigned her to a different nurse...

what do you think of that one???

[uscstu4lfe]

To Country Nurse: As far being absent all the time goes, there's really not much you can do about that. Maybe s/he is having private problems? Who knows. And as far as the BP/recapping things... being a new grad is scary! Take the time out to demonstrate and teach - I think that's what makes a preceptor a good one! My preceptor was so friendly and always answered my questions - no matter how stupid they were. She took time out to show me how to do certain things, sometimes several times in a row! I really think that's what makes a preceptor a good one! Like another poster said here... some people are just not good teachers and aren't patient enough.