First-time ICU preceptor: any tips?

[coffee&scrubs, BSN, RN]

Hello! I've been in my first position as an ICU nurse for almost a year, and I was informed that starting next week I will be helping precept/orient new nurses. I'm pretty nervous & I'd love any tips on orienting in general and teaching strategies/ways of phrasing feedback that have worked for you. I'm signed up for a class on precepting, but the earliest one isn't for several weeks. Thanks!

As a side note- I know that less than a year is not as much as I would want to have as a preceptor, but our unit has lost many of our more experienced nurses and we have to work with what we have- I just want to do the best I can!

[smf0903]

I think one of the most important things is making sure your orientee becomes comfortable coming to you with issues/questions but also tempering that with giving them a chance to figure things out without spoon-feeding them everything. The worst preceptors at our facility are the ones who do everything and let their orientees watch...when those orientees are on their own they tend to sink quickly.

I am big on making orientees stock right out of the gate. People think that’s weird but you have to know where things are at and what’s available. Stocking rooms and carts is the best way to get familiar with your supplies! Use any downtime to show where policies and procedures references can be found. Drips always seem to freak new people out so touching on those helps too.

I am a chart nazi (because my preceptors were chart nazis LOL). I go over charting as they are doing it so that corrections/additions can be made right then and there.

Have fun! I love precepting new people...it’s fun to watch people learn and become more confident in their skills and thinking.

[Alexander the Great, ADN, RN]

I'm currently on orientation in an ICU and find some qualities of my preceptor that I like:

-let's me critically think on my own and try and figure out what needs to be done first and why.

-confirms my questions that I have and provides constructive feedback.

-let's me handle a two patient load while checking my documentation and helping me with new experiences.

-talks me through new experiences rather than doing it and making me watch.

I have had a great experience so far and the fact that you are asking what you can do to better yourself shows that you care. That, in and of itself, should help you tremendously. Also, my preceptor doesn't act like they know everything. They let me know when they don't know something and attempt to find the answer for me. It's okay not to know everything. None of us do.

Good luck!!

[etienhh, MSN, RN]

I've been a preceptor for several new grads and internal transfers now, and I have to agree with all the above!

Here are some of my tips:

• Allow them to just take it all in the first 1-2 shifts. Explain what you're doing and why you're doing.
• Start getting them to develop those hands-on skills early to create muscle memory-- priming lines, drawing up meds, setting up an a-line, etc.
• When it comes to titrating meds, like weaning bridging a patient from propofol to precedex in preparation for extubation, I like to summarize the situation at hand and ask them what they want to do and have them tell me why. Let them think aloud in a safe environment with you so they can get comfortable with not only titrations but also using their critical thinking skills to look at the whole situation (vitals, patient's RASS score, etc.).
• Ask them at the beginning and/or end of the shift what they would like to focus on or what they think is going to help them the most.
• Admit what you don't know! Learn with them and don't be afraid to refer to other nurses on the unit, whether it's for something you don't know or getting your orientee to learn from someone new and maybe see something they haven't been exposed to yet. It takes a village to precept sometimes, and it promotes honesty and camaraderie!

Personally, I like to slowly loosen the reigns and start giving them more and more autonomy while being a fly on the wall. Obviously use your best judgement. If they're not safe enough to have that much freedom, then stick a little closer. That's okay! They might just need more time. Once they have a good handle on charting, I like to starting giving them the responsibility of taking care of one patient one day. Then maybe patient care for two patients and charting only for one. Then patient care and charting for both.

Like those above said, have fun! You obviously have a lot of great qualities both as an individual and as a nurse for them to want you to have such a responsibility! Best of luck!

[Nurse Beth, MSN]

Congratulations!!! Being tapped for preceptor means they believe you represent the organization positively and are a role model. It's an honor. Nurses at 1 yr out can be fantastic preceptors for many reasons.

I've worked with the residency program in my hospital for years. The most common concern from residents is that they do not get enough feedback. From who? Their preceptors. You. To them, you are almost on a pedestal. (remember, lol?)

Give specific feedback "You showed a lot of initiative when you jumped in to help transfer that open heart to bed" rather than general "You're doing good".

Consider walking out to the parking lot with her/him after shift, every shift, to debrief. What went well/ What didn't?

Encourage them to keep a daily journal (requires reflection, develops critical thinking, shows progress).

Gibe specific feedback.

Socialize them to the unit. Eat meals and take breaks with him/her. What does it mean when the manager's door is closed? Who is the reigning salsa-making queen, so don't bring salsa to the potluck, bring guacamole instead.

Give specific feedback. Can't say it enough.

Newly licensed nurses learn step-by-step and prefer black and white to ambivalence, so be patient.

Be aware of the phases of Reality Shock and guide them through.

I hope you love it, and best wishes!

[emmjayy, BSN, RN]

Here for the comments.

I have just been tapped to precept a student during their capstone placement just before graduation. This is not quite the same as training a new hire but is still kind of intimidating and overwhelming to think about, since I have been in the ICU for just over a year at this point!

I do vividly recall what being a student in the ICU felt like, so I want to try to make sure I make the student feel welcome, explain everything that is happening, etc. I am a little nervous about explaining all my thought processes because I feel like much of what I do is instinct at this point and it may be difficult for me to slow it down and talk through what is happening. I am also feeling a little insecure now about my knowledge, because I will have to explain the why's of everything and I want to make sure I do a good job! It is going to feel a little weird, watching over my patients and watching over my student to make sure she has a good experience and learns a lot. I think I am going to learn a lot as well, since I will be brushing up on a lot of things to ensure I can teach them successfully.

I think my strategy will be to encourage my student to ask questions and to have her first follow me and watch/ask/perform assessments with me, then start having her perform some of the tasks with my supervision while discussing why we're doing them. I'm really big on tracking and trending labs/vitals/I&O's as well, so we will definitely do a lot of that while correlating to the disease process we are dealing with and talking through what our next move will be. I never really realized how much thinking and knowledge goes into critical care until I had to start thinking about how I'm going to teach these things to a newbie!