What To Expect From Your Preceptor

  1. Not all preceptors are made in heaven; most are downright human. You can still learn from them, though, even if they're not perfect. Here's how --

    What To Expect From Your Preceptor

    We all have had these fantasies of what our preceptor would be like: warm, nurturing, a mother who protects you from doctors, managers and raging Physical Therapists and a friend who welcomes you to the city and buys you drinks at your new favorite bar. We all expect and are certain we deserve an educated, experienced and competent preceptor who loves to teach (and does it well) and never says a discouraging word. Unfortunately, there are precious few of these paragons of precepting and too few of them for everyone to get one. So some new orientees are going to have to make do with an imperfect human preceptor who may or may not like to teach and may or may not be good at it. Some will get a preceptor who hates to precept or is burned out on it or has so many personal issues going on that an orientee is enough to push them over the edge. Sad, but true.

    My first preceptor was experienced but not quite competent, hated to teach and was what we called, in those days, "Manic/depressive". She'd be uppity up up or she'd be downedy down down -- and sometimes more than once in the same shift. Some mornings she'd be practically catatonic until she disappeared into the bathroom and would come back bouncing off the walls . . . later, when she accidentally overdosed, I learned why.

    Your preceptor is not your friend. Hopefully she's friendly and approachable, and maybe one day she'll BE a friend. After four decades in nursing, I have several friends who were once my preceptors and several who were once my orientees. But she doesn't have to be your friend to teach you. She doesn't even have to LIKE you -- or you her -- in order for you to learn from her. Some orientees get lucky; others get someone like Diana, my first preceptor. You take what you get and learn the most you can from them -- even if, in some cases, that is what NOT to do. (Drinking before work and getting high AT work -- definitely a "don't.)

    A good preceptor can teach in the manner that most fits your style of learning. An adequate preceptor can teach in more than one style. A new preceptor or a poor preceptor may have only one way of teaching and that may or may not be the way you learn best. So you may have to struggle to learn, find other folks who can maybe explain those pesky pacer checks better than your preceptor or look things up a LOT. Looking things up is never a bad thing. Even a good preceptor has one or two things they cannot for the life of them explain to you right at this moment. After 4:00, I get stupid and while I can check pacing thresholds in my sleep (and probably have), I absolutely cannot explain them in a coherent fashion. Fortunately, I recognize this and sent my orientee to a colleague if they absolutely have to have pacer checks done right now. On the other hand, my colleagues are always sending their orientees to me to explain how LVADs work. If you have more than one preceptor, that's a blessing. You'll learn different things from each of them.

    A good preceptor will stress critical thinking -- and the WAY they stress is may or may not make you uncomfortable. Mortimer fires questions at his orientees until they can snap back the answers faster than he can come up with questions. Renae explains things until her orientees' eyes glaze over and I swear I saw one of them go to sleep while Renae was explaining and wake up just in time to summarize . . . . Edith comes up with ever-outlandish scenerios and asks her orientee to walk through them, verbalizing what they'd do in each instance. (If the power ever goes out in the whole hospital while your patient is on dialysis with a balloon pump and an LVAD, each with a battery that lasts less than an our and is on 4 pressors and no way to contact the pharmacy for refills and then a tornado comes through town and the building catches fire, Edith's orientees will have already considered that possibility and come up with a plan. One of those styles will seem like a horror show to you and another might seem like fun. Hopefully you'll get the preceptor whose style you like. Maybe you won't.

    Some of you will get really great preceptors and some of you will get really awful ones. Some of you will get bad preceptors who will learn and one day become great ones. Some of you will get the great preceptor whose husband is in the CCU down the hall in cardiogenic shock . . . again . . . and whose mother is living with her and is showing signs of dementia and whose son just totaled the car (again) and who really ought not to be precepting this summer, except we have more new orientees than we have experienced preceptors so she's going to have to suck it up and take an orientee (again.) You can learn from any preceptor -- although some will be a better fit than others.

    A preceptor is there to help you grow from a brand new novice nurse to a competent, skilled nurse. But we're not here to spoon feed you the answers and we WILL tell you to look stuff up. Believe me, that's easier now than it was when I had to lug a 10 pound text book everywhere I went. You might think it would be so much easier if I'd just TELL you the dose range for Lasix or the procedure for hanging blood instead of making you look it up. And it would be. It would be easier for both of us. But you'll remember better if you look it up. You'll also learn your resources and how to utilize them. And every single orientee I've ever had (including "guest orientees" I've only worked with for a day) has looked something up and then taught ME something I didn't know. As a preceptor, I believe that if you don't learn something from every single orientee, you're not doing it right. Clearly I'm doing it right, because some of my most respected colleagues were once my orientees.

    I hope you all get the preceptor of your dreams. But if you don't, it's not the end of the world or even your career. Ask the right questions. (That would be thoughtful questions. Not "How do I put in a Foley?" but "I've looked up the procedure and I think I have everything I need, but I've never done this before so can we talk it through together before we go into the room?") Write down the answers so you'll remember for the next time, and go home every evening and study over your notes. Why were we concerned about Mrs. VT's K+ of 3.1 but not Mrs. ST's? Could you have set up your sterile field a little differently so you wouldn't have had to reach all the way across it?

    You'll finish orientation, but hopefully you'll never be finished with learning.
    Last edit by Joe V on Jun 15, '18
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    16 Comments

  3. by   NicuGal
    Two thumbs up!
  4. by   Farawyn
    Love it.
    My first preceptors: Michele, I love you! She put up with my immaturity and fear (covered by bravado) and helped me assimilate and not kill anyone. Dawn scared the crap out of me, but taught me to run a tight ship.
    My BEST mentors: C, J and G, and also P and Geri: COBs with claws and heart. They taught me how to draw blood, how to teach, how to be selfless, how to be SELFISH (as in, taking a LUNCH) that if you wear lipstick you look and feel better, and how to find things out for myself.
    J, P and Geri are some of my best friends and always will be. I am so lucky to have them in my lives.

    My patients are lucky that I learned from the best.
  5. by   Lev <3
    To Meredith, Andrea, and Kathy: thank you!
  6. by   dah doh
    My preceptor was and still is an awesome nurse; but taught way over my new grad head & would disappear for hours at a time! I called it "self-orientation"! My orientation taught me self-reliance, how to look up stuff, and when to ask questions! It also taught me how NOT to precept others.

    I've been precepting others for over a decade now. I try to keep it simple & give lots of feedback. When I push you, it's only because I know you can do it! When I ask you questions, it's not a trick; I'm trying to figure out how you think! I can change up my teaching style only if you don't respond well, but 95% do well so I must be doing ok. I only claim to be smart, not brilliant, so it's ok to correct me if I'm wrong! I can only make you as good a nurse as you put in the effort to adapt to suggestions. I also warn orientees of my faults: I'm not really awake until I'm nearly done with my coffee so don't ask too complex a question until then; I'm cranky when I'm hungry; do it my way unless I say it's ok otherwise; I'll tell you my pet peeves up front so don't do them because it's usually a safety thing. My orientees are my friends by the end and they usually have a hard time letting me go...
    Last edit by dah doh on Jun 2, '15
  7. by   Jaykalkyn, BSN, RN
    dah doh, you sound like an awesome preceptor. I hope whomever I get is as good as you sound.
  8. by   LadyFree28
    Currently, I enjoy that I'm in an atmosphere where there are many nurses with different teaching style but their knowledge comes through in order to be meaningful and create better nurses-I couldn't ask for anything more.

    I hope to be able to precept as successful as the nurses who precepted me once I learn this be specialty.

    I have precepted in the past and my biggest thing was thinking things through, ensuring reason and rationale for actions, and staying organized in order to think; I'm big on mental lists and brain sheets when needed; and I like to ensure a "teach back" method when possible.

    I also like to preach the 3 C's of becoming a proficient nurse: competency, consistency, and confidence.
  9. by   rnsrgr8t
    Love this!!! I like the part that you may not like them and they may not like you but you can still learn from them. My first preceptor right out of nursing school, hated me and made my life a personal and I almost quite being a nurse. HOWEVER, she was an AWESOME nurse and very detailed oriented. I learned A LOT from her. How she treated me was inexcusable but I STILL learned, in the end, how to be a good nurse from her. A lot of my detail orientated, anal retentive routines I use to make sure I do not make a mistake, I learned from her (and I still do them 17 years later). She taught me to always think a few steps ahead of my day. Whenever I have down time to look around and see what is the next thing I can do (rather than just sitting). She taught me how to chart as I go. She taught me to have a strict routine whenever I give meds and know each med before I give it. I can still remember her face and name. I have no idea what happened to her as I left my first job after a year and a half (I did not fit in with the politics). I would love to be able to show her that I AM a good Nurse and NP (she never believed I could do it) and that despite everything, she DID teach me a lot. Awesome nurses do NOT mean awesome teachers/preceptors and can make for a difficult experience for their students/preceptees. You CAN learn from their example though. In an ideal world, everyone would have the ideal experience that Ruby talks about. That is not reality and it is important to realize that even in a less than ideal situation, you CAN still learn.
  10. by   klriggs53
    My preceptor was not motherly and as our time drew to an end it became almost adversarial. I learned a lot, with an unnecessarily high stress level and I am grateful. There are numerous styles and motivations for precepting. All too often, the bottom line involves dollar signs. If you are precepting with a nurse that was introduced to nursing in a "trial by fire " method, as opposed to a nurse that was nurtured and supported, the ambiance is totally different with a distinctly different learning curve and outcome. Preceptors have their own baggage and it is easy to take that for granted. Whatever method is utilized, it is important to differentiate your nursing practice from theirs, incorporate the good facets, and move on with a stronger base. Thank you for your article, it was tremendously on point and pertinent. Well done.
  11. by   jayrans
    I'm a novice nurse and I'm in my 4th week of orientation. I'm transitioning from working in long term care facility to working in a hospital setting. If anyone will ask how it's going, I would say it's been terrible so far. I'm only assigned to one preceptor because she's the only regular staff in the day shift and she's nasty. She will say words like " have you not done this in the Nursing Home?" And other stuff that are unprofessional. Now I'm thinking of telling my manager if it's okey for her if I will nights. Probably things will get better if I work nights. I hope and pray that things get better for me and I thankful that I found this article that is very helpful in easing up my stressful situation. Thanks a lot Ruby Vee
  12. by   dudette10
    What you wrote about the hit or miss from the preceptor pool is reality.

    And it shouldn't be, but it won't change.

    I had had a long conversation with a friend that was enlightening. He said that healthcare systems are set up to fail on the front lines. Errors happen in such large numbers because the front lines are unsupported, while the offices are filled with people (and salaries) to audit the check boxes that the front lines have to check to ensure compliance with federal and state guidelines for accreditation and reimbursement.

    Yep, that pretty much sums it up.

    So, your burnt out preceptor who can't teach is what you're left with because all the money for precepting training programs and a reduction in work load for that trained preceptor is not possible. The money has to go to yet another QI nurse who audits the checkboxes per federal and accrediting body regulations, and he has to call the already stressed floor nurse (and have an unnecessary 15 minute conversation with her) about making sure the stroke education is documented in this box, and the meaningful use checkbox is also ticked off, and how the checkboxes need to be checked every 24 hours or the cycle starts all over again.
  13. by   Twinmom06
    I had a great first preceptor. The hospital sort of stank but she taught me FABULOUS time management skills!
  14. by   Susie2310
    Quote from dudette10
    What you wrote about the hit or miss from the preceptor pool is reality.

    And it shouldn't be, but it won't change.

    I had had a long conversation with a friend that was enlightening. He said that healthcare systems are set up to fail on the front lines. Errors happen in such large numbers because the front lines are unsupported, while the offices are filled with people (and salaries) to audit the check boxes that the front lines have to check to ensure compliance with federal and state guidelines for accreditation and reimbursement.

    Yep, that pretty much sums it up.

    So, your burnt out preceptor who can't teach is what you're left with because all the money for precepting training programs and a reduction in work load for that trained preceptor is not possible. The money has to go to yet another QI nurse who audits the checkboxes per federal and accrediting body regulations, and he has to call the already stressed floor nurse (and have an unnecessary 15 minute conversation with her) about making sure the stroke education is documented in this box, and the meaningful use checkbox is also ticked off, and how the checkboxes need to be checked every 24 hours or the cycle starts all over again.
    In my area the large health systems have announced very good profits, and have recently built new large buildings and re-modeled others, so I do not believe the lack of support of front line nursing is due to lack of money, but rather due to priorities. Quite simply, the choice is made to allocate money to other (areas).

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