GN Orientation the good the bad the ugly

Chloe'sinNYNow · Jun 15, 2008

Congratulations Picu!

my biggest grief w my last preceptor was she would be mean and critical if I looked like I was struggling (which I was!) and would tell me to look up the protocols and research my paperwork instead of explaining and showing me how things were supposed to be done. So my :twocents: here is to show your new grad. Chances are he/she doesn't know even how to find supplies if he/she's never worked on that unit before. So a tour firsthand is a major help too.

Also, show how procedures are done without expectations of checking off the skill on a validation checklist, and don't expect that your new grad will "get it" on their own next time. Sometimes it takes a couple attempts to do an invasive procedure on your own. Especially if as a new grad you're also concerned w/ being checked off on that validation skills list.

Good luck! Wish I was able to do what you're doing. I think it's terrif!!

Chloe

RN-BSN, BA

seanpdent, ADN, BSN, MSN, APRN, NP · Jun 15, 2008

IMHO, I would make sure to see everything through the GN's eyes. Don't ever forget what it was like to be in their shoes! If we nurture, educate and teach the GN's we will help develop a strong nurse who in the end will be an asset to you and your unit and not a burden.

Best of luck!

Pediatric Critical Care Columnist · Jun 16, 2008

One really important thing you need to do is get a list of things the GN is not permitted to do at your hospital. There will be things that hospital and even your unit's policy forbids being done by unlicensed personnel and you'll need to ensure that your GNs don't break those rules. For example, in our PICU the GN cannot give anything IV push, they can't obtain specimens from EVDs, they can't take verbal or telephone orders, they can't give neuromuscular blockers or monitor patients on neuromuscular blockers unsupervised, they can't give cytotoxics and they can't care for any patient with an open sternum. There are a few more but I can't pull them out right at the moment.

The novice nurse will be caught up in tasks and will not be able to think about much else other than getting those tasks done, so they cannot be made responsible for a PICU patient too early in the game. They also have to think through the steps of virtually every routine task we just do without thinking about. So if you're able to break tasks down into steps for them when you're teaching them, it helps them learn it better. The first time I precepted a new grad I had to stop and think about steps, because I do so many things by rote after 11 years. And don't let them neglect their charting.

Make sure you introduce them to the rest of the staff each shift and make sure others know they're GNs so they will know what to expect from and for them. I like to give them a little more than just the other person's name though. I might say something like, "This is Barb. She is one of our senior nurses who often does charge and she can recite report on every patient in the unit with dates and lab results and sibling names all from memory." Or, "This is James. He's the go-to guy about spinal cord injuries. And here's Michelle, she used to work in the burn unit so she's a good resource for dressing changes." It makes them feel more confident about approaching others for information and help.

Don't forget to have fun. Work doesn't have to be so serious it gives you an ulcer!

SoundofMusic · Jun 17, 2008

Oh, gosh -- just try to have a relaxed attitude and tone of voice while precepting. You can teach a 100 different ways, but it was the relaxed and casual preceptors that just allowed me to relax that I learned the most with. I just CANNOT learn when someone is being stern, overly serious, never smiles, never chats or makes eye contact, etc. Compliment them on what they're doing right -- build confidence.

Be nice -- be interested in them. Don't scold, don't ever ridicule. Include them in things.

I had one preceptor who almost begrudingly asked me one night if I wanted to be included while they ordered in pizza -- it just took her almost everything she had to be friendly and include me in it. I mean -- what gives with that stuff?

I also hated it when I was "punished" for forgetting things. "Go around and take down ALL the IV bags that are unlabeled in EACH room on the unit because you forgot to label yours today .... stuff like that which was almost punitive in nature.

annacat · Jun 17, 2008

I have a great preceptor right now. She is very encourageing and I respect her authority. We have a good balance.

I think that structure in how you teach tasks is very important. Perhaps provide your GN with a sheet to organize how she recieves and gives report. I have found that how I am given report strongly influences how I understand my patient's information and later give report at the end of the shift. Give your GN a way to organize poorly delivered information and know what information he/she needs filled in from other sources (labs, meds, chart notes).

Also don't act like you expect the GN to have absorbed 100% of what you have taught them in the first week. The one way my preceptor stresses me out is to ask me to recall the rational behing a procedure after ten hours of learning a bunch of other important information. Instead you could ask "Do you remember where to look for Magnesium and Potasium goals and what to do with them in relation to the patient's Mag and K+ lab values"? No? That's o.k. lets go through it again. So much better than "And what to these Mag and K values mean?" Way to vague for a GN who has no experience on the floor. And stress producing for a good GN who just wants to do it right, take care of the patient, and please the preceptor.

Good luck! You are awsome for taking on this task!

lilywater · Jun 19, 2008

First off, congrats on how far you've come. I think one of the most important thing to do is to be conscientious of how you instruct and give criticism because GNs and new nurses can easily internalize what is said to them. Your daily attitude toward an orientee and how you give feed back can really make or break their orientation. Also patience is up there on important things to. Us newer nurses are not going to be as quick on things and most of us know that a preceptor's day is somewhat slowed down because of all the explaining, demonstrating, etc. A mistake I have seen preceptors make is showing their frustration and even comparing them to the other new grads as my horrible preceptor from a previous position I had did to me. Above all be honest with your criticisms and deliver them in a way that respects boundaries and is still acceptable for another person. I'm not necessarily saying to baby someone, but as a preceptor the way you deliver criticism can really impact a new nurse's perception of their competence. I had awful preceptors in the job I last came from. Someone being a good nurse does not make them a good preceptor. They talked down to me, were not patient, belittled me infront of patients and management and so on. I had an awful experience and with the job I have now it is completely opposite. Good luck and I hope you can instill all the best into your orientee.

Chloe'sinNYNow · Jun 19, 2008

Well said Lilywater.

You said the things I've mentioned in my other posts when venting about my previous preceptors in my last job. Sure wish I knew how and who to speak up to about them.

Glad your new experience turned out better.

PicuRN, you're gonna be a terrific precpetor because you aren't just taking the hospital-led class and then starting on their P&P. But you are here asking for tips and advice from nurses like myself and others above who wish our preceptors had done it your way. See? You're already proving to be a very good role model!! :yelclap:

Chloe

RN-BSN, BA