new grad and preceptor

peds4now, RN · May 3, 2007

Your preceptor may be quick, experienced, and smart, which makes him a great role model, but that is not his only role.

He needs to teach you skills: you need to be assertive and tell him you know overtraining/overlearning is needed, especially for psychomotor skills. It is not realistic to expect you to have it absolutely down after watching him. I mean, as nurses we know about getting a return demonstration, and not just once, no?

Also, if you are absolutely new, you should be following him and helping him, listening to him think out loud for a couple of days, I think. He should be challenging you to prioritize and know stuff, but he should be running the show at the beginning. He is supposed to be your safety net. You know how to handle one patient from nursing school (maybe even 2-3), but you need to learn how a real nurse gets through the whole shift, keeps everything straight, prioritizes. You should be setting a few objectives for each day and sharing that with him. He should be helping you achieve your objectives.

I would attempt to speak to him about how this isn't what you expected or need. See it as part of your learning experience, but don't be sad if it doesn't get results. He's the 1st person in your chain of command (dang I hate that I am actually using that phrase!). I would attempt to talk to him about it. Otherwise, I would speak to the person who assigned you to him, or your non-preceptor "mentor" if you have one.

P.S., I know it is so hard, but please stand up for yourself and ask questions! Maybe he just doesn't know exactly what to do! You have to ask questions, and it's okay to know nothing (p.s., study at night to prepare)

Double P.S.-I am a graduating student and am guilty of being too quiet. But it helps me to remember that my first nursing degree is almost done, and soon I won't get to ask stupid questions anymore.

cedavid22 · May 3, 2007

if you've only been working a couple of times...you should only be on 1 patient...you can learn a lot from 1 pt. when i've precepted, i usually let them shadow me the first day, then 1 pt. the next, so they can see the "big" picture. as they move on to two...i let them focus on only those two & pull them in when i have something new to teach. & let them progress as needed. i feel in the beginning, you really should be able to focus on the pts. as a whole first (assessment, why is this pt. taking these meds & checking what each med is for, checking labs, practicing good documentation, practicing report, talking to the m.d., etc.) & you should be getting comfortable with non-thinking skills like setting up IV's, giving injections, pouring meds, learning your way around the facility, pt. hygiene, etc. (when you master this stuff...that saves you a ton of time). you'll learn nursing skills as you go along. worry about getting down the no-brainer basic ones first to save time. try to get organized & get a good pattern going...so, when you add on pts., you're not overwhelmed. saving time is key! if you're really bored & have done everything for your pt., offer other nurses help. these are your future co-workers...i'm sure they'll love that & you might learn something.

my method may be different than others & certainly not the only one, but i got a lot of praise for this. don't worry about having a ton of pts. at once & not learning everything...in fact, enjoy it while you can. depending on how long your orientation is...you'll progress to the full load fine as long as you start off well. & remember that you're still not going to know everything when you're off orientation...but its always good to know who your resources are when you need help.

as for your preceptor...he seems like he needs more patience with you & definitely needs to praise you more often. he can't expect you to learn the very first time, but definitely don't act like it was the first time learning it...that can be frustrating. if you don't remember all the steps...tell him what you know...& just try to do the best & have him guide you along. dont let him intimidate you to not ask questions. this is your license, too...& you need to learn correctly early on to gain good habits. definitely take notes as you go along with your orientation & review them. i don't think you need to speak to the manager just yet...its too early...speak to him about these issues...you have to be patient with him as well, b/c being a preceptor is also stressful. hope that was helpful..g'luck!

jjjoy, LPN · May 3, 2007

i feel in the beginning, you really should be able to focus on the pts. as a whole first (assessment, why is this pt. taking these meds & checking what each med is for, checking labs, practicing good documentation, practicing report, talking to the m.d., etc.) & you should be getting comfortable with non-thinking skills like setting up IV's, giving injections, pouring meds, learning your way around the facility, pt. hygiene, etc. (when you master this stuff...that saves you a ton of time).

The problem is that with just one or two patients, you don't really get much practice at hanging IV's, calling MDs, etc because maybe that day they only get 1 new bag hung and the MD doesn't need to be called and the labs were normal etc...

In my nursing program, it WAS all about the whole patient (dx, meds, background, psychosoc issues, etc) with minimal chance to practice performing skills and no real need to prioritize since we just had a few patients and not as many responsibilities as full-time RNs. We could take 20 minutes to double check the MAR, pour meds and pass them to one patient.

As a new grad on a med-surg floor, one patient was boring. Two was okay. Three felt like a good challenge. Four felt like I was going to miss something. But when I wanted to stay at 3 patients for several days, my preceptor said no, saying I'd have to manage with more patients than that and I'd better get used to it quick!

TigerGalLE, BSN, RN · May 4, 2007

I am a new grad, freshly off of orientation for 1 month now. When I precepted I did it differently. I started with all 6 patients from the get go. (a busy renal resp. floor). I followed my preceptor and we did everything together just like I would when I was off of orientation. She slowly built me up to doing things independently. Until I was doing it alone and she was checking behind me. I liked doing it that way. It worked well for me. I guess everyone is different though.

I think you should work side by side with ur preceptor and take the full load. You see more and learn more. You also don't get spoiled only having 2 patients.

chuck1234 · May 4, 2007

Talk to your nurse manager.

I think it is time to have another preceptor.

Good luck!!!

SICU Queen · May 4, 2007

Your preceptor sounds like he's forgotten what it's like to be new. Talk with him, and if you can't remedy the situation, you need to get a new preceptor.

Not everyone clicks... and you deserve an orientation that is going to benefit you.

jjjoy, LPN · May 4, 2007

I am a new grad, freshly off of orientation for 1 month now. When I precepted I did it differently. I started with all 6 patients from the get go. (a busy renal resp. floor). I followed my preceptor and we did everything together just like I would when I was off of orientation. She slowly built me up to doing things independently. Until I was doing it alone and she was checking behind me. I liked doing it that way. It worked well for me. I guess everyone is different though,

I think that's a great idea as long as that full load isn't too full for the nurse to be able to teach. With a full load, too often, if the experienced nurse stops to explain or let the newbie try a new skill, he/she can't catch up the rest of shift. So instead, the preceptor brushes off questions or answers brusquely and makes the newbie step aside if they're taking too long on a new skill.