Hi experienced nurses. I’m a 5 year med/surg tele nurse at a community hospital. It’s A large unit. I just started precepting a new hire/rehire about three weeks ago. She’s at week six already. I’m told she’s been working at an office as a health coach, but was in hospital several years ago.
shes been out of the hospital 8 years. Any tips on getting her better up to speed? She doesn’t seem to be getting it!
She’s very good with the routine head to toe assessment and charting the routine daily required documentation, but that’s about it.
It gets as basic as making sure she pulls two pills instead of one...always has to run back. Minimal critical thinking, time management skills, Where to find meds not just stocked in pixie, and some other everyday skills (discharge education, secondary bags often antibiotics, especially when not with current fluids and programming flush bag is needed)
Responses to attempts at guidance is usually me repeating five times for her to still not get after multiple times with skill.... next day, five times explanation of same common skill. And “oh!” Like she’s heard it for the first time.
I’m frustrated. Prior preceptors of hers experience same frustrations.
I’m starting to keep a log of these to turn into educators and manager.
I am strongly in favor of having regular "orientation progress sheets" that are filled out each day and signed by the preceptor and orientee. On the sheets, the skills reviewed and/or performed are listed -- along with some comment as to whether the orientee is ready to do that skill or task independently with no supervision or whether additional practice or information is needed. If such sheets are pre-printed, they can be filled out in only 5 or 10 minutes, especially if the preceptor fills it out throughout the shift.
Such a record usually shows clearly that the orientee is mastering basic skills and moving on to more advanced skills ... or not. And the orientee is not blindsided by some negative (but kind) feedback if she has reached a plateau and is not progressing.
I also believe there should be some basic, flexible guidelines as to what skills should be mastered at various points in the scheduled orientation. For example, "at the half-way point, an orientee should be able to do a, b, and c independently without error." Again, that way, the orientee can see for herself whether she is meeting the standard or not.
Such sheets reduce the "gossipy" or "writing them up" nature of having to document poor performance. The record of how the shift went is filled with objective facts of what happened. Problems can be identified early and everyone involve can see where the orientee is in her progress towards independent practice.
She kinda sounds like a new grad, like me! Let her have some patients of her own and be hands off(unless things are about to hit the fan yk) and be there to answer questions. or even better, make her think through her own question!
Being an experienced nurse it was supposed to be 6-8 weeks, but it’s likely going to be 12 weeks.
We will not be able to be assigned less patients. (General culture of how it works) and there are days half of the nurses have an orientee. Most new grads. Best I can do is take anything above what she takes on my own and watch with the others.
Shes been taking the assignment for several weeks. When there is a very stable group with minimal need to call the doctor, communicate changes with the care team, she can do most of it. Anything that interferes with the plannned schedule and routine seems to be where the problem happens.
I've been a new nurse for just over a year now, and I'm still like this but it's a little bit better. She needs to up her nursing judgement, and perhaps a method of destressing. Whenever things hit the fan for me I have to remember to destress then tackle the problem rather than freaking out and not be able to do anything
You should have a metric for evaluating her and should not invent your own through a "log." That's not helpful.
Do you have a precepting class at your hospital?
Yes, we do have a precepting class. I’ve been through it several years ago but they’ve revamped our orientation process since. We have a Book that has all skills and sign off on competency as it’s achieved. The new employee puts some of their feelings in and preceptor will sign off on competent areas.
I do an as you go type redirection/education mostly. I had suggested a couple times something similar to a new grad “intensive period” which is a two week pop up skills thing with some skills lab and lecture/discussion education. They discussed and decided today that she’s going to be a part of this. She was not included at first since she’s not a new grad
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
On 8/27/2020 at 8:45 AM, Sweetheart2005 said:
I’m not criticizing to make myself feel better. I’m sorry if it’s coming across that way but that’s not the intent. I’m truly just extremely frustrated with the issues with the progression and concerned that not only she will drown but harm someone or not catch something that leads to harm in the process.
It doesn't sound at all like you're "criticizing" her to make yourself feel better. She's showing definite areas of concern that don't seem to be getting better. Absolutely keep a log; in fact work on it with her every day if you have time. Go over the things she did well, and make a note of the "things to work on again tomorrow". That will either help her to focus on the things she's not getting, or at least start seeing the writing on the wall before it has to be pointed out to her.
You have the patience of Job; good luck to you both.
Specializes in Psychiatry, Community, Nurse Manager, hospice.
13 hours ago, Sweetheart2005 said:
Yes, we do have a precepting class. I’ve been through it several years ago but they’ve revamped our orientation process since. We have a Book that has all skills and sign off on competency as it’s achieved. The new employee puts some of their feelings in and preceptor will sign off on competent areas.
I do an as you go type redirection/education mostly. I had suggested a couple times something similar to a new grad “intensive period” which is a two week pop up skills thing with some skills lab and lecture/discussion education. They discussed and decided today that she’s going to be a part of this. She was not included at first since she’s not a new grad
Okay.
Precepting is a skill also.
Just like your preceptee needs to work on some things, you probably do too.
You seem to me to be hypervigilant. I suggest backing off a little.
Just like your preceptee needs to work on some things, you probably do too.
You seem to me to be hypervigilant. I suggest backing off a little.
Agreed precepting is a skill. I’ve been told multiple times I’m a good preceptor and a good teacher. I’m sure there are things I could work on.
I’m usually pretty laid back and and allow my orienteers to do their thing and hang back unless there are questions or something that truly needs intervention
This one an unusually difficult trainee. I saw multiple safety issues when I would give her leeway, so then I became more vigilant.
... They discussed and decided today that she’s going to be a part of this. She was not included at first since she’s not a new grad
Sometimes you have to think outside the box.
2 hours ago, Sweetheart2005 said:
Agreed precepting is a skill. I’ve been told multiple times I’m a good preceptor and a good teacher. I’m sure there are things I could work on.
I’m usually pretty laid back and and allow my orienteers to do their thing and hang back unless there are questions or something that truly needs intervention
This one an unusually difficult trainee. I saw multiple safety issues when I would give her leeway, so then I became more vigilant.
When you get that gut feeling, you go with it. That's just being 'tuned in' to me.
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llg, PhD, RN
13,469 Posts
I am strongly in favor of having regular "orientation progress sheets" that are filled out each day and signed by the preceptor and orientee. On the sheets, the skills reviewed and/or performed are listed -- along with some comment as to whether the orientee is ready to do that skill or task independently with no supervision or whether additional practice or information is needed. If such sheets are pre-printed, they can be filled out in only 5 or 10 minutes, especially if the preceptor fills it out throughout the shift.
Such a record usually shows clearly that the orientee is mastering basic skills and moving on to more advanced skills ... or not. And the orientee is not blindsided by some negative (but kind) feedback if she has reached a plateau and is not progressing.
I also believe there should be some basic, flexible guidelines as to what skills should be mastered at various points in the scheduled orientation. For example, "at the half-way point, an orientee should be able to do a, b, and c independently without error." Again, that way, the orientee can see for herself whether she is meeting the standard or not.
Such sheets reduce the "gossipy" or "writing them up" nature of having to document poor performance. The record of how the shift went is filled with objective facts of what happened. Problems can be identified early and everyone involve can see where the orientee is in her progress towards independent practice.