I'm orienting a new nurse for the first time. She's been with me for 3 weeks - the first week she was only allowed to shadow (was taking her NCLEX that week) and then took 1 patient last week and this week. She's supposed to increase by 1 patient every couple of weeks. I think she's a very intelligent person and has a lot of book knowledge but we're having trouble getting her to think "real world." I recognize that when you are only responsible for 1 pt that there are a lot of things you can do that you can't do when you have 4 or 5. That being said, here's what's happening:
We make our rounds to see pt's and do assessments first thing. She does a very detailed assessment, but it usually takes 20-30 minutes. I've tried to encourage her to multi-task during her assessment (like evaluating orientation, speech, etc while also checking extremities) and that listening to each lung lobe for 1-2 minutes isn't always necessary. I can listen to all heart/lung/bowel sounds and be on to the next thing and she's still on lungs. I realize that sometimes you're hearing things in the lungs that you need to listen longer, but if the pt is in the hospital for a seizure or stroke and on initial evaluation the lungs are clear, move on. I'm trying to show her how to do a speedier assessment by example, but it hasn't worked yet. Then we get our am meds ready. She is going through every med for her pt and looking it up and checking side effects and interactions. When I've asked her about this and asked if she knows her meds, she says yes but she feels responsible about possible drug interactions. She'll get caught up about a drug that may cause constipation and then we're giving colace and thinks of that as counteractive. I try to explain that the pt needs that drug and since it is causing constipation, we are helping by giving the colace and that also as nurses we cannot know every possible drug interaction of every drug we give - we CAN know basic drug classes and interactions between classes and the general side effects. She has also been somewhat argumenative about the textbook way of doing things (like saying that auscultating to verify NG placement is wrong and the only right ways are to check pH which our hospital doesn't do or to do a chest x-ray - but we can't do a chest x-ray everytime a NG has to be replaced or even each shift.) I'm glad she knows the best way to do it, but sometimes you have to adapt and do things how you can.
I know this was long, but wanted to give some examples. Am I being too hard or picky? I'm trying to realize she's just getting started, but I want to help her get out of the "nursing school" mode and into the "real world" mode so she doesn't drown as her pt load increases. What's the best way to address this without being harsh? I'm trying to let her know that no nurse has ALL the answers or knows everything and to trust her instincts!
Thanks everybody. I guess I just needed to hear that I'm not being completely unreasonable in what I'm expecting. I've had a lot of students and with them it's easy for me to say "I want you to be able to tell me about these meds before you give them" or to critique what they're doing a little more. But I don't feel the same when someone is essentially a peer. It's hard to be their friend and preceptor sometimes. I want her to learn to use her instincts and to realize that sometimes when you're doing things there isn't a set way to do it - you just improvise and get through it. She wants procedures and policies and well, you get the point.
I think I may sit down with her at lunch tomorrow and ask her what she feels is her weakness at this point and then suggest what I think are some weaknesses. I'm also going to try to get her to take 2 pts. We offer a minimum of 12 weeks orientation on the floor so she's still got quite some time, but now is the time to get a schedule started. Our first "milestone" meeting with our clinical educator isn't for 2 weeks, so she's got time.
I know it's hard going from the textbook world to the real world. I struggled with that on the NCLEX-RN because I was a working LPN and some of the questions I had to answer what I knew the test wanted instead of what you really do. It's just the way our system is.
A lot of the judgement calls/instincts just take time. I learned a lot of that by watching what the seasoned nurses around me did. Another thing we're experiencing with her and some of our other new grads is that it is also the time of year for all the new residents. You know, the ones who you call for orders and they say "what do you think I should do?" It's scary to think that a new resident is asking a new nurse for advice! (I caught her taking a TO yesterday from one for "daily UA w/ C&S" - DAILY!)
Anyhoooo...I'm trying to push her whenever I can. I think she started to understand the NG thing when we had a pt who pulled out 4 NG's during our shift and that was a daily thing - she realized that CXR couldn't be done every time. Will keep you updated! Keep the advice coming!
Specializes in Community Health, Med-Surg, Home Health.
I think it is impossible to know each and every side effect of the medications, and when you have alot of patients, it gets worse. What I did as a new nurse was continue to read about drugs at my leisure. At work, I would look at essential information, such as indications, contraindications, allergies and special alerts, and what I noticed is I remembered more and more as time went on.
I am STILL learning more about medications, even after having my license since 2006. Now, I look up drugs I don't know at all, and keep the extension of the pharmacist at my side in case of any uncertainty. I work in a clinic, and have to do a great deal of teaching, which helps. We have electronic charting and the micromedix to do a quick review while we are chatting with the patients. I laugh, because many times, the patient thinks I am looking at their chart, but I am actually quoting side effects from there. And, what I do is write the names of unfamilar drugs on a list (even after teaching them), and review them when I have time at home.
If the OP's nurse graduated from a program like mine, I feel for the new nurse, because while we had a pharmacology class, not much emphasis was placed on medications. In fact, I was so disappointed, because after that semester, drugs almost never came up again until we got to OB (and still was not much). I had to take an NCLEX review course in pharmacology before the state boards. Thank God for that, because that was the only way I knew most of the medications that popped up on that exam.
Keep up the good work precepting. Many preceptors are not really teachers, and make a new nurse simply miserable. And, most mentorships are not for long...hospitals here send the nurse flying on her own in a few short weeks.
Specializes in Community Health, Med-Surg, Home Health.
Thanks everybody. I guess I just needed to hear that I'm not being completely unreasonable in what I'm expecting. I've had a lot of students and with them it's easy for me to say "I want you to be able to tell me about these meds before you give them" or to critique what they're doing a little more. But I don't feel the same when someone is essentially a peer. It's hard to be their friend and preceptor sometimes. I want her to learn to use her instincts and to realize that sometimes when you're doing things there isn't a set way to do it - you just improvise and get through it. She wants procedures and policies and well, you get the point.
I think I may sit down with her at lunch tomorrow and ask her what she feels is her weakness at this point and then suggest what I think are some weaknesses. I'm also going to try to get her to take 2 pts. We offer a minimum of 12 weeks orientation on the floor so she's still got quite some time, but now is the time to get a schedule started. Our first "milestone" meeting with our clinical educator isn't for 2 weeks, so she's got time.
I know it's hard going from the textbook world to the real world. I struggled with that on the NCLEX-RN because I was a working LPN and some of the questions I had to answer what I knew the test wanted instead of what you really do. It's just the way our system is.
A lot of the judgement calls/instincts just take time. I learned a lot of that by watching what the seasoned nurses around me did. Another thing we're experiencing with her and some of our other new grads is that it is also the time of year for all the new residents. You know, the ones who you call for orders and they say "what do you think I should do?" It's scary to think that a new resident is asking a new nurse for advice! (I caught her taking a TO yesterday from one for "daily UA w/ C&S" - DAILY!)
Anyhoooo...I'm trying to push her whenever I can. I think she started to understand the NG thing when we had a pt who pulled out 4 NG's during our shift and that was a daily thing - she realized that CXR couldn't be done every time. Will keep you updated! Keep the advice coming!
Oh, where were you when I was a newbie! You sound GREAT!! Like I said, many preceptors are impatient. I know it is a hard job to mentor others, but those that are successful create confident nurses for those that are new to the field! Keep it up!:redbeathe:heartbeat:bowingpur:bow:
Encourage her to take three or four patients one morning for a few hours and have her report back to you at the end of, say, two or four hours. Have some specific goals, like all meds administered, initial assessments done and charted, any order changes noted, etc. She can ask for help at any time, but let her see how she handles it.
If she does well, let her continue. If she's already gotten way behind, take one or two patients back and let her regain her balance.
After a few days of working with several patients and seeing what difficulties she has, then offer to let her shadow again, perhaps the first half of shift, helping you out, but without full responsibility for the patients so that she can observe how you and other nurses deal with the multiple responsibilities.
Those are both opportunities I would've appreciated starting out.
Specializes in Cardiac, stroke, telemetry,Med-surgical.
I'm trying to realize she's just getting started, but I want to help her get out of the "nursing school" mode and into the "real world" mode so she doesn't drown as her pt load increases."
Thank you! Gush, this is my problem too. Now I understand how my nurses felt around me. Thank you for being patient with her and trying to help her. That's exactly what I am doing during my assessments; I am so afraid to miss something... Total frick.
Ahhhh, precepting, the best time in the world :).I feel a more hands on approach, is always best.The fact that she shadowed for a few days was great.Now she needs to step it up.Alot of nurses don't realize how everything flows, until they have a full team.Starting her out slowly is good.But do not make it too slow, you are going to be behind her all the way, if she has any questions or concerns, you are there for her.We have the majority of our nurses be precepted taking/handling the team, by week 3 or 4.Of course, they have their preceptor with them.We usually have anywhere from 5-8 pts per nurse.What you need to stress to him/her is that this is the time to learn, be scared, ask questions,take the team w/ the backup (you), so when they get out on their own, they feel ready/confident to do it.The preceptees have to use their orientation time for their best.Many new nurses need help to focus, time manage,help to manage ever changing demands on a sec basiS.You are training them on the floor, not nursing processes, unless, of course, it is a new procedure etc.Sometimes it takes a few days of bad teams, craziness and tears to help them figure it all out.With that being said, you also dont want to make them feel so out of it and out of control, they dont think they can do it.REAL nursing is alot different that what we learned in school.If you are going to a preceptor on a routine basis, see if your manager will send you to a preceptor class, for more tips etc,also a guideline (flexible of course) of where your manager thinks that person should be in their orientation...Good luck!!!
During my orientation I had a wonderful, sweet preceptor, who always tried to make sure I had a good day and didn't feel overwhelmed. She would call me frequently (esp. when I had the whole team) and ask if she could do anything to help, if I felt comfortable, etc.
It was nice, and wonderful, but I knew (luckily) that once off orientation I would have some bad days, I would feel overwhelmed, and I felt I needed to figure out how to muddle through that (in a safe manner, of course). I feel like had I not forced myself to be overwhelmed every once in a while, with my preceptor as my safety net, I would have been a mess once I got off orientation.
Anyway, moral of that novel.. I'd also encourage her to step up the patient load, experiment with some time management techniques. Be there for her, offer help and advice, have discussions about what is going well or not going well. This may sound weird, but I think orientation is the best time to get in over your head (a little bit, anyway), because you do have that safety net of your preceptor to work with you to figure out how you could handle that situation better.
Thanks for all the advice everyone. I wanted to let you know how Friday went. She took 2 high maintenance pt's - 1 who was frequently asking for pain meds and on contact precautions and 1 who was a CVA and we later found out was going through DT's and had to be restrained. She stayed very busy but on task. We had a talk at lunch about what she thought she was weak at and she agreed with me. She's doing much better about prioritizing, so I think we may have made the turn. She's supposed to take 2 pts for another week or so, unfortunately she'll be off the floor for a week to take a telemetry class, so hopefully we can pick right back up. Our hospital has a timeline set out for when they want the nurse residents to advance in the number of pts they have and really want you to stick to it since they get 12 weeks on the floor.
Specializes in Cardiac, stroke, telemetry,Med-surgical.
Dear Lana, thank you for sharing your experience with us. As a student nurse, I was always concentrated on myself: my needs, my difficulties, my side of story.
wow, it sounds like you are a great preceptor! When I was precepted, I had 3 patients my first night on the job. I had ALL the patients by day 3 and I HAD to prioritize. I felt like I was thrown to the wolves, but it taught me to multi-task real quick. You sound like you are being very patient. Just remember that in school, you are taught "the correct way" to do things and it will take some time for her to realize that it isnt always like that in the real world.
:redbeathe:heartbeat:bowingpur:bow:
LanaBanana
1,007 Posts
Thanks everybody. I guess I just needed to hear that I'm not being completely unreasonable in what I'm expecting. I've had a lot of students and with them it's easy for me to say "I want you to be able to tell me about these meds before you give them" or to critique what they're doing a little more. But I don't feel the same when someone is essentially a peer. It's hard to be their friend and preceptor sometimes. I want her to learn to use her instincts and to realize that sometimes when you're doing things there isn't a set way to do it - you just improvise and get through it. She wants procedures and policies and well, you get the point.
I think I may sit down with her at lunch tomorrow and ask her what she feels is her weakness at this point and then suggest what I think are some weaknesses. I'm also going to try to get her to take 2 pts. We offer a minimum of 12 weeks orientation on the floor so she's still got quite some time, but now is the time to get a schedule started. Our first "milestone" meeting with our clinical educator isn't for 2 weeks, so she's got time.
I know it's hard going from the textbook world to the real world. I struggled with that on the NCLEX-RN because I was a working LPN and some of the questions I had to answer what I knew the test wanted instead of what you really do. It's just the way our system is.
A lot of the judgement calls/instincts just take time. I learned a lot of that by watching what the seasoned nurses around me did. Another thing we're experiencing with her and some of our other new grads is that it is also the time of year for all the new residents. You know, the ones who you call for orders and they say "what do you think I should do?" It's scary to think that a new resident is asking a new nurse for advice! (I caught her taking a TO yesterday from one for "daily UA w/ C&S" - DAILY!)
Anyhoooo...I'm trying to push her whenever I can. I think she started to understand the NG thing when we had a pt who pulled out 4 NG's during our shift and that was a daily thing - she realized that CXR couldn't be done every time. Will keep you updated! Keep the advice coming!