Precepting an ED nurse

Larry77, RN · Apr 4, 2007

We had a binder that came from staff ed that had all the skills we had to have signed off by our preceptor but nothing that came from ED. My preceptor gave me what you are speaking of though with all the standard orders and commonly used forms (ie blood admin, AMA, Trauma flow sheet, code flow sheet) and had me study them even before I started my shifts.

There is a few topics on here if you want to do a search about new hire's or precepting that might give you more pointers but what you are talking about is a great idea.

Just a personal note, not everyone succeeds in ED so if this new hire does not do well don't take all the credit...she/he just may not be a good fit.

phiposurde · Apr 4, 2007

I did it a few time, so I'm not and expert. But I got good review, so I guess i wasn't to bad!!!8)

First, that you care enough to ask a list how to do it is a good sign of what kind of person you are. You don't believe you know everything but have enough confidence. I was once a new grad in an ER and got one of those bad people!! I almost quit nusring because of it. New grad are especially "fragile" Cause there "triangle of knowledge" is missing side. They have knowledge but not a lot of experience and a lot of insecurity, especially if they are in the ER. If they don't have that insecurity, I would be very worry cause that mean they could be one of those know-it-all. In that case it would be important to bring them back to earth!! For the others, one process I learn that is important is not to give them too many answer...let them found them. Like the chinese proverb say:" if someone hungry give him a fish, but if you want them to never be hungry again teach them how to fish".

DoN't be affraid if you don't know something. Question them on why they do things, it is good to verify there critical care thinking. Sometimes, i would stop them in the middle of something and say:" ok you have a person that is doing bla bla, what would you do in that situation?" Choose situation like SZ,V-tach,SOB, ect.Get them ready for the unexpected. And show them how to use the crash cart.

At last, for the department as per say, tell them about what you know. Review what you think is important( lunch time, protocol,overtime, request for vacation,ect). One thing we do at my hospital we do a scavender hunt in the department. They have a list of the most thing we use and they have to find them. It help them getting use to the department.

Hope I help!!!8)( man can i talk sometimes )

onitor

ShannonSRN · Apr 4, 2007

Hello all.
I am due to begin precepting a new nurse to the ED next Monday. I have been an ED nurse for about 2.5 years, feel confient that I contribute well to my unit.
Our ED has no educator, and no formal precepting course. We were recently assigned a new director, so hopefully there will be some changes. We have seen a great deal of turnover in the past few years, most from new grads that were hired and very overwhelmed.
I *do not* want my preceptee to be one of those new grads. I am excited about this opportunity, but also very very nervous. I feel it is a big responsibility & that I owe her a lot in terms of education & making her feel welcome.
Soo...any tips for me? I want to make her some type of resource that includes our commonly used forms, as well as general information regarding how our unit runs, how to request vacation, etc... but am not quite sure how to format it. I was given the go-ahead by our management to create some type of resource & was told that if it works out well for us, it will be used for all new grads.
Any advice would be greatly appreciated.
Thanks!

I was a new grad in the ER last year, in a unit that was unorganized, no manager, and nurses were taking up to 12 patients (obviously low staff). My preceptor lacked and time to be able to precept me, and should have never been assigned to do so. This ER was so understaffed with huge pt (unsafe) load. They hired 4 new grads, all very intelligent, motivated and able, but we all left due to the lack of leadership, and it was just plain unsafe! I had 11 patients by myself after only 1 month!!!

After reading your post, I feel as though we work in the same hospital. They have hired a new manager, who seems to have his goals clear and set. They seem to be running better, but still have a shortage of staff. I have been tempted to go back, but am terrified to think it possible.

My point of all this is...be by his/her side as much as possible, when with a patient doing assessments, explain why and how. As you are well aware, ER assessments are quick, new RN's are used to having time. Go over priority, even if it sounds obvious. Advise him/her to have a quick drug references. The reference you want to make is awesome!

I wish my preceptor would have had the time to actually precept, he was so smart, and had great character. We are still friends, as well as several ER nurses I met. All of them keep encouraging me to come back, but I am soooo leary!

Good luck. They wouldn't have chosen you as preceptor if they thought you couldn't handle it!!!

CCL"Babe", BSN, RN · Apr 4, 2007

The ED I worked in had a scavenger hunt as well.

The staff put together a binder of things that we did frequently. It also included key ED Policies and protocols and some of the less frequently used ones. Examples: rape protocol, hazardous materials exposure, chest pain protocol, isolation to name a few.

We also would try and get them ride a-longs with the local Paramedic Unit so they could understand and hopefully appreciate how the medics/ems worked.

Victoriakem · Apr 4, 2007

At my hospital new grads have a 6 month orientation. They start out on the Urgent care side, with more stable patients with a preceptor. After doing well there, then they go to the Acute side, the "Heart attack" side, as I call it. New hires that have adequate orientation tend to stay longer than those who are thrown in & expected to sink or swim. It cost lots of $$ to hire & train people, so it's a waste not to treat them well. Plus, there is a push to hold onto nursing staff, & make it worth it to stay where they are.

It's sad to here these stories how good employees left because they were not mentored well. A real loss to the hospital & the patients.

porcelina22 · Apr 4, 2007

I am set to start my orientation as a new grad in the ED on May 21st. My ED has an entire protocol from an organization of ED educators that has to be finished in my six month training. I am also to shadow an RN, Tech, and US for set number of shifts- those Tech shifts are extremely helpful in knowing where everything is!

Since your grad probably hasn't had ACLS, it may be helpful to print off those algorithms. I still have to take the class and I have never been in a code situation, so I know I need to study that heavily. Maybe your pharmacy can provde you with a list of commonly used dsrugs specific to the ED. Also, having copies of common policies and procedures to study would be helpful.

Just remember that your preceptee will probably be nervous and will need lots of encouragement. I know I will!

Chrissy

jojotoo, RN · Apr 5, 2007

I think that it is important to make a new nurse feel "safe" about asking a lot of questions. I tell my orientees that they can ask me anything.

I also try to encourage critical thinking skills by asking THEM a lot of questions. EX: Why are we doing this lab test? What are the normals? How did you decide which order to carry out when there are multiple orders? What reaction should you be watching for if you give this medication? I think that by giving them repeated opportunities to verbally outline their thinking, this helps them to better organize their plan of care.

Our new grads usually only get 2-6 wk orientation on days and then they complete their orientation on nights (if they were hired for PM shift). I let them be "task" nurses at the beginning of the shift so they get a lot of practice with different skills (IV, Foleys, NGTs, etc). Then I will hand pick the patients that are assigned to them, always just starting with one that I want them to follow from beginning to end. Then we eventually add another patient, and another one, etc. - until they have built up their skills and confidence to take a full assignment.

TigerGalLE, BSN, RN · Apr 6, 2007

I am finishing up my last week of orientation on a busy renal/resp floor. So i have a few tips (coming from the orientee)..

As your orientee becomes more independent it is okay for you to back off.. Let them make some decisions and then give your input. After about 2-3 weeks let them start calling/talking to docs. The more they do this the less nervous they'll be about it when orientation ends.

Also.. do not disappear on them. If you leave tell them where you are going. It is the most frustrating thing to have a question and your preceptor is no where to be found. So give them independence.. but stay close enough for comfort.

Don't hover.. Ask them if they want you to come with them to talk to patients or to do IVs or whatever. (As long as you know they are competent)

I hope this helps.. These were just some of my frustrations as an orientee

hjwdancer · Apr 9, 2007

As a new grad, just off of orientation:

I had a great preceptor who provided me with a fount of knowledge, including resource people for certain areas. Ex: one of the er nurses had a heavy psych background- I knew where to turn with psych questions. She is such a great preceptor.

Provide feedback on performance: That is my only complaint about my orientation. At the end of my time, I couldn't tell if I was performing as expected. Each week tell your new person/orientee: our goals were/weren't met this week and why and how to fix them.

Also: Your person may be new to the hospital; don't forget to show them around.

I also was at a loss my first few weeks on "what" to ask- the ER is a fluid, everchanging environment. Help your person by pointing out protocols, frequently used meds, and helping them deal with difficult patients.

Good luck- It must be very tough to be a preceptor!

EmerNurse, BSN, RN · Apr 9, 2007

I'm in the process of precepting a new grad now. While we have a unit educator, they're not very involved - we don't have an official orientation program for new grads/hires. Pretty much it's hook 'em up with someone and off they go. My grad did a couple weeks on days and then came to me on nights. From the start, we discussed what she needed to accomplish (what WE wanted to accomplish). I feel this is a team effort to orient someone to the unit, it's not all on the new grad.

I got a major win in when my director agreed that she should be on MY schedule until her orientation is over, and that, for the most part, I decide (with her) when that is. It's allowed my preceptee and I to map out the next couple of weeks, where we want to go and what we will use to measure her progress.

While we're insanely busy, and she's learning to drive in the fast lane right off, she's doing well and each shift is a little better than the last. She knows she can ask me anything, and what I don't know, we look up together. At the end of each shift together, we take a couple minutes to go over the shift (de-brief if you will) and talk about what went well and what we'll work on. I feel (and I think she does too) that she's not left wondering how she's doing. I'm at the stage now where *I* am learning not to hover, as she becomes more independent. I'm getting there LOL.

So far so good.

MeryMellen · Apr 9, 2007

I am a new grad and just came off orientation in December. I had several preceptors, some were wonderful, some were just ok. The best preceptors talked me through each patient. So when they came through the door with certain symptoms they would go through what the worse case scenario would be and what labs and tests should be done to help rule out those dx. I started out just following my preceptor for the first week or so then I started with my own patient to do start to finish. Within about 2 or 3 weeks I felt comfortable with one patient then they moved me to two. Once I was comfortable I moved to 3, etc. I noticed that at the beginning of orientation my preceptor did a lot of the talking but at the end I was doing all the talking. I would stress to her that she does not know everything and is not expected to know everything, the more she asks questions and uses the time she has for orientation the more she'll gain. If she has a questions about something even if she thinks it's stupid, she should ask and not feel uncomfortable cause she may not have you as a safety net in the future. Now's the time to know nothing... not 6 months from now when she's on her own. The thing I wish I had heard at the beginning of Orientation is that the expectation is not that everything ordered is going to be done within 5 minutes. The MD's know that... but for some reason I used to get easily flustered by a long "to do" list. PRIORITIZE! Who's the most important patient to see? What "task" is the most important to complete for that patient? Learning to pull myself away from sick patients to two minutes to pop my head into other patient's rooms was a challange, but is important.