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Discussion

Precepting an extern?

I somehow managed to get myself an extern this summer. This is my first time "precepting"

Basically what happened was; back in January my manager said, "Are you cool with getting an extern?" I said, "Sure!" After that I completely forgot about the conversation.

Come this Monday, my extern was there waiting for me bright and early!! No warning. Great! I hadn't really put much thought into it. Add to that, I literally just switched from nightshift to dayshift, so I'm still pretty much relearning quite a few things myself. Turns out she goes to the same school as I did (at least I'm familiar with the curriculum and what she should know at this point).

So the first day (monday), I just told her to follow me around and get a feel for the unit. I couldn't really think of anything else.

Over the past three days I've pretty much just been having her do procedures that are appropriate for her clinical level. Showing her the ropes and how we do things on our unit. She's proven herself to be pretty darn sharp and a quick learner. She's also been spot on with most of her clinical skills and I feel pretty comfortable that she's probably going to be good with whatever I throw at her.

We don't go back until Tuesday, so I've got a bit of time to mull over this.

I'm trying to think up ideas on how best to help her learn over the summer? I know it sounds silly to ask, but I'm new at this myself! She is going into the hardest phases/rotations of clinicals once she starts school again in September. Basically I've got 3 months to help this student get the most out of the learning experience. And I think we both agree that's it is pretty cool that she is getting paid to do this. Since she's going to be picking up some of my tasks, etc (making my life easier), I'm on here afterhours asking for suggestions?

How does everyone else handle having an extern work with them? How much do you let them do? How should I conduct this?

I know that in her third semester she will be expected to carry 3 patients in clinicals. I was thinking that next week I will give her one patient, the week after that I will give her two, and from then on let her handle three? (I normally have 4-5 over the course of a workday). I was thinking that at any point I could jump in to help in case there was a new learning experience that came along...i.e. a code (I'm ACLS certified so we can run to those if one happens closeby), discharges, admits, blablablabla. She stated that she's interested in sharpening her clinical skills so I'm going to be throwing a lot of caths and dressing changes at her (big on the med-surg floor).

One of the big things I'd like to teach her is time-management skills. I think most experienced nurses realize time management is very important to understand. How can I help her improve on them?

I basically see this as an opportunity for us both to learn (me=how to precept/her=how to be an RN), and any suggestions are very welcome. I'd like to keep my extern busy/engaged/learning/practicing. I'm not a slave driver or anything I swear!

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Wow!

I would LOVE to work with you! I say it's good you are actually giving her a pt of her own, because I am an nurse intern and I bascially get treated as a tech with 12 pts and doing more tech duties, than nursing duties. (not that this is a bad thing).

I think the biggest thing I needed to know from the beginning was time management. How should I do my assessment? Right after report, should I check the chart and then go in and do my assessment? Should I chart as I go? Things like that are important to know when you are first starting.

Wound and dressing changes are good as well. I have yet to do one at work, but have done several in clinicals.

I bet she's learned more in that one day with you than she has learned in clinicals all semester.

  • Experts

I am the coordinator of an extern program -- and I think it's appalling that you were just thrown into this precepting experience with no prepartion. Your employer should have provided you with such things as:

1. The goals/objectives of the extern program

2. The priorities for their learning and suggestions on how to teach those things

3. Tips for working with this level of "nurse" -- not the same as a new grad orientee

4. Guidelines as to what skills they are allowed to perform "independently" and what skills require your direct supervision

5. An overview of what type of orientation the extern has received prior to joining you in the clinical setting

6. etc. etc. etc.

It sounds to me though, that you are starting off right. Give her a little time to learn her way around and for you to get to know each other. Find out what her personal goals are, her experiences with nursing have been, her comfort level, etc. Don't assume the she is exactly like you were at that stage of your career or that she is exactly like anyone else -- or that she SHOULD be at a certain level. Nursing programs are changing and each is different, which means that students may not come to us with the same level of skills that we had at that stage of our careers.

Start with the simple, common nursing activities and move into the more sophisticated aspects of nursing at a pace that fits her abilities to handle them. Always remember that she is not finished with school yet. If she struggles with something or is awkward in her performance, that's OK for now. Just keep her moving in a forward direction and give her a chance to develop. The "pieces fall into place" at different paces for different students and that's OK. If you provide a comfortable, supportive environment in which she feels safe, it will give her the best opportunity to try out new behaviors and grow as a professional. Her future nursing school will help her develop even further. You will not be her only teacher: it's not all up to you. Help her feel comfortable and establish a basic foundation of "being" like a nurse on a unit with a patient assignment. That may be your most important task, particularly as you get to know her. The specific skills will follow.

I wish you were my preceptor. You are awesome. I definitely agree with the time management skills, that is probably the one area that really terrifies me the most.

llg, excellent and thank you for all preceptors for the reminders !!!! As a preceptor, giving constructive criticism that helps the receiver grow and not feel bad about oneself but uplifted to learn is a huge skill that takes practice.

To help this, I meet with my preceptee on the first day each week after we get report and allow the person to set personal goals for that shift. I then Know what to focus on, I also set one or two of my own, based upon what I know they need to work on... but only one or two... don't overwhelm.. stick to the goal.

We work 3 12's, so after giving report on final day 3 that week we meet for a few minutes and talk about how we've met each others goals and set improvements and goals for the next week. This is also the private time, away from peers where I add things that I've noticed that need improvement... help on and have the preceptee choose one or two to focus on the next week. It's not about me or my goals, this is for them.. And the process continues the first shift of the next week again. We document our discussions to look back to see growth and make sure we are communicating effectively. Perception in a stressful learning environment really does vary.

You will be an excellent preceptor because of your .work here in wanting to learn. Do not be afraid to give constructive criticism, that's how we learn, it is uncomfortable, and it does need to be done. Just keep it in check and set realistic achievable goals for your noobie so you can praise and praise.

Welcome to the world of growing our young, you've graduated, now go and grow a good one!:bow:

  • Author
I am the coordinator of an extern program -- and I think it's appalling that you were just thrown into this precepting experience with no prepartion. Your employer should have provided you with such things as:

I actually did get a 1 page memo about a month ago relating some of the things you mentioned. It just wasn't very detailed - which is why I'm asking for ideas here. Most of the nurses that are precepting have been doing it for a long time. I'm assuming I kind of fell through the cracks in this case. You're making me think it would probably be a good idea to get in touch with whoever coordinates the program here at my hospital. My manager is the one that decides who gets externs/how many externs we get/etc. I'm assuming my manager is just a bit scatterbrained and overlooked me and my extern in this case. Maybe it was just my can-do attitude? I'll call the coordinator on Monday and find out more.

  • Experts
I'll call the coordinator on Monday and find out more.

That sounds like a good idea. Good luck!

Sounds like you are going to make a great preceptor. I agree with the above posters. I am starting my first job next week as a new grad, and I hope I have a great preceptor like you all!! I would take the advice of the above poster and sit down each week to discuss the progress of the extern. This is one thing I plan on discussing with my preceptor and doing. Good luck and thank you for making us great nurses!!

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