Precepting a floor nurse

needsmore$ · Mar 19, 2013

Where to start....

I have been precepting for 25 years or so. I find that to start, I just have the new associate work with me to watch what I do. Then we talk about the critical thinking that ED nurses do in all aspects of our care...from where we put IVs to the why's. I stresss the recognition of "sick" vs "non sick" appearance and always plan for the worst case scenario and how to rule out things using assessments and history taking.

I go over the A-B-C method of assess and intervention of all patients.

When ready and the new asociate has learned "my routine"-- I start by giving her 1 patient-- usually a level 3 or 4 ESI acuity. They focus on assessing and learning how to document their findings. I take care of the tasks of IVs, etc until they are proficient at the nursing assessment stuff, and then we add the IVs, etc.

ENA has orientation modules as well that cover soup to nuts of systems assessment.

Good luck

needsmore$ · Mar 19, 2013

And a side note

Do not let other staff dictate the type of patients you get. (if possible) I have had many charge nurses give me the "more complicated" stuff right off the bat because "this is a good one for her/him". If you don't build the foundation then the "good stuff or the "interesting" won't make sense.

I know many times you get what comes in the door but it takes a preceptor twicew as long to do what needs to be done... explanations, etc. If you are able to take a few weeks to get the lesser acuity stuff to start, then when you get the level 2s and 1s, it makes sense

needsmore$ · Mar 19, 2013

And give them an empty very large 3 ring binder. I print out info about what we're caring for. I use 'up to date' alot. I highlight the important stuff and before they know it, they have made their own ED reference book

BSNbeauty, BSN, RN · Mar 19, 2013

Needmore$, If I would have had a preceptor like you in the ED I would have survived passed my 30 days. I came from ICU to the ED and it was a big challenge. My preceptor was really nice but was not a good teacher. From day 1, I was basically on my own. If I would have had an orientation like you described I would have had a different outcome I'm sure. I know deep down I'm not a ED nurse, however I would have loved to stay atleast 2 years.

Where to start....
I have been precepting for 25 years or so. I find that to start, I just have the new associate work with me to watch what I do. Then we talk about the critical thinking that ED nurses do in all aspects of our care...from where we put IVs to the why's. I stresss the recognition of "sick" vs "non sick" appearance and always plan for the worst case scenario and how to rule out things using assessments and history taking.
I go over the A-B-C method of assess and intervention of all patients.
When ready and the new asociate has learned "my routine"-- I start by giving her 1 patient-- usually a level 3 or 4 ESI acuity. They focus on assessing and learning how to document their findings. I take care of the tasks of IVs, etc until they are proficient at the nursing assessment stuff, and then we add the IVs, etc.
ENA has orientation modules as well that cover soup to nuts of systems assessment.
Good luck

Vespertinas · Mar 20, 2013

Crazy&cute, your story of no orientation (with no materials) and OP's story of no preceptor training workshop makes me realize (again) how spoiled I've been!

One suggestion I'd make, OP, is to ask your orientee sometimes how she'd like to do things/how she learns best. I've been surprised at how stonewalled I could get because I was insistent on instructing my way when it was completely not suited to orientee's preferred method of learning. More specifially I mean: does she prefer to watch you do everything and then she'll repeat or would she rather do it on her own as you instruct? Would she feel more comfortable taking on complete patients as you increase them one by one or would she be okay helping a little here and there with everything? Of course, these preferences can be limited at your own discretion but a little moulding to her needs goes a long way. :)

When you're all done with this experience, maybe you could write down what you wish you had known before you started this... and then work with a clinical educator to start developing a preceptor training workshop for the hospital. Could be a great project.

Sadala, ADN, RN · Mar 21, 2013

I just wanted to thank all of you who take the time to precept (perhaps they don't give you a choice, really, ha!) But still, it means a lot to those of us coming up that there are people who REALLY WANT US TO KNOW the things that will be the most helpful for us, for our pts, and for their safety. I'll take a preceptor who wants to teach me all of those things any day of the week and twice on Sundays.

UK_RN_AJ · Mar 21, 2013

Coming from acute medicine to emergency I was blessed with a fantastic mentor and I use the same rules that they taught me from day one. To start, along with my mentor I was taught to master initial assessment . For every patient on arrival much like moremoney$ I used ABCDE, even on the time wasters, everyone got the same full systematic (which works really well for me) assessment on initial attendence.

A- Airway and C-spine = assessment + if adverse signs = intervention and Treat it !!

Breathing and ventilation = assessment + if adverse signs = intervention and treat it!!

Circulation and hemorrhagic control = assessment = if adverse signs = Intervention and treat it !!

Disability and neurological = assessment = if adverse signs = Intervention and treat it !!

exposure and enviromental control= assessment = if adverse signs = Intervention and treat it !!

I focused on these initial assessments to start with and then Following that learned to do a a more focused assessment on there specific problem, if i did know something i would write it down and add it to a book and look it up and was actively and constructively challenged on my knowledge. I was always given plenty of targets and goals which helped me to see my own progress.

Now that I help With new starters I do much the same, find out what they know and what they want to learn in the long run. Focus them on the initial assessments from that work onto more complex assessments and nursing skills.

bebbercorn · Mar 22, 2013

I agree with Vespertinas, the best preceptors I had usually asked where I was in my learning and usually said something along the lines of "This is how I do it. You have to find the best way for you, but try my way on and see how it fits." I have had awesome preceptors. I hope it goes well for you!

exit96 · Mar 24, 2013

A good preceptor is PRICELESS. Thanks to all who do it passionately and do it well!

inteRN · Apr 10, 2013

Thank you! That helps!