Precepting in ICU/CCU

[limaRN, BSN, RN]

Hi all,

I will be precepting a senior nursing student for approximately 290 hours in their last semester. I am excited to teach as I went to the same program several years ago. I have read a few articles on precepting that mention open and clear communication, being present with the student, and active listening as key points for teaching/ precepting. I have read some other threads in which similar questions have been asked. I was looking for some info specific to the ICU.

For those that have precepted before: what worked for you? what didn't work? how much specific ICU info did you cover?

[dah doh, BSN, RN]

Start by talking about your routine, talk about the patients' diseases, problems, & goals. When you assess the patient, show them how to do it. Review frequency of routine stuff, vitals, charting, etc. Show them how look up meds, policies, find supplies etc. Review patho and meds by asking them "tell me what you know about this", have them tell you normal values, ask what the abnormal value means...the idea is to get them to talk to you so you can educate based on need. Have them look at policy on new procedures then have them explain it to you. Let them know its ok to say, "I don't know, but I'll look it up." (Make sure they do look it up).

Switch up patient type every few shifts so they can experience more...look for learning opportunities with other nurses' patients. Have them talk to the patient, families, ancillary staff, and talk to the DOCTOR too! Have them practice and give change of shift report and transferring a patient report. Try to do a quick critique of their performance at the end of the shift. Make sure you point out what was good & bad and make sure you tell them how to improve. Since they are students, make sure you stay with them for pretty much all patient related care to ensure patient safety. Once you judge that they are safe, you can let them do stuff more independently such as assessments, vitals, charting, etc. Hope this helps. Good Luck!

[limaRN, BSN, RN]

Start by talking about your routine, talk about the patients' diseases, problems, & goals. When you assess the patient, show them how to do it. Review frequency of routine stuff, vitals, charting, etc. Show them how look up meds, policies, find supplies etc. Review patho and meds by asking them "tell me what you know about this", have them tell you normal values, ask what the abnormal value means...the idea is to get them to talk to you so you can educate based on need. Have them look at policy on new procedures then have them explain it to you. Let them know its ok to say, "I don't know, but I'll look it up." (Make sure they do look it up).

Switch up patient type every few shifts so they can experience more...look for learning opportunities with other nurses' patients. Have them talk to the patient, families, ancillary staff, and talk to the DOCTOR too! Have them practice and give change of shift report and transferring a patient report. Try to do a quick critique of their performance at the end of the shift. Make sure you point out what was good & bad and make sure you tell them how to improve. Since they are students, make sure you stay with them for pretty much all patient related care to ensure patient safety. Once you judge that they are safe, you can let them do stuff more independently such as assessments, vitals, charting, etc. Hope this helps. Good Luck!

Thank you! This is really helpful!

[dah doh, BSN, RN]

You are welcome! Hopefully your student really wants to be in your unit. Just be aware that some students need a gentle nudge to encourage them, some need to be dragged to do everything, some need to be reined in because they go a thousand miles a minute...keep your teaching simple and basic (because they haven't gone through your didactic), keep them focused on the task at hand but directed toward the goal. It takes time and experience to figure out how to precept well and keep in mind that everyone learns differently so you may have to adapt your teaching style with each new person. If nothing else, you will learn patience because it takes them a long time to do anything! Also, just because you are a good nurse, doesn't necessarily make you a good teacher, but if you want to precept, just learn from each student and new grad and you will figure it out.

[imaginations]

I've just been preceptor into ICU and I had two preceptors whom I spent an equal amount of time between. The methods I found most helpful were those that involved my preceptor talking me through a task (e.g. ETT suction), doing the task (often several times while I watched on) and talking me through the actions and then me doing the task with her observation and guidance (and then feedback). Almost a see one, do one, teach one method -- except the end result was not me teaching something but rather recognising the need for it and being confident enough to step in and act without prompting (which was followed by positive feedback from my preceptor, things along the line of 'good choice' or 'I would have done the same thing').

Methods I found less useful were those where my preceptor jumped in and did tasks before I even had a chance to think about them and didn't give me the opportunity to develop my own routines of care and practice under her guidance. I really needed the opportunity to start planning care and making decisions with a guide, rather than watching someone act (and not in critical situations but with little things that I needed to develop a sense of - like planning the day, doing the obs, changing an infusion three hours early while I was at tea and so forth) before I'd gotten the chance to consider it.

Goodluck!!!!

[Sw88tpea, BSN]

I recommend that you start by asking how they learn. When asked my answer was, 'I want to see someone do it first, as I've never seen it done before. Next time I'll do it.' I did not do well being thrown in without having a systematic approach. It's important to know how someone learns. It's also important to ask what they know. Some nursing students were CNAs or EMTs and have great things to offer you as well. Teaching at the bedside and not behind a computer was always where learning was done best-the focus is directly on the pt. Good luck and have fun!

[limaRN, BSN, RN]

Thank you all so much for your wonderful replies. We start tomorrow!! I'll let you know how it goes.

[limaRN, BSN, RN]

Update: thank you all for your replies! We have done 3 shifts so far and she has gotten to see some pretty sick pts. We had a post-op CABG pt that was bleeding and a therapeutic hypothermia pt who we cooled the first night then warmed the second.

I always try and explain everything we are doing. It is difficult at times because this is the first time she has seen a vent, central line, a-line, swan, etc. I let her do as much as I feel is safe and that she is comfortable with and am with her 100% of the time. I made sure to ask how she learns best and try to teach that way. I feel she may be a bit overwhelmed with the first week but I understand because we've had some pretty sick pts. I let her know that I absolutely don't expect her to know anything about critical care and that I know all this info is new.

We have talked and set some goals for where she would like to be at the end of the semester and I made sure to ask how she thought I was doing, was I meeting her needs, etc. All in all going very well and looking forward to the next few months!

[MDG0407]

Sounds like you're an awesome preceptor. I will be in the CICU for my practicum...hope I have a preceptor like you!

[dah doh, BSN, RN]

Sounds like its going well! Keep it up!

[hsingh]

i always wanted to do that. But school changes the policies, and now i hope i get a job as a new grad in Critical Care