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Precepting New Grads

Specializes in Emergency Department.

Hi all! This is my first post on allnurses! I have been a long time lurker for about 6 years. Finally decided to join the community! I currently have about 2.5 years of experience as a ED RN. I am certified in emergency nursing. Over the past year, I have precepted two new graduate nurses to the department. I was just asked to precept a another graduate nurse. I enjoy the teaching process and someday hope to be a clinical nurse instructor. I would love feedback from new graduate nurses and from experienced preceptors on things to do to make the experience the most I can for the new grad and to help them to become the best ED nurse they can be. I would also like feedback from newer nurses on things that their preceptors did that was not beneficial so that I can learn from others mistakes! I have inquired to the other new grads who I precepted and received helpful feed back from them. The ED can be an overwhelming, fast paced environment for new nurses and I want to be able to foster a safe and healthy learning environment for my future coworkers!

emtb2rn, BSN, RN, EMT-B

Specializes in Emergency. Has 21 years experience.

Have a program with clearly defined goals and targets by date. Regular formal feedback with the preceptor & nurse educator will help ensure that everyone is on the same page regarding the new grad's progression. Be flexible and allow new grads to get exposure to as many facets of the er as possible, even when it's not their pt as even observing helps.

We have a board in the break room. And people anonymously post what they want to learn about. For example I gave a PowerPoint on Hyperkalemia. And u got a CEU for attending the class. It was fun and nurses won prizes if they could answer the big questions. The management loved it. And so do the staff. I try to make it fun. Plus if there is food nurses will usually come. We did it on the hour. Turned out well. Next time we r doing one on Sepsis. We have a lot of new grads and nurses that have been there for awhile. Me and the clinician r trying to help everyone. And make it a more positive place. Obviously since the trauma center we work at is bananas !! [emoji4]

Pixie.RN, MSN, RN, EMT-P

Specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN. Has 12 years experience.

Welcome to allnurses! Glad you finally de-lurked. :) Clearly you are doing the right things if they keep selecting you to precept new grads. How big is your ED? Trauma center?

EDRNCCmom, MSN, RN

Specializes in Emergency Department.

Welcome to allnurses! Glad you finally de-lurked. :) Clearly you are doing the right things if they keep selecting you to precept new grads. How big is your ED? Trauma center?

My ED has 28 beds, 2 trauma bays, and 8 hallway beds/rooms. We are not a trauma center but like all ED's we get our fair share of traumas which we stabilize and transfer out. We see about 4000-5000 patients each month. Our new graduates go through the hospital wide residency program, but department specific teaching is up to the primary preceptor.

EDRNCCmom, MSN, RN

Specializes in Emergency Department.

Have a program with clearly defined goals and targets by date. Regular formal feedback with the preceptor & nurse educator will help ensure that everyone is on the same page regarding the new grad's progression. Be flexible and allow new grads to get exposure to as many facets of the er as possible, even when it's not their pt as even observing helps.

Thanks for the great advice!

sjalv

Specializes in CVICU. Has 1 years experience.

I have been a nurse for over a year now in the same unit where I was a new grad. It is a CVICU and let me tell you, my clinical experience during school sucked. One of the biggest things that helped me succeed as a new grad in critical care was my preceptor's patience with my lack of clinical skills. Some of my fellow new grads were not so lucky. If a new grad says they don't know how to prime tubing, or do basic things like check tube feed residuals, do not chastise them. Take the 5 minutes it does to teach them the basic skill that they're lacking, then move on. It is more concerning if a new graduate doesn't have physiology knowledge required to critical analyze their patient's condition, but do not belittle them for not knowing something that takes less than 10 minutes to teach.

I see the attitude often where experienced nurses will say, "She doesn't know how to start IV? She's never put in a catheter? There's no way she'll make it here." Such blanket statements are not always 100% accurate and the critical thinking a new grad has should not be outshone by their lack of physical skills. Admitting things like this can be hard for a new grad, especially in critical care, but having an understanding preceptor helps to ease the knowledge gap. Not everyone had stellar clinical experiences in school.

Joanie49

Specializes in Med surg.. Has 1 years experience.

I have not worked in the ED, but I have had a preceptorship experance and I thought the most helpful things my preceptor did was ALWAYS ask me before doing a skill or giving a IV med or whatever is ask if I am comfortable with it! That opened the conversation up to if I had questions or possibly reviewing the procedure before going in the room, and clearly for safety purposes!! She trusted me and knew I would say either yes or no which also built trust between us both.. Personally I find "quizzing" and like intense questioning about meds or random other things very annoying and unhelpful.. I think it is stressful personally and as a new nurse makes me feel stupid if I don't know it right off the tip of my tounge and lets face it new nurses feel lost enough... I think just casually bringing up info about a med that you may feel is important for safety or a procedure is much more helpful and will open the conversation up to the new nurse asking questions.

I think honestly just being supportive of the new nurse and understanding this is a scary time coming right out of nursing school and into the real world will be key. I had a very positive preceptorship experience and I think mainly because she was a good preceptor and because we meshed well and also did not get annoyed with my 100 questions every hour lol. It sounds as though you are putting a big effort into being supportive and the best preceptor you can possibly be by reading your post above!! Best wishes!

cupcakeluver

Specializes in Ortho.

I'm a new grad set to be on my own July 11. I've had multiple preceptors during this past month. I've had a pretty good experience so far. I think previous posters have given great advice.

The only thing I would like to add is let your grad do stuff! If it's something you've been over and the grad is competent and knowledgeable then let them have a chance to try it out. I also prefer my preceptor to let me think a minute if I don't get something right away. I'm usually going through the steps or trying to recall something. I have a preceptor that always wants to tell me the answer. Sometimes I just need a minute to think about it and sometimes I really have forgotten/don't know. It helps me way more to actually do the skill/charting myself and think through the process. Obviously this is after my preceptor and I have went over the particular topic/skill.

Also, I agree about lack of clinical skills. I did some things frequently in school and other things I rarely even saw. You want to let your new grad know that it's okay. It makes it so much easier to come to you and tell you that I need some practice with this skill or with this issue. It just really eases a lot of the stress that you're feeling as a new grad and it helps me learn so much more because I'm not worrying that my preceptor is thinking I'm stupid or a terrible nurse.

I think it's awesome that you care enough to even ask for advice. I'm sure you're a great preceptor!!! Thanks so much for helping us goofy newbies during this difficult time!!

EDRNCCmom, MSN, RN

Specializes in Emergency Department.

Thanks everyone for the great advice! I remember the scared feeling of being a new grad and I want the newbies to feel supported and helped. I'm seeing a trend in the post regarding skills - I will try to be especially mindful to allow as much hands on as possible while not being judgmental if the new grad hasn't ever performed the skill before. Precepting intimidates me as it can truly impact nurses futures - I saw one new grad have a bad experience with a preceptor and she ended up quitting.

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

Make sure you teach your orientee where she can look for help/answers/guidance once she's on her own. It's great to look up a procedure for her and hand it to her before she goes to place her first NG tube or hang her first unit of blood, but makes sure she knows where to find the procedure. Teach her where here best resources are located -- the corner behind which the CNAs stash the extra IV poles, the name of the only housekeeper who will clean up a puddle of pee on the floor, the pharmacist who likes to answer questions about drug compatibility, etc. I'm an introvert; I always tell my orientees to introduce themselves to anyone I forget to introduce them to, but I really try to introduce them to everyone they meet. "This is Dr. Tim, he's a pulmonologist and our medical director. He likes to scuba dive, and he'll write any order you need for a chance to show off his underwater photography." "This is Cindy, our point of care pharmacist. She teaches the hospital classes on paralytics and sedation, so if you ever have questions about those drugs, she's the one to ask. Cindy just got back from Nepal, where her family still lives." "This is Glen. He's in charge of ordering supplies and he's the go-to person for questions about where you find the glucose testing strips or the spare spare intubation kit. His daughter is in her last year of college at Universitiy of Oregon." It helps build relationships for your orientee to have a little tidbit to chat to Glen or Cindy or Dr. Tim about, and it smooths the path for her.

If your orientee just moved to your city to take this job, ask her over your PBJ's at lunchtime whether she's heard about Sonny's Pit Beef barbecue, because it's got the best brisket this side of Texas. The wine tastings at Ye Olde Wine Cellar are a fun way to try the local wines, and no you don't know a dentist you can recommend, but let's ask Mary because she just got braces for all four of her daughters. (Don't get into the habit of partying with your orientee until she's on her own, though. That can get you both into trouble if things don't work out with her orientation.) I'm old enough to be grandmother to the last few orientees I had, so I made a point of introducing them to people their own age. Not just their fellow orientees, but Jeff the RT, Ingrid the EMT who likes to line dance and MarySue who is Emily's orientee in the MICU. People who are new in town and don't know anyone do better at fitting in to their new jobs when they also know a bit about their new city.

Give your orientee your cell phone number, your email address -- give her a way to get in touch with you at 5:30 AM when she has a bad case of stomach flu and can't remember the procedure for calling in sick. And if she calls in sick twice, make sure she knows about the occurance policies.

I worked all through high school and college, but many of today's new grads have never had a job. In addition to orienting them to their first nursing job, you may be mentoring them in their first job of any kind. You can teach a new grad now to slam in an NG, IV and Foley in ten minutes flat, but if you've failed to socialize her into proper workplace behavior, she's going to fail. Don't let that happen. Talk about wheat time to come to work, being prepared to take report. what is an appropriate length for a break and whether your manager dislikes seeing people eating lunch in the report room and wants them to eat in the cafeteria instead. Make sure they know not to wear shorts and flip flops to the staff meeting, where to stash their purse during their shift and where to park their car, bike or motorcycle. Walk out of the hospital with them and the end of the shift and make sure they know that the Monday through Friday subway stopped is closed on weekends, so when they come to work on Saturday they get off somewhere else, or they can park for free on nights or whatever they need to know. My last preceptor even made a point of advising me what to order (and more importantly what NOT to) when the whole shift ordered take-out. My first preceptor (in a world famous teaching hospital) told me it was my job to keep the interns from killing my patient. It's something I've never forgotten.

Sorry this has gotten so long. I'm sure others will have more tidbits.

GucciBeaR143, BSN

Specializes in Trauma/ER, Pysch, Pedi, Free Standing ER, L&D, ICU. Has 11 years experience.

Agree ^_^ I've been a preceptor for years if I'm not in triage or charge role. I ask every student/new grad the same thing: "what is your short term goal for today?" It can be as simple as: answering/transferring phone calls, down time forms, IV/lab sticks, EKG performing, troubleshooting machines, etc. Sometimes, I use the new employee check off list and expand from there.

If you're constantly the preceptor, why not start your own checklist and re-assess goals/progress like a careplan.

Congratulations and welcome ~

apillarofsalt

Specializes in Pediatrics.

Your facility's orientation process sounds like the one I oriented at as a new grad.

My preceptor was a nightmare. She had me do most of her work, which is the only way to learn, and I tried to be as enthusiastic as possible. As time went on, I realised she had me doing a lot of unnecessary tasks as favours to other staff members (not fun). At one time I was watching 8 patients because she wanted to take a break with another nurse. Not safe at all for a new grad in the ED.

She had a "throw them to the wolves" mindset, and I performed very poorly under that pressure. One of my first IV attempts was on an incoming trauma patient, and I had never been in a trauma bay before. I panicked and missed, in front of over a dozen coworkers. After that, I kind of accepted that this nurse either *wanted* me to fail, or her approach was just one that was not conducive to my success and she didn't care enough to change it.

There were other nurses that went above and beyond for me though. Something as small as having someone offer to grab me a drink when they ran to get one, or introduce me to other staff went a long way. This made the ED feel less overwhelming, and I felt welcomed by these kindnesses.

Ultimately, I think the most helpful attitude is just to treat a orientee as an equal--in most cases they'll respond as one. The skills take time, but no new nurse should ever have to "earn respect" or "do their time". The orientee may not have equal experience or skill, but being treated well from the get-go makes a person more responsive to learning.

I think the most important things is good communication from both parties. Preceptor should be honest and upfront. I think bad communication is one of the reasons why precepting goes bad.

Nurse Beth, MSN

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

We have a board in the break room. And people anonymously post what they want to learn about. For example I gave a PowerPoint on Hyperkalemia. And u got a CEU for attending the class. It was fun and nurses won prizes if they could answer the big questions. The management loved it. And so do the staff. I try to make it fun. Plus if there is food nurses will usually come. We did it on the hour. Turned out well. Next time we r doing one on Sepsis. We have a lot of new grads and nurses that have been there for awhile. Me and the clinician r trying to help everyone. And make it a more positive place. Obviously since the trauma center we work at is bananas !! [emoji4]

Wow, what great ideas, I love to hear such positive educational activities

This thread is wonderful! I just graduated Saturday with my ADN (YAY!)

I have been accepted into a 17 week fellowship program at a level one trauma center pending boards. I am so nervous, excited and terrified. This thread gives me hope that I will be placed with a caring preceptor that will take time with me, allow me to ask questions and express concerns. Thank you to all the awesome nurses paving the way for us newbies!

vintagemother

Specializes in Med-Surg, Psych, Geri, LTC,.

I precepted in the ED as a student, and have not worked in the ED, yet, as I'm a new graduate. I've precepted as a nurse in other areas, though, so take what I have to say with that in mind.... [emoji41]

I think it is helpful to allow the new grad 1 shift to simply observe you, rather than actually get involved in pt care. This way, she can see how you manage your time and watch you prioritize when unexpected things happen.

The ED I precepted in had different areas for different acuity levels. (I assume that this is standard in all EDs). My preceptor and the unit mgr tried to have me precept in areas with the most Acute pts, those who were likely to be admitted or needed extensive care.

I was responsible for a limited number of pts on day 1, then it progressed each shift until I was taking care of a full load.

I also had the opportunity to talk with my preceptor on the areas that I felt that I needed more practice on. For me, this was IV starts, codes, giving report to the floor nurses, and the new shift.

I don't know if this is helpful, but this is my experience.

I think, ideally, you will be able to give her unofficial feedback on areas that need improvement and then, you can allow him/her to have opportunities to work on those items.

I recall that there were certain areas of the ER in which only seasoned/ experienced nurses could work. (Lobby triage was one of these areas)

In those cases, it actually was helpful to me to observe my preceptor work and prioritize and triage, even though I couldn't do it myself. It was helpful to me to see how a good nurse gets it done.

Make sure he/she gets experience communicating with the MDs/PAs/Other Providers, as new nurses are sometimes shy about this.

Make sure she knows where to find policies and procedures, as well. This way, she can practice safely on her/his solo.

RescueNinjaKy

Specializes in Cath/EP lab, CCU, Cardiac stepdown. Has 3 years experience.

What I really appreciated was when my preceptor asked me how do I learn best. And I told her honesty. Show me the first time. Then let me do it but walk me thru it the second time and then help me only if I'm doing it wrong on the rest. It helps reinforce it for me. Those that just make you do it with no guidance makes me nervous.

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