Precepting New ICU Nurses

[Morguein]

I'm currently orienting a nurse in the ICU and I wanted to find out how other hospitals orient their new ICU nurses. At my hospital, we have a guideline that sort of helps us in guaging what our orientees should know each week, but it really isn't all that specific or organized...and of course, you aren't always guaranteed to get the patients that will meet those guidelines. Precepting is HARD work. I'm finding it really takes a lot of energy and responsibility to do this. This is my third orientee and I LOVE teaching new ICU nurses; but I think my main problem is finding the time to go over things with them. When we are training our orientees, we have our own patient too and they are not always easy patients. We'll get assigned 2 patients and I'll give the orientee the more difficult and challenging patient; and I'll take the more "easier" one; but I still find that it can be a challenge to be able to be available completely to the new nurse. Do you all find that to be the case where you work? I feel guilty when I can't be totally available every second. Can anyone give me a run-down of how your hospital trains new ICU nurses. How long is your orientation? Right now, since my orientee has been a nurse for a little less than 2 years, they're giving her 6 weeks to start out..and if needed, she can have another 2 weeks or so. What do you guys do on a week-by-week basis? When do you have your orientee start taking care of 2 patients? Do you all ever ask for one-to-ones when you feel like you aren't able to spend enough time with your orientees? Thanks for any input. :)

[*PICURN*]

Sorry I can't help much! I will be orienting in the PICU in about a week and a half, all I know is that I will be on orientation for 3 months (new grad)

[J_W, DNP, APRN, CNS]

To truly give an a adequate orientation to a new nurse (especially a GN) the preceptor should not have any patients. I know this is difficult due to staffing, but if your hospital wants a quality nurse who can critically think through situations and intervene appropriately, then your orientee should have both patients or one challenging patient and you have no patients, then you could concentrate on testing/quizing your orientee about the meds/drips, pathophys, assessment findings, etc about the patients. The hospital I work at as a CNS is about to start doing this in March, I just hope that administration doesn't change their minds...This method of precepting comes from the PBDS model, I know some will not like this, I am not fond of it, but it is good tool/assessment to use on new nurses and experienced nurses, and the important part is that the preceptor have no patients in addtion to the orientee...

[PJMommy]

I agree with JWRN. In my unit, I was oriented with 2 pts from day one and my preceptor had none -- just helped me with mine. I have since seen a couple of new nurses who really struggle getting through orientation because their preceptors chose to take one pt and give one pt to the orientee. The orientee has a heck of time making that step from organizing and caring for one pt and then later trying to take the normal two pts. I just about choked one night when a pt was respiratory arresting and being intubated but the preceptor did everything and the orientee wasn't even in the this pt's room because the orientee said "oh, that's my preceptor's pt". Omigosh! What a learning experience missed!

[Morguein]

So, if the Preceptor has no patients and the orientee has both patients, does the preceptor pretty much do 50% + the work in the beginning? I'm thinking of time management. The orientee will most likely be pretty slow at first and would need lots of help and explaining. So basically, the preceptor is sharing duties with both patients..at least in the beginning? I'm trying to understand each persons' role here. Typically what I do in the beginning is have my orientee shadow me for the first day and maybe let them write the vitals down on the flowsheet and do an assesment on the patients and give medications etc... but mostly shadowing me and getting to know where everything is. Then on day 2 or 3 depending on how comfortable they are, i'll give them 1 patient and i'll take the 2nd more stable patient and am there to help the orientee and answer questions when needed. Then maybe after a few weeks of that, I'll give the orientee both patients and I'll have no patients and will just be around to help if needed. I pretty much become the "tech" and let the orientee do all of the RN duties. I'm not sure if I like the idea of giving the orientee both patients from day one. It seems overwhelming. I realize the preceptor is there to help; but it still seems like a bit much. But PJ, you seemed to have done okay with that though. I'm just trying to find the best way to orient new ICU nurses that wont overwhelm them, yet is still very challenging and educational and prepares them adequately. I like the idea of the preceptor not having patients. I would prefer that my orientee get one patient and I get zero patients and be available completely to the orientee. And then, preferrably, have my orientee at some point take 2 patients on their own and I get zero patients and am available to the orientee 100%. That would be the ideal situation...but I don't see that happening at my hospital. I may bring it up to our NM, but probably will be laughed at. hehe! Thanks for all of your input. I appreciate the time you all took to respond. :)

[PJMommy]

Moonepie, When I first oriented, we took "easy" patients so my preceptor had lots of time to teach. In those first couple weeks, no - I absolutely could not get everything done and learn at the same time. That's where my preceptor was the other half of the team -- he'd check for new orders when I'd forgotten to, he'd make sure I'd charted restraints, he'd give meds for one of the pts if I couldn't get to it, etc. I still remember being so frustrated because I felt like I'd never be organized enough to get all my work done. :)

By the end of the 12-week orientation, I was very comfortable taking care of most patients alone. It was still another 3 months off of orientation before I took a trauma admit. There is NO way you'll get to do or see everything on orientation...just a fact of life. I've been working a year now....and I still have never pulled pacer wires, I hadn't pulled chest tubes until the other night, there are a couple drugs I've only had to titrate a couple of times, I just had my first pt die a couple of weeks ago, etc. All these things won't happen in 3 months of orientation.

One of the most important lessons a new orientee can learn is where to go for answers after he/she is off of orientation. There will be a LOT of questions (hopefully) and the new grad needs to be comfortable asking those questions.