Precepting New Nurses

BostonTerrierLover, BSN, RN · Mar 26, 2012

I let the first day be a total follow me, and see what I do today. To keep this from becoming just being a shadow, I let them handle some of the workload "while" they are with me, without a load. (eg. noting and beginning new orders, administering medications, performing head to toe assessments on a patient I have already seen to assess their assessment skills, Chart Checking, IV Initiation/care, and compare all this together to decide if they are competent enough to take on patient the next day). I always make sure they get to witness at least one admit and one discharge process. I use this day to show them our charting system, and basic everyday tasks. I make sure to show them around the unit, and introduce them to other staff.

The next day they have one patient (prefer a possible D/C), this is a great day to let them take on an admission. They can learn their way through the paperwork while only having one patient in their care. Once again, I monitor how well the admission went, and answer any questions there. The Discharge patient also helps them understand the Facility's D/C process.

With all that performed to your satisfaction, The next step I give them one low acuity patient, and a higher acuity or demanding patient that will let me see how adaptive their skills are, and where help is needed. After this, I talk about whether they feel comfortable taking on another patient (and if not why?), if they have performed competently so far.

I remind them if we aren't progressing well enough, that this is their time to learn the ropes, and I would rather them experience the full load while I am here as back-up to answer any question, or help, than to let them take on a full load when the experience is almost over, with just colleage support waiting after (worse case scenario you extend the orientation).

Another important issue is How Long Is the Orientation where You Are? and Were they an LPN upgrade to RN? Anyway, you will develope a plan that is right for you, and you have to be comfortable with the way it plays out.

I would just plan where you want orientee to be by shift 1, 2, 3, etc.

Good Luck, and thank you for stepping up to help a new nurse!

Perpetual Student · Mar 26, 2012

I've never worked med-surg, so I can't address the best way to divide up the work and so on in that setting. I have, however, oriented nurses (mostly experienced ones going to a different job) and precepted students. I want to add a few tips to make you and your preceptee's experience as pleasant as possible.

Remember that everyone has different learning styles and paces. You should adapt the orientation to best teach your student rather than expecting the student to fall in with your teaching style and pace. I recently precepted a nursing student who was far off my anticipated course and I had to make substantial modification to my approach. While she probably would not have been a successful nurse working in my setting (which is OK, the pace can be daunting to some), she was able to learn a lot that I hope will help her in her career.

I like to initially focus on explaining the basic goals and priorities of our unit and how it relates to the big picture.

Initially the new hire is in a state of shock. Don't get annoyed that he/she doesn't remember everything. It takes time to acclimate to the new environment. There are so many people to meet, things to locate, etc. that it can initially be quite overwhelming.

Be honest. Give prompt constructive feedback. If there is a problem, fix it early. Don't spring the bad news on your student at the last minute.

I recommend exposing the student to any good learning opportunities that arise. If there is going to be a procedure or diagnosis that doesn't come around very often try to get your student involved.

I had more to say, but gotta go to work. :eek:

classicdame, MSN, EdD · Mar 26, 2012

I think it is important to have a list of accomplishments for each week -start slow and work up. Also, give the new nurse a copy of the expectations so he/she will be able to check them off and have that feeling of accomplishment. I also recommend you BOTH have all the patients that are your assignment. She is certainly capable of doing vital signs and other tasks right now. You add the rest as you go along. I am disappointed that your Educator is not more involved.

Music in My Heart · Mar 26, 2012

I have my preceptee shadow me and do everything that they're permitted within their scope and with which they're comfortable. Prior to entering the room, we do a quick review of the major points.

As they prove themselves to me, I give them more latitude to act without me standing next to them.

Vespertinas · Mar 26, 2012

For my second orientee I treated her just like my first and she didn't jive with my plan at all. What I'm saying here is that you should keep your feelers out for how your orientee is doing and adjust accordingly. I know that advice is so general you probably think I'm being useless but.. keep it in mind because that one minor issue of my anal retentiveness actually killed the whole experience for the both of us.

Daisy_08, BSN, RN · Mar 26, 2012

I would let her shadow the first day and discuss what their goals are, and if you think those goals are approrrite then work at meeting them. I would also feel her out. Maybe she has a big attitude problem or some learning deficits that will effect how much freedom you give her. Being able to handle atleast the min of a full load should be the main goal. The best preceptor I had both pushed me past my limits, made me feel safe, pathetic and confident all at one time. I think as I was getting to a full load shed had one day where I just did meds and charting the next day did everything but meds and then put it all together. Also when your a student is the only time you can just abandon your patients to watch something really cool, so be nice and her go!

Aurora77 · Mar 26, 2012

As a recent preceptee (if that's a word), I can tell you what my preceptor did. The first day I just followed her. After that, for a couple of weeks we kind of tag teamed the whole team of patients. She'd show me how she likes to get organized for the day and then we'd go together to do things, with me doing all the treatments/assessments/med passes, etc and her there to watch and assess me. Then I'd start having 3 or so patients on my own for a week. The last week I had all the patients and she was just there to answer questions. When we had downtime, she'd go through the orientation book and the computer system.

I had a 5 week orientation. I also did my final precepting for my ASN program on this floor, so I already had experience with the computer system, some idea of types of patients to expect, that sort of thing.

I'm very excited for you and hope it goes well. I love to teach so I want to precept some day, once I get more nursing experience under my scrubs.

pitt34 · Mar 26, 2012

Thanks for all the advice! I am very excited to have the opportunity to orient a new nurse. I just didn't want to move too quickly with her and appreciate the recommendations.

wooh, BSN, RN · Mar 26, 2012

It depends on where they are in the process. New grad or new to specialty or new to unit?

Generally first day, I let them shadow, and as we have time, let them do whatever they're comfortable with.

After the first day, we work together to decide on next assignment. If they have one or two patients, I have them come along with me for anything interesting on our other patients.

I tend to move pretty quick to the entire load while I work as a resource for them, and help them when they're getting a bit too far behind. For med-surg, the hardest part is staying organized and prioritizing the care for a whole load of patients. So I want them to start working on that asap. Figuring out what works for them and what doesn't, learning through trial and error.

I'm a big believer of throwing in the deep end and trying to swim, just making sure I'm nearby to keep them from drowning.

Vespertinas · Mar 27, 2012

Please tell me management did provide you with a framework as classicdame alluded to

1018rn · Mar 27, 2012

I agree with bostonterrierloverrn, give her the chance to see the flow of your day, then start integrating her into the mix. It's funny how much of your job you take for granted that you know, and this will keep her from being intimidated and give her a chance to figure out what she doesn't know. Good luck!