Precepting new nurses

Tweety, BSN, RN · Sep 15, 2004

I've been told that a hospital worth working for will only have internships, not preceptorships.
What's the deal? One would think that the one on one, preceptor/mentor method of introducing a new RN to the world of work would be tried and true.
Is there something I'm not "getting?"

I was in an internship too, but also had a preceptor. "Internship" is another term for the period of orientation and instruction, but you still should have a preceptor as part of the internship. Make sense?

chris_at_lucas_RN, RN · Sep 15, 2004

I was in an internship too, but also had a preceptor. "Internship" is another term for the period of orientation and instruction, but you still should have a preceptor as part of the internship. Make sense?

Sorta.

There are only two internships yearly--June and January, to accomodate December and May graduates. But you can't get a job til you are licensed, or at least have your GN.

It will no doubt be confusing until I am at the other end of the process.

Thanks.

NeuroICURN · Sep 16, 2004

Well, I don't know what type of setting you are in and what your routine is like, but here is a few things that I do....

1. We have to do full assessments a minimum of every two hours. At the beginning of each shift, just after getting report, I have them make a chart with the titles 8am, 10am, 12pm...etc. Then, under each time, I have them write EVERYTHING that has to be done at each time. I.E. Vital Signs, I/O, Neuro check, Treatment screen, Assessment screen, BGM, any labwork due. That way, they know exactly what has to be done in each time block, and later, whether or not they've done it (they can cross it off as it's completed, that way they have a sense of accomplishment). I still make to do lists for myself for out of the normal routine stuff, so I don't forget!!

2. I have them increase the dificulty level of patient's. First they take care of 1 uncomplicated pt. Then they could move up to 2 uncomplicated pts, 1 complicated and 1 uncomp. The theory behind this is that they can start to build skills, get used to the routine and then build confidence. You can't just throw someone to the wolves and expect them to survive.

3. I stay with them for the first assessment and do it with them explaining as I go what and why I'm doing things. I often give them little quizes to try to build their critical thinking skills....i.e. I'm going to hold this medication for pt. X now...why? or Yes, nimodipine is a ca channel blocker and helps to keep BP down in post aneurysm clipping pt's, but what is the REAL reason I'm giving it?? Anyway, I treat them like little games and it teaches them to think.

4. I pass on little tips and tricks (which you said you're already doing, right?)

5. I remember what it's like to be new and scared out of my mind! :) Let's face it, we've all been there and 10 shifts is hardly enough to expect her to be competent.

sharann, BSN, RN · Sep 16, 2004

I thought about this overnight and I think that having her work with a couple more nurses for a shift will help her (I am NOT implying you are at fault here). She may gain a new perspective and maybe someone else's "way" will suit her style. We all have our own way. I work with a nurse who has been an ICU nurse for 30 years and is still always behind in her charting, while others are done before the wheels cool off after the gurney arrives in PACU! I was soooo fortunate to have found a preceptor 3 yrs ago to help me (after my first preceptor in another hospital was horrid to me). Keep us updated on how she's doing.

Tweety, BSN, RN · Sep 16, 2004

I thought about this overnight and I think that having her work with a couple more nurses for a shift will help her (I am NOT implying you are at fault here). She may gain a new perspective and maybe someone else's "way" will suit her style. We all have our own way. I work with a nurse who has been an ICU nurse for 30 years and is still always behind in her charting, while others are done before the wheels cool off after the gurney arrives in PACU! I was soooo fortunate to have found a preceptor 3 yrs ago to help me (after my first preceptor in another hospital was horrid to me). Keep us updated on how she's doing.

The person I'm precepting is currently in her last couple of weeks. She recently added me so she could learn another person's style, so she's precepting with two of us right now. Probably not a bad idea. Her other preceptor is anxious, rushing, go, go, go and I'm oh so laid back but still manage to leave on time.

JacelRN, BSN, RN · Sep 16, 2004

I agree with sharann but I feel you should be the one to decide when. Consistency might be what she needs most but I was the type of personality to pick the best from several preceptors. One taught me how to work the computer, another, how best to organize, the third (yes I had three) was simply the best at keeping me calm and comfy. Each nurse has strengths and weakness and so will this new nurse but perhaps there is a personality on the floor you can recognize as similar to hers.

Also, I use color and fold my papers to be organized. Many of the nurses on my floor say "what the heck" when they see how I fold my Cardex and MAR sheets, but it works for me and I learned if from a Tele nurse during school. I fold one patient's sheets to one corner, and then the second the opposite way, and so on. I can easily flip to the dressing changes, meds due, insulin protocol sheet, etc. I write all over and list my interventions like O2, Foley, activity, VS, labs, etc and red ink indicating special notes to pass on to the next shift. I cross things out when they are completed on my two hour check list. I simply write out the hours on one corner, 20, 22, 00, you get the idea.

This new nurse also may just need to have one or two patients at first, then when she is ready and it is time appropriate ofcourse, let her tell you when she feels organized enough to take on more. Or sit down with her and ask her how best she can learn. Some people are quick learners and some take longer as posted earlier. Hopefully, we can all be encouraging and supportive of our new nurses. It will be hard enough when she's doing it by herself. :rolleyes:

Good luck and don't give up on her,

JacelRN

jjolson4120 · Sep 17, 2004

I am actually a new grad who is in her 6th week of orientation. I am orienting to a Bone Marrow Transplant Unit, which is EXTREMELY specialized...and something you barely even touch on in nursing school. The first two weeks were really overwhelming...very scary for a new grad. It seem like the 3rd week though, things started falling into place. My preceptor kind of turned me loose on that 3rd week. It was like I was almost forced into organizing (which was a GOOD thing). Also, her and I would sit down in the morning before we left the confrence room, and she would ask me how I felt about the day, what did I need help with. I find that I am a lot more comfortable if I can organize my shift without maybe telling her each step that I am going to perform: organize it in my head, on my cheat sheet. (She is always double checking that things are done, but this way it is MY routine, not hers.) Also, something that my preceptor did right off the bat, was to ask me what is going on in my life outside of work. Sometimes, orietees are having other stressors outside of work that may be affecting their mind at work. My preceptor also makes sure to have lunch with me if at all possible...it is kind of our down time to catch up on the day and talk about my/her concerns. I don't know if any of this helps...I hope so! Good Luck with everything. PLease let me know if you have any other questions!!!

mattsmom81 · Sep 17, 2004

The person I'm precepting is currently in her last couple of weeks. She recently added me so she could learn another person's style, so she's precepting with two of us right now. Probably not a bad idea. Her other preceptor is anxious, rushing, go, go, go and I'm oh so laid back but still manage to leave on time.

Tweety I bet you are a great preceptor and they appreciate your style. :)

The overly anxious, flighty nurse usually makes the newbie overly uncomfortable too I've found...not helpful to already anxious new nurses. :coollook:

jad2 · Sep 21, 2004

Tweety I bet you are a great preceptor and they appreciate your style. :)
The overly anxious, flighty nurse usually makes the newbie overly uncomfortable too I've found...not helpful to already anxious new nurses.

I agree 100% with you.

His posts pick me up when I am feeling down.

bklynborn · Sep 21, 2004

I am the preceptor for my floor and do alot of it. We do written report only at the end of the shift. One thing that has worked very well for me is this: I made up my own form for report on microsoft word and keep blank copies in a notebook that I carry with me. During report I take down all the information on my form. (this replaces my flow sheet and takes getting used to) I write everything you normally do such as Name, Dr, Dx, Consulting Dr, VS, Accuchecks, Diet, IVF's, rate, location, drsg's, Orientation, Lungs sounds, Bowel Sounds etc, etc......Then at the bottom of the are areas that are blank labeled PRN's, Abnormal Lab Values this shift, Procedures done today, New Orders, Miscellaneous, etc, etc..... While I'm doing my morning assessment I fill in the Lung sounds, Bowel sounds, etc. During the shift when I give a PRN I write it down. Also abnormal labs, important new orders and any other miscellaneous information that is important. By the end of shift my report is done. Also when charting I have everything right in front of me like times PRN's were given, lung sounds, etc... I also keep in my notebook copies of all our protocols, Dr's beeper numbers, Hosp Extension numbers, IV compatibles list, Yada, Yada. On the outside spine I have written "Joanna's Brain". The doctors really get a kick out of it. They'll come up to me, where's your brain, can I see that Heparin Protocal or whatever. My brain along with my report keeps me organized and "always" out on time. I have had 1 or 2 preceptees that just couldn't seem to get it together and they are no longer there. I think some people are just not capable of multi-tasking!

You sound a lot like me....I tend to do the same thing, the gal I am precepting however tends to fly by the seat of her pants and this seems to find her wasting time and often doubling back only to find that she has already done whatever it was she was planning to do. I think part of her problem is that she was a rehab nurse prior to taking time off and then getting recertified for med-surg. Unfortunately I think she will just have to figure this out on her own. Iwill as her preceptor continue to offer suggestions, and do what ever I can to help her succeed. Liek I said before her skills are good it is more of a time management issue, she doesn't delegate to the NAC and has a hard time asking for help. I am sure that in time she will work this out in time. I did get her orientation extended, so she will end up with more liked 25 shifts. They will end October 1st.

nurse 4 christ · Oct 6, 2004

I am a lpn who has been licensed for only 14 months now. back in may I was placed back on orientation do to my poor time magament. When I came off orientation last september I thought I was ready> I had been a nurse aid and monitor tech. knowledge and hands on skills I am very good at. pt teaching and education is also good. I do have poor documentation skills and time management. I was placed on orientation again do to a problem solving exec. who was hired to find week links and get rid of them. My director stayed behind me and I have been placed back on my own. I have the dr's respect and co workers even with the reorientation. My advise is that some people do take longer then others. If skills and knowledge are good be patient. that will save lives and the time management will come along. I work as a cardiac nurse and am encouraged by the power to be's to continue to improve on time management skills. even in business alot of people have this trouble. I was restarted with only 3 pt's and worked my way back up to 6 patient. It will help with confidence and also allow her to re structure her time patern. good luck to you both.

helana · Oct 6, 2004

i'm the preceptor for my area and i worked alot with so many new staff or new garduates,in our area we used to devide the paitents by their speciality (sugical,plastic,urology,.....etc.) and i think that helped me alot in organizing my work with the new peaple in the area,beside that i made up an orientation form for our area where i include in it informations about the area's layout,the placement of all the needed things and what we used to do each shift,and the new staff and i will revise it every now and then and discuss those things and it helped me alot.