Precepting a nursing student

Despareux · Mar 1, 2012

I hope you don't mind me giving you perspective from a student nurse point-of-view. I've had nothing but great experiences with all my preceptors. They have been patient, they will quiz me to put my critical thinking skills to test; and they allow me to do all the care as long as I am honest with them about my skill level and what I'm going to need help with--no problem from my end :) Keep in mind nursing students sort of get in the way and may be a little needy initiallty; also because of their lack of experience, time management could end up a nightmare.

classicdame, MSN, EdD · Mar 1, 2012

agree with above post. You will be teaching time management just by doing it. Think out loud so the student will understand the processes your brain is using to come to decisions. Do not be critical. That only shuts people out. There are different learning styles so maybe you can discuss that first. Does the student like to get news from newspaper (tactile), TV (visual) or radio(auditory)? That alone will help you decide how to direct your teaching to some degree. GOOD LUCK.

PinkNBlue, BSN, RN · Mar 1, 2012

I agree with the previous posters. I had an absolutely phenomenal preceptor and experience in my last semester of school. Everyone on the unit accepted me as an employee which was such a great feeling and made me feel comfortable. When quizzing, don't be critical and if they're struggling, help them think it through. Sounds common sense but some like to watch them squirm and then nothing is learned. You sound like you're going to be a great preceptor just by being enthusiastic about having a student. :) that's awesome. Good luck!

PinkNBlue, BSN, RN · Mar 1, 2012

Also make a copy of whatever report sheet you use so they can try it out. I tried several during my preceptorship which helped me time manage.

CrazyCatLadyRN, BSN, RN · Mar 1, 2012

Thanks for the advice! I already planned on the paper brain. To think like me they will definitely need a copy of my paper brain! I can't function without it! Im glad they picked me because I feel like I could really help with bridgi g the gap between nursing school, nclex, and the real world. Especially since I just did it haha. I've still got all hose nclex topics and study tools fresh in my mind. When you have precepted how independent did you let the student be? How much did you let them chart, etc. they will have to be under my long in.

wish_me_luck, BSN, RN · Mar 2, 2012

Okay, I am in my practicum now and have a preceptor. She is great so far. I agree that just doing things with them helps time management (as long as you have good time management). Let the student do as many things hands on as possible. If they don't know how, be like "you can watch the first one or two, then you do it". One thing I wish my preceptor would do more of is like let me do whatever needs to be done and her watch, then, give me feedback. Not in a critical sense, but constructive criticism. At the same time, give the student praise for the good things. It's hard being a student around experienced nurses because experienced nurses tend to have their way of doing things, while students are trying to figure out how they want to do things and they tend to be very textbook.

I'll give you an example. Today I had clinical (different from practicum, but still in the hospital), I am very to the book on stuff, if possible. I was giving a medication IV push and I flushed first with 5 cc of NS and gave the medication and then flushed with the rest of the NS after (it was a 10 cc NS flush). We were taught to flush before and after IV pushes plus in between medications that are IV push given at the same time in order to check patency and to prevent incompatibilities. The nurse I was with did it different and only flushed after because earlier in the day, she checked it or something. But, I didn't know that. She at first jumped on me over it, and then I explained the way I was taught. She was more understanding then and actually told me the way I was taught was fine and good practice. Anyway, my point is, even though you have your method of doing something, students tend to be by the book. And I know, I somewhat sought that validation that I was doing the procedure correctly. I felt bad at first when she told me not to do it like that and I started questioning myself. It also causes fear that the student will do something bad to a patient.

Things I have picked up from my preceptor in practicum is pretty much getting a method down. She gets report, then assigns her patients to herself, writes down when meds are due on a sheet of paper, then accuchecks, meds that are due, and assessments are all done at the same time in the morning. The meds are done in three hr increments- like 7-9 am are done at one time (we're allowed and it's the only way we can keep up); the exceptions are like blood sugars/insulin or something to that effect or IVs that are running; somewhere in there are dressing changes and other things that need to be done; charting is done right after she is done with that specific patient (as far as assessing them; we have computers we tote with us); check your orders occasionally, esp. if you see a physician come to the floor; and chart checks, care plan updates, and clearing pumps are end of shift. But, yeah, your little student will learn a lot from observing a method and picking up little things too. By the end, they will probably have an idea of what things you do that they want to incorporate in their nursing and what maybe doesn't work for them.

I also definitely liked having a copy of the papers. That way, I could sit there and say well this is what I would need to keep in mind if I was taking care of this patient without my preceptor. Without papers, I felt like it was okay, here's the medication, give it to them and you don't have the full picture unless you looked at all the charts. Where I am, we have SBAR sheets.

I don't know about anyone else, but as far as medication administration, IVs are my hardest thing to understand. Like showing how to backprime something, working the pumps, even just actually priming an IV bag. I primed my first bag at the beginning of this semester in OB...and I am a senior. Work on the student's difficulties, seriously.

And yes, challenge the student to think on a higher level.

CrazyCatLadyRN, BSN, RN · Mar 2, 2012

thanks wish_me_luck! good advice!

KelRN215, BSN, RN · Mar 2, 2012

Thanks for the advice! I already planned on the paper brain. To think like me they will definitely need a copy of my paper brain! I can't function without it! Im glad they picked me because I feel like I could really help with bridgi g the gap between nursing school, nclex, and the real world. Especially since I just did it haha. I've still got all hose nclex topics and study tools fresh in my mind. When you have precepted how independent did you let the student be? How much did you let them chart, etc. they will have to be under my long in.

How independent you allow the student to be depends on a lot of things. How is the student progressing? What does his/her school expect of him/her? Always remember that the student is working under YOUR license. I precepted a senior nursing student last semester and her school (my alma mater) expects students to be 'independent' at managing a full assignment by the end of the semester. Now, keep in mind, this senior practicum was 120 hrs long... the equivalent of 3 weeks of full time employment. Don't know any new grad that would be independent after 10 12 hr shifts. I allowed my student do do all assessments, chart everything and write notes but I checked and double-checked EVERYTHING. At my institution, the students can log in and chart their own assessments but it has to be verified by the supervising RN.

Guest 360983 · Mar 3, 2012

Things that my current preceptor does that I love, and that I wish someone had done with me in nursing school:

-Focus on documentation. Almost all of my "class" of new grads struggles with this as it isn't really covered much in nursing school. If your student can't chart online, have her write out notes while you do it in the computer.

-Quiz the student to see what she understands about your patients. Don't be mean, but ask things like "Who is your sickest patient? Who is next sickest? Why?" My preceptor also likes me to assess new patients without looking at the triage notes (I eventually look at them but she doesn't want me to use them as a crutch). After new assessments, we go over what I am (or should be) worried about with the patient, what orders I should anticipate, and if I expect the patient to be discharged or admitted. I have a huge tendency to get task oriented when I'm overwhelmed so her quizzing helps keep me thinking of the bigger picture.

-Don't expect your student to keep up with you. Something that is highly recommended in my new grad program is not to give the new grad one patient, then two, then three, but to have the new grad take all of the patients but only focus on one skill at a time. Start with assessments, and when that's ok, move on to medications, then calling the MD, etc. Mastering one skill at a time is supposed to allow us to learn time management faster. This probably isn't feasible in the short amount of time with a student, but maybe you can adapt it to your student and unit.

-If your student is doing something you think is crazy, nicely ask why. If the patient isn't in immediate danger, don't go "OMG YOU are CRAAAAAZY!!!!!" Give him/her a chance to explain what they're doing.

PinkNBlue, BSN, RN · Mar 3, 2012

-Don't expect your student to keep up with you. Something that is highly recommended in my new grad program is not to give the new grad one patient, then two, then three, but to have the new grad take all of the patients but only focus on one skill at a time. Start with assessments, and when that's ok, move on to medications, then calling the MD, etc. Mastering one skill at a time is supposed to allow us to learn time management faster. This probably isn't feasible in the short amount of time with a student, but maybe you can adapt it to your student and unit.

That is a GREAT idea!

Guest 360983 · Mar 3, 2012

PinkNBlue--I was skeptical, but it really seems to work. We get lots of small victories to boost our confidence, we can practice one thing until it's right and we understand it, and the preceptor is ideally always available to answer questions and keep an eye on us because she's taking care of the same patients.