Precepting: One preceptor/2 orients?

[yogi2000]

Hi,

I'm new to this site. I would like some input about what other RN's think about one preceptor orienting 2 RNs at the same time, on the same day. Our 18 bed SICU has recently had an exodus of nurses, for a multitude of different reasons. Our unit will be expanding in Oct to staff an additional 12 beds. Our nurse manager has hired over 20 new RN's, and there are not enough experienced RNs to orient these new hires. She (or someone higher up on the administrative ladder) has decided the best way to deal with this is to have several of us orient two RNs at the same time. So far I see I am scheduled to have 2 orients on the same shift with me for 5 days ( the next schedule is not out yet). Our unit has an extremely high acuity, and most of the new hires are new grads. In addition, we have recently converted to using computerized medical records software, which has been very stressful. We are also constantly hounded about specific documentation requirements, which if found deficient, will result in corrective action being taken against the offending RN (extremely punitive, in my opinion). I am TOTALLY against the proposed practice of one preceptor/2 orients . I intend to inform my nurse manager that I refuse to do this. Just wondered what others think, am I overreacting? By the way, I have worked in this ICU for 20 years.

[Penguin67]

Ideally, it shouldn't be done. Like you mentioned, there are basic things that we must do and it's hard to watch two nurses do everything up to policy. Why did you get two? Are there other nurses working the shift and couldn't they get a preceptor?

On the flip side of the coin, we can have 10 nursing students in a group and as the instructor, I am responsible for all of their work. It can get hairy at times, and until I get to know their strengths and weaknesses, it is hard to let them completely go.

Another experience that I had was having a group of nursing students on the floor where I worked part time as a staff nurse. Three of them had patients of mine. Sounded like the day would be wild, but I just dragged all three of them with me, talked out loud about everything that I did and they got alot out of it. When I could, I gave them hands on skills.

It can depend upon the unit and whether or not you want to have a preceptor. I'd definitely talk with one of your managers to see what alternatives exist, or how your patient load will be decreased with two new grad orientees.:twocents:

[owensmommy]

I agree that you are being set up for unsafe nursing practice. I have had multiple orientees at once (at one point I had three). This was on a med-surg floor at the time. It was very difficult to manage more than one orientee at a time. I felt somewhat like a nursing instructor. So, since you are in a SICU, I think that it is definitely unsafe for you to have to look after 2 new grads! New grads take SO MUCH time and effort to train, after all, they are NEW grads. I think you are doing the right thing by refusing to take on 2 at a time. They have to understand that it's probably not the best practice. Wouldn't they want to turn out some great new nurses that had a one on one preceptorship rather than some 'pretty good' new nurses that shared a preceptor and didn't get as much attention during orientation?? The manager should respect your standpoint given your seniority.

[NICUgirl77]

I agree with you and think that having 2 orientee's is not good for you or the new nurses! The new hires won't get as much of a chance at hands on experience and you wil probably get burned out. Our unit staggers when they start all the new grads so there are enough preceptors. Another concern is when they all get off orientation at the same time your unit will be filled with brand new unexperienced nurses! good luck at getting this changed.

[Turtle in scrubs]

I can't imagine.

:stone

[annmariern]

i'd be drinking from the purell dispensers after 12 hours . Thats too much, on top of your pts and families.....surely they can sort something out.

[kmoonshine, RN]

Honestly, it's possible that it could work out well.

I've had a couple of orientees on several occasions but I don't have a lot of experience to back up my thoughts on this issue. I do think that in the beginning the orientees must have 1:1 precepting. However, after a few weeks, I could see how precepting 2 people could work out well (assuming they don't give you extra staff on top of your regular assignment). If your ratio is 1 nurse for 2 patients, each orientee could have a patient and you could oversee the care for these 2 patients. It would also be beneficial to set some time aside each day and talk with both of the orientees and encourage them to share their knowledge with one another (what went well, what went wrong, interesting facts, interesting patients, discuss meds, etc).

This would be a disaster if they add more patients to your regular assignment. If anything, they should lessen your assignment and have another RN available - that extra RN may not have the years of experience to qualify to be a preceptor, but they can staff to offset the extra responsibility of double-precepting.

I'm coming from an ED perspective, so forgive me if this scenario would not work out in the ICU.

[llg, PhD, RN]

We used to do if often in the NICU where I used to work. As someone pointed out above, it is common for a nursing instructor for have 10 students.

Making it work is all a matter of changing the way you do things. For example: You don't have the two orientees each off doing different things with different patients until they are at a point in their orientation at which they can be "left alone" a bit and trusted to come to you PRN. Instead, the 3 of you go to a bedside and the 2 orientees do something together for 1 patient with you supervising. Or they take turns doing something physical with the patient. Such methods keep you away from dangerous situations where both orientees need supervised at the same time. They take turns and/or do things together.

Such learning can be quite effective. The 2 orientees learn by watching each other and by the discussion that naturally occurs between the 2. It gives them time to absorb the complexity of the situations they encounter without being as overwhelmed with trying to do everything themselves. They have a "built in buddy" to support them. As they progress in their skills, they can be a little more separate.

It might add a bit of extra time to the orientation process ... but it doesn't have to be unsafe if the preceptors make a few changes in their teaching strategies.