Precepting Pearls

[rac1, ASN, BSN, RN]

Tell me what your preceptor did great that helped you learn, feel confident, and do a good job.

I'd also like to know what your preceptor did poorly that frustrated you, and made you had a poor relationship which slowed down your learning.

If you have any suggestions that are pearls of wisdom for teaching/precepting those that lack critical thinking/judgement - lay it on me.

I am precepting a new grad - precepted plenty of nurses at this point, this one is rough. New grad is eager and willing, but slightly entitled and cocky, also not a critical thinker.

Would love some ideas, fresh takes and best tips......

[Been there,done that, ASN, RN]

Yikes! That's a bad combo. I would start with a patient that needed the nurse's critical thinking. Ask " what needs to be done here?" Perhaps when she can't come up with the answer. The cockiness will subside.

[rac1, ASN, BSN, RN]

31 minutes ago, Been there,done that said:

Yikes! That's a bad combo. I would start with a patient that needed the nurse's critical thinking. Ask " what needs to be done here?" Perhaps when she can't come up with the answer. The cockiness will subside.

I'm doing this. I switched a few weeks in to asking: "What do we need to do right now? Which patient should we see first? Look at the monitor - what does this mean we have to do? What do we do if there is no u/o for one hour? How do we do this procedure?" etc...... I'm reteaching things I've taught every shift. I'm hearing "I didn't know if I did that right," and "We were so busy I didn't want to ask if that was right" when things are wrong (things that I've never had to teach this many times). I thought the cockiness would subside - I mostly ignore it and simply address what exactly needs to be done in the moment with my most professional nurse face on, because the docs are not going to put up with that and it'll definitely come out and hit NewGrad in the rear. I have check-off lists. I reiterate and teach and use teach-back. Then NewGrad walks away and does not do what was just taught back to me, then when I address that discrepancy I get a deer-in-headlights look and the "I didn't know" - I mean what? How - I just told you several times, then you told me back correctly. I don't know what gives. 

[JBMmom, MSN, NP]

That's got to be frustrating, sounds like you're doing all the things that a great preceptor would be doing. Especially the teach and teach-back method. If that's not getting through then something's really not quite right. I have two friends that precepted new grads about a year ago. One subscribed to the "sink or swim" theory of precepting. After showing her new grad something a reasonable amount of times, she just stopped and left them alone. I felt badly as I watched her struggle through a couple rough nights. I offered small bits of help here and there, and some encouragement, but my friend was pretty clear on the plan so I didn't overstep. She became the MUCH stronger of the two new grads, whether it was the teaching method, her personality or her skillset I'm not sure, but it seemed to work. Good luck whatever you do, sounds like your new grad is lucky to have you!

[Been there,done that, ASN, RN]

There must be evaluations regarding her progress. How are those going?

What is management and nursing education's feedback regarding your evaluation. Seems like you need assistance.

[rac1, ASN, BSN, RN]

4 hours ago, JBMmom said:

That's got to be frustrating, sounds like you're doing all the things that a great preceptor would be doing. Especially the teach and teach-back method. If that's not getting through then something's really not quite right. I have two friends that precepted new grads about a year ago. One subscribed to the "sink or swim" theory of precepting. After showing her new grad something a reasonable amount of times, she just stopped and left them alone. I felt badly as I watched her struggle through a couple rough nights. I offered small bits of help here and there, and some encouragement, but my friend was pretty clear on the plan so I didn't overstep. She became the MUCH stronger of the two new grads, whether it was the teaching method, her personality or her skillset I'm not sure, but it seemed to work. Good luck whatever you do, sounds like your new grad is lucky to have you!

Thanks for your sweet words!

I am really trying here. I think I may have to start letting her struggle in other ways - I do let her struggle with answering my critical thinking questions. I am hoping there is maybe just a tipping point she needs to get to. Hoping.

[rac1, ASN, BSN, RN]

6 minutes ago, Been there,done that said:

There must be evaluations regarding her progress. How are those going?

What is management and nursing education's feedback regarding your evaluation. Seems like you need assistance.

Yes - in close communication with management and our educator. I'm trying all the things. Just thought I'd pop in here and see what worked for others in these situations. =) 

[Koalified]

You sound like a great preceptor! I wonder if NewGrad and you are just not a good match. Could be personality differences or just something random that you guys don’t jive. 

That said, one of the things I hated about my preceptor when I was a new grad was making me do things that was the “proper” way to do a chart check when literally no one including her was doing it that way. It was tedious and complicated and involved paging through paper charts and 2 different computer systems - 1 nursing system, 1 unit secretary system. So, what I’m saying is maybe teach/mention something that the administration deems the “proper way to do things” but don’t make the orientee actually do the thing if you yourself isn’t doing it. 

Someone mentioned the sink or swim method. I actually kinda enjoy that method when it’s used towards the end of the training if the preceptor is keenly aware of what’s going on. As long as the preceptor jumps in when definitely needed, sink or swim method gives the orientee the simulation of a true working environment with the safety net of someone still watching over them. 
 

 

[DrNurseCNS]

rac1 sounds like you are really trying with this new nurse and it's time for a "come to Jesus meeting" with you, the new grad, the manager and the educator. A formal action plan needs to be in writing delineating where she needs to improve and what the metrics are that will show improvement. Be clear and concrete (maybe use SMART goals?) so that upon the next meeting it is easy to show where she has had success and where she is falling short. Continue your Socratic method of making her answer what the main problems and priorities are for patient care that shift. I also agree that she may have figure things out on her own (as long as there is no danger to the patient etc) without you rescuing her.

Maybe she is not cut out for your particular area of specialty and might be a better fit elsewhere--just don't make her someone else's problem!

This action plan documentation will be useful in setting further goals and for probationary review, or worst case scenario, dismissal.

[NurseMentor4fun, BSN, MSN, RN]

I just participated in a webinar from ANPD that discussed Trauma informed professional development.  It was amazing and it had some ideas that I found useful. For some nurses the transition from student to able practitioner can be difficult or traumatic.  Remember to make discussions of how new nurses is feeling a part of normal orientation.  Sometimes we can find that a distraction outside of work is making it difficult for them to concentrate at work. It could be that their own lack of confidence is making it difficult to absorb the information that they really need.

Here is a link to the article that the webinar addressed. 

The Healers are Broken A Call for Trauma-Informed Professional Development in Nursing Https://doi.org/10.1097/NND.0000000000000761

I also believe the above mentioned action plan is a must do at this point. If a concrete plan with defined expectations doesn't fix the problem then maybe trying another specialty area is in order.

Good luck.

[Michelle K]

I will never forget this, but she made me check all the lines, IV, talk to the patient, and super fast environmental check, its likes going in as a super nurse with all the senses open. Of course, I never learned this immediately but have mastered it throughout the years. You will be surprise how many nurses waste so much time, when they are about to start an IV infusion, but the IV does not work. 

[rac1, ASN, BSN, RN]

23 hours ago, Koalified said:

You sound like a great preceptor! I wonder if NewGrad and you are just not a good match. Could be personality differences or just something random that you guys don’t jive. 

That said, one of the things I hated about my preceptor when I was a new grad was making me do things that was the “proper” way to do a chart check when literally no one including her was doing it that way. It was tedious and complicated and involved paging through paper charts and 2 different computer systems - 1 nursing system, 1 unit secretary system. So, what I’m saying is maybe teach/mention something that the administration deems the “proper way to do things” but don’t make the orientee actually do the thing if you yourself isn’t doing it. 

Someone mentioned the sink or swim method. I actually kinda enjoy that method when it’s used towards the end of the training if the preceptor is keenly aware of what’s going on. As long as the preceptor jumps in when definitely needed, sink or swim method gives the orientee the simulation of a true working environment with the safety net of someone still watching over them. 
 

 

Thanks for responding. I really like this advice. I try to be cognizant of what you're talking about. I often teach "this is the right way, and this is what I do" - I explain that it is their nursing license and they have to be comfortable with their actions. I explain my reasoning and let them decide what to do. Sometimes I explain I want them to do something until they are more confident with their own skills. In my experience, some new grads believe me, and some don't care and are already lazy. I can't force their hand, but I try to teach them to be (what I think of as) a good nurse. Over this last week, I did come to the conclusion that it is going to be a sink or swim for this new grad - I think it will actually help her come to the conclusion that she needs help, and mostly that the things I am saying are real and need to be applied. And obviously, I am there and not leaving her in any way. I think I see the light for this one. ?